影像存档及传输系统在临床教学中的应用

影像存档及传输系统（PACS）是一种综合性的影像管理系统,通过高速计算机设备及通讯网络,将数字化图像资料进行有效的采集、传输、存储和管理,可实现医院内无胶片化的管理以及医学影像资源的共享,提升了医院和放射科的整体数字化建设水平,在更好地为临床医疗工作服务的同时,也极大地方便了教学和科研工作,为医学影像学的临床教学提供了更加先进的手段。现就我们将PACS应用于医学影像学临床教学的经验介绍如下。     

浅淡PACS系统对医学影像学的意义

PACS系统，是影像存档及通讯系统（picture archiving and communication system）足近年来随着数字成像技术、计算机技术和网络技术的进步而迅速发展起来的，是由医学图像采集、大容量数据存储、图像显示和处理及局域或广域的影像传输网络等部分组成。其主要功能是完成数字化成像设备的网络传输、数字化存储和管理、医学影像的在线查询、调取和软拷贝显示。利用PACS可促进影像科室的管理水平的提高，简化工作程序，降低成本，促进工作流程更趋合理化、规范化。那么PACS系统将对医学影像学的发展产生不可估量的重要意义。     

图像归档与传输系统及其在核医学中的应用

随着信息技术和医学影像技术的快速发展，图像归档与传输系统(PACS)已开始进入国内大中型医院，与医院信息系统(HIS)等一起成为现代医院必不可少的信息管理工具。核医学作为医学影像学的组成部分，必然纳入PACS的操作和管理。本文阐述了PACS的原理及其在核医学中的应用。     

PACS案例式教学在医学影像学教学的应用

<正>随着现代医学的发展,医学影像学越来越重要。传统教学主要以教为主导,学生被动学习,学生的主观能动性及实践能力较差。传统影像教学法已不能满足医学教育的需要,只有改变教学模式,才能更好地满足现代临床教学的需求。医学影像的存储和传输系统(picture archiving and communication system,PACS)已广泛应用于影像科,为传统的医学影像专业教学带了机遇与挑战。PACS以全数字化、无胶片     

基于免费软件Efilm与PacsOne的PACS系统的构建

随着医学影像学数字化进程的加快,特别是DICOM3.0协议的广泛认可,医学图像存储与传输系统(PACS)也获得了快速发展.然而专业PACS软件公司提供的产品,动辄数十上百万的售价,使许多医院对此望而却步.基于这种现状,如何低成本组建一套合适的PACS系统成为国内一项急需解决的课题,也是决定PACS能否快速普及的一个关键所在.笔者通过实践,借助网上流行的免费工作站软件Efilm与一款免费的PACS服务器软件,搭建了一套服务器/客户机(C/S)构架的PACS系统,实现了PACS的大部分功能,并且拥有较高的系统性能,现介绍如下.     

医学影像存档与通信系统的组建与应用

目的:探讨图像存储及传输系统的组网方案及具体实施方法,构建PACS系统。方法:根据我院影像设备状况及临床工作需求,建立一个基于局域网的PACS系统,该系统由3个采集工作站及12个标准工作站组成,将符合DICOM标准及不符合DICOM标准的影像设备接入该网络,在PACS中开展医疗工作。结果:该PACS系统实现了图像的获取、传输、存储、处理、输出、分析和诊断报告生成等功能,实现了科室无胶片化管理。结论:PACS系统具有实用、经济、灵活、安全及可扩展性强等特点,完全满足影像科临床工作需要,为今后建立大型PACS系统打下良好的技术基础。     

PACS系统的实施与初步应用

医学影像学已从传统的胶片存储,向利用计算机和网络通讯技术逐渐向影像没备数字化的现代医学技术发展。现介绍有关图像存储与传输系统(picture archiving and communication systems,PACS)的实施及在我院初步使用过程中的相关问题。     

PACS系统在影像科的应用

医学影像存档与传输系统PACS （Picture Amhiriry and Commune System）是数字化图像技术与现代化通讯及计算机技术相结合的产物。Pacs系统通过对图像信息的采集、存储、管理、处理及传输功能，使图像资料得以有效管理和充分利用。在更好地为临床医疗服务的同时，在医疗教学及远程医疗教学提供更先进的手段。     

天健PACS系统常见问题及解决方法

我院自2003年引进天健PACS系统以来，在图像传输、调阅、打印等方面均较为方便，但PACS系统在使用过程中常常会出现一些问题，如不能及时得到解决，将会严重影响我科正常的工作流程，现将我科PACS系统常见问题及解决方法总结如下，以供参考。     

医学影像存档和通讯系统的临床应用研究

目的:客观评价PACS基于HIS和RIS系统下的临床应用价值。材料和方法:采用GE公司PACS网络系统,在HIS系统下运行RIS进行PACS处理。对PACS的流程、所需工作站、信息点分布、数据流量以及存储进行需求分析。在PACS和HIS间建立HL7/DICOM网关,HIS/RIS接口采用HL7标准,PACS采用DI-COM3.0连接。图像无损压缩到原来的1/3至1/4进行存储。结果:PACS系统改变了工作模式和流程,充分达到资源共享。结论:PACS实现了对图像的采集、显示、存储、传输等无纸化信息管理。     

医学影像存档与通讯系统在影像诊断教学中的初步应用

目的 评价医学影像存档与通讯系统(picture archiving and communication systems，PACS)在医学影像诊断教学中的应用价值。方法 利用GE PACS和天助公司的放射信息管理系统(radiology information system，RIS)、终端图文工作站等硬件、软件配置，构建大屏幕多媒体阅片室，设置典型影像教学片库，开辟电子学习室，直接从PACS调取图像制作多媒体幻灯教学课件和制备考试题库。结果 成功完成了各项构建，在PACS设置的教学分类片库中积累了有价值的影像资料近5000例，改变了传统的影像教学方法，实现了影像教学的实时化、多样化，在影像诊断教学和实习中获得一致好评，提高了教学质量。结论 PACS有利于提高医学影像诊断学的教学质量，值得完善和推广。     

基于医学影像存储与传输系统的交互式CT影像教学模块的开发与实践

目的 开发基于医学影像存储与传输（PACS）的交互式CT影像教学模块，满足临床医生和低年资影像诊断医生对CT影像知识进一步继续医学教育的需求。方法 PACS采用100M主干网，10M交换到桌面；在浏览工作站和诊断工作站安装教学模块；教学内容按部位分类，以树枝模式管理；教学文字资料来源于具有一定权威的教科书、专著及期刊；图像资料来源于各部位经病理及临床证实的病例，以数码相机、扫描仪等方式数字化或直接从PACS系统提取，编辑处理后，经医学数字影像通讯标准（DICOM）3.0服务器转换为标准数字图像，以文件形式存放于PACS图像服务器硬盘。结果 CT影像教学模块能够实时调阅最合适病种的CT征象、临床特点、病理、鉴别诊断、典型图像及注释、正常断面解剖等，供教学、诊断和报告参考。结论 基于PACS的CT影像教学模块能提供交互式教学及科研工具，提高CT室工作质量和工作效率。     

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards

RATIONALE AND OBJECTIVES: The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS: Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS: Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION: Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.     

PACS-based functional magnetic resonance imaging.

The picture archiving and communication system (PACS) technology reaches its 10th anniversary. Retrospectively no one could foresee the impact the PACS would have to the health care enterprise, but it is common consent today, that PACS is the key technology crucial to daily clinical image operations and especially to image related basic and clinical research. During the past 10 years the PACS has been matured from a research and developmental stage into commercial products which are provided by all major modality and health care equipment vendors. The PACS, originally implemented in the Radiology Department, needs to grow and has already carried well beyond departmental limits conquering all image relevant areas inside the hospital. During the past 10 years a dramatic development in imaging techniques especially within MRI emerged. Advanced 3D- and 4D-MR imaging techniques result in much more images and more complex data objects than ever before which need to be implemented into the existing PACS. These new imaging techniques require intensive post-processing apart from the imaging modality which need to be integrated into the image workflow and the PACS implementation. Along with these new imaging techniques new clinical applications, e.g. stroke detection, and research applications, e.g. study of heart and brain function, in Neurology and Cardiology require changes to the traditional PACS concept. Therefore inter-disciplinary image distribution will become the high-water mark for the next 10 years in the PACS endeavor. This paper focuses on one new advanced imaging technique, functional magnetic resonance imaging (fMRI), and discusses how fMRI data is defined, what fMRI requires in terms of clinical and research applications and how to implement fMRI in the existing PACS.     

Analysis of the cost-effectiveness of PACS

Picture archiving and communications systems (PACS) have emerged as an important part of digital imaging technology. However, the future of PACS is uncertain because its economic viability is in doubt. Cost-effectiveness analysis is an accepted technique for evaluating the economics of new technologies. This paper addresses the cost-effectiveness of PACS and identifies factors that are important in determining the cost of PACS relative to film-based radiology. These include the impact of PACS on physician productivity, maintenance costs, discount rates, and the time period for amortization of capital goods. The effectiveness of PACS is also explored in terms of improvements in diagnostic accuracy and timely diagnosis. Financial and clinical impacts should be integrated to provide information about how PACS expenditures will affect radiology departments, hospitals, and national research and development objectives.     

PACS系统在影像诊断教学中的应用

PACS系统是数字化图像技术与现代通讯及计算机技术相结合的产物，在更好地为临床医疗服务的同时，也为医学影像教学提供了更先进的手段。为此初步探讨了PACS系统在影像诊断教与学两方而的应用及价值，以及其对于远程医学影像教学的意义。     

医学图像存储与传输系统的初步应用与效益分析

目的：通过组建及应用大型医学图像存储与传输系统（PACS），总结PACS对医院工作方法、管理及服务等诸方面的贡献。方法：运用质量因素处理（QFD）的方法对医院诊断与非诊断性劳动比值、科研数据可查询率（％）、胶片查询、单位服务成本、病人等待时间等方面的分析，比较建立及应用PACS前后之间的诸多参数及因素。结果：组建PACS后，急诊影像检查时间平均减少64％、数据信息保存比率提高了50％、出报告时间缩短、胶片用量节省33％、图像检索的时间效率提高95％，以及其他诸多方面都有不同程度的改善和提高。结论：组建1个真正符合医院具体实际情况的大型PACS系统非常重要，因为它将对医院的工作方法、管理等方面起到积极的推动作用，加快和促进医院向更快、更高的数字化方向发展。     

通过工作列表实现数字化网络各系统之间患者信息的一致性

目的 实现图像存储与传输系统(picture archiving and communication system，PACS)、放射学信息系统(radiology information systems，RIS)、影像设备之间患者检查信息的一致性。方法 我院引进GE Signa 1．5T磁共振、数字乳腺，Agfa数字X线摄影、计算机X线摄影及GE CT等数字化医学设备。GE PACS是英文系统，所以前期医院在未解决信息一致性时只通过PACS对检查影像进行保存，通过PACS系统中简单的信息管理工作，并没有真正意义上的worklist。2个月后，我院采用国际上先进的解决方法即通过医学数字成像及通讯(digital imaging and communication in medicine，DICOM)标准的工作列表(worklist)的方法实现信息的一致性。在RIS系统中将患者中文信息转换为英文信息，保存并为worklist提供患者的英文信息。结果 我院在集成PACS和RIS的2年多时间以来，通过worklist来保证RIS与影像设备患者检查信息的一致性，取得了非常好的效果。在所有诊断工作站上，诊断医生通过中文RIS系统，对病人的信息进行编辑、修改、产生。结论 通过worklist实现PACS、RIS、影像设备之间患者检查信息的一致性是可行的。     

PACS for imaging centers

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized interfaces such as HL-7, Web access and the choice of view stations.     

Creation of an educational CD-ROM using a PACS

Presentation of MIRIAM 2: We describe the materials used for the creation of and the content of a CD-ROM entitled '77 neuroradiological case reports'. We mention the gathering of clinical and imaging data, exclusively provided by a PACS. Our work demonstrates that a CD-ROM is an appropriate interactive medium for radiological teaching. Its creation can be simplified thanks to a PACS, but it nonetheless remains work intensive.