DICOM Standard Conformance in Veterinary Medicine in Germany: a Survey of Imaging Studies in Referral Cases

In 2016, the recommendations of the DICOM Standards Committee for the use of veterinary identification DICOM tags had its 10th anniversary. The goal of our study was to survey veterinary DICOM standard conformance in Germany regarding the specific identification tags veterinarians should use in veterinary diagnostic imaging. We hypothesized that most veterinarians in Germany do not follow the guidelines of the DICOM Standards Committee. We analyzed the metadata of 488 imaging studies of referral cases from 115 different veterinary institutions in Germany by computer-aided DICOM header readout. We found that 25 (5.1%) of the imaging studies fully complied with the “veterinary DICOM standard” in this survey. The results confirmed our hypothesis that the recommendations of the DICOM Standards Committee for the consistent and advantageous use of veterinary identification tags have found minimal acceptance amongst German veterinarians. DICOM does not only enable connectivity between machines, DICOM also improves communication between veterinarians by sharing correct and valuable metadata for better patient care. Therefore, we recommend that lecturers, universities, societies, authorities, vendors, and other stakeholders should increase their effort to improve the spread of the veterinary DICOM standard in the veterinary world.     

A DICOM document-oriented approach to PACS infrastructure

The need for long-term storage requires the future migration of image data from a PACS to its successor system. This paper considers the cost of such migration. It is proposed that storage of data as “documents” in DICOM Part 10 formats on industrystandard media could reduce the time and cost of data migration relative to on-line DICOM transfer. The relation to present efforts in developing document-oriented electronic patient records is discussed. DICOM Part 10 files are found to be a sufficient representation of image documents, but additional software tools will be needed to reach its full potential. There is a significant cost benefit of the document storage method, but it is one of many factors which must be balanced in the selection of a PACS.     

Extracting data from a DICOM file

DICOM v3.0 is a vendor-independent standard for digital medical images that describes a file format and network protocol for the exchange of images between computer systems. When simply viewing a DICOM file, it is not necessary for the user to understand the details of the entire DICOM standard. However, understanding parts of the standard is essential when DICOM files are read and processed by a user-generated program. This paper offers an overview of information a user needs to write a program for extracting the image and acquisition parameters from a DICOM file.     

Real-Time Patient Radiation Dose Monitoring System Used in a Large University Hospital

Radiation dose monitoring in medical imaging examination areas is mandatory for the reduction of patient radiation exposure. Recently, dose monitoring techniques that use digital imaging and communications in medicine (DICOM) dose structured reports (SR) have been introduced. The present paper discusses the setup of a radiation dose monitoring system based on DICOM data from university hospitals in Korea. This system utilizes the radiation dose data-archiving method of standard DICOM dose SR combined with a DICOM modality performed procedure step (MPPS). The analysis of dose data based on a method utilizing DICOM tag information is proposed herein. This method supports the display of dose data from non-dosimeter-attached X-ray equipment. This system tracks data from 62 pieces of equipment to analyze digital radiographic, mammographic, mobile radiographic, CT, PET-CT, angiographic, and fluorographic modalities.     

Creation and Curation of the Society of Imaging Informatics in Medicine Hackathon Dataset

In order to support innovation, the Society of Imaging Informatics in Medicine (SIIM) elected to create a collaborative computing experience called a “hackathon.” The SIIM Hackathon has always consisted of two components, the event itself and the infrastructure and resources provided to the participants. In 2014, SIIM provided a collection of servers to participants during the annual meeting. After initial server setup, it was clear that clinical and imaging “test” data were also needed in order to create useful applications. We outline the goals, thought process, and execution behind the creation and maintenance of the clinical and imaging data used to create DICOM and FHIR Hackathon resources.     

DICOM医学图像采集的方法与实践

医学图像采集是PACS的重要环节,也是PACS实用化的关键。本文比较了几种常见的图像采集方法,重点介绍了通过DICOM接口的图像采集,在详细阐明了DICOM网络的概念和DICOM消息交换的规范之后,介绍了我们编写的DICOM医学图像采集软件,本软件是在Windows平台上利用SocketAPI编写而成,提供了DICOM标准定义的验证、存储、查询和检索等服务,测试结果表明,本软件能够顺利地与成像设备连接并采集图像。     

JavaScript Access to DICOM Network and Objects in Web Browser

Digital imaging and communications in medicine (DICOM) 3.0 standard provides the baseline for the picture archiving and communication systems (PACS). The development of Internet and various communication media initiated demand for non-DICOM access to PACS systems. Ever-increasing utilization of the web browsers, laptops and handheld devices, as opposed to desktop applications and static organizational computers, lead to development of different web technologies. The DICOM standard officials accepted those subsequently as tools of alternative access. This paper provides an overview of the current state of development of the web access technology to the DICOM repositories. It presents a different approach of using HTML5 features of the web browsers through the JavaScript language and the WebSocket protocol by enabling real-time communication with DICOM repositories. JavaScript DICOM network library, DICOM to WebSocket proxy and a proof-of-concept web application that qualifies as a DICOM 3.0 device were developed.     

Enterprise-scale image distribution with a Web PACS

The integration of images with existing and new health care information systems poses a number of challenges in a multi-facility network: image distribution to clinicians; making DICOM image headers consistent across information systems; and integration of teleradiology into PACS. A novel, Web-based enterprise PACS architecture introduced at Massachusetts General Hospital provides a solution. Four AMICAS Web/Intranet Image Servers were installed as the default DICOM destination of 10 digital modalities. A fifth AMICAS receives teleradiology studies via the Internet. Each AMICAS includes: a Java-based interface to the IDXrad radiology information system (RIS), a DICOM autorouter to tape-library archives and to the Agfa PACS, a wavelet image compressor/decompressor that preserves compatibility with DICOM workstations, a Web server to distribute images throughout the enterprise, and an extensible interface which permits links between other HIS and AMICAS. Using wavelet compression and Internet standards as its native formats, AMICAS creates a bridge to the DICOM networks of remote imaging centers via the Internet. This teleradiology capability is integrated into the DICOM network and the PACS thereby eliminating the need for special teleradiology workstations. AMICAS has been installed at MGH since March of 1997. During that time, it has been a reliable component of the evolving digital image distribution system. As a result, the recently renovated neurosurgical ICU will be filmless and use only AMICAS workstations for mission-critical patient care.     

Serum bactericidal titres for monitoring antimicrobial therapy: current status and potential role in the management of multidrug-resistant Gram-negative infections

BackgroundSerum bactericidal titres (SBTs) were widely used in the 1970s and 1980s to monitor antimicrobial therapy but are now seldom recommended. It is the only laboratory test that integrates drug pharmacodynamics, host pharmacokinetics and synergistic or antagonistic interactions of antimicrobial combinations into a single index of antimicrobial activity. We hypothesized that SBTs could play a renewed role in monitoring antibiotic treatment of multidrug-resistant Gram-negative infections. However, the last critical appraisal of the test was published over 30 years ago.ObjectivesThis narrative review provides an updated assessment of the SBT test and its methodological limitations. We performed a diagnostic meta-analysis to estimate the value of SBTs for predicting clinical failure or death during antibiotic treatment.SourcesA comprehensive literature search of PubMed including all English publications was performed in December 2019 using the Medical Subject Headings (MeSH search terms “serum”, “bactericidal”, “inhibitory”, “titre”, “monitoring”, “anti-infective agents” “antimicrobial therapy” and “therapeutic drug monitoring”).ContentAlthough standardized methods for performing SBTs were approved in 1999, the test remains labour intensive, and results may not be available until 72 hr. However, the use of non-culture-based endpoints (i.e. spectrophotometric or fluorescent) may shorten test time to 24 hr. Despite considerable heterogeneity in published studies, a meta-analysis of 11 evaluable studies published from 1974 to 2007 indicated a critical SBT result (peak SBT ≤1:8 or trough ≤1:2) is associated with a diagnostic odds ratio for clinical failure during antibiotic treatment of 12.27 (95% confidence interval 5.28–28.54) and a 5.32 (95% 1.32–21.42) odds of death.ImplicationsSBTs have prognostic value for identifying patients at high risk for antibiotic treatment failure, but the slow turnaround time of the current test limits its clinical utility. Standardization of a more rapid SBT testing method is needed.     

Validating DICOM Content in a Remote Storage Model

Verifying the integrity of DICOM files transmitted between separate archives (eg, storage service providers, network attached storage, or storage area networks) is of critical importance. The software application described in this article retrieves a specified number of DICOM studies from two different DICOM storage applications; the primary picture archiving and communication system (PACS) and an off-site long-term archive. The system includes a query/retrieve (Q/R) module, storage service class provider (SCP), a DICOM comparison module, and a graphical user interface. The system checks the two studies for DICOM 3.0 compliance and then verifies that the DICOM data elements and pixel data are identical. Discrepancies in the two data sets are recorded with the data elements (tag number, value representation, value length, and value field) and pixel data (pixel value and pixel location) in question. The system can be operated automatically, in batch mode, and manually to meet a wide variety of use cases. We ran this program on a 15% statistical sample of 50,000 studies (7500 studies examined). We found 2 pixel data mismatches (resolved on retransmission) and 831 header element mismatches. We subsequently ran the program against a smaller batch of 1000 studies, identifying no pixel data mismatches and 958 header element mismatches. Although we did not find significant issues in our limited study, given other incidents that we have experienced when moving images between systems, we conclude that it is vital to maintain an ongoing, automatic, systematic validation of DICOM transfers so as to be proactive in preventing possibly catastrophic data loss.     

一种DICOM文件并行传送算法的设计与实现

DICOM文件传送是PACS中非常重要的一类文件操作.本文通过分析DICOM文件传送的基本原理,发现DICOM文件串行传送中有大量时间消耗在网络连接和DICOM连接上.为了尽快完成海量影像文件的DICOM传送任务,本文从两方面改进文件传送算法：一是减少网络和DICOM连接次数,每次连接尽量传送更多的文件;二是通过文件并行传送来成倍增加单位时间内文件传送数量.然后针对PACS中待传送DICOM文件特点,设计一种基于任务划分策略的DICOM文件并行传送算法.该算法采用＂一次DICOM连接传送一类文件＂的传送机制和＂Master-Slave＂结构的集中式动态负载平衡方案.该算法在.NET framework 4框架下实现,测试表明上述算法具有良好的并行性能,且显著提高了DICOM文件传送效率.     

基于DICOM标准的多参数生理监护系统的研究

目的:建立一个基于DICOM标准的多参数生理监护局域网系统,实现对病人生理参数的实时监测,为病人提供及时的救助;实现图像和生理波形图共享,医院标准化和信息数字化的全面实施。方法:在深入研究DICOM通信协议模块、DICOM网络协商模块、DICOM存储模块、DICOM查询/获取模块等的基础上,利用Visual C++.Net工具,运用C++面向对象编程思想,将DICOM通信相关PDU封装成类,并采用基于TCP的客户端/服务端(SCU/SCP)Socket网络通信编程模型实现系统的主要功能。结果:建立了一个基于DICOM标准的多参数生理监护局域网系统,这个系统由三个部分组成:多参数生理监护设备,多参数生理监护服务器,多参数生理监护工作站。文章讨论了在DICOM医学波形中SCP和SCU的功能,选择DICOM标准的原因,和该局域网系统的功能。医院对系统进行了评估,评估表示该系统满足临床需要。结论:DICOM标准的不断应用将涵盖所有医学成像和信号类设备,多参数生理监护仪数据的DICOM标准化应用,为将来信号类医疗设备跟医院现有的PACS/RIS、HIS等系统互连融合提供了前提基础。     

Attachment quality is related to the synchrony of mother and infant monitoring patterns

We investigated whether attachment quality is related to infant–mother dyadic patterns in monitoring animated social situations. Sixty 12-month-old infants and their mothers participated in an eye-tracking study in which they watched abstractly depicted distress interactions involving the separation of a “baby” and a “parent” character followed by reunion or further separation of the two characters. We measured infants’ and their mothers’ relative fixation duration to the two characters in the animations. We found that infant attachment disorganization moderated the correspondence between the monitoring patterns of infant–mother dyads during the final part of the animations resulting in reunion or separation. Organized infants and their mothers showed complementary monitoring patterns: the more the mothers focused their attention on the “baby” character, the more the infants focused their attention on the “parent” character, and vice versa. Disorganized infant–mother dyads showed the opposite pattern although the correlation was nonsignificant: mothers and their infants focused on the same character. The attachment-related differences in the nature of the synchrony in the attentional processes of infants and their mothers suggest that by 12 months the dyads’ representations of social situations reflect their shared social–emotional experiences.     

Functional anatomy of cortical areas characterized by Von Economo neurons

Von Economo’s neurons (VENs) are large, bipolar or corkscrew-shaped neurons located in layers III and V of the frontoinsular and the anterior cingulate cortices. VENs are reported to be altered in pathologies such as frontotemporal dementia and autism, in which the individual’s self control is seriously compromised. To investigate the role of VENs in the active human brain, we have explored the functional connectivity of brain areas containing VENs by analyzing resting state functional connectivity (rsFC) in 20 healthy volunteers. Our results show that cortical areas containing VENs form a network of frontoparietal functional connectivity. With the use of fuzzy clustering techniques, we find that this network comprises four sub-networks: the first network cluster resembles a “saliency detection” attentional network, which includes superior frontal cortex (Brodmann’s Area, BA 10), inferior parietal lobe, anterior insula, and dorsal anterior cingulate cortex; the second cluster, part of a “sensory-motor network”, comprises the superior temporal, precentral and postcentral areas; the third cluster consists of frontal ventromedial and ventrodorsal areas constituted by parts of the “anterior default mode network”; and the fourth cluster encompasses dorsal anterior cingulate cortex, dorsomedial prefrontal, and superior frontal (BA 10) areas, resembling the anterior part of the “dorsal attentional network”. Thus, the network that emerges from analyzing functional connectivity among areas that are known to contain VENs is primarily involved in functions of saliency detection and self-regulation. In addition, parts of this network constitute sub-networks that partially overlap with the default mode, the sensory-motor and the dorsal attentional networks.     

Top-down and bottom-up deficits in conflict adaptation after frontal lobe damage

The ability to adaptively control our responses to conflicting information is crucial if we are to respond in a flexible manner to the environment. The “conflict monitoring model” proposes that the prefrontal cortex is responsible of reactive adjustments in cognitive control. We present neuropsychological data contrasting the performance of patients with prefrontal lesions with the one exhibited by patients with lesions outside the frontal lobe and nonlesioned participants, on the processes involved in the dynamic adaptation to conflicting stimulus information. Relative to both lesioned and nonlesioned control groups, prefrontal patients were impaired in adapting to conflict when all features of the conflicting stimuli and their associated responses changed on consecutive trials. However, the prefrontal patients also showed an unusually large conflict adaptation effect when the stimuli and/or response features repeated across trials. We conclude that prefrontal cortex is relevant both for genuine “top-down” conflict monitoring and for regulating the influence of “bottom-up” responses based on the integration of stimulus features across trials.     

基于贝叶斯网络的临床信息模型检索方法研究:以HL7 V3为例

临床信息模型的可复用性是实现健康医疗信息互联互通和共享的重要基础,检索并识别出临床信息模型中可复用的对象是提高复用性的一种有效途径。以HL7.org发布的HL7V32017标准版本为研究对象,应用扩展的4层贝叶斯网络表征该临床信息模型,在简单贝叶斯网络的基础上增加分层消息描述(HMD)之间语义相似性的扩展层,通过网络的逐层概率推演识别出可复用的临床信息模型。实验设计“就诊预约”、“实验室结果”和“病人实体”等3个检索任务,并应用平均精度均值MAP、平均精度AP和截止点准确率等3个指标以评价检索方法的性能。最终构建含有3428个节点和22646条边的4层贝叶斯网络,自上而下依次为数据元素层、HMD层、重复的HMD层和消息类型层,各层节点数量分别为2177、422、422和407。检索结果显示,MAP值达到了0.382,在第3、第5和第10截止点的平均准确率分别达到77.8%、60.0%和46.7%;该方法不仅可以检索出通用型和领域型两类可复用模型,还能够发现临床语义切实相关的对象(例如检索“就诊预约”时返回的“预约更新通知”对象)。所提出的方法将有助于提高HL7V3信息模型的复用性,并促进临床信息标准的国际化建设,同时对其他临床信息模型检索方法的优化和改进存在一定的借鉴意义。     

基于网络药理学探究络石藤-牛膝药治疗关节炎的作用机制

目的 基于网络药理学分析“络石藤-牛膝”药对治疗关节炎（Arthritis）的潜在作用机制。 方法 通过检索中草药系统药理学数据库平台（TCMSP）进行药对“络石藤-牛膝”有效成分及靶基因筛选;以“Arthritis”为关键词,在GeneCards数据库、NCBI基因数据库以及OMIM数据库进行人类基因检索并获得关节炎相关基因;将筛选出的药对靶点与疾病靶点输入韦恩图制作软件Venny2.1,获得共有靶点;运用STRING数据库进行PPI网络构建,Cystoscape构建“药物-成分-靶点-疾病”网络;运用R语言软件对关键靶基因进行基因本体论（GO）功能富集分析及与基因组百科全书（KEGG）通路的集分析。 结果 从TCMSP中筛选获得络石藤9种化合物成分,94个靶点;牛膝获得21种化合物成分,205个靶点。Venny映射得到128个共有靶点,STRING数据库筛选出5个基因簇和4个核心基因构建PPI网络。GO功能富集分析显示,“络石藤-牛膝”药对涉及2329条生物过程,150项分子功能相关,60项细胞组成相关。通过KEGG通路富集分析,“络石藤-牛膝”药对治疗关节炎富集到154条信号通路。 结论 基于网络药理学,从有效成分、基因靶点、信号通路等方面初步验证了“络石藤-牛膝”药对治疗关节炎的作用机制。     

Analysis of “task-positive” and “task-negative” functional networks during the performance of the Symbol Digit Modalities Test in patients at presentation with clinically isolated syndrome suggestive of multiple sclerosis

An abnormal pattern of brain activations has been shown in patients with multiple sclerosis during the performance of several cognitive tasks. The aim of this study is to investigate abnormalities of the patterns of activation/deactivation in the functional networks related to “task-positive” and “task-negative” events during the execution of the Symbol Digit Modalities Test (SDMT) in patients with clinically isolated syndromes (CIS) and preserved cognitive abilities. Eighteen CIS patients within 3 months from their first clinical attack and 15 healthy controls (HC) underwent neuropsychological assessment and performed an adapted functional magnetic resonance imaging (fMRI) version of the SDMT. “Task-positive” responses to task execution and “task-negative” activity of the default mode network were compared between groups. A regression analysis was performed to investigate the correlation between fMRI results and T2 lesion load (T2 LL) and brain atrophy. Neuropsychological performance did not differ between groups. Compared to HC, CIS patients exhibited an enhanced deactivation of the “task-negative” network at the level of the posterior cingulate cortex, whereas no differences between groups were found when the patterns of “task-positive” events were compared. A regression analysis detected a correlation (p < 0.001,r ranging from 0.62 to 0.73) between T2 LL and “task-positive” activations of areas that are part of the attention network, comprising the anterior cingulate gyrus, left prefrontal gyrus and inferior parietal lobe. No correlation was found between patterns of functional modifications and brain atrophy. CIS patients experience an enhanced pattern of brain deactivations during cognitive performances, which might contribute to their normal neuropsychological status.