Web PACS浏览工作站的构建

目的：作为B／S客户端的Web浏览器实现了Web PACS浏览工作站分布式的特点，但它却不支持DICOM格式，本文利用Java技术构建基于DICOM标准的web PACS浏览工作站，扩展了常用Web浏览器（以IE为主）对医学影像的处理功能。方法：首先根据DICOM3．0标准编写DICOM核心类以实现对DICOM文件的解析，在此基础上利用Java开发环境JDK1．6及Java开发工具Eclipse3．2优化Applet界面布局，在Applet中加载图像并实现图像及病人基本信息的显示，完成基本的图像处理功能．最后利用Java Plug-in技术将Applet加载至Web浏览器，从而实现了分布式Web PACS浏览工作站的构建。结果：本研究开发的具有DICOM图像浏览功能的Java Applet，用户界面友好，操作简便，能将每一台连网的PC机变成“浏览工作站”，能高效加载DICOM图像至Web浏览器，单幅、多幅、动态放映等显示模式间可灵活切换．实现了窗宽／窗位调整、图像平滑、锐化等基本图像处理操作。结论：DICOM图像浏览的Java Applet实现是构建Web PACS浏览工作站的关键．为医学影像的广域共享，远程影像教学和远程会诊提供了思路，将推动PACS工作模式进入新的纪元。     

PACS系统在超声影像学临床教学中的应用

超声影像学的临床教学过去主要依赖对超声检查的实时观摩,缺乏丰富多样的图像资料和详细全面的病例资料[1]。随着PACS(P ictures arch iving and Commun ications System)系统的投入使用,这个问题得到明显改善。现就PACS系统在超声影像学临床教学中的应用作一探讨。1提供了丰富多样的高质量影像资料PACS系统及图像存储与传输系统,是应用于医院的数字医疗设备如CT、MR、US、DSA、CR等所产生的数字化医学图像信息的采集、存储、管理、诊断、信息处理的综合应用系统。它以高速计算机设备为基础,以高速网络连接各种影像设备和相关设…     

The impact of image storage organization on the effectiveness of PACS

Picture archiving communication system (PACS) requires efficient handling of large amounts of data. Mass storage systems are cost effective but slow, while very fast systems, like frame buffers and parallel transfer disks, are expensive. The image traffic can be divided into inbound traffic generated by diagnostic modalities and outbound traffic into workstations. At the contact points with medical professionals, the responses must be fast. Archiving, on the other hand, can employ slower but less expensive storage systems, provided that the primary activities are not impeded. This article illustrates a segmentation architecture meeting these requirements based on a clearly defined PACS concept.     

Comparing image search behaviour in the ARRS GoldMiner search engine and a clinical PACS/RIS

Information search has changed the way we manage knowledge and the ubiquity of information access has made search a frequent activity, whether via Internet search engines or increasingly via mobile devices. Medical information search is in this respect no different and much research has been devoted to analyzing the way in which physicians aim to access information. Medical image search is a much smaller domain but has gained much attention as it has different characteristics than search for text documents. While web search log files have been analysed many times to better understand user behaviour, the log files of hospital internal systems for search in a PACS/RIS (Picture Archival and Communication System, Radiology Information System) have rarely been analysed. Such a comparison between a hospital PACS/RIS search and a web system for searching images of the biomedical literature is the goal of this paper. Objectives are to identify similarities and differences in search behaviour of the two systems, which could then be used to optimize existing systems and build new search engines.Log files of the ARRS GoldMiner medical image search engine (freely accessible on the Internet) containing 222,005 queries, and log files of Stanford’s internal PACS/RIS search called radTF containing 18,068 queries were analysed. Each query was preprocessed and all query terms were mapped to the RadLex (Radiology Lexicon) terminology, a comprehensive lexicon of radiology terms created and maintained by the Radiological Society of North America, so the semantic content in the queries and the links between terms could be analysed, and synonyms for the same concept could be detected. RadLex was mainly created for the use in radiology reports, to aid structured reporting and the preparation of educational material (Lanlotz, 2006) [1]. In standard medical vocabularies such as MeSH (Medical Subject Headings) and UMLS (Unified Medical Language System) specific terms of radiology are often underrepresented, therefore RadLex was considered to be the best option for this task.The results show a surprising similarity between the usage behaviour in the two systems, but several subtle differences can also be noted. The average number of terms per query is 2.21 for GoldMiner and 2.07 for radTF, the used axes of RadLex (anatomy, pathology, findings, …) have almost the same distribution with clinical findings being the most frequent and the anatomical entity the second; also, combinations of RadLex axes are extremely similar between the two systems. Differences include a longer length of the sessions in radTF than in GoldMiner (3.4 and 1.9 queries per session on average). Several frequent search terms overlap but some strong differences exist in the details. In radTF the term “normal” is frequent, whereas in GoldMiner it is not. This makes intuitive sense, as in the literature normal cases are rarely described whereas in clinical work the comparison with normal cases is often a first step.The general similarity in many points is likely due to the fact that users of the two systems are influenced by their daily behaviour in using standard web search engines and follow this behaviour in their professional search. This means that many results and insights gained from standard web search can likely be transferred to more specialized search systems. Still, specialized log files can be used to find out more on reformulations and detailed strategies of users to find the right content.     

基于开源软件设计的网页化PACS与三维影像处理系统

基于开源软件建立PACS与三维医学成像系统,可为医院提供一种低成本PACS/RIS实施方案,或者作为现有医疗信息系统的有益补充.我们将三种开源软件DCM4CHEE、Oviyam、Osirix等在异构操作系统网络上进行集成,建立了一套网页化PACS与三维影像处理系统,并对包括MDCT、MRI等大型数据集在内的多模态影像数据的网络传送与查看进行了验证,结果证明系统的实时性与稳定性能够满足医学教育、科研与统计等工作需求.     

Towards a Theory of PACS Deployment: An Integrative PACS Maturity Framework

Owing to large financial investments that go along with the picture archiving and communication system (PACS) deployments and inconsistent PACS performance evaluations, there is a pressing need for a better understanding of the implications of PACS deployment in hospitals. We claim that there is a gap in the research field, both theoretically and empirically, to explain the success of the PACS deployment and maturity in hospitals. Theoretical principles are relevant to the PACS performance; maturity and alignment are reviewed from a system and complexity perspective. A conceptual model to explain the PACS performance and a set of testable hypotheses are then developed. Then, structural equation modeling (SEM), i.e. causal modeling, is applied to validate the model and hypotheses based on a research sample of 64 hospitals that use PACS, i.e. 70 % of all hospitals in the Netherlands. Outcomes of the SEM analyses substantiate that the measurements of all constructs are reliable and valid. The PACS alignment—modeled as a higher-order construct of five complementary organizational dimensions and maturity levels—has a significant positive impact on the PACS performance. This result is robust and stable for various sub-samples and segments. This paper presents a conceptual model that explains how alignment in deploying PACS in hospitals is positively related to the perceived performance of PACS. The conceptual model is extended with tools as checklists to systematically identify the improvement areas for hospitals in the PACS domain. The holistic approach towards PACS alignment and maturity provides a framework for clinical practice.     

Clinical input into designing a PACS

The purpose of this study was to evaluate clinical attitudes and expectations in the implementation of a neuroradiology picture archiving and communication system (PACS). A 1-page survey of expectations and clinical attitudes toward a neuroradiology mini-PACS was distributed to 49 full-time faculty members in the departments of neurosurgery, neurology, and otorhinolaryngology at an academic center. Interest in viewing soft-copy images was moderate to very high for over 89% of clinicians. All clinicians were comfortable with phone consultations with radiologists while viewing soft-copy images. Clinicians preferred retrieving images from personal computers over workstations and film libraries by 72.9%, 27.1%, and 0%, respectively. However, 38.5% of surgeons felt the need for hard copy in the operating room. Clinicians estimated that in 18.3% of cases, patients took their in-house films to outside institutions for consultations. Clinicians were enthusiastic about implementing PACS. Although acceptance of soft-copy viewing among clinicians is high, some provision for supplying hard-copy images appears to be necessary.     

Integrating Dictation with PACS to Eliminate Paper

Five years ago our department migrated from a film-based imaging environment to a PACS-based environment. We discovered that our reliance on paper tracking forms for clinical history and dictation information was hindering our practice. Integrating dictation with PACS was one of three key components we needed to free ourselves from the tyranny of paper, the other two being an online worklist and an online patient history. We discuss our evolution to a (mostly) paperless reading room environment, our implementation, general performance, and future development plans, focusing on integrated dictation.     

Coping with PACS downtime in digital radiology

As radiology departments become increasingly reliant on picture archiving and communication systems, they become more vulnerable to computer downtime that can paralyze a smoothly running department. The experiences and strategies developed during various types of picture archiving and communication system (PACS) downtime in a large radiology department that has completely converted to soft copy interpretation in all modalities except mammography are presented. Because these failures can be minimized but not eliminated, careful planning is necessary to minimize their impact.     

Tracking PACS Usage with Open Source Tools

A typical choice faced by Picture Archiving and Communication System (PACS) administrators is deciding how many PACS workstations are needed and where they should be sited. Oftentimes, the social consequences of having too few are severe enough to encourage oversupply and underutilization. This is costly, at best in terms of hardware and electricity, and at worst (depending on the PACS licensing and support model) in capital costs and maintenance fees. The PACS administrator needs tools to asses accurately the use to which her fleet is being subjected, and thus make informed choices before buying more workstations. Lacking a vended solution for this challenge, we developed our own.     

A cost analysis of film image management and four PACS based on different network protocols

Picture Archive and Communication Systems (PACS), which allow the electronic acquisition, storage, transportation, and viewing of medical images, hold the eventual promise of reduced costs, improved imagemanagement logistics, and ultimately, improved patient care. But at what point in the future will PACS really cost less than film-based image management for a given hospital size; and how are these costs affected by the choice of the digital communication network? To address these questions, a static differential cost model has been constructed. PAC systems based on two high-speed networks (less than 150 megabytes per second Mbps) and two lowspeed networks, as well as film, were considered for five different sized hospitals (ranging from 15,000 to 125,000 procedures per year) and two time periods (1995 and 2000). PACS equipment was assumed to have a payoff of five years. The model considered all capital and supply costs and personnel costs for the PACS and for film storage and retrieval. It did not consider any possible cost savings from logistics improvement likely to result from the adoption of a PACS. Based on the assumptions outlined, high-speed-network PACS are less costly than those based on low-speed networks for all scenarios considered. Further, even though all possible PACS cost savings were not considered, high-speed network PACS appear to be less costly than film for hospitals larger than 60,000 procedures in 1995 and larger than 15,000 in 2000, while low-speed-network PACS should cost less than film for 60,000 and 30,000 procedure hospitals in 1995 and 2000 respectively.     

利用PACS实施口腔内科根管治疗质量监控的初步研究

目的 探讨标准化方法监控根管治疗质量的应用效果和存在的问题.方法 5名评价者,采用随机、单盲、对照的方法,对存储于PACS中的根管治疗病例进行评价,使用社会科学统计程序(SPSS ver16.9)分析比较其评价结果.结果 随机抽取病例156例,根据根管治疗中的3个阶段4个方面分别给予评价.对于诊断片和定位片,5名评价者的评价结论无统计学差异;对于根管充填位置和密合程度的评价,存在统计学差异.结论 PACS可以作为临床质量监控的手段;管理者在使用PACS监控根管治疗质量时,应当首先进行标准化培训.     

PACS和HIS的融合方法

PACS管理医学影像并向诊断和临床医师提供医学图像处理和显示功能,在医院的应用中必然要求与HIS融合.本文基于SAN结构,提出PACS在功能、流程和数据三方面与HIS的融合方法,并给出了数据融合的实现算法.     

The importance of a picture archiving and communications system (PACS) manager for large-scale PACS installations

Installing a picture archiving and communication system (PACS) is a massive undertaking for any radiology department. Facilities making a successful transition to digital systems are finding that a PACS manager helps guide the way and offers a heightened return on the investment. The PACS manager fills a pivotal role in a multiyear, phased PACS installation. PACS managers navigate a facility through the complex sea of issues surrounding a PACS installation by coordinating the efforts of the vendor, radiology staff, hospital administration, and the information technology group. They are involved in the process from the purchase decision through the design and implementation phases. They can help administrators justify a PACS, purchase and shape the request for proposal (RFP) process before a vendor is even chosen. Once a supplier has been selected, the PACS manager works closely with the vendor and facility staff to determine the best equipment configuration for his or her facility, and makes certain that all deadlines are met during the planning and installation phase. The PACS manager also ensures that the infrastructure and backbone of the facility are ready for installation of the equipment. PACS managers also help the radiology staff gain acceptance of the technology by serving as teachers, troubleshooters, and the primary point-of-contact for all PACS issues. This session will demonstrate the value of a PACS manager, as well as point out ways to determine the manager’s responsibilities. By the end of the session, participants will be able to describe the role of a PACS manager as it relates to departmental operation and in partnership with equipment vendors, justify a full-time position for a PACS manager, and identify the qualifications of candidates for the position of PACS manager.     

Large-scale PACS implementation

The transition to filmless radiology is a much more formidable task than making the request for proposal to purchase a (Picture Archiving and Communications System) PACS. The Department of Defense and the Veterans Administration have been pioneers in the transformation of medical diagnostic imaging to the electronic environment. Many civilian sites are expected to implement large-scale PACS in the next five to ten years. This presentation will relate the empirical insights gleaned at our institution from a large-scale PACS implementation. Our PACS integration was introduced into a fully operational department (not a new hospital) in which work flow had to continue with minimal impact. Impediments to user acceptance will be addressed. The critical components of this enormous task will be discussed. The topics covered during this session will include issues such as phased implementation, DICOM (digital imaging and communications in medicine) standard-based interaction of devices, hospital information system (HIS)/radiology information system (RIS) interface, user approval, networking, workstation deployment and backup procedures. The presentation will make specific suggestions regarding the implementation team, operating instructions, quality control (QC), training and education. the concept of identifying key functional areas is relevant to transitioning the facility to be entirely on line. Special attention must be paid to specific functional areas such as the operating rooms and trauma rooms where the clinical requirements may not match the PACS capabilities. The printing of films may be necessary for certain circumstances. The integration of teleradiology and remote clinics into a PACS is a salient topic with respect to the overall role of the radiologists providing rapid consultation. A Webbased server allows a clinician to review images and reports on a desk-top (personal) computer and thus reduce the number of dedicated PACS review workstations. This session will focus on effective strategies for a seamless transition. Critical issues involve maintaining a good working relationship with the vendor, cultivating personnel readiness and instituting well-defined support systems. Success depends on the ability to integrate the institutional directives, user expectations and available technologies. A team approach is mandatory for success.     

PACS与DICOM

近几年来随着医院信息化的深入发展及数字影像时代的到来，医学图像归档和通讯系统（picture archiving and communication system，PACS）在我国已开始逐渐发展起来。不少PACS软件产品都称是依据医学数字成像和交换（digital imaging and communication in medicine，DICOM）标准^[1]开发并与DICOM兼容的。但是对PACS、DICOM的理解及PACS究竟如何遵从DICOM标准都是一个值得深入探讨的问题。