Benefits of the DICOM Modality Performed Procedure Step

A few years ago, the Digital Imaging and Communications in Medicine standard introduced a network transaction that is initiated by modality equipment, mainly at the beginning and at the end of the acquisition. This transaction, the Modality Performed Procedure Step (MPPS), is sent to the Picture Archiving and Communication System and/or to the Radiology Information System. It carries information about what really has been performed by the modality equipment during acquisition. In this paper, we present MPPS and discuss its benefits. We show how MPPS enables efficient radiology workflow and how it ensures accuracy and completeness of imaging information. We think our paper helps bridge the gap between MPPS implementation and deployment. By understanding all the MPPS benefits, the end user becomes aware of the great enhancement in patient care that this transaction provides.     

基于DICOM的医学影像设备接口设计与实现

医学影像存档与通讯系统(Picture Archiving and Communication Systems,PACS)是目前医院信息化建设的热点,医学数字成像和通信标准(Digital Imaging and Communication in Medicine,DICOM)是有关医学图像及其相关信息的数据编码及通讯的国际标准,支持DICOM标准是医学影像设备并入PACS网络的必要条件。为使目前尚不符合DICOM标准的影像设备有效并入PACS系统,必须为其添加DICOM接口。我们介绍了DICOM信息模型并实现了接口的软件系统,重点介绍了应用VisualC 编程实现DICOM服务中的C-STORE和DCM文件的读写功能。     

Streamlining Importation of Outside Prior DICOM Studies into an Imaging System

A patient has an imaging study performed at one facility and has the study exported to portable media. Later, the patient takes the media to a different institution. The study on that media may need to be imported into that new institution’s imaging system. This would be done to avoid a repeat examination, or so that the study can be on file for reference purposes. Importing prior studies is best performed by creating a new order on the institution’s imaging system and then associating the DICOM objects from the prior study with it. In this way the prior study is actually inserted into the imaging system’s electronic health record (EHR) and is properly indexed so that it can be identified and later retrieved as needed. In the past at the Department of Veterans Affairs (VA), importing prior DICOM studies into the VA systems had been a very slow labor-intensive process that took anywhere from 10 to 30 min to import a single study. We have developed a new DICOM Importer application that reduces the manual effort to import a prior study to less than a minute. We have redesigned and automated the process to make it much more efficient for the user. The Importer also handles contract examinations that are ordered by the VA and performed at outside imaging facilities, with similar time savings. This work is important because is addresses one of the major unsolved problems with import reconciliation workflow: how to efficiently handle the importing of prior studies.     

基于DICOM标准的TLS网络安全传输技术研究与实现

随着医疗信息化的发展,图像归档与通信系统(PACS)、医院信息系统/放射科信息系统(HIS/RIS)等医疗信息管理系统日渐普及和完善,这些系统之间的互操作越发频繁,通过网络由一个封闭的系统走向开放,走向区域化成为必然。而信息的传输安全是使之成为可能的前提条件。基于网络安全的必要性,着重研究了医学数字成像与通信(DICOM)标准和安全传输层(TLS)协议,并结合OpenSSL工具包和DCMTK工具包实现了DICOM医疗信息TLS安全传输。     

DICOM标准的语义扩充

医学图像数字成像和通信（Digital Imaging and Communicationsin Medicine，DICOM）标准是美国电气制造商联合会（NEMA）和美国放射学会（ACR）为了医学图像的存储和传输而制定的标准，在医学上得到广泛的应用。但该标准目前没有充分定义图像语义内容，从而使得实际中不能有效的实现DICOM的基于语义的应用。本文讨论了医学图像中的语义描述层次结构，概述了DICOM标准中对图像的描述方法并指出了该标准对图像语义内容描述的不足，给出了使用DICOM标准中私有属性对DICOM图像语义内容进行扩充的方法。     

Radiology IT: Applications Integration vs. Consolidation

The question of whether Radiology IT systems should be composed of multiple applications integrated using standard data exchange protocols, such as DICOM and HL7, or implemented using consolidation of applications and systems has been debated for the past 30 years. The adequacy of the former approach has become a burning issue because the demands on Radiology IT systems have increased greatly. We report here on the experience of the Radiology Information Technology (IT) implementation at the Memorial Sloan-Kettering Cancer Center (MSKCC) over the past 11 years; during this time, the weekly image accumulation rate increased from 100,000 to 2,000,000 images. During the implementation period, major difficulties were encountered, largely as a result of the inadequacies of the Radiology IT architecture widely used in the healthcare industry. The approach we chose to correct some of these difficulties has been consolidation of some of the multiple systems and applications. Three examples of systems consolidation are discussed: (1) converting a dual-tier image storage system to a single tier, (2) consolidation of Mammography reading into PACS, and (3) enabling 3D visualization and analysis on the PACS workstation. Nevertheless, substantial research and development are needed in order to proceed with more extensive systems consolidation and, thus, a more manageable IT installation.     

Assessment of DICOM Viewers Capable of Loading Patient-specific 3D Models Obtained by Different Segmentation Platforms in the Operating Room

Patient-specific 3D models obtained by the segmentation of volumetric diagnostic images play an increasingly important role in surgical planning. Surgeons use the virtual models reconstructed through segmentation to plan challenging surgeries. Many solutions exist for the different anatomical districts and surgical interventions. The possibility to bring the 3D virtual reconstructions with native radiological images in the operating room is essential for fostering the use of intraoperative planning. To the best of our knowledge, current DICOM viewers are not able to simultaneously connect to the picture archiving and communication system (PACS) and import 3D models generated by external platforms to allow a straight integration in the operating room. A total of 26 DICOM viewers were evaluated: 22 open source and four commercial. Two DICOM viewers can connect to PACS and import segmentations achieved by other applications: Synapse 3D® by Fujifilm and OsiriX by University of Geneva. We developed a software network that converts diffuse visual tool kit (VTK) format 3D model segmentations, obtained by any software platform, to a DICOM format that can be displayed using OsiriX or Synapse 3D. Both OsiriX and Synapse 3D were suitable for our purposes and had comparable performance. Although Synapse 3D loads native images and segmentations faster, the main benefits of OsiriX are its user-friendly loading of elaborated images and it being both free of charge and open source.     

Teaching DICOM by Problem Solving

The Digital Imaging and Communications in Medicine (DICOM) is the standard for encoding and communicating medical imaging information. It is used in radiology as well as in many other imaging domains such as ophthalmology, dentistry, and pathology. DICOM information objects are used to encode medical images or information about the images. Their usage outside of the imaging department is increasing, especially with the sharing of medical images within Electronic Health Record systems. However, learning DICOM is long and difficult because it defines and uses many specific abstract concepts that relate to each other. In this paper, we present an approach, based on problem solving, for teaching DICOM as part of a graduate course on healthcare information. The proposed approach allows students with diversified background and no software development experience to grasp a large breadth of knowledge in a very short time.     

Establishing a Web-Based DICOM Teaching File Authoring Tool Using Open-Source Public Software

Online teaching files are an important source of educational and referential materials in the radiology community. The commonly used Digital Imaging and Communications in Medicine (DICOM) file format of the radiology community is not natively supported by common Web browsers. The ability of the Web server to convert and parse DICOM is important when the DICOM-converting tools are not available. In this paper, we describe our approach to develop a Web-based teaching file authoring tool. Our server is built using Apache Web server running on FreeBSD operating system. The dynamic page content is produced by Hypertext Preprocessor (PHP). Digital Imaging and Communications in Medicine images are converted by ImageMagick into Joint Photographic Experts Group (JPEG) format. Digital Imaging and Communications in Medicine attributes are parsed by dicom3tools and stored in PostgreSQL database. Using free software available from the Internet, we build a Web service that allows radiologists to create their own online teaching file cases with a common Web browser.     

DICOM for Clinical Research: PACS-Integrated Electronic Data Capture in Multi-Center Trials

Providing surrogate endpoints in clinical trials, medical imaging has become increasingly important in human-centered research. Nowadays, electronic data capture systems (EDCS) are used but binary image data is integrated insufficiently. There exists no structured way, neither to manage digital imaging and communications in medicine (DICOM) data in EDCS nor to interconnect EDCS with picture archiving and communication systems (PACS). Manual detours in the trial workflow yield errors, delays, and costs. In this paper, requirements for a DICOM-based system interconnection of EDCS and research PACS are analysed. Several workflow architectures are compared. Optimized for multi-center trials, we propose an entirely web-based solution integrating EDCS, PACS, and DICOM viewer, which has been implemented using the open source projects OpenClinica, DCM4CHEE, and Weasis, respectively. The EDCS forms the primary access point. EDCS to PACS interchange is integrated seamlessly on the data and the context levels. DICOM data is viewed directly from the electronic case report form (eCRF), while PACS-based management is hidden from the user. Data privacy is ensured by automatic de-identification and re-labelling with study identifiers. Our concept is evaluated on a variety of 13 DICOM modalities and transfer syntaxes. We have implemented the system in an ongoing investigator-initiated trial (IIT), where five centers have recruited 24 patients so far, performing decentralized computed tomography (CT) screening. Using our system, the chief radiologist is reading DICOM data directly from the eCRF. Errors and workflow processing time are reduced. Furthermore, an imaging database is built that may support future research.     

Leveraging Internet Technologies with DICOM WADO

The digital imaging and communications in medicine (DICOM) 3.0 standard was first officially ratified by the national electrical manufacturers association in 1993. The success of the DICOM open standard cannot be overstated in its ability to enable an explosion of innovation in the best of breed picture archiving and communication systems (PACS) industry. At the heart of the success of allowing interoperability between disparate systems have been three fundamental DICOM operations: C-MOVE, C-FIND, and C-STORE. DICOM C-MOVE oversees the transfer of DICOM Objects between two systems using C-STORE. DICOM C-FIND negotiates the ability to discover DICOM objects on another node. This paper will discuss the efforts within the DICOM standard to adapt this core functionality to Internet standards. These newer DICOM standards look to address the next generation of PACS challenges including highly distributed mobile acquisition systems and viewing platforms.     

Foreign Exam Management in Practice: Seamless Access to Foreign Images and Results in a Regional Environment

A challenge for many clinical users is that a patient may receive a diagnostic imaging (DI) service at a number of hospitals or private imaging clinics. The DI services that patients receive at other locations could be clinically relevant to current treatments, but typically, there is no seamless method for a clinical user to access longitudinal DI results for their patient. Radiologists, and other specialists that are intensive users of image data, require seamless ingestion of foreign exams into the picture archiving and communication system (PACS) to achieve full clinical value. Most commonly, a clinical user will depend on the patient to bring in a CD that contains imaging from another location. However, a number of issues can arise when using this type of solution. Firstly, a CD will not provide the clinical user with the full longitudinal record of the patient. Secondly, a CD often will not contain the report associated with the images. Finally, a CD is not seamless, due to the need to manually import the contents of the CD into the local PACS. In order to overcome these limitations, and provide clinical users with a greater benefit related to a patient’s longitudinal DI history, the implementation of foreign exam management (FEM) at the local site level is required. This paper presents the experiences of FEM in practice. By leveraging industry standards and edge devices to support FEM, multiple sites with disparate PACS and radiology information system (RIS) vendors are able to seamlessly ingest foreign exams within their local PACS as if they are local exams.     

基于存储服务的JPEG2000医学DICOM图像压缩的研究

由于医学图像所包含的数据量巨大,不利于存储和在现有网络上有效地传输,本研究使用VC++实现基于联合图像专家组2000(Joint Photographic Experts Group2000,JPEG2000)图像压缩算法对医学图像进行处理,根据医学数字图像通讯(Digital Imaging and Communicationin Medicine,DICOM)标准中存储服务的规则实现医学图像的存储服务。研究结果表明,使用JPEG2000压缩算法处理后的医学图像,不仅能大大节约存储空间,而且能降低传输时所需要的带宽。因此,JPEG2000压缩算法在DICOM推广及远程医疗的发展中具有积极意义。     

Losing Images in Digital Radiology: More than You Think

It is a common belief that the shift to digital imaging some 20 years ago helped medical image exchange and got rid of any potential image loss that was happening with printed image films. Unfortunately, this is not the case: despite the most recent advances in digital imaging, most hospitals still keep losing their imaging data, with these losses going completely unnoticed. As a result, not only does image loss affect the faith in digital imaging but it also affects patient diagnosis and daily quality of clinical work. This paper identifies the origins of invisible image losses, provides methods and procedures to detect image loss, and demonstrates modes of action that can be taken to stop the problem from happening.     

Integrating Multiple Clinical Information Systems using the Java Message Service Framework to Enable the Delivery of Urgent Exam Results at the Point of Care

The aim of this study is to determine if network-enabled personal digital assistants (PDAs) can be used to facilitate the timely delivery of urgent radiological exam results by reducing the interval from when the radiologist's initial interpretation is available to when it is first viewed by an emergency department (ED) physician. A web- and Java message service (JMS)-based application was built to replace the original fax-based wet-read procedure. The new system allows radiologists to enter wet-reads from the picture archiving and communication system (PACS) display station and to track discrepancies between the wet-read and final report. It also notifies the ED physicians when exam results are available via the PDAs and permits them to view the full text of the wet-read and final reports from the devices. The new system is compared to the original procedure with the results showing improvements with the wireless method. Furthermore, feedback from a qualitative survey of PDA users was positive, suggesting that PDAs may provide one means for accessing urgent clinical data at the point of care.     

Translating the IHE Teaching File and Clinical Trial Export (TCE) Profile Document Templates into Functional DICOM Structured Report Objects

The Integrating the Healthcare Enterprise (IHE) Teaching File and Clinical Trial Export (TCE) integration profile describes a standard workflow for exporting key images from an image manager/archive to a teaching file, clinical trial, or electronic publication application. Two specific digital imaging and communication in medicine (DICOM) structured reports (SR) reference the key images and contain associated case information. This paper presents step-by-step instructions for translating the TCE document templates into functional and complete DICOM SR objects. Others will benefit from these instructions in developing TCE compliant applications.     

VirtualPACS—A Federating Gateway to Access Remote Image Data Resources over the Grid

Collaborations in biomedical research and clinical studies require that data, software, and computational resources be shared between geographically distant institutions. In radiology, there is a related issue of sharing remote DICOM data over the Internet. This paper focuses on the problem of federating multiple image data resources such that clients can interact with them as if they are stored in a centralized PACS. We present a toolkit, called VirtualPACS, to support this functionality. Using the toolkit, users can perform standard DICOM operations (query, retrieve, and submit) across distributed image databases. The key features of the toolkit are: (1) VirtualPACS makes it easy to use existing DICOM client applications for data access; (2) it can easily be incorporated into an imaging workflow as a DICOM source; (3) using VirtualPACS, heterogeneous collections of DICOM sources are exposed to clients through a uniform interface and common data model; and (4) DICOM image databases without DICOM messaging can be accessed.

Dicoogle - an Open Source Peer-to-Peer PACS

Picture Archiving and Communication Systems (PACS) have been widely deployed in healthcare institutions, and they now constitute a normal commodity for practitioners. However, its installation, maintenance, and utilization are still a burden due to their heavy structures, typically supported by centralized computational solutions. In this paper, we present Dicoogle, a PACS archive supported by a document-based indexing system and by peer-to-peer (P2P) protocols. Replacing the traditional database storage (RDBMS) by a documental organization permits gathering and indexing data from file-based repositories, which allows searching the archive through free text queries. As a direct result of this strategy, more information can be extracted from medical imaging repositories, which clearly increases flexibility when compared with current query and retrieval DICOM services. The inclusion of P2P features allows PACS internetworking without the need for a central management framework. Moreover, Dicoogle is easy to install, manage, and use, and it maintains full interoperability with standard DICOM services.