PACS在颈椎后方结构测量及其临床意义

目的　利用图像存储传输系统(PACS)结合CT片测量颈椎后方解剖学结构,为临床颈椎椎弓根置钉提供资料。 方法　利用PACS结合CT片,由5名脊柱外科医师对2000例正常人颈椎椎弓根的矢状位及横断为进行精确测量,得出椎弓根的长度、宽度、高度、向内侧倾斜、向头、尾侧倾斜角度的数据值, 并分别计算各节段左右侧椎弓根测量值的均值和标准差,进行统计学分析。 结果　寰椎入钉点距离一般在后弓中点旁开17～20 mm,在C2～7各椎弓根均有髓腔,C2～7椎弓根的高度大于宽度,C3、C4椎弓根直径最小,仍可置入3.5 mm的螺钉。寰枢椎螺钉在矢状面入钉角向头侧倾斜为正角,下颈椎螺钉向尾侧倾斜为负角,C4接近水平, C5～7负角逐渐增大, C7可达-19°左右。在横断位上测量的椎弓根的进钉角度显示,其中C2最小,下颈椎椎弓根具有变异性,术前利用CT片通过PACS进行精确测量,指导术中准确选钉与安全置钉具有指导性意义。 结论　应用PACS系统结合CT片术前测量,能够指导术中安全置入颈椎椎弓根螺钉,明显减少并发症,是一种值得推广的方法。     

下颈椎新型双螺纹椎弓根螺钉设计的解剖学测量

目的 通过测量正常人群颈椎解剖学参数,为设计新型双螺纹椎弓根螺钉提供理论依据。方法 纳入100名健康人群,完善颈椎CT扫描,在CT片上分别测量C_3～7的双侧椎弓根螺钉进钉路径长度(包括椎体内长度、椎弓根长度、椎板长度,作为椎弓根螺钉长度设计参考)、进钉外展角和椎弓根峡部的宽度和高度(作为椎弓根螺钉直径设计参考)。计算各测量结果的均值及四分位数。结果 纳入成年健康志愿者100人的基本信息,包括身高、年龄,体重,合并疾病,其中男54例,女46例,平均年龄35.95岁。从C_3～7,各参数左右两侧对比,差异无统计学意义(P>0.05),男女间对比,差异无统计学意义(P>0.05)下颈椎椎弓根螺钉进钉路径椎体平均长度(15.85±1.20)～(19.40±1.50)mm;椎弓根平均长度(5.42±1.06)～(6.03±0.84)mm;椎板平均长度(9.52±1.15)～(10.33±1.58)mm。进钉外展角平均值范围(39.82±2.53)°～(42.56±2.50)°;椎弓根峡部宽度平均值(5.84±0.87)～(7.10±1.05)...     

下颈椎椎弓根的数字化影像学观测

目的:探讨成人下颈椎椎弓根螺钉内固定的相关解剖学参数,为临床选择应用螺钉的直径、长度、角度,进钉点定位及判断手术复位等提供理论依据.方法:采集颈椎CT图像,并依据性别与身高等因素分组,对椎弓根具有临床意义的数据进行测量.结果:椎弓根皮质、松质骨高度、宽度,第3～7颈椎同节段侧别间比较因性别和身高因素差异有统计学意义.男性较女性均宽大,第3～7颈椎总的趋势均逐渐增大.椎弓根轴线骨性长度、椎弓根长同节段侧别间比较与性别和身高因素关系密切,男性第3颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短;女性第4颈椎椎弓根轴线骨性长度最短,第7颈椎椎弓根长度最短.椎弓根外展角度及向头、尾侧倾斜角度,无性别差异.结论:下颈椎椎弓根等骨性结构个体差异较大(性别、身高因素关系密切),但仍是有规律可循的.术中螺钉直径的选择主要取决于下颈椎椎弓根松质骨的宽度,但应注意个体差异,第3～7颈椎均可用3.5mm的螺钉;螺钉长度选用范围29～32 mm,置入角度有明显规律性,是术中螺钉进钉定位、判断手术复位程度的重要依据.     

颈椎椎弓根的形态观测及临床意义

为给颈椎弓根螺钉的设计和手术方法提供解剖学基础，采用测量方法对20例成人骨骼的颈2至胸1的椎弓根及其相关结构作了观测。椎弓根高为6．4±1．1－9．1±1．3mm，其厚为3．6±1．8－7．2±1．3mm，长为9．6±1．4－15．1±1．2mm.。根体长为25±1．1－30±1．9mm，椎弓根内倾角为26．2°±6．0°－46．0°±3．5°，体根柱角为90．7°±2．3°－105．6°±4．6°，PS值为0．5±0．4mm-4.4±1.2mm，PM值为0．8±0.2-7.4±1.2mm。颈椎弓根螺钉的直径以3．0mm以内较安全，其长度不宜短于15．1±1．2mm，不宜长于29．1±1．4mm，颈椎弓根入钉是位于关节突柱背面，可根据纵向的上关节突关节面最低点下方距离（PS值）和横向上关节突柱外缘内侧距离（PM值），在胸1此值为椎板外缘外侧距离）来确定，螺钉置入方向通过水平面上的内倾角和矢状面上的体根柱角确定。     

下颈椎椎弓根入口处皮质厚度的影像学测量

目的：对下颈椎椎弓根四壁及入口毗邻结构的皮质厚度行影像学测量，为临床椎弓根钉植入提供参考。方法：对8例新鲜颈椎进行DR摄片和螺旋CT扫描重建。在AutoCAD软件中测量CT图像显示的椎弓根四壁及入口处毗邻结构（包括上关节突前壁（ACS）、椎板前壁（ACL）、下关节突前壁（ACI）和横突孔后壁（PCT））的皮质厚度，并行统计学分析。结果：双斜位DR片示颈椎椎弓根内壁（MCP）、上壁（SCP）、下壁（ICP）皮质较厚，而外壁（LCP）菲薄。统计学分析发现同一颈椎的MCP、SCP、ICP、ACL、ACS和ACI之间的厚度无差别，LCP和PCT皮质菲薄，明显薄于前6项指标。MCP、SCP、ICP、ACS和PCT在C3-7间的厚度无差别，PCTc明显小于其它4项指标。结论：同一颈椎PCT和LCP明显薄于其它各项指标，提示PCT和LCP抵抗外力强度最小，MCP、SCP、ICP和ACS在C3-7间厚度无差别，提示其在不同颈椎间抵抗外力可能一致。颈椎椎弓根钉固定时应该避免靠近PCT和LCP。     

枢椎椎弓根的测量及其临床意义

目的:为枢椎椎弓根螺钉固定手术提供解剖学依据。方法:55例成年人枢椎干标本,分别测量其椎弓根的宽度、高度,以及枢椎椎弓根在横断面和矢状面上的角度。结果:枢椎椎弓根的宽度为(8.22±1.48)mm,高度为(8.24±0.86)mm,在横断面上内斜角为36.57°±3.18°,在矢状面上的上倾角为26.79°±2.10°。结论:枢椎椎弓根有足够的空间供椎弓根螺钉固定,椎弓根螺钉的直径应小于3.5mm,且在横断面和矢状面上要有一定的角度。     

三维重建可视化系统可增强下颈椎椎弓根钉置入的准确性

BACKGROUND: Pedicle screw implantation is a common method to repair many kinds of diseases of the lower cervical spine. Three-dimensional (3D) reconstruction visualization system can be used in order to improve the accuracy of the implant and improve the prognosis.     

颈椎后路关节突—椎弓根联合内固定的解剖学基础

对３０例成人干燥椎骨第２￣７颈椎的下关节突厚度、相邻椎骨关节突对合厚度、关节突进钉点与横突孔外侧壁间的角度、椎弓根的长宽高度、椎弓根与椎体矢状面及水平面间的夹角等项指标进行了观测。通过综合分析所得结果，对颈椎后路关节突－椎弓根联合固定的可行性和螺丝钉的选择、进钉方向及深度等进行了讨论。     

下颈椎椎弓根放射影像学观察可描述椎弓根个性化特点及置钉相关性

背景：因颈椎椎弓根结构复杂以及形态变异大,术中个性化置钉需要简便、可靠的监测方法。 目的：通过放射影像学观察描述下颈椎椎弓根在X射线片上的影像特点,为在下颈椎椎弓根内安全置钉提供帮助,以减少并发症。 方法：制备10新鲜颈椎骨标本,以细钢丝缠绑在下颈椎椎弓根狭窄部,摄颈椎正、侧、斜位片,观察下颈椎椎弓根形态在不同投照位置中的变化。 结果与结论：X射线片中下颈椎椎弓根的正位片影像是椎体两侧倾斜的管状结构,椎弓根椭圆形截面的长轴向内倾斜。侧位片上椎弓根未被直接显示,仅为重叠在椎体后上壁的高密度影。斜位片清楚的显示了椎弓根狭窄部的4个侧壁及其截面形状。提示颈椎正、斜位片的椎弓根影像可以较好地反映下颈椎椎弓根的形态,对了解椎弓根个性化的特点及置钉有重要意义。     

Puncture-proof picture archiving and communication system

As we become increasingly dependent on our picture archiving and communications system (PACS) for the clinical practice of medicine, the demand for improved reliability becomes urgent. Borrowing principles from the discipline of Reliability Engineering, we have identified components of our system that constitute single points of failure and have endeavored to eliminate these through redundant components and manual work-around procedures. To assess the adequacy of our preparations, we have identified a set of plausible events that could interfere with the function of one or more of our PACS components. These events could be as simple as the loss of the network connection to a single component or as broad as the loss of our central data center. We have identified the need to continue to operate during adverse conditions, as well as the requirement to recover rapidly from major disruptions in service. This assessment led us to modify the physical locations of central PACS components within our physical plant. We are also taking advantage of actual disruptive events coincident with a major expansion of our facility to test our recovery procedures. Based on our recognition of the vital nature of our electronic images for patient care, we are now recording electronic images in two copies on disparate media. The image database is critical to both continued operations and recovery. Restoration of the database from periodic tape backups with a 24-hour cycle time may not support our clinical scenario: acquisition modalities have a limited local storage capacity, some of which will not contain the daily workload. Restoration of the database from the archived media is an exceedingly slow process, that will likely not meet our requirement to restore clinical operations without significant delay. Our PACS vendor is working on concurrent image databases that would be capable of nearly immediate switchover and recovery.     

Economic model of a whole hospital picture archiving and communication system installation

Journal of Digital Imaging -     

基于数字化影像归档和通信系统的电子申请单集成系统设计

目的根据DICOM接口协议,设计了电子申请单集成系统,使电子化的申请单在电子病历系统与医学影像归档和通信系统（picture archiving and communication system,PACS）之间能够传输和比对,简化临床业务流程。方法通过接口字典文档,HIS系统和PACS系统共同遵循DICOM协议准则。首先设计基本业务流程,然后运用M程序语言编译接口平台,再按照DICOM准则对接接口字典。结果设计完整的从医生开具医嘱到CR、CT、MRI检查终端设备显示的电子申请单集成接口系统,完成身份比对,医嘱比对及影像检查结果匹配等跨系统业务流程的节点传输流程系统。结论系统设计在PACS系统建设中,对医院影像科内的工作流程进行了重新分析,优化设计包括了自动操作和工作合并以及某些设备的迁移,消除不必要的工作步骤以简化流程,扩展采用遵从DICOM标准的成像设备工作列表（MWL）,使患者的基本信息、检查信息、影像信息、诊断信息、检查结果分发信息在流程中完善和统一。     

图像归档和通讯系统(PACS)的发展与应用

图像归档和通讯系统 (Picture Archiving and Communication System,PACS) ,是经通讯网络获取、存储、管理和显示放射医学图像的集成信息系统。近年来 ,国外的 PACS技术和应用已逐步进入成熟期 ,有大量的研究成果和应用实例 ;但我国的 PACS研究和应用因起步较晚 ,尚处在相对落后的局面。本文介绍了 PACS系统发展历程 ,概述了国外 PACS研究和应用的现状 ,最后分析了国内 PACS的发展状况 ,展望了其在我国医疗信息系统发展中的应用前景。     

Concept of Hokkaido University picture archiving communication system

With a mind toward the effective acquisition, processing, presentation, and reading of radiological images, a survey of how the human visual system perceives images is presented here. The level is chosen to be suitable for the radiologist, and the relative emphasis on the various visual cues of luminance, color, form, texture, motion, and depth is chosen based on their importance with radiological images. Examples of the radiological relevance of the various visual properties are given. We cover first what the visual system's behavior is and then survey some of the properties of the physiological mechanisms that provide this behavior.     

Justifying the picture archiving and communication system: General considerations based on the trieste experience

Journal of Digital Imaging -     

Developing policies and procedures for a picture archiving and communication system

Policies and procedures (P&P) constitute the mechanism for planning, standardizing, and documenting the provision of clinical services. Upon approval by hospital management, the P&P is an official statement of hospital rules and regulations. Each P&P establishes organizational responsibility for providing services. P&P are a mechanism for communicating standard operating procedures to hospital and medical staff. P&P serve as a reference document for unusual events, as well as routine procedures. P&P are often reviewed by inspection teams from the Joint Commission on Accreditation of Hospital Organizations (JCAHO) to determine whether the hospital has documented systematic practices. A picture archival and communications system (PACS) provides a new vehicle for providing radiology services. P&P that were designed for conventional film-based imaging are often not appropriate for electronic imaging. Because PACS is new and not yet widespread, good examples of PACS P&P are not yet available. JCAHO has no official requirements for PACS: PACS is viewed only as a means for the hospital to accomplish its work. Successful P&P development is a team effort, drafted by personnel responsible for executing the procedure, assisted by staff proficient in PACS technology, and tested in the field. The P&P should be reviewed and approved by management personnel knowledgeable about hospital and imaging operations. P&P should be written in clear and concise language. Successful P&P development is an ongoing effort. P&P must be periodically reviewed and updated to reflect changes in PACS technology and changes in clinical operations. New P&P must be developed when a deficit is noted. PACS security is a good example of a topic worthy of P&P development, especially in the face of the Health Insurance Portability and Accountability Act (HIPAA) legislation of 1996. What are the provisions for access control? Does the system include a feature for automatic shut-off of the software? Are there “generic” passwords and log-ins shared by a community of users? How are passwords assigned and how frequently are they changed? What security measures are in place to assure passwords are given to the appropriate user? Who grants and denies access? Service calls are another topic for P&P. Who initiates a service call? What is the process for escalating a service call from the operator level to the vendor? What immediate actions are expected by the operator in order to restore PACS services? How are service events documented? Who is responsible for determining when “downtime” procedures should be initiated or suspended? When our hospital’s total electrical system had to be shut down for an extended period, we found that a P&P was lacking for a task as mundane as shutting down and restarting our PACS components. What is the sequence for the shutdown? Who is responsible for shutting down and restarting? How long can the devices operate on uninteruptible power supplies (UPS)? What components are on emergency power? Should we expect the components to survive the switchover to generator power? Developing this P&P was worth the effort: it made the PACS more fault-tolerant and served as a reference document 3 years later when expansion of our physical plant required two more power outages.