医学影像设备管理系统的设计与开发

目的：设计和开发出一套功能全面、操作简便而又实用的放射科设备管理信息系统。方法：本论文从软件工程的角度出发进行分析和设计,采用J2EE、SPRING、HIBERNATE等先进流行的Web框架技术,对一款医学影像设备管理维护系统进行初步设计和开发。结果：根据对现有医院影像设备管理的需求分析和实地调研,完成了一款医学影像设备管理维护系统的具体开发,系统主要功能模块包括系统管理、采购管理、设备信息管理、故障信息管理、设备维护管理、设备说明书管理等等。结论：该医学影像设备管理系统总体来说,功能全面、操作简便而又实用,能够满足医院影像设备管理的大部分需求,极大的提高了医学影像设备的管理效率。     

导入JCI标准提升医疗影像设备管理系统

引进JCI认证标准(Joint Commission International国际医疗卫生机构认证联合委员会),使医疗影像设备管理从结构导向到结果导向转变.当今传统的管理评审标准:结构、过程、结果这一程序来讲,最关注的是结构,如设备的故障率、检查病人次数、单机收入等,但JCI的理念认为应该关心的是结果,是安全、质量、整体绩效,这是一个从结构为中心的导向转为以结果为中心、以病人为中心的导向.对任何可能产生的风险都要提前考虑预警,更具前瞻性.学习这一国际先进医院管理体系,改进医疗影像设备管理系统,抓好医疗影像设备的管理,提升医院医疗服务质量.让医疗影像设备在医疗工作中充分发挥作用,提高社会效益和经济效益.     

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。     

临床医学信号实时动态监测分析系统

阐述一临床医学信号实时动态监测分析系统的实现方案。此临床医学信号实时动态分析系统采用低负荷基本生命体征长时间连续检测方法，以病区为基本单元，实现了以病人为中心的病人临床信息网络，能够连接和控制病床前监护设备和急救设备。该系统能够和军队医院信息管理系统互联互通，共享信息，在医院应用中取得了良好效果。     

医用核磁共振成像设备的风险因素分析与管理

目的：分析确定医用核磁共振成像设备的相关风险因素，针对这些风险因素设计相应的风险管理流程与方案，以更好地保障医患安全及设备本身的安全运行。方法：本论文从医用核磁共振设备的成像原理出发，分析各个设备系统可能存在的风险因素，结合国家现有的相关标准与医院临床实践需求，设计出医学核磁共振成像设备的风险管理流程及其具体管理方法。结果：根据对现有医院影像设备管理的需求分析和实地调研，结合核磁共振成像设备的自身运行特点，完成了核磁共振成像设备的主要风险因素的具体分析，所设计的风险管理流程涵盖了与核磁共振成像设备相关的风险识别、风险分析、风险控制等等风险管理基本环节。结论：虽然医用核磁共振设备技术复杂，在平时运行维护过程中对安全性要求较高．但是，如果医院能够建立合理的医用磁共振设备的风险管理流程，让操作员工熟悉每个风险因素的前因后果，熟悉相应的科学处置方案，完善相应的风险管理细则，就可以降低每个风险的发生几率，可以保障医务人员及患者的安全，从而可以保持核磁共振成像设备的安全运行，提高设备管理效率等等。     

AMIGO多维影像引导手术系统

美国哈佛大学医学院附属布列根和妇女医院与美国国立卫生研究院(NIH)共同开发多维影像引导手术操作系统AMIGO(advanced multimodality image-guidance operating)。AMIGO系统是将X光、B超、CT、MRI、PET-CT等多种设备的影像有效地整合在一起,使手术医生能够随时精确地观察到患者整个身体的实时影像,有助于确定最佳手术方案。     

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。     

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。     

向现代化技术管理要效益

医疗检查收费是医院经济收入的主要渠道,但在医院医疗检查设备的使用中存在大量私收、漏收,人情费等问题,给医院造成非常大的经济损失。我院信息科对医院管理的主要信息流进行了综合分析,探讨了医院检查性收费管理的科学规律,引进开发了符合医院实际的医疗设备控费管理系统。将电子技术、计算机技术与精密传感、医疗设备的运用技术有效地结合,实现数据、设备共享。实现了堵漏增收的目的,全面提高了医疗服务水平和科学管理水平。     

基于IMU的C形臂旋转角度定位方法的研究

目的移动式X线透视影像设备(C形臂)凭借其便携、实时的优势已成为图像引导手术中标准配置设备,然而大部分医院配备的C形臂不具备旋转角度测量功能。方法本文设计了一种基于惯性测量单元的C形臂旋转运动角度定位方法。通过融合惯性测量单元中各惯性测量器件的实时测量数据,构建世界坐标系和载体坐标系的旋转矩阵,利用四元数分量求解C形臂旋转角度,从而对C形臂旋转运动进行定位。本文设计了精密电动旋转平台标定实验和C形臂旋转定位实验对本文方法进行了评估。结果在精密电动旋转平台标定实验中,本文设计方法的最大定位误差为0.5°;在C形臂的实验中,最大定位误差为0.8°,能够满足临床手术导航需求(定位误差不大于1°)。结论本文设计的定位方法不需要标定和校正过程,流程简单易行,具有很强的适应性,能够为后续手术导航提供必要的角度信息。     

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.     

DICOM Modality Worklist: An essential component in a PACS environment

The development and acceptance of the digital communication in medicine (DICOM) standard has become a basic requirement for the implementation of electronic imaging in radiology. DICOM is now evolving to provide a standard for electronic communication between radiology and other parts of the hospital enterprise. In a completely integrated filmless radiology department, there are 3 core computer systems, the picture archiving and communication system (PACS), the hospital or radiology information system (HIS, RIS), and the acquisition modality. Ideally, each would have bidirectional communication with the other 2 systems. At a minimum, a PACS must be able to receive and acknowledge receipt of image and demographic data from the modalities. Similarly, the modalities must be able to send images and demographic data to the PACS. Now that basic DICOM communication protocols for query or retrieval, storage, and print classes have become established through both conformance statements and intervendor testing, there has been an increase in interest in enhancing the functionality of communication between the 3 computers. Historically, demographic data passed to the PACS have been generated manually at the modality despite the existence of the same data on the HIS or RIS. In more current sophisticated implementations, acquisition modalities are able to receive patient and study-related data from the HIS or RIS. DICOM Modality Worklist is the missing electronic link that transfers this critical information between the acquisition modalities and the HIS or RIS. This report describes the concepts, issues, and impact of DICOM Modality Worklist implementation in a PACS environment.     

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.     

Patient dose management in digital radiography

Purpose:

To present the experience in patient dose management and the development of an online audit tool for digital radiography.

Materials and methods:

Several tools have been developed to extract the information contained in the DICOM header of digital images, collect radiographic parameters, calculate patient entrance doses and other related parameters, and audit image quality.

Results:

The tool has been used for mammography, and includes images from over 25,000 patients, over 75,000 chest images, 100,000 computed radiography procedures and more than 1,000 interventional radiology procedures. Examples of calculation of skin dose distribution in interventional cardiology based upon information of DICOM header and the results of dosimetric parameters for cardiology procedures in 2006 are presented.

Conclusion:

Digital radiology has great advantages for imaging and patient dose management. Dose reports, QCONLINE systems and the MPPS DICOM service are good tools to optimise procedures and to manage patient dosimetry data. The implementation of the ongoing IEC-DICOM standard for patient dose structured reports will improve dose management in digital radiology.     

Impact of digital radiography on clinical workflow

It is commonly accepted that digital radiography (DR) improves workflow and patient throughput compared with traditional film radiography or computed radiography (CR). DR eliminates the film development step and the time to acquire the image from a CR reader. In addition, the wide dynamic range of DR is such that the technologist can perform the quality-control (QC) step directly at the modality in a few seconds, rather than having to transport the newly acquired image to a centralized QC station for review. Furthermore, additional workflow efficiencies can be achieved with DR by employing tight radiology information system (RIS) integration. In the DR imaging environment, this provides for patient demographic information to be automatically downloaded from the RIS to populate the DR Digital Imaging and Communications in Medicine (DICOM) image header. To learn more about this workflow efficiency improvement, we performed a comparative study of workflow steps under three different conditions: traditional film/screen x-ray, DR without RIS integration (ie, manual entry of patient demographics), and DR with RIS integration. This study was performed at the Cleveland Clinic Foundation (Cleveland, OH) using a newly acquired amorphous silicon flat-panel DR system from Canon Medical Systems (Irvine, CA). Our data show that DR without RIS results in substantial workflow savings over traditional film/screen practice. There is an additional 30% reduction in total examination time using DR with RIS integration.     

SmartWADO: an Extensible WADO Middleware for Regional Medical Image Sharing

Medical image sharing is an important problem in modern radiology, with wide applications in Internet and mobile devices. Some important features need to be added and optimized to medical image sharing. In this paper, we present an extensible Web Access to DICOM Persistent Objects (WADO) middleware based on image cache and real-time Web monitor technology for regional medical image sharing. We first develop the extension method of WADO standard and workflow of extended WADO service. Then, we design a medical image cache method to improve the performance of medical image on-demand transmission. Using the real-time monitor can discover the performance bottlenecks and optimized critical points. The experimental results show that the middleware effectively delivers medical images and reports to Web clients over the Internet, regardless of the platform used for access. It can be deployed in one hospital to provide WADO service to medical workers and also can be applied to regional picture archiving and communication systems (PACS) to transmit medical images and reports to Internet users in a way that is transparent to end-user applications.     

DICOM versus HL7 for modality interfacing

Digital modalities such as CT, MRI, Ultrasound and Computerized Radiography systems, generating softcopy images to be used by a Picture Archiving and Communication System (PACS), need to identify the images properly in order to retrieve and manage them. In many cases, a technologist re-enters patient demographic and study related information at the modality, even although it is usually already present somewhere in the hospital Information System (IS). In order to achieve a higher level of efficiency and uniquely identify the created image objects, it is obvious that an interface between the IS and modality to exchange this information is highly desired. There are two options for a modality vendor to implement an IS interface, either using the Health Level (HL7) or Digital Imaging Communication in Medicine (DICOM) communication standard. This paper will explain characteristics of both protocols, and demonstrate that it is preferred to use DICOM versus HL7. In addition, it will show that DICOM is, supported by most modality vendors, based on the result of a poll of their Modality Worklist versus HL7, support.     

基于ITK读写DICOM医学图像文件

目的 介绍使用ITK读取DICOM文件文件头信息、访问像素数据以及存储DICOM文件的使用方法,以促进ITK在国内医学图像处理领域的普及应用。方法 使用itk：：ImageFileReader类和itk：：GDCMImageIO类对DICOM文件的文件头进行解析。介绍了使用图像迭代器访问图像像素的方法,熟悉C编程的研究人员快速访问像素数据的方法,及使用itk：：ImageFileWriter类进行图像写操作的方法。结果 使用本文的方法能够获取DICOM医学图像文件头中的医疗信息,读取像素数据,并以DICOM格式存储医学图像信息。结论 即使对DICOM标准和图像格式没有深入的了解,使用ITK也能方便地读写DICOM医学图像文件。     

DICOM医学图像文件数字签名的实现

目的:对DICOM医学图像进行数字签名.保证其信息的完整性、不可抵赖性、真实性和可靠性.方法:利用OpenSSL工具包及DCMTK工具包中的dcmsign对DICOM医学图像中的相关信息进行签名,并保存在同一DICOM文件的后面.结果:经签名后的DICOM文件可鉴定文件中信息的完整性、不可抵赖性、真实性和可靠性.结论:利用OpenSSL工具包及DCMTK工具包中的dcmsign对DICOM文件数字签名可实现其在远程医疗及区域PACS传输中的安全性.     

A Workflow for Ensuring DICOM Compatibility During Radiography Device Software Development

In medical devices, nonconformance with Digital Imaging and Communications in Medicine (DICOM) standard is a serious risk. DICOM nonconformance radiology devices could cause undetected image loss, increasing examination time, and costs in health centers and could even result in the wrong patient treatment. However, there is a rich literature on medical standards that identify the best practices for producing safe and effective medical software. However, these standards do not expressly provide tools to deal with all the relevant DICOM compatibility issues in a specific case. This study aims to introduce a systematic software development workflow that complies with medical standards and ensures DICOM conformance of a new or upgraded radiology software project. In this approach, DICOM conformance gets the highest priority, and the whole software project is organized around it. Software requirement analysis, risk evaluation, and test management tasks are arranged systematically to make the final device DICOM conformant. This conceptual framework was developed during the R&D work towards a novel radiography device, and it could be employed as a roadmap in other medical imaging software projects. The proposed methodology controls the DICOM compatibility risk of the final software, and its systematic evaluation complied with medical standards.