Evaluation of structure recognition with the multiscan echocardiograph. A cooperative study in 580 patients

Real time, two-dimensional, images of the heart can now be obtained with the multiscan ultrasound system recently introduced. To assess the clinical usefulness of this technique a cooperative study was carried out in four cardiac centers. This paper describes the experience with and the results in 580 patients with different ages and disorders.Since a unique feature of multiscan is the instantaneous display of cardiac geometry and anatomy, structure recognition was chosen as the most important parameter to analyze. Image quality or recognition levels for eight specific cardiac structures were documented. Results also include recognition levels for different age and disease groups and a comparison between the four centers. In addition, information was gathered on the general diagnostic capability of the multi-element system and the possibility of quantitation of dimensions.Aortic root, anterior mitral valve leaflet and left ventricular posterior wall were the structures most readily recognized. Excellent or good images were seen in two-thirds of all patients. Best visualization was obtained in young patients. A positive diagnosis could be made or confirmed in about one half of the patients with valvular, congenital or myocardial disease and in nearly all patients with pericardial effusion. As experience was gained, the diagnostic importance of the technique shifted from structure recognition towards analysis of left ventricular function.It is clear that the multiscan system does allow excellent orientation and yields quick, non-invasive information of pertinent clinical value. The method provides an immediate overall impression of the heart. It is foreseen that this technique in combination with existing time-motion recording methods will expand the use of echocardiography drastically.     

Access数据库软件在医学影像资料管理中的应用

目的 利用微机进行医学影像资料智能化管理,探索建立实用微型临床影像资料数据库。方法 一台PentiumⅡ微机,直接在Microsoft Access数据库应用软件中建立临床影像资料系统。运用X-Vicieoo图像存储系统或扫描仪获取常规X线片、CT、MRI、DSA等的数字化图像,并与文字部分连接。结果 依靠Acceas数据库建立的医学影像资料管理系统能实时动态完整地输入或输出日常各类临床影像资料(包括图像)。同时还可进行图像和文字处理、存档及网络传输。结论 Access数据库软件用于医学景仰资料系统管理,具有软硬件配置要求低,操作简便、运行安全,易于实现同络化等优点。     

Microcomputer image processing for burn patients

A computer-based system was developed to handle information and images in a clinical setting. The system is based on an 80286 AT computer, the topology of which includes a 16-bit color image capture/display graphics adapter and a 256 gray scale 8-bit digital image analysis processor. Using its color capabilities, we have created a picture database of patients' injuries, radiographs, and other relevant clinical data. The computer-based imaging system allows instant access to this information and minimizes subjective evaluation, making comparison of and follow-up of treatments more objective. The image analysis components permit digital characterization of the burn wound, enhancing our ability to quantitatively evaluate wound size, contracture, graft take, and re-epithelialization. This is a cost-effective method of handling information and images in the clinical setting as well as an effective research and teaching tool that facilitates management and follow-up care of the patient with burns.     

台北荣民总医院护理信息化管理及借鉴

介绍了台北荣民医院护理信息化管理模式,包括完善的护理人员"进阶制度"的信息化、护理教师临床实务指导能力考评效果的信息化、院内护理丰富资源共享性的信息化、计算机执行医嘱核对实物图片信息化等。结合大陆护理信息化管理工作实际,可参考和借鉴台北荣民总医院的护理信息化管理经验,尝试建立院内网络护理信息库,实现资源共享;计算机录入校正、显示各类药品实物图片信息,提高医嘱执行查对的准确性;加强各级护理人员信息化的管控,把护理管理者从繁琐的数据登记中解脱出来,提高工作效率。     

Pediatric digital echocardiography: a study of the analog-to-digital transition.

Limited information is available that describes the practical conversion of a pediatric echocardiography laboratory from videotape to a primarily digital format. To help pediatric echocardiographers begin to make the analog-to-digital transition, we report our pediatric digital acquisition protocol and the acquisition and storage parameters of 1000 unselected, consecutive digitally acquired studies of pediatric patients with known or suspected congenital or acquired heart disease. With the use of our acquisition protocol, a complete normal study requires 46 moving clips and 12 still-frame images. Five hundred consecutive patient studies acquired with "high" JPEG (Joint Photographers Experts Group) compression (group 1) were compared with the next 500 examinations acquired using "medium" JPEG compression (group 2) for number of moving clips, still images, and megabytes of storage space. No intergroup difference was found in the number of moving clips or still images. When JPEG compression was decreased from high to medium, the average clip storage requirement per patient increased, and the number of patients stored per 230-MB magneto optical disk decreased significantly. Non-ECG-triggered timed single-plane clips and still images required significantly more storage space than ECG-triggered single-beat clips and still images. The frequency of multiplane sweeps was.03% and was independent of diagnosis. With the use of high JPEG compression, the digital storage cost per patient was $1.90, which was 6.0 times greater than that for simultaneously recorded 120-minute VHS videotape. Many features of the digital paradigm, including decreased MOD storage space, enhanced serial study comparisons, random image access, and improved image quality, mitigate this cost differential.     

Multi-media computer-based chart: modern tool of clinical record keeping

AIM: To design the program of computer multimedia case history (MCH) for collection, storage and analysis of information about the patient including diagnostic images; to test MCH for application in telemedical consulting and control over valid conduction of the treatment protocol. MATERIAL AND METHODS: Brief representation of information is reached by integrated multilevel placement of the data on common time axis. Dynamics of the selected parameters is represented as normalized diagrams in the same system axes. Electron tables are filled either by hand or import of the data from individual electron file of all the information about the patient. Diagnostic images and conclusions are obtained from local computer bases of the diagnostic units. Inexpensive commonly used computers allows one to input digital micro- and macrophotos, x-ray images, etc. Monitor information is available from the universal computer net directly from the monitors Geolink-M. RESULTS: MCH was tested in the Hematological Research Center of RAMS. In cooperation with Bryansk diagnostic center N 1 telemedical consulting and some data bases were perfected. The MCH system joints routine activity of the clinic without any problems raising quality of the patients management, facilitating the access to therapeutic and diagnostic information and its analysis. On-line breaking the limits of the controlled parameters and protocols is detected automatically. These events are emphasized by "blocking questions" which must be worked out by the user. The information on the patient can be fully stored on CD-ROM in line with the MCH program providing organization of the data. CONCLUSION: The system is introduced which collects medical information from various sourses and builds up comprehensive representation of the data on the same time axis. The system provides control over implimintation of the protocols of the patients' management, gives a convenient access to medical information, ensures its reliable storage and availability in case of the patients transfer to other medical institutions, facilitates analysis of clinical cases, conduction of medical consulting.     

A computerized perioperative data integration and display system

Object The operating room is rich in digital data that must be rapidly gathered and integrated by caregivers, potentially distracting them from direct patient care. We hypothesized that current desktop computers could integrate enough electronically accessible perioperative data to present a unified, contextually appropriate snapshot of the patient to the operating room team without requiring any user intervention. Materials and methods We implemented a system that integrates data from surgical and anesthesia devices and information systems, as well as an active radiofrequency identification location tracking system, to create a comprehensive, unified, time-synchronized database of all digital data produced by these systems. Next, a human factors engineering approach was used to identify selected data to show on a large format display during surgery. Results A prototype system has been in daily use in a clinical operating room since August 2005. The system functions automatically without any user input, as the display system self-configures based on cues from the primary data. The system is vendor agnostic with respect to input data sources and display options. Conclusion Automatic integration and display of team-synchronizing data from medical devices and hospital information systems is now possible using software that runs on a personal computer. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Methods for ultrasonic imaging of the heart

Ultrasound imaging of the heart is divided into one-dimensional methods currently in use, preliminary techniques which have been developed for two-dimensional static and motion imaging, those techniques currently under development for two-dimensional motion imaging, and goals which appear achievable and which would appear to lead to an ultimate cardiac diagnostic system. The primary current one-dimensional display of cardiac ultrasound data is range as a function of time. This provides dynamic information about cardiac structures lying within a relatively narrow ultrasonic beam but fails to show the coordinated motion of entire structures under study and depicts movements which occur across the beam as intermittently appearing echo complexes. Preliminary approaches employing mechanical assemblies which contain either moving transducers or rotating reflectors have been used to show feasibility of motion imaging. Systems currently under development for two-dimensional motion imaging of the heart use mechanical or electronic beam scanning or multielement arrays for real-time presentations or use ECG-based sampling and computer processing for image construction and data processing. Achievable goals for future development include the simultaneous imaging of solid structures of the heart as well as quantitative display of blood flow data in a motion format and in three dimensions with specific indications of tissue and flow macrostructure.     

Using digital image processing for the assessment of postural changes and movement patterns in bodywork clients

A number of scientific/research quality software packages exist for the capture, display and analysis of digital images. This article discusses the use of a high resolution video camera and a desktop computer coupled with the freeware scientific visualization software package NIH Image to visually represent and record posture and movement protocols in the clinical, research or educational setting. Existing digital image processing techniques and tools can be extrapolated to the purposes of research, data gathering and clinical application in the field of bodywork.     

DR双能量减影技术在胸部病变的诊断价值

目的探讨双能量减影在胸部直接数字化X线摄影技术的临床应用价值。方法随机抽取83例胸部双能量减影数字化X线摄影（DR）。83例病人均进行胸部后前位片的双能量减影的图像后处理,形成标准DR图像、软组织减影图像、骨骼减影图像各一幅即所谓的“骨肉分离”技术。结果由于双能量减影去除了骨性胸廓的干扰,增加肺部检出钙化的敏感性和准确性,增加肺结节的检出率,对肺部的良、恶性定性有意义;对骨性胸廓病变的诊断更加准确;对肺结节的检出率较普通胸片明显提高。双能量减影对显示骨性胸廓和中央气道的病变,如骨转移瘤、骨折、骨质破坏、钙化等较常规胸片、单纯直接数字化摄影均有明显提高,统计学有明显差异。双能量减影图像上肉眼判断有、无钙化非常可靠。结论双能量减影直接数字化X线摄影技术提供了更多的影像诊断信息,增加了诊断的准确性的信心,具有较高的实用临床价值和推广价值。     

Image storage,transmission and manipulation

Summary

Medical imaging is the study of human functions and anatomy through pictorial information. During the past 15 years all new medical imaging modalities introduced are digital-based systems. Firstly the concept of digital imaging, the meaning of spatial and density resolutions, and signal-to-noise ratio is reviewed. Based on these definitions, the current technology in image storage and transmission is discussed including the magnetic disk, the parallel transfer disk, the optical disk, Ethernet, the fibre distributed data interface (FDDI), and Ultranet.

Among many image manipulation functions, two simple types which are commonly used in clinical applications are discussed, one for visualization enhancement and the other for quantification.     

MDCT-imaging of peripheral arterial disease.

With the design and development of advanced computed tomography (CT) techniques and applications, like the newest generation of 16-detector-row CTs, CT angiography of the lower limb becomes a feasible tool for imaging peripheral vascular disease. Due to several advantages, compared with conventional digital subtraction angiography (DSA), including minimal invasiveness, CT angiography competes against diagnostic DSA in several clinical situations. 16-DCT offers the possibility to acquire thin slices from the diaphragm to the ankle in less than 40 sec. Easily, a data set of 800 to 1200 transverse slices may be created. To use transverse reconstructions alone to read these volumetric data sets is not appropriate. Powerful post-processing tools for volumetric analysis are required so that routine interpretation can be performed as efficiently and accurately as transverse section review. Because of its widespread availability and applicability, CT angiography of the lower extremities may be applied to patients in a pre- or post-procedural situation and also serves as a first line modality in patients with acute onset of clinical symptoms. Although multidetector CT arteriography is rapidly achieving clinical acceptance, further studies need to be performed to fully evaluate the clinical value of this method of peripheral arterial imaging. This article reviews the current status of multidetector CT peripheral arteriography, including indications, technical details, image post-processing, radiation exposure, and clinical results.     

Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

An interactive processing system for ultrasonic compound imaging, real-time image processing and texture analysis

An interactive processing system for ultrasonic imaging, real-time image processing and texture analysis was developed and has been used under real clinical conditions at the 2nd Department of Gastroenterology and Hepatology, Vienna, since 1983. The major goal of this system is to determine what digital approaches to ultrasonic imaging, aided by computer processing, can contribute to ultrasonic diagnosis and whether clinically-relevant information can be extracted which is not obtained by conventional approaches.     

螺旋CT资料建立颅面三维模型

背景:三维螺旋CT可以在胶片或计算机屏幕上展示多角度的立体图像,但复杂的三维解剖形态很难在二维的胶片或计算机屏幕上直观显示,颅颌面外科的手术模拟和方案设计往往更需要三维实体模型.目的:用螺旋CT数据资料建立颅面三维模型,探讨该模型在颅颌面外科领域的应用.方法:患者行螺旋CT扫描,层厚2 mm,螺距1.0 mm,利用工作站,进行扫描图像的容积三维重建后,重新间隔分层,利用CuteFTP 4.0软件以BMP格式下载.应用课题组自主开发的CT图象处理软件对已下载的二维图象进行过滤、筛减、降噪、校正失真等处理,对图像的边缘轮廓进行提取,得到面颅骨皮质骨边缘轮廓的矢量化线图,将该线图数据输入Surfacer 9.0重建软件,对轮廓曲线进行矢量叠加,从而得到面颅骨的三维三角形面片线框模型及实体模型.进一步在该模型上按镜像关系重构衬垫物的三维模型.结果与结论:实验得到了颅面骨骼表面轮廓的三维实体模型,并在其上进行了整形手术的计算机辅助设计,通过快速成型技术加工出衬垫物模板.用螺旋CT数据资料可以建立颅面三维模型,该模型在颅颌面畸形损伤肿瘤等的诊断和治疗中将发挥重要作用.     

Respiratory therapy as a component of an integrated hospital information system: the Parkland On-Line Information System (POIS).

Information handling is an important part of the activities of health care professionals, and the Parkland On-line Information System (POIS)--a computerized hospital information system--was established to more efficiently handle the processing and storage of information in our institution. Computerization of a respiratory therapy department is more effective if done in the context of a comprehensive, integrated hospital information system. Information and requests for services flow into the respiratory therapy departmental computer from other hospital terminals, and information, such as patient charges and statistical data, flow out of the departmental computer to those requesting such information. POIS is an implementation of the IBM Patient Care System. We have found that a computerized hospital information system can facilitate patient care by easing the burden of information processing.     

Current status of digital mammography

Some inherent limitations to further technical improvement in film-screen mammography exist. Many of these limitations can be overcome effectively with digital mammography, in which image acquisition, display, and storage are performed independently, thus allowing the optimization of each. Presented is a brief background of digital and analog imaging with emphasis on the features and drawbacks of digital mammography systems. Image storage, processing, and display, computer-aided detection and diagnosis, as well as telemammography are also discussed.     

An object-oriented approach to data display and storage: 3 years experience, 25,000 cases

Object-oriented programming techniques were used to develop computer based data display and storage systems. These have been operating in the 8 anaesthetising areas of the Adelaide Children's Hospital for 3 years. The analogue and serial outputs from an array of patient monitors are connected to IBM^TM compatible PC-XT computers. The information is displayed on a colour screen as wave-form and trend graphs and digital format in real time. The trend data is printed simultaneously on a dot matrix printer. This data is also stored for 24 hours on hard disk.The major benefit has been the provision of a single visual focus for all monitored variables. The automatic logging of data has been invaluable in the analysis of critical incidents. The systems were made possible by recent, rapid improvements in computer hardware and software. This paper traces the development of the program and demonstrates the advantages of object-oriented programming techniques.     

基于DICOM标准的超声图像归档与通讯系统的研制与初步应用

目的 开发超声图像归档与通讯系统(PACS)，实现超声成像设备的网络化，解决超声图像的存储和诊断报告书写的计算机化、标准化。方法 利用C 计算机语言开发超声图像工作站，获取、显示、处理和打印超声动静态图像，将科室内10台超声设备连接成医学数字影像传输(DICOM)网络；中心图像服务器和超声科信息管理系统服务器与各图像工作站组成计算机以太网，构成超声PACS；再通过交换机与医院Internet WWW服务器连接，实现超声彩色图文报告的院内发布。结果 成功实现了DICOM数字图像和高质量视频图像的获取、显示、处理和网络传送，与医院信息系统无缝连接，图像的中心存储，诊断报告书写计算机化以及共享打印等功能。结论 超声图像管理系统的应用提高了工作效率及管理水平，推动了医生工作模式的变革，方便了工作、科研和教学，提高了医疗服务层次。规范化、计算机化的诊断报告质量优于人工书写报告。     

电子喉镜诊疗信息数字化临床应用研究（附623例报告）

目的：对625例电子喉镜诊疗信息进行数字化应用及临床效果总结。方法：把病人在电子喉镜下的诊疗信息通过计算机及软件转化为数字信息,进行实时采集,记录,储存,结果：通过对623例病人电子喉镜的检查,诊断及手术的数字化应用,取得良好的临床效果。结论：把电子喉镜与计算机结合起来,不仅可以提高诊疗水平,而且具有图像清晰,色彩真实,打印报告,病历查询,统计分析,数据库管理,远程会诊,科研教学等优点。