国内外PACS现状及发展趋势

医学影像存储与传输系统(Picture Archiving and Communication Systems,PACS)是近年来随着数字成像技术、计算机技术和网络技术的进步而迅速发展起来的,旨在全面解决医学图像的获取、显示、存储、传送和管理的综合系统.PACS的名称是在此之前1984年召开的第一届国际PACS和个人健康数据(PHD)会议上正式提出来的.西方发达国家从大处着眼80年代初就认识到PACS在医疗诊断和治疗过程中所处的重要地位,并着手研究该系统中涉及到的大量影像数据存储、影像传输速度、影像质量及存储和传输的标准等关键技术.从80代至今,20余年PACS已取得了长足的进步.     

基于PACS的彩超影像采集工作站的设计与应用

为了使医院模拟彩超诊断仪能够接入现有PACS系统,促进医院数字化与信息化发展,本文介绍了一种基于PACS系统的彩超影像采集工作站的设计方法及其应用.该系统使彩超诊断仪与PACS系统得以紧密地联系起来,实现了彩超图像的采集,同时按照DIC0M标准实现了彩超图像的存储与传输等一系列功能,推动了PACS系统的发展和医院信息系统的完善.     

Discussion on the implementation standard of PACS

目的 通过制定和遵循影像存储与传输系统(picture archiving and communication system,PACS)的实施规范,以提高PACS安装速度,降低PACS故障率和安装实施成本.方法 PACS实施规范包括系统安装前的需求分析、实施计划书的制定、工作表单的编写、与HIS等软件接口开发、PACS软件实施中的规范要求、项目验收6个工作步骤.结果 本实施规范是笔者多年对多个医院PACS实施和维护经验的总结.只有规范化操作和实施,才能降低PACS故障率,提高项目建设速度.结论 PACS系统涉及多个领域,需要不断总结,才能达到最佳实施效率.     

影像存储与传输系统实施规范的探讨

目的 通过制定和遵循影像存储与传输系统（picture archiving and communication system,PACS）的实施规范,以提高PACS安装速度,降低PACS故障率和安装实施成本.方法 PACS实施规范包括系统安装前的需求分析、实施计划书的制定、工作表单的编写、与HIS等软件接口开发、PACS软件实施中的规范要求、项目验收6个工作步骤.结果 本实施规范是笔者多年对多个医院PACS实施和维护经验的总结.只有规范化操作和实施,才能降低PACS故障率,提高项目建设速度.结论 PACS系统涉及多个领域,需要不断总结,才能达到最佳实施效率.     

PACS系统在放射科的应用体会

影像存档和通讯系统(picture archiving and com-munication system,PACS)是传统放射技术和计算机技术相结合的产物,由获取、传输、存储、显示和管理数字化医学影像等几部分组成.笔者所在医院放射科在2005年组建科内PACS,将计算机X线摄影(computed radiography,CR)、数字胃肠、CT及数字减影血管造影(digital subtraction angiography,DSA)等数字化影像设备联机联网,有效地改善了工作环境.提高了影像质量和工作效率.     

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…     

医学影像存档与通信系统存储系统的探讨

由于PACS系统需要一个高性能的存储系统的支撑，本文重点讨论了PACS的存储管理系统方案、PACS对计算机存储体系的要求、如何选择适当的存储架构以及PACS设计原则和分析方法.     

一体化数字医院PACS的实现

本文从PACS的关键技术，如影像数据的采集方法、影像存储及介质的选取、影像传输的网络、中间组件技术等方面阐述了一体化数字医院PACS的建设及其特点。     

基于网格及IHE XDS/XDS-I技术框架和协议的区域影像电子健康记录系统的设计与实现

提出并实现了一种具有影像信息共享交换功能的区域电子健康记录系统（EHR），完全符合IHE XDS／XDS-I技术框架和协议，同时应用网格概念和SOA架构，实现区域间多家医疗机构的病人影像信息的共享交换和影像信息的预处理及智能流动。该系统由病人基本信息主索引服务器、注册中心、存储池、网格服务器、安全服务模块、网关及网格代理结点、PACS／EMR工作站和医院现有PACS系统或医学影像设备及RIS系统等8个组件组成，解决了采用ebXML标准与注册中心、存储池的通信和PACS／RIS或其他现有影像信息系统只能通过DICOM标准和HL7通信相冲突的难题。在上海市3家医院和科研单位进行了系统测试，主要有图像及报告的发布流程和用户的查询提取流程，结果表明该系统是在不增加网络带宽和存储资源的情况下，解决区域间影像信息共享交换的有效方案，具有安全可靠、可伸缩和易管理的特点。     

一种符合医学数字影像与通讯标准的医学影像管理系统的设计

医学影像的存储与传输在数字化医疗快速发展的今天占据着非常重要的地位。为了实现医学数字影像与通讯（DICOM）医学影像在局域网上的传输和查询,本文设计了一个符合DICOM标准的医学影像管理系统。该系统能对DICOM格式文件进行解析,并在数据库中把DICOM影像文件与对应的病历信息进行关联存储,可以给医院影像科提供完全数字化的影像和数据。此研究工作不仅满足了医院影像中心对大量影像数据存储的需求,同时也促进了PACS系统的发展。     

Hardware and software requirements for a picture archiving and communication system’s diagnostic workstations

Electronic systems (picture archiving and communications systems [PACS]) for image and multimedia data distribution, archiving, and transmission, represent the future of radiology. The workstation is the point of contact between a PACS and the radiologist or referring physician. Therefore, the acceptance of PACS is highly dependent on workstation functionality and performance. This paper, based on our experience in evaluating commercial workstations and on a review of recent literature, describes hardware and software requirements for diagnostic workstations that could be used for making primary diagnoses in a radiology department. Requirements for PACS workstations for use in referring clinics are also briefly described. These workstations must be able to handle the large volume of images to be viewed efficiently, add new functionality to improve the productivity of physicians, technologists, and other health care providers, and provide enough flexibility to allow the electronic systems to grow as medical imaging technology evolves.     

Image display for clinicians on medical record workstations

Image display on electronic medical record (EMR) workstations is an important step in widespread implementation of picture archiving and communications systems (PACS). We describe a pilot project for implementing image display capability that is integrated with the EMR software, and will allow display of images on the physician’s workstation. We believe this pilot will provide valuable information about usage patterns in image display needs, which will be valuable in planning further expansion of PACS in our institution.     

An integrated picture archiving and communications system-radiology information system in a radiological department

In this report we present an integrated picture archiving and communication system (PACS)-radiology information system (RIS) which runs as part of the daily routine in the Department of Radiology at the University of Graz. Although the PACS and the RIS have been developed independently, the two systems are interfaced to ensure a unified and consistent long-term archive. The configuration connects four computer tomography scanners (one of them situated at a distance of 1 km), a magnetic resonance imaging scanner, a digital subtraction angiography unit, an evaluation console, a diagnostic console, an image display console, an archive with two optical disk drives, and several RIS terminals. The configuration allows the routine archiving of all examinations on optical disks independent of reporting. The management of the optical disks is performed by the RIS. Images can be selected for retrieval via the RIS by using patient identification or medical criteria. A special software process (PACS-MONITOR) enables the user to survey and manage image communication, archiving, and retrieval as well as to get information about the status of the system at any time and handle the different procedures in the PACS. The system is active 24 hours a day. To make the PACS operation as independent as possible from the permanent presence of a system manager (electronic data processing expert), a rule-based expert system (OPERAS; OPERating ASsistant) is in use to localize and eliminate malfunctions that occur during routine work. The PACS-RIS reduces labor and speeds access to images within radiology and clinical departments.     

Enterprise-class digital imaging and communications in medicine (DICOM) image infrastructure

Most current picture archiving and communication systems (PACS) are designed for a single department or a single modality. Few PACS installations have been deployed that support the needs of the hospital or the entire Integrated Delivery Network (IDN). The authors propose a new image management architecture that can support a large, distributed enterprise.     

Issues Surrounding PACS Archiving to External, Third-Party DICOM Archives

In larger health care imaging institutions, it is becoming increasingly obvious that separate image archives for every department are not cost effective or scalable. The solution is to have each department’s picture archiving communication system (PACS) have only a local cache, and archive to an enterprise archive that drives a universal clinical viewer. It sounds simple, but how many PACS can truly work with a third-party Integration of the Health Care Enterprise Compliant Image Archive? The answer is somewhat disappointing.Key words: PACS, IHE Actors, enterprise archiving     

Subsystem throughputs of a clinical picture archiving and communications system

We measured the throughtput rates of individual picture archiving and communications system (PACS) subsystems including the acquisition, archive, display, and communication network as a basis of evaluation the overall throughput of our clinical PACS. The throughput rate of each PACS subsystem was measured in terms of average residence time of individual images in the subsystem. The residence time of an image in a PACS subsystem was determined by the total time the image was required to be processed within the subsystem. The overall throughput of the PACS was measured as the total residence time of an image in the various subsystems. We also measured throughputs of the PACS subsystems using three types of networks (Ethernet; fiber distributed data interface; and UltraNet, UltraNetwork Technologies, San Jose, CA), and the results were compared. Approximately 200 gigabytes of data transactions including magnetic resonance, computed tomography and computed radiography images from our PACS were analyzed. Results showed that PACS throughput was limited by three major factors: (1) low-speed data interface used in the radiologic imaging devices and archive devices; (2) competition for systems processing time among the PACS processes; and (3) network degradation caused by heavy network traffic. We concluded that PACS performance could be improved with a well-designed network architecture, a job prioritizing mechanism, and an image routing strategy. However, device-dependent low-speed data interface has limited PACS performance.     

Evaluation of teleradiology for interpretation of intravenous urograms

The diagnostic yield of a commercial teleradiology/picture archiving and communication system (ATT-Philips Comm View T/PACS) was evaluated for 100 urograms. A single image from each examination was digitized (2048 x 1684 x 12-bit pixels) and transmitted from a satellite hospital over a T-1 line using the T/PACS system. The video display of each digitized image was reviewed independently by four radiologists. The same four radiologists reviewed the original film images at a different time without knowledge of their T/PACS interpretation. There was no statistically significant difference in the sensitivity for clinical findings between T/PACS (86%) and film (89%). The false positive rate, however, was significantly higher with T/PACS than with film (44 versus 32 false positive findings per 100 films). We conclude that T/PACS of the type studied here demonstrates sufficient sensitivity for the detection of clinically important urographic findings in the emergency setting. A final reading of the original films is still necessary, however, to assure appropriate specificity.     

The practical use and evaluation of picture archiving and communication system in the department of orthopaedic surgery

A picture archiving and communication system (PACS) was started in June 1989 in the outpatient clinic of the Department of Orthopaedic Surgery. Hokkaido University, Sapporo, Japan. The PACS system has several advantages: space savings for storage of images, safe custody and quick access to image data, simultaneous access to image data, the possibility of obtaining good quality data on utilization of images, and applications for medical education and resident training. However, this system has just begun, and several problems must still be solved. In this article, we describe our experiences with the PACS system in the outpatient clinic of the department of orthopaedic surgery.