The DICOM standard

The DICOM Standard for network communication has been approved by ACR and NEMA in October 1993. The ACC has joined the effort in 1992 and drives the extension of DICOM for Media Interchange with a focus on defining a digital recording standard for communication between catheterisation laboratories. This is a necessary foundation towards cinefilm replacement. DICOM networking is being adopted as a European Standard called MEDICOM and the increasing interest of the ESC is likely to result in the adoption of DICOM Media Storage and interchange as an extension of MEDICOM in 1995. This represents a major breakthrough in the communication of medical images in electronic form. DICOM has been designed to offer an integrated approach to the increasing use of high speed computer networks in health care as well as larger and higher throughput storage media. This article focuses on the network communication as well as introduces the extension of DICOM for Media interchange which has been approved early 1995.     

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。     

DICOM灰阶图像软拷贝快速标准化显示方法

提出一种基于图形处理器(GPU)的标准灰阶显示函数(GSDF)的实现方法,依照Barten模型,以DICOM标准中对于GSDF的相关定义为基础,通过三次样条插值获取表现值与数字驱动等级(DDL)值对应关系,实现由存储值直接得到符合DICOM标准的显示效果。算法基于图形硬件加速技术,使得GSPS操作的实时性得到提升。应用本方法可弥补多数显示设备不具备内置DICOM P14校正的不足,具有很好的应用价值。     

Intracardiac and intraluminal echocardiography: indications and standard approaches

In particular clinical scenarios, transthoracic and transoesophageal echocardiography (TEE) have limitations. This study sought to test if intracardiac and intraluminal echocardiography (ICLE), including 2-D, M-mode and Doppler analysis with a miniaturised, multiple-frequency transducer-tipped catheter, is suitable for assessing distinct cardiac and vascular disorders. ICLE was employed in 10 animals using 6 standard approaches. In 12 patients undergoing device closure of patent foramina ovalia (PFO) (n = 6) or atrial septal defects (ASD) (n = 3), or aortic stent implantation (n = 3), interventional procedures were guided by ICLE and, for comparison, also by TEE. ICLE provided enhanced diagnostic information on the aorta, cardiac valves, main pulmonary vessels and both atria and, therefore, added to the diagnostic spectrum of TEE. Especially for guiding interventional procedures (e.g., device closure of atrial septal defects and patent foramina ovalia), ICLE was shown to be helpful. Compared with the conventional approach, the technique reduced fluoroscopy time for device closure procedures: 6.5 min vs. 8.9 min, p < 0.0011. With the patient in a supine position, ICLE was better tolerated than TEE. Complications did not occur, either with ICLE or with TEE. In conclusion, ICLE adds to conventional echocardiography and promises to become a clinical alternative for guiding interventional procedures.     

超声心动图对肺栓塞诊断价值的研究

目的　探讨经胸超声心动图 (TTE)和经食管超声心动图 (TEE)对肺栓塞的诊断价值。方法　对10例临床疑诊肺栓塞患者进行了TTE和TEE检查 ,并与CT结果对照 ,其中 4例患者进行了治疗后TEE随访。结果　 10例患者右心房内径 (5 7± 9)mm ,右心室内径 (3 4± 5 )mm ,肺动脉收缩压 (91± 19)mmHg(1mmHg=0 .13 3kPa) ,所有患者均有中度 -重度三尖瓣反流。检出右肺动脉内活动性血栓 2例 ,附壁血栓 2例 ,右心室活动性血栓 2例 ,左肺动脉活动性血栓 3例 ,附壁血栓 1例。 10例患者中 4例为左肺动脉或右肺动脉远段血栓 ,由TEE检出。所有结果经CT或手术证实。溶栓加抗凝治疗 3例 ,手术治疗 1例 ,2 0d～ 3个月后随访TEE ,肺动脉内血栓明显缩小或消失 ,肺动脉压力下降。结论　超声心动图技术在检出右心系统和肺动脉内血栓、明确肺栓塞的临床类型、评价肺栓塞的血流动力学改变和随访治疗效果等方面具有重要价值 ;TEE是检出左右肺动脉远段血栓的可靠方法     

Fusion of three-dimensional X-ray angiography and three-dimensional echocardiography

Objective Cardiovascular intervention guidance requires knowledge of heart function relative to its blood supply or venous drainage. Functional and vascular anatomic data are usually generated on different imaging systems, so fusion of the data is necessary to simultaneously visualize the results for intervention planning and guidance. The objective of this work is to establish the feasibility of fusing volumetric ultrasound (U/S) data with three-dimensional (3D) X-ray imaging data for visualization of cardiac morphology, function and coronary venous drainage. Methods Temporally resolved U/S volume data was registered with the 3D reconstruction of vascular structures derived from X-ray modeling and reconstruction. U/S image registration was obtained by optical tracking fiducial markers with simultaneous X-ray imaging. The proposed technique was applied to phantom data for accuracy assessment of the registration process and to biventricular pacemaker implantation as clinical example. Results Fusion of U/S data with 3D X-ray reconstruction data produced an RMS registration error below 2 mm. Conclusion Preliminary clinical feasibility of U/S-derived data synchronously with X-ray derived 3D coronary venography was established. This technique can be applied for fusion of functional U/S data with 3D anatomic X-ray data of the coronary veins during a biventricular pacemaker implantation procedures.     

Transoesophageal echocardiography: its role in the management of patients in a district general hospital

The aim of this study was to assess the value of a transoesophageal echocardiography (TOE) service in a district general hospital (DGH). A series of 151 consecutive cases was analysed retrospectively to determine the relative additional benefit of TOE over transthoracic echocardiography (TTE) in establishing diagnoses and making therapeutic decisions. Of the 151 cases, 140 were suitable for the two procedures to be compared. In 56%, TOE provided useful information for patient management. This consisted of the detection of new major findings (33%) and the exclusion of significant abnormalities (23%), suspected either clinically or by TTE. TOE made a minor clinical contribution in 8% of cases, while in 30% there was concordance between the two studies. Finally, in 6% both examinations were inconclusive. We conclude that TOE has a significant complementary role to TTE in terms of clinical diagnosis and patient management in the DGH setting.     

超声与心导管法对比研究冠心病左室舒张功能

目的　以超声与心导管法检测冠心病左室舒张功能。方法　62例患者均行经胸多普勒超声检查和冠状动脉及左室造影检查。其中冠状动脉正常者29例,年龄(47.0±1.8)岁,异常者33例,年龄(48.3±0.9)岁。结果　冠造异常组左室舒张末压显著高于正常组(17.6mmHgvs13.2mmHg,P<0.05);心房收缩前左室舒张速率正常组远大于异常组［分别为-(224.63±52.18),-(87.81±24.41),P<0.05］;心房收缩引起的左室舒张压力增加正常组远高于异常组［(6.66±0.92)mmHgvs（0.96±1.87）mmHg,P=0.0094］;心房收缩肺静脉逆流加速度两组差异显著(5.10±0.31vs4.12±0.20,P=0.0106);等容舒张指标左室等容舒张时间两组均有延长,左室最大舒张速率两组均有减少,但两组比较上述两指标差异均无显著性意义。等容舒张时间常数两组比较差异不显著。结论　冠脉缺血是左室弛张障碍加重和心肌僵硬度增加、顺应性下降的重要因素;冠脉异常组无论舒张早、中、后期弛张障碍和中、后期顺应性减低均重于冠脉正常者;存在冠脉缺血以外因素引起左室舒张末压增高,主要是引起弛张障碍,集中表现在舒张早期。     

The role of transesophageal echocardiography in critical care: UCSF experience.

The applications of transesophageal echocardiography (TEE) now encompass the arena of critical care. We reviewed the indications, findings, and outcome of TEE in the critical care setting in a tertiary care hospital and report our experience. Eighty-three transesophageal echocardiograms were performed in 69 critically ill patients for the following indications: endocarditis (43%), embolic source (13%), hypotension (10%), mitral regurgitation (10%), left ventricular function (6%), aortic dissection (4%), prosthetic valve dissection (4%), and other (10%). Findings were unexpected in 21 of 83 studies and led to a change in management in 17%. On the basis of the results of TEE, 22% of patients had further evaluation by a more invasive technique, and 19% of patients had surgical intervention without further study. No significant complications attributable to TEE were noted. We conclude that TEE is a safe and useful diagnostic technique with fairly broad applications in the critical care setting.     

心率变化对64层螺旋CT冠状动脉成像质量的影响及其对策

目的：探讨心率变化对64层螺旋CT冠状动脉成像质量的影响和相应对策。方法：回顾性分析收集心率变化患者1100例,正常无明显心率变化患者500例,根据心率变化幅度分组,无明显心率变化患者500例为对照组,即A组,心率变化2~6次/min患者500例为试验组B组,心率变化7~12次/min患者500例为试验组C组,心率变化12次/min以上患者100例为试验组D组,均进行64层螺旋CTA检查,将试验组各组结果分别与对照组相比较,判断二者之间有无统计学差异。结果：心电编辑前试验组各组与对照组存在明显统计学差异（P＜0.05）,通过心电编辑功能处理后试验组B组、C组与对照组无明显统计学差异（P＞0.05）,而试验组D组与对照组仍存在明显统计学差异（P＜0.05）。结论：运用64层螺旋CT心电编辑功能软件能够有效地提高心率变化患者冠状动脉诊断率。     

超声心动图在抗肿瘤治疗致心肌损害监测中的作用

正近年来,随着抗肿瘤治疗的不断进步以及新型化疗药物、靶向药物等的临床广泛应用,癌症患者死亡率逐渐下降,生存期明显延长,乳腺癌的5年生存率国际上最高可达到85%以上。但与此同时,抗肿瘤治疗所致心血管并发症也逐渐得到广泛关注。所有抗肿瘤治疗(化疗、放疗、靶向治疗)均可导致短期或长期心血管并发症,其中心肌损伤所致心功能不全和心力衰竭是最常见的心血管并发症之一,严重影响患者预后,已引起临床上的高度重视[1]。     

双源CT冠状动脉造影图像质量与心率的关系

目的评估平均心率和心率范围对于双源CT冠状动脉造影图像质量的影响。方法收集行双源CT冠状动脉造影检查患者134例,所有CTA图像数据均包括完整的检查时的心电图数据。由两名熟悉心血管的CT医师在未知扫描期间心率和心率范围的情况下进行分析和分级。图像质量分为四级．并做统计学处理。结果评估了134个病人,共1751个冠状动脉节段。不同评分组冠状动脉节段数分别为：1分,899（51.34％）;2分,727（41．51％）;3分,114（6．51％）;4分,11（0．62％）。按照扫描期间的平均心率以70bpm为界分为≥70bpm组和〈70bpm组,5、12、14、16段两组图像质量未见差异．其余各段图像质量可见明显差异（t分别=3．38、3．13、2．28、2．90、2．95、3．50、4．16、3．89、3．24、2．89、3．49、3．51,P均〈0．05）。按照扫描期间心率范围（最高心率一最低心率）8bpm为界将所有患者分为≥8bpm组和〈8bpm组,在任何冠状动脉节段均未发现双源CT冠状动脉造影的整体图像质量与心率范围之间存在的相关性（t分别=0．45、1．41、0．97、1．27、1．00、1．05、1．69、0．84、0．99、1．48、0．44、0．46、0．48、0．43、0．44、0．20,P均〉0．05）。结论双源CT可以在很大范围的平均心率和心率变化范围内获得具有诊断意义的图像质量。     

超声心动图和 CT 血管成像诊断肺静脉异位引流的价值

目的对比分析CT血管成像(CTA)和超声心动图在肺静脉异位引流诊断中的应用价值.方法对2009年6月至2011年12月接受诊疗的30例肺静脉异位引流患儿的超声心动图和CTA资料进行回顾性分析.所有患儿的临床和超声心动图资料齐全,其中21例患儿接受CTA检查,18例患儿接受手术治疗.结果根据手术结果及CTA结果,30例患儿中完全性肺静脉异位引流27例、部分性肺静脉异位引流3例.完全性肺静脉异位引流分型包括:心上型15例、心内型4例、心下型6例、混合型2例.经胸超声心动图结果:心上型15例,心内型4例,心下型6例,混合型1例,不确定者1例.21例患儿行CTA,其中18例与超声心动图结果一致,3例与超声诊断结果不完全一致.第1例超声心动图提示完全性肺静脉异位引流(心下型),CTA提示混合型(心上型+心下型);因患儿家属放弃治疗,故未经手术证实;第2例患儿超声心动图检查提示混合型(心内+心上型)肺静脉异位引流,CTA提示部分性肺静脉异位引流,最后手术证实超声诊断正确;第3例病情复杂,超声心动图及CTA检查均未分型,患儿未行手术治疗,所以也未经手术证实.结论超声心动图是诊断肺静脉异位引流的首选检查方法,对于心下型及混合型肺静脉异位引流的患儿,联合CTA更能提高该病诊断的准确率.     

心率波动对64层螺旋CT冠状动脉成像质量的影响和相应对策

目的:探讨64层螺旋CT心电编辑功能在心率波动患者冠状动脉成像中的应用价值.方法:回顾性分析收集心率波动患者1 700例,根据心率波动幅度分组,心率波动在3～7次/min之间患者800例为试验组B组,心率波动在8～12次/min之间患者800例为试验组C组,心率变化在12次/min以上患者100例为试验组D组,正常无明显心率波动或心率波动在2次/min以下的患者800例,为对照组,即A组.所有患者均进行64层螺旋CT冠状动脉检查,将试验组各组结果分别与对照组相对照,判断二者之间有无统计学差异.结果:心电编辑前试验组各组与对照组存在明显统计学差异(P<0.05),通过心电编辑功能处理后试验组B组、C组与对照组无明显统计学差异(P>0.05),而试验组D组与对照组仍存在明显统计学差异(P<0.05).结论:运用64层螺旋CT心电编辑功能软件能够有效地提高心率波动患者冠状动脉诊断率.     

基于DICOM标准的超声造影分析系统

目的通过DICOM超声造影动态图像的传输和解析,能对主流的超声造影仪器造影数据进行脱机分析,得到时间强度曲线和适合团注的拟合曲线及其参数数据,提出回归分析的评价:拟合优度检验。方法使用鼠标自动跟踪任意一帧造影图象的感兴趣区域,计算其造影平均强度,给出时间强度曲线。根据造影团注过程符合的曲线,使用最小二乘法的迭代方法求出拟合曲线及其参数,并给出拟合优度检验指数。结果通过对临床原始超声造影动态图像进行分析研究,使用本方法拟合得到程度较高的拟合优度检验。结论该方法可用于超声造影临床定量分析。