DICOM医学图像的存储与管理

随着数字化医学成像设备在医院的广泛使用,对医学图像及相关数据的存档管理以及在不同科室之间的数据共享的要求越来越迫切,这就需要建立PACS(图像存档和通讯系统),这方面国外已经发展了很多年,我国目前处于起步阶段.本文参照PACS系统的一个已经被国际认可的医学图像标准即医学成像和通讯标准DICOM(digital imaging and communication in medicine),研究了标准的各个部分,特别是兼容性、信息对象定义(IOD)、服务对象对类(SOP)、数据编码等部分,就具体实现PACS系统的一个重要方面即医学图像的存档和管理做了深入的探讨,在此基础上建立了医学图像数据库系统,为实现医学图像信息的网络共享打下了基础.     

The Information Security Needs in Radiological Information Systems—an Insight on State Hospitals of Iran, 2012

Picture Archiving and Communications System (PACS) was originally developed for radiology services over 20 years ago to capture medical images electronically. Medical diagnosis methods are based on images such as clinical radiographs, ultrasounds, CT scans, MRIs, or other imaging modalities. Information obtained from these images is correlated with patient information. So with regards to the important role of PACS in hospitals, we aimed to evaluate the PACS and survey the information security needed in the Radiological Information system. First, we surveyed the different aspects of PACS that should be in any health organizations based on Department of Health standards and prepared checklists for assessing the PACS in different hospitals. Second, we surveyed the security controls that should be implemented in PACS. Checklists reliability is affirmed by professors of Tehran Science University. Then, the final data are inputted in SPSS software and analyzed. The results indicate that PACS in hospitals can transfer patient demographic information but they do not show route of information. These systems are not open source. They don’t use XML-based standard and HL7 standard for exchanging the data. They do not use DS digital signature. They use passwords and the user can correct or change the medical information. PACS can detect alternation rendered. The survey of results demonstrates that PACS in all hospitals has the same features. These systems have the patient demographic data but they do not have suitable flexibility to interface network or taking reports. For the privacy of PACS in all hospitals, there were passwords for users and the system could show the changes that have been made; but there was no water making or digital signature for the users.     

Computers in imaging and health care: Now and in the future

Early picture archiving and communication systems (PACS) were characterized by the use of very expensive hardware devices, cumbersome display stations, duplication of database content, lack of interfaces to other clinical information systems, and immaturity in their understanding of the folder manager concepts and workflow reengineering. They were implemented historically at large academic medical centers by biomedical engineers and imaging informaticists. PACS were nonstandard, home-grown projects with mixed clinical acceptance. However, they clearly showed the great potential for PACS and filmless medical imaging. Filmless radiology is a reality today. The advent of efficient softcopy display of images provides a means for dealing with the ever-increasing number of studies and number of images per study. Computer power has increased, and archival storage cost has decreased to the extent that the economics of PACS is justifiable with respect to film. Network bandwidths have increased to allow large studies of many megabytes to arrive at display stations within seconds of examination completion. PACS vendors have recognized the need for efficient workflow and have built systems with intelligence in the management of patient data. Close integration with the hospital information system (HIS)-radiology information system (RIS) is critical for system functionality. Successful implementation of PACS requires integration or interoperation with hospital and radiology information systems. Besides the economic advantages, secure rapid access to all clinical information on patients, including imaging studies, anytime and anywhere, enhances the quality of patient care, although it is difficult to quantify. Medical image management systems are maturing, providing access outside of the radiology department to images and clinical information throughout the hospital or the enterprise via the Internet. Small and medium-sized community hospitals, private practices, and outpatient centers in rural areas will begin realizing the benefits of PACS already realized by the large tertiary care academic medical centers and research institutions. Hand-held devices and the Worldwide Web are going to change the way people communicate and do business. The impact on health care will be huge, including radiology. Computer-aided diagnosis, decision support tools, virtual imaging, and guidance systems will transform our practice as value-added applications utilizing the technologies pushed by PACS development efforts. Outcomes data and the electronic medical record (EMR) will drive our interactions with referring physicians and we expect the radiologist to become the informaticist, a new version of the medical management consultant.     

基于CORBA的医院信息系统与PACS的分布式集成研究

在实际医学应用中 ,医生需要及时获得病人的有关图像和文本记录信息。这些信息有助于医生进行病历诊断 ,临床试验和研究分析。但是这些信息分布零乱 ,并且位于不同的系统上 ,如图像管理和通信系统 (Picturearchiving and comm unication information systems,PACS) ,医院信息系统 (Hospital inform ation systems,HIS)等 ,这些系统使用不同的标准和协议 ,并且都不支持分布式操作 ,使系统间信息不能完全共享。为了实现各种医学系统间的分布式操作和信息的共享 ,本文结合当前流行的 WWW技术 ,利用分布式处理软件 (Common object requestbroker architecture,CORBA) ,提出了一种基于 WEB的 PACS和 HIS分布式集成方法 ,该方法将图像和文本信息系统及各种医学应用都看作是 CORBA组件对象 ,把对这些系统和应用的操作都当作是对应用对象的处理 ,利用面向对象的技术实现了对 PACS和 HIS系统的分布式集成和互操作 ,并且利用 WEB技术实现了信息的共享     

A Mobile Phone Integrated Health Care Delivery System of Medical Images

With the growing computing capability of mobile phones, a handy mobile controller is developed for accessing the picture archiving and communication system (PACS) to enhance image management for clinicians with nearly no restriction in time and location using various wireless communication modes. The PACS is an integrated system for the distribution and archival of medical images that are acquired by different imaging modalities such as CT (computed tomography) scanners, CR (computed radiography) units, DR (digital radiography) units, US (ultrasonography) scanners, and MR (magnetic resonance) scanners. The mobile controller allows image management of the PACS including display, worklisting, query and retrieval of medical images in DICOM format. In this mobile system, a server program is developed in a PACS Web server which serves as an interface for client programs in the mobile phone and the enterprise PACS for image distribution in hospitals. The application processing is performed on the server side to reduce computational loading in the mobile device. The communication method of mobile phones can be adapted to multiple wireless environments in Hong Kong. This allows greater feasibility to accommodate the rapidly changing communication technology. No complicated computer hardware or software is necessary. Using a mobile phone embedded with the mobile controller client program, this system would serve as a tool for heath care and medical professionals to improve the efficiency of the health care services by speedy delivery of image information. This is particularly important in case of urgent consultation, and it allows health care workers better use of the time for patient care.     

Radiologists in the IT era: the Saitama experience

In recent years, intra-hospital computerisation including picture archiving and communication system (PACS) and electronic medical chart system (EMCS) has been rapidly introduced in Japan. The current system has, however, encountered many problems, such as, storage format of images, quality of diagnostic monitors, and compatibility of PACS and EMCS introduced by multi-vendors. In 2003, Saitama Medical University Hospital introduced PACS and EMCS, which can prevent inconsistency and loss of medical care information and can be linked to provide high quality medical care. This paper describes how radiologists should be involved in a hospital information system as specialists of PACS, based on our experience.     

The Clinical Application of a PACS-Dependent 12-Lead ECG and Image Information System in E-Medicine and Telemedicine

This study presents a software technology to transform paper-based 12-lead electrocardiography (ECG) examination into (1) 12-lead ECG electronic diagnoses (e-diagnoses) and (2) mobile diagnoses (m-diagnoses) in emergency telemedicine. While Digital Imaging and Communications in Medicine (DICOM)-based images are commonly used in hospitals, the development of computerized 12-lead ECG is impeded by heterogeneous data formats of clinically used 12-lead ECG instrumentations, such as Standard Communications Protocol (SCP) ECG and Extensible Markup Language (XML) ECG. Additionally, there is no data link between clinically used 12-lead ECG instrumentations and mobile devices. To realize computerized 12-lead ECG examination procedures and ECG telemedicine, this study develops a DICOM-based 12-lead ECG information system capable of providing clinicians with medical images and waveform-based ECG diagnoses via Picture Archiving and Communication System (PACS). First, a waveform-based DICOM-ECG converter transforming clinically used SCP-ECG and XML-ECG to DICOM is applied to PACS for image- and waveform-based DICOM file manipulation. Second, a mobile Structured Query Language database communicating with PACS is installed in physicians’ mobile phones so that they can retrieve images and waveform-based ECG ubiquitously. Clinical evaluations of this system indicated the following. First, this developed PACS-dependent 12-lead ECG information system improves 12-lead ECG management and interoperability. Second, this system enables the remote physicians to perform ubiquitous 12-lead ECG and image diagnoses, which enhances the efficiency of emergency telemedicine. These findings prove the effectiveness and usefulness of the PACS-dependent 12-lead ECG information system, which can be easily adopted in telemedicine.     

Interfacing aspects between the picture archiving communications systems,radiology information systems,and hospital information systems

Information relevant to radiological applications is commonly managed by several autonomous medical information systems including hospital information systems (HIS), radiological information systems (RIS), and picture archiving and communications systems (PACS). In this report, we explain the need to coordinate these systems and to provide some framework in which they can exchange information. In the first half of this report, we describe the integration of a PACS system into a hospital operation. Next, we present the interfacing methods between the HIS and the RIS, and between the RIS and the PACS. Two methods are further detailed for the communication between the RIS and the PACS (1) the triggered database to database transfer, and (2) the query protocol. The implementation of the first method successfully allows RIS reports, procedure and patient demographic information to be displayed at the request of the user along with the associated images at a PACS workstation. The query protocol allows a PACS to dynamically query RIS information. It will be eventually integrated into the design of a scientific multimedia distributed medical database system built on top of the HIS, the RIS, and the PACS.     

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。     

A Study on Image Quality Management in PACS Used by Korean Hospitals

This study evaluated a method to maintain the optimal image quality in clinical practice for image quality management in a picture archiving and communication system (PACS) that uses typical technology for digital medical images. This study conducted a survey of 25 hospitals in Seoul and metropolitan areas that had installed PACS to examine the reality of image quality management. Sixteen diagnostic monitors were used as calibration tools to compare and analyze the external illuminance uniformity and grayscale standard display function (GSDF) values at each frequency. According to the survey results, most of the hospitals did not have any particular rules or standardized methods for image quality control. In a PACS, the calibration frequency was examined within the allowable limits of error for each week and month. The calibration was not affected by the difference in brightness of the environment for reading an image. The GSDF measurement values were quite different from the standard values. In conclusion, to improve the image quality of the digital system, it is important to make good use of the system and maintain the image quality. Therefore, it is critical to capitalize on the method suggested in this study and maintain the optimal image quality to guarantee a high level of observer satisfaction.     

A Multimodal Search Engine for Medical Imaging Studies

The use of digital medical imaging systems in healthcare institutions has increased significantly, and the large amounts of data in these systems have led to the conception of powerful support tools: recent studies on content-based image retrieval (CBIR) and multimodal information retrieval in the field hold great potential in decision support, as well as for addressing multiple challenges in healthcare systems, such as computer-aided diagnosis (CAD). However, the subject is still under heavy research, and very few solutions have become part of Picture Archiving and Communication Systems (PACS) in hospitals and clinics. This paper proposes an extensible platform for multimodal medical image retrieval, integrated in an open-source PACS software with profile-based CBIR capabilities. In this article, we detail a technical approach to the problem by describing its main architecture and each sub-component, as well as the available web interfaces and the multimodal query techniques applied. Finally, we assess our implementation of the engine with computational performance benchmarks.     

A literature review on communication between picture archiving and communication systems and radiology information systems and/or hospital information systems

The purpose of this literature review is to present the concepts surrounding the issue of communication between imaging systems and information systems in radiology and the literature about them. Picture archiving and communication systems (PACS) were developed to combine viewing of modality images, archiving, and distribution of images. When PACS is integrated/interfaced with radiology information systems (RIS) or hospital information systems (HIS), it can merge patient demographics, medical records, and images. To address several issues surrounding communication between PACS and HIS/RIS and to make interface development easier and faster, various organizations have developed standards for the formatting and transfer of clinical data. Additional work continues to better handle these issues. Communication protocol Health Level 7 (HL7) is a standard application protocol used for electronic text data exchange in health care by most HIS/RIS. The imaging communication protocol for PACS is the Digital Imaging and Communications in Medicine (DICOM) standard specification protocol that describes the means of formatting and exchanging images and associated information.     

Developing a Medical Image Content Repository for E-Learning

The integration of medical informatics and e-learning systems could provide many advanced applications including training, knowledge management, telemedicine, etc. Currently, both the domains of e-learning and medical image have sophisticated specifications and standards. It is a great challenge to bring about integration. In this paper, we describe the development of a Web interface for searching and viewing medical images that are stored in standard medical image servers. With the creation of a Web solution, we have reduced the overheads of integration. We have packaged Digital Imaging and Communications in Medicine (DICOM) network services as a component that can be used via a Web server. The Web server constitutes a content repository for searching, editing, and storing Web-based medical image content. This is a simple method by which the use of Picture Archiving and Communication System (PACS) can be extended. We show that the content repository can easily interact and integrate with a learning system. With the integration, the user can easily generate and assign medical image content for e-learning. A Web solution might be the simplest way for system integration. The demonstration in this paper should be useful as a method of expanding the usage of medical information. The construction of a Web-based repository and integrated with a learning system may be also applicable to other domains.     

Business Model for the Security of a Large-Scale PACS,Compliance with ISO/27002:2013 Standard

Data security is a critical issue in an organization; a proper information security management (ISM) is an ongoing process that seeks to build and maintain programs, policies, and controls for protecting information. A hospital is one of the most complex organizations, where patient information has not only legal and economic implications but, more importantly, an impact on the patient’s health. Imaging studies include medical images, patient identification data, and proprietary information of the study; these data are contained in the storage device of a PACS. This system must preserve the confidentiality, integrity, and availability of patient information. There are techniques such as firewalls, encryption, and data encapsulation that contribute to the protection of information. In addition, the Digital Imaging and Communications in Medicine (DICOM) standard and the requirements of the Health Insurance Portability and Accountability Act (HIPAA) regulations are also used to protect the patient clinical data. However, these techniques are not systematically applied to the picture and archiving and communication system (PACS) in most cases and are not sufficient to ensure the integrity of the images and associated data during transmission. The ISO/IEC 27001:2013 standard has been developed to improve the ISM. Currently, health institutions lack effective ISM processes that enable reliable interorganizational activities. In this paper, we present a business model that accomplishes the controls of ISO/IEC 27002:2013 standard and criteria of security and privacy from DICOM and HIPAA to improve the ISM of a large-scale PACS. The methodology associated with the model can monitor the flow of data in a PACS, facilitating the detection of unauthorized access to images and other abnormal activities.     

Foreign Exam Management in Practice: Seamless Access to Foreign Images and Results in a Regional Environment

A challenge for many clinical users is that a patient may receive a diagnostic imaging (DI) service at a number of hospitals or private imaging clinics. The DI services that patients receive at other locations could be clinically relevant to current treatments, but typically, there is no seamless method for a clinical user to access longitudinal DI results for their patient. Radiologists, and other specialists that are intensive users of image data, require seamless ingestion of foreign exams into the picture archiving and communication system (PACS) to achieve full clinical value. Most commonly, a clinical user will depend on the patient to bring in a CD that contains imaging from another location. However, a number of issues can arise when using this type of solution. Firstly, a CD will not provide the clinical user with the full longitudinal record of the patient. Secondly, a CD often will not contain the report associated with the images. Finally, a CD is not seamless, due to the need to manually import the contents of the CD into the local PACS. In order to overcome these limitations, and provide clinical users with a greater benefit related to a patient’s longitudinal DI history, the implementation of foreign exam management (FEM) at the local site level is required. This paper presents the experiences of FEM in practice. By leveraging industry standards and edge devices to support FEM, multiple sites with disparate PACS and radiology information system (RIS) vendors are able to seamlessly ingest foreign exams within their local PACS as if they are local exams.     

A case for automated tape in clinical imaging

Electronic archiving of radiology images over many years will require many terabytes of storage with a need for rapid retrieval of these images. As more large PACS installations are installed and implemented, a data crisis occurs. The ability to store this large amount of data using the traditional method of optical jukeboxes or online disk alone becomes an unworkable solution. The amount of floor space, number of optical jukeboxes, and off-line shelf storage required to store the images becomes unmanageable. With the recent advances in tape and tape drives, the use of tape for long term storage of PACS data has become the preferred alternative. A PACS system consisting of a centrally managed system of RAID disk, software and at the heart of the system, tape, presents a solution that for the first time solves the problems of multi-modality high end PACS, non-DICOM image, electronic medical record and ADT data storage. This paper will examine the installation of the University of Utah, Department of Radiology PACS system and the integration of automated tape archive. The tape archive is also capable of storing data other than traditional PACS data. The implementation of an automated data archive to serve the many other needs of a large hospital will also be discussed. This will include the integration of a filmless cardiology department and the backup/archival needs of a traditional MIS department. The need for high bandwidth to tape with a large RAID cache will be examined and how with an interface to a RIS pre-fetch engine, tape can be a superior solution to optical platters or other archival solutions. The data management software will be discussed in detail. The performance and cost of RAID disk cache and automated tape compared to a solution that includes optical will be examined.     

Design and Implementation of Disaster Recovery and Business Continuity Solution for Radiology PACS

In the digital era of radiology, picture archiving and communication system (PACS) has a pivotal role in retrieving and storing the images. Integration of PACS with all the health care information systems e.g., health information system, radiology information system, and electronic medical record has greatly improved access to patient data at anytime and anywhere throughout the entire enterprise. In such an integrated setting, seamless operation depends critically on maintaining data integrity and continuous access for all. Any failure in hardware or software could interrupt the workflow or data and consequently, would risk serious impact to patient care. Thus, any large-scale PACS now have an indispensable requirement to include deployment of a disaster recovery plan to ensure secure sources of data. This paper presents our experience with designing and implementing a disaster recovery and business continuity plan. The selected architecture with two servers in each site (local and disaster recovery (DR) site) provides four different scenarios to continue running and maintain end user service. The implemented DR at University Hospitals Health System now permits continuous access to the PACS application and its contained images for radiologists, other clinicians, and patients alike.     

PACS课程实验教学内容初探

目的：PACS是医学影像获取、存储、显示、处理、传输和管理的技术综合与集成。它基于现代计算机和网络通讯技术,以数字化方式获取、管理、应用和共享医学影像和诊断信息。结合实践教学提高大学生全面、综合的PACS知识素质与技能越来越得到重视。因此,本文对高校PACS课程实验教学内容进行初步研究和探索。方法：在分析PACS技术特点及其实践教学重要性的基础上,本文主要从医学信息标准、数字化医学影像应用、医学影像设备和计算机软硬件技术与网络通讯等四方面对PACS课程实验内容进行探索。结果：较为详细地描述了PACS在医学信息标准、数字化医学影像应用、医学影像设备和计算机软硬件技术与网络通讯各技术层面相应的实验内容。结论：本文对于PACS系统课程所需要开展的实验内容进行了初步的研究和探索。由于PACS系统的技术复杂性和临床应用领域的特殊性．目前社会上对PACS课程在实验教学内容设置方面的研究成果较少。虽然文中所提出的实验内容在合理性和实际可行性方面都需要进一步完善提高,但该研究成果具有相当的启发意义和价值。     

A cost analysis of film image management and four PACS based on different network protocols

Picture Archive and Communication Systems (PACS), which allow the electronic acquisition, storage, transportation, and viewing of medical images, hold the eventual promise of reduced costs, improved imagemanagement logistics, and ultimately, improved patient care. But at what point in the future will PACS really cost less than film-based image management for a given hospital size; and how are these costs affected by the choice of the digital communication network? To address these questions, a static differential cost model has been constructed. PAC systems based on two high-speed networks (less than 150 megabytes per second Mbps) and two lowspeed networks, as well as film, were considered for five different sized hospitals (ranging from 15,000 to 125,000 procedures per year) and two time periods (1995 and 2000). PACS equipment was assumed to have a payoff of five years. The model considered all capital and supply costs and personnel costs for the PACS and for film storage and retrieval. It did not consider any possible cost savings from logistics improvement likely to result from the adoption of a PACS. Based on the assumptions outlined, high-speed-network PACS are less costly than those based on low-speed networks for all scenarios considered. Further, even though all possible PACS cost savings were not considered, high-speed network PACS appear to be less costly than film for hospitals larger than 60,000 procedures in 1995 and larger than 15,000 in 2000, while low-speed-network PACS should cost less than film for 60,000 and 30,000 procedure hospitals in 1995 and 2000 respectively.