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.     

HIS／PACS融合方案设计

PACS作为数字化医院的重要组成部分,越来越受到各级医院的重视,而系统集成作为PACS项目实施过程中重要的一环则直接影响到整个系统的成功部署.本文介绍了一个PACS与HIS系统集成的实际案例,使用Powerbuilder设计电子申请系统,利用Oracle存储过程实现不同系统间的数据同步,完成了第四军医大学西京医院的PACS/HIS软件融合,该方案经临床实用,反响良好.     

TeamViewer软件在核医学科远程诊断中的应用

目的探讨使用TeamViewer软件作为远程诊断软件,实现核医学报告在线书写、审核功能来提高基层医院核医学科诊疗水平的可行性。方法访问TeamViewer官方网站,下载TeamViewer软件,连接到医院内网的影像归档和通信系统(PACS)工作站上(客户端),以及远程诊断控制端设备(计算机、手机或者平板计算机),分别安装TeamViewer软件,控制端与客户端进行软件设置,客户端计算机设置双网卡,设置路由表,连接医院内网与外网,最后进行控制端与客户端连接,进行远程诊断应用。结果远程诊断控制端设备通过TeamViewer访问互联网连接客户端PACS工作站,远程诊断操作方便,速度快,简洁高效。结论 TeamViewer软件成本低,易于实施,操作简便,可有效实现核医学远程诊断,利于推广实施。     

PDCA循环结合6S管理法应用于急救医疗设备管理作用探讨

目的 探讨利用PDCA(计划、实施、检查和行动)循环和6S(整理、整顿、清扫、清洁、素养、安全)管理法降低医院急诊抢救室医疗设备的故障率与故障频次,优化急救医疗设备管理流程。方法 临床工程处联合急诊抢救室成立管理小组,进行现状把握,统计急诊抢救室从2022年1月至6月的医疗设备的故障待机时间、使用时间与故障频次。组织全员进行头脑风暴,利用鱼骨图、柏拉图等工具,探究故障原因并制定实施对策。统计对策实施后2022年7月至12月的数据,比较故障率和故障频次变化,评价对策实施的效果。结果 开发了设备管理软件MEIS,实现医疗设备的自助查询、报修、追溯功能。改善后的医疗设备使用时间为96 946 h,故障待机时间为369 h。目标达标率为112.5%,进步率为62.38%。对策实施后较实施前急救医疗设备故障率(1.01%vs 0.38%)和故障频次(121次vs 51次)明显降低,差异具有统计学意义(P <0.05)。结论 利用PDCA循环和6S管理法降低了急救医疗设备的故障率和故障频次,规范了急救医疗设备的维护保养、操作使用、故障管理、计量管理流程。有助于提高相关工作人员的职业素养能力和...     

基于开源软件设计的网页化PACS与三维影像处理系统

基于开源软件建立PACS与三维医学成像系统,可为医院提供一种低成本PACS/RIS实施方案,或者作为现有医疗信息系统的有益补充.我们将三种开源软件DCM4CHEE、Oviyam、Osirix等在异构操作系统网络上进行集成,建立了一套网页化PACS与三维影像处理系统,并对包括MDCT、MRI等大型数据集在内的多模态影像数据的网络传送与查看进行了验证,结果证明系统的实时性与稳定性能够满足医学教育、科研与统计等工作需求.     

医院信息系统规范化管理的做法和体会

目的通过实施多项具体措施,对医院信息系统应用进行规范化管理。方法①制定多项规章制度、建立”三级”监控模式,对管理制度进行规范;②对门诊、住院流程进行全程优化,从而规范应用流程,提高系统使用效率;③加强人员培训、规范系统操作、提高医疗数据质量。结果通过上述具体措施的实施,医院信息系统应用逐步实现了正规化、规范化管理,大大提高了工作效率和医院的整体管理水平。结论只有加强应用医院信息系统应用的规范化管理,才能最大限度地发挥信息资源的管理效应,实现优质、高效、低耗的管理目标。     

基于LEADTOOLS V14.5的医学数字图像与通讯图像阅读软件的设计

医学数字图像与通讯(DICOM)图像阅读软件是一个相对独立的软件,它既可以嵌入到医疗影像管理系统(PACS)的影像工作站中,用于DICOM图像的读写、显示和基本的图像处理,也可以单独安装于个人电脑上,方便医生随时随地浏览DICOM图像.LEADTOOLS V14.5是Leadtools公司最新开发的医学软件开发包,在它的基础上开发DICOM图像阅读软件,可以大大缩短开发时间,降低开发成本.我们将从设计原理、编程思路、具体实现等几个方面详细介绍如何应用VC++.NET和LEADTOOLS V14.5,设计DICOM 3.0标准下的DICOM图像阅读软件.     

DICOM SR原理及其在PACS中的设计与实现

本文首先分析目前国内医院信息化现状,然后针对弊端结合对DICOM SR和IHE原理解析,通过对业务流程和软硬件系统按照国际标准进行规范,提出了符合DICOM和IHE的结构化诊断报告的模型实现,并阐述该模型实现的在全院PACS的设计与实施的具体应用.关键字:DICOM SR;IHE;PACS;HL 7;RSNA;HIMSS     

基于LEADTOOLS V14．5的医学数字图像与通讯图像阅读软件的设计

医学数字图像与通讯（DICOM）图像阅读软件是一个相对独立的软件,它既可以嵌入到医疗影像管理系统（PACS）的影像工作站中,用于DICOM图像的读写、显示和基本的图像处理,也可以单独安装于个人电脑上,方便医生随时随地浏览DICOM图像.LEADTOOLS V14.5是Leadtools公司最新开发的医学软件开发包,在它的基础上开发DICOM图像阅读软件,可以大大缩短开发时间,降低开发成本.我们将从设计原理、编程思路、具体实现等几个方面详细介绍如何应用VC＋＋.NET和LEADTOOLS V14.5,设计DICOM 3.0标准下的DICOM图像阅读软件.     

医学成像和通讯系统的CORBA设计方案

针对目前医学信息系统的异构带来了彼此之间通讯和信息共享的困难 ,对象管理组 (OMG)制定了CORBAMed软件规范 ,规定了医学信息系统的软件架构 ,定义各种服务的接口。本文尝试将 CORBA应用于医学图像存档和通讯系统 ,提出 CORBA解决方案的 PACS系统模型 ,分析了软件系统的视图层次 ,最后讨论了CORBAMed的相关服务。     

Blogging Your PACS

Acquiring, implementing, and maintaining a picture archiving and communication system (PACS) is an enduring and complex endeavor. A large-scale project such as this requires efficient and effective communication among a large number of stakeholders, sharing of complex documentation, recording ideas, experiences, and events such as meetings, and project milestones to succeed. Often, mass-market technologies designed for other purposes can be used to solve specific complex problems in healthcare. In this case, we wanted to explore the role of popular weblogging or “blogging” software to meet our needs. We reviewed a number of well-known blog software packages and evaluated them based on a set of criteria. We looked at simplicity of installation, configuration, and management. We also wanted an intuitive, Web-based interface for end-users, low cost of ownership, use of open source software, and a secure forum for all PACS team members. We chose and implemented the Invision Power Board for two purposes: local PACS administrative purposes and for a national PACS users' group discussion. We conclude that off the shelf, state-of-the-art, mass-market software such as that used for the currently very popular purpose of weblogging or “blogging” can be very useful in managing the variety of communications necessary for the successful implementation of PACS.     

Enterprise-Wide CR Implementation: The Shands Healthcare System Experience

Major healthcare systems are comprised of hospitals and clinics of different sizes and locations. Many such enterprises are already using picture archiving and communication systems (PACS) and computed radiography (CR) in their main hospitals. The integration of other hospitals and clinics into PACS is a more complex problem. The introduction of CR in remote facilities presents problems, as patient populations, department sizes, and work flow patterns may differ among facilities, and inadequate implementation programs may lead to disruption of patient care services. Although the University of Florida has had an operating PACS for years, facilities affiliated with the Shands Healthcare System (SHS) had not been incorporated into PACS until recently. This article presents the 5-year process to convert all film-screen radiological services to CR in the main hospital, five affiliated community hospitals, and four clinics. The article shows the importance of leadership by the medical physicist from inception of the project through installation and clinical implementation.     

Process reengineering: The role of a planning methodology and picture archiving and communications system team building

The acquisition of a picture archiving and communications system (PACS) is an opportunity to reengineer business practices and should optimally consider the entire process from image acquisition to communication of results. The purpose of this presentation is to describe the PACS planning methodology used by the Department of Defense (DOD) Joint Imaging Technology Project Office (JITPO), outline the critical procedures for each phase, and review the military experience using this model. The methodology is segmented into four phases: strategic planning, clinical scenario planning, installation planning, and implementation planning. Each is further subdivided based on the specific tasks that need to be accomplished within that phase. By using this method, an institution will have clearly defined program goals, objectives, and PACS requirements before vendors are contacted. The development of an institution-specific PACS requirement should direct the process of proposal comparisons to be based on functionality and exclude unnecessary equipment. This PACS planning methodology is being used at more than eight DOD medical treatment facilities. When properly executed, this methodology facilitates a seamless transition to the electronic environment and contributes to the successful integration of the healthcare enterprise. A crucial component of this methodology is the development of a local PACS planning team to manage all aspects of the process. A plan formulated by the local team is based on input from each department that will be integrating with the PACS. Involving all users in the planning process is paramount for successful implementation.     

Clinical computer applications in the radiology department

The information society is currently developing. In the field of radiology, the PACS (picture archiving and communication system) and teleradiology are widely employed in medical practice. The Ministry of Health and Welfare (MHW) reported that physicians should consider some problems in Telemedicine in December 1997. The technology of storage media is improving and we encourage the standardization of data formatting and the transmission protocol to utilize medical electronic information. Several standards exist in the medical imaging field, the DICOM (digital imaging and communications in medicine) standard, the IS&C (image save and carry) standard and the Common Standard that the Medical Information System Development Center (MEDIS-DC) defined for the electronic storage. The PACS requires high transmission speed, integrated services digital network and an asynchronous transfer mode switching system. The MHW needed a technical requirement for the electronic image storage without films in March 1994. The requirement was divided into three parts, (1) security, (2) long-term reproducibility, (3) common usage. The MEDIS-DC published the Common Standards for electronic storage in 1996. When we use the PACS via network, we must consider the security. The present network may have low security, and falsification, such as illegal login may occur. In the future, these problems will be solved, and the network-wide PACS will likely become a commonly used system.     

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.     

Tools to manage the enterprise-wide picture archiving and communications system environment

The presentation will focus on the implementation and utilization of a central picture archiving and communications system (PACS) network-monitoring tool that allows for enterprise-wide operations management and support of the image distribution network. The MagicWatch (Siemens, Iselin, NJ) PACS/radiology information system (RIS) monitoring station from Siemens has allowed our organization to create a service support structure that has given us proactive control of our environment and has allowed us to meet the service level performance expectations of the users. The Radiology Help Desk has used the MagicWatch PACS monitoring station as an applications support tool that has allowed the group to monitor network activity and individual systems performance at each node. Fast and timely recognition of the effects of single events within the PACS/RIS environment has allowed the group to proactively recognize possible performance issues and resolve problems. The PACS/operations group performs network management control, image storage management, and software distribution management from a single, central point in the enterprise. The MagicWatch station allows for the complete automation of software distribution, installation, and configuration process across all the nodes in the system. The tool has allowed for the standardization of the workstations and provides a central configuration control for the establishment and maintenance of the system standards. This report will describe the PACS management and operation prior to the implementation of the MagicWatch PACS monitoring station and will highlight the operational benefits of a centralized network and system-monitoring tool.     

Budgeting for PACS

There are a number of models for the acquisition of digital image management systems. The specific details for development of a budget for a PACS/RIS acquisition will depend upon the acquisition model - although there are similarities in the overarching principles and general information, particularly concerning the radiology service requirements that will drive budget considerations.While budgeting for PACS/RIS should follow the same principles as budgeting for any new technology, it is important to understand how far the implementation of digital image management systems can reach in a healthcare setting. Accurate identification of those elements of the healthcare service that will be affected by a PACS/RIS implementation is a critical component of successful budget formation and of the success of any business case and subsequent project that relies on those budget estimates.A budget for a PACS/RIS capital acquisition project should contain capital and recurrent elements. The capital is associated with the acquisition of the system in a purchase model and capital budget may also be required for upgrade - depending upon a facility's financial management processes.The recurrent (or operational) cost component for the PACS/RIS is associated with maintaining the system(s) in a sustainable operational state.It is also important to consider the service efficiencies, cost savings and service quality improvements that PACS/RIS can generate and include these factors into the economic analysis of any proposal for a PACS/RIS project.     

The importance of a picture archiving and communications system (PACS) manager for large-scale PACS installations

Installing a picture archiving and communication system (PACS) is a massive undertaking for any radiology department. Facilities making a successful transition to digital systems are finding that a PACS manager helps guide the way and offers a heightened return on the investment. The PACS manager fills a pivotal role in a multiyear, phased PACS installation. PACS managers navigate a facility through the complex sea of issues surrounding a PACS installation by coordinating the efforts of the vendor, radiology staff, hospital administration, and the information technology group. They are involved in the process from the purchase decision through the design and implementation phases. They can help administrators justify a PACS, purchase and shape the request for proposal (RFP) process before a vendor is even chosen. Once a supplier has been selected, the PACS manager works closely with the vendor and facility staff to determine the best equipment configuration for his or her facility, and makes certain that all deadlines are met during the planning and installation phase. The PACS manager also ensures that the infrastructure and backbone of the facility are ready for installation of the equipment. PACS managers also help the radiology staff gain acceptance of the technology by serving as teachers, troubleshooters, and the primary point-of-contact for all PACS issues. This session will demonstrate the value of a PACS manager, as well as point out ways to determine the manager’s responsibilities. By the end of the session, participants will be able to describe the role of a PACS manager as it relates to departmental operation and in partnership with equipment vendors, justify a full-time position for a PACS manager, and identify the qualifications of candidates for the position of PACS manager.     

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.