System Integration and DICOM Image Creation for PET-MR Fusion

This article demonstrates a gateway system for converting image fusion results to digital imaging and communication in medicine (DICOM) objects. For the purpose of standardization and integration, we have followed the guidelines of the Integrated Healthcare Enterprise technical framework and developed a DICOM gateway. The gateway system combines data from hospital information system, image fusion results, and the information generated itself to constitute new DICOM objects. All the mandatory tags defined in standard DICOM object were generated in the gateway system. The gateway system will generate two series of SOP instances of each PET-MR fusion result; SOP (Service Object Pair) one for the reconstructed magnetic resonance (MR) images and the other for position emission tomography (PET) images. The size, resolution, spatial coordinates, and number of frames are the same in both series of SOP instances. Every new generated MR image exactly fits with one of the reconstructed PET images. Those DICOM images are stored to the picture archiving and communication system (PACS) server by means of standard DICOM protocols. When those images are retrieved and viewed by standard DICOM viewing systems, both images can be viewed at the same anatomy location. This system is useful for precise diagnosis and therapy.     

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。     

The department of veterans affairs integration of imaging into the healthcare enterprise using the VistA hospital information system and Digital Imaging and Communications in Medicine

The United States Department of Veterans Affairs is integrating imaging into the healthcare enterprise by using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and clinical database. Radiology images are acquired with DICOM and are stored directly in the HIS database. Images can be displayed on low-cost clinician’s workstations throughout the medical center. High-resolution diagnostic quality multimonitor VistA workstations with specialized viewing software can be used for reading radiology images. Two approaches are used to acquire and handle images within the radiology department. Some sites have a commercial Picture Archiving and Communications System (PACS) interfaced to the VistA HIS, whereas other sites use the direct image acquisition and integrated diagnostic display capabilities of VistA itself. A small set of DICOM services has been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back. DICOM has been the cornerstone in the ability to integrate imaging functionality into the healthcare enterprise. Because of its openness, it allows the integration of system components from commercial and noncommercial sources to work together to provide functional cost-effective solutions.     

Experience with Importation of Electronic Images into the Medical Record from Physical Media

The purpose of this article is to describe a system we developed for importing images on compact discs (CDs) from external imaging departments into our clinical image viewing system, and to report on key metrics regarding veracity of information seen on the CDs. We recommend careful attention to the process of CD importation because of the error rate we have seen. We developed a system and process for importing images on CD into our EMR. The importation system scans the CD for digital imaging and communications in medicine (DICOM) images, and collects all patient information seen. That information is presented to the patient for verification. Once validated, the image data is copied into our clinical viewing system. The importation system includes facilities for collecting instances of incorrect data. About 90% of images are now exchanged between our healthcare enterprise and other entities via CD. Data for the wrong patient (e.g., the wrong CD) is seen in about 0.1% of cases, and a similar number of CDs have data for more than one patient on the CD(s) the patient bring to our facility. Most data are now exchanged via DICOM files. DICOM images burned onto CD media are now commonly used for image exchange. However, applications to import DICOM images are not enough. One must implement a process to assure high confidence that the data imported belongs to the patient you are importing.     

基于VTK的肝组织CT断层图像三维重建

目的利用可视化开发包（VTK）将计算机断层扫描（cT）图像合成三维立体图像,以利于更好地制定肝癌患者的治疗方案。方法建立基于VC6．0平台上的VTK可视开发环境,获取患者的DICOM格式的CT图像,采用VTKfilter滤波器和拉普拉斯锐化模板对图像进行滤波、增强等预处理,利用光线投影Ray—Casting算法对图像进行三维重建。结果该方法可生成效果较好的三维图像,其分辨率较高,图像重建速度快,且可进行切割、旋转、缩放等功能。结论基于VTK的光线投影算法可用于对人肝组织的三维重建,有利于医生直观地观察病变组织的形状和位置,为诊断和治疗提供依据。     

Linking Whole-Slide Microscope Images with DICOM by Using JPEG2000 Interactive Protocol

The use of digitized histopathologic specimens (also known as whole-slide images (WSIs)) in clinical medicine requires compatibility with the Digital Imaging and Communications in Medicine (DICOM) standard. Unfortunately, WSIs usually exceed DICOM image object size limit, making it impossible to store and exchange them in a straightforward way. Moreover, transmitting the entire DICOM image for viewing is ineffective for WSIs. With the JPEG2000 Interactive Protocol (JPIP), WSIs can be linked with DICOM by transmitting image data over an auxiliary connection, apart from patient data. In this study, we explored the feasibility of using JPIP to link JPEG2000 WSIs with a DICOM-based Picture Archiving and Communications System (PACS). We first modified an open-source DICOM library by adding support for JPIP as described in the existing DICOM Supplement 106. Second, the modified library was used as a basis for a software package (JVSdicom), which provides a proof-of-concept for a DICOM client–server system that can transmit patient data, conventional DICOM imagery (e.g., radiological), and JPIP-linked JPEG2000 WSIs. The software package consists of a compression application (JVSdicom Compressor) for producing DICOM-compatible JPEG2000 WSIs, a DICOM PACS server application (JVSdicom Server), and a DICOM PACS client application (JVSdicom Workstation). JVSdicom is available for free from our Web site (), which also features a public JVSdicom Server, containing example X-ray images and histopathology WSIs of breast cancer cases. The software developed indicates that JPEG2000 and JPIP provide a well-working solution for linking WSIs with DICOM, requiring only minor modifications to current DICOM standard specification.     

White Matter Fiber Tracking Computation Based on Diffusion Tensor Imaging for Clinical Applications

Fiber tracking allows the in vivo reconstruction of human brain white matter fiber trajectories based on magnetic resonance diffusion tensor imaging (MR-DTI), but its application in the clinical routine is still in its infancy. In this study, we present a new software for fiber tracking, developed on top of a general-purpose DICOM (digital imaging and communications in medicine) framework, which can be easily integrated into existing picture archiving and communication system (PACS) of radiological institutions. Images combining anatomical information and the localization of different fiber tract trajectories can be encoded and exported in DICOM and Analyze formats, which are valuable resources in the clinical applications of this method. Fiber tracking was implemented based on existing line propagation algorithms, but it includes a heuristic for fiber crossings in the case of disk-shaped diffusion tensors. We successfully performed fiber tracking on MR-DTI data sets from 26 patients with different types of brain lesions affecting the corticospinal tracts. In all cases, the trajectories of the central spinal tract (pyramidal tract) were reconstructed and could be applied at the planning phase of the surgery as well as in intraoperative neuronavigation.     

Dicoogle - an Open Source Peer-to-Peer PACS

Picture Archiving and Communication Systems (PACS) have been widely deployed in healthcare institutions, and they now constitute a normal commodity for practitioners. However, its installation, maintenance, and utilization are still a burden due to their heavy structures, typically supported by centralized computational solutions. In this paper, we present Dicoogle, a PACS archive supported by a document-based indexing system and by peer-to-peer (P2P) protocols. Replacing the traditional database storage (RDBMS) by a documental organization permits gathering and indexing data from file-based repositories, which allows searching the archive through free text queries. As a direct result of this strategy, more information can be extracted from medical imaging repositories, which clearly increases flexibility when compared with current query and retrieval DICOM services. The inclusion of P2P features allows PACS internetworking without the need for a central management framework. Moreover, Dicoogle is easy to install, manage, and use, and it maintains full interoperability with standard DICOM services.     

PACS and multimodality in medical imaging.

A PACS (Picture Archiving and Communication System) is a system that is able to store, exchange, display and manipulate images and associated diagnoses from any modality within a hospital in a timely and cost-effective way. Several developments, such as the DICOM standard, fast and convenient networking, and new storage solutions for large amounts of data, make the setup of such a PACS system possible. As the information acquired with various imaging modalities is then available and often complementary, it is desirable for the clinician to have a point-by-point spatial co-registration of images from different modalities in order to enable a synergistic use of the multimodality imaging of a patient for increased diagnostic accuracy. Various types of algorithms are available for the matching of medical images from the same or from different modalities. Co-registration algorithms based on voxel properties consist of a similarity or dissimilarity measure and an iterative or non-iterative method minimizing the dissimilarity or maximizing the similarity between the two images by a transformation of one image relative to the other.     

NIRViz: 3D Visualization Software for Multimodality Optical Imaging Using Visualization Toolkit (VTK) and Insight Segmentation Toolkit (ITK)

Optical imaging using near-infrared light is used for noninvasive probing of tissues to recover vascular and molecular status of healthy and diseased tissues using hemoglobin contrast arising due to absorption of light. While multimodality optical techniques exist, visualization techniques in this area are limited. Addressing this issue, we present a simple framework for image overlay of optical and magnetic resonance (MRI) or computerized tomographic images which is intuitive and easily usable, called NIRViz. NIRViz is a multimodality software platform for the display and navigation of Digital Imaging and Communications in Medicine (DICOM) MRI datasets and 3D optical image solutions geared toward visualization and coregistration of optical contrast in diseased tissues such as cancer. We present the design decisions undertaken during the design of the software, the libraries used in the implementation, and other implementation details as well as preliminary results from the software package. Our implementation uses the Visualization Toolkit library to do most of the work, with a Qt graphical user interface for the front end. Challenges encountered include reslicing DICOM image data and coregistration of image space and mesh space. The resulting software provides a simple and customized platform to display surface and volume meshes with optical parameters such as hemoglobin concentration, overlay them on magnetic resonance images, allow the user to interactively change transparency of different image sets, rotate geometries, clip through the resulting datasets, obtain mesh and optical solution information, and successfully interact with both functional and structural medical image information.     

Managing Biomedical Image Metadata for Search and Retrieval of Similar Images

Radiology images are generally disconnected from the metadata describing their contents, such as imaging observations (“semantic” metadata), which are usually described in text reports that are not directly linked to the images. We developed a system, the Biomedical Image Metadata Manager (BIMM) to (1) address the problem of managing biomedical image metadata and (2) facilitate the retrieval of similar images using semantic feature metadata. Our approach allows radiologists, researchers, and students to take advantage of the vast and growing repositories of medical image data by explicitly linking images to their associated metadata in a relational database that is globally accessible through a Web application. BIMM receives input in the form of standard-based metadata files using Web service and parses and stores the metadata in a relational database allowing efficient data query and maintenance capabilities. Upon querying BIMM for images, 2D regions of interest (ROIs) stored as metadata are automatically rendered onto preview images included in search results. The system’s “match observations” function retrieves images with similar ROIs based on specific semantic features describing imaging observation characteristics (IOCs). We demonstrate that the system, using IOCs alone, can accurately retrieve images with diagnoses matching the query images, and we evaluate its performance on a set of annotated liver lesion images. BIMM has several potential applications, e.g., computer-aided detection and diagnosis, content-based image retrieval, automating medical analysis protocols, and gathering population statistics like disease prevalences. The system provides a framework for decision support systems, potentially improving their diagnostic accuracy and selection of appropriate therapies.     

Research and Implementation of DICOM Format Conversion on Medical Images

INTRODUCTION　　With the developmentof technology of network and communication and the gen-eralization of medical digital imaging facilities,Picture Achieving and CommunicationSystem( PACS) has been developing rapidly recently.By means of computer com-munication network,PACS,instead of traditional film- format imaging,captures,saves,shows and transfers medical imaging and related information of digital way.It s obvious that PACScan help to efficiently diagnose.In order to transfer i…     

Teaching DICOM by Problem Solving

The Digital Imaging and Communications in Medicine (DICOM) is the standard for encoding and communicating medical imaging information. It is used in radiology as well as in many other imaging domains such as ophthalmology, dentistry, and pathology. DICOM information objects are used to encode medical images or information about the images. Their usage outside of the imaging department is increasing, especially with the sharing of medical images within Electronic Health Record systems. However, learning DICOM is long and difficult because it defines and uses many specific abstract concepts that relate to each other. In this paper, we present an approach, based on problem solving, for teaching DICOM as part of a graduate course on healthcare information. The proposed approach allows students with diversified background and no software development experience to grasp a large breadth of knowledge in a very short time.     

VirtualPACS—A Federating Gateway to Access Remote Image Data Resources over the Grid

Collaborations in biomedical research and clinical studies require that data, software, and computational resources be shared between geographically distant institutions. In radiology, there is a related issue of sharing remote DICOM data over the Internet. This paper focuses on the problem of federating multiple image data resources such that clients can interact with them as if they are stored in a centralized PACS. We present a toolkit, called VirtualPACS, to support this functionality. Using the toolkit, users can perform standard DICOM operations (query, retrieve, and submit) across distributed image databases. The key features of the toolkit are: (1) VirtualPACS makes it easy to use existing DICOM client applications for data access; (2) it can easily be incorporated into an imaging workflow as a DICOM source; (3) using VirtualPACS, heterogeneous collections of DICOM sources are exposed to clients through a uniform interface and common data model; and (4) DICOM image databases without DICOM messaging can be accessed.

An integrated medical image database and retrieval system using a web application server

We developed an Integrated Medical Image Database and Retrieval System (INIS) for easy access by medical staff. The INIS mainly consisted of four parts: specific servers to save medical images from multi-vendor modalities of CT, MRI, CR, ECG and endoscopy; an integrated image database (DB) server to save various kinds of images in a DICOM format; a Web application server to connect clients to the integrated image DB and the Web browser terminals connected to an HIS system. The INIS provided a common screen design to retrieve CT, MRI, CR, endoscopic and ECG images, and radiological reports, which would allow doctors to retrieve radiological images and corresponding reports, or ECG images of a patient simultaneously on a screen. Doctors working in internal medicine on average accessed information 492 times a month. Doctors working in cardiological and gastroenterological accessed information 308 times a month. Using the INIS, medical staff could browse all or parts of a patient's medical images and reports.     

Computer-aided diagnosis of sonographic liver cirrhosis: a spleen-reference approach

This article aimed to develop a computer-aided diagnosis (CAD) algorithm for differential diagnosis of cirrhotic and noncirrhotic livers, allowing free adjustment of system settings to obtain the best scanned images. A spleen-referenced approached was proposed. 505 pairs of images acquired from 322 subjects using three ultrasound imaging systems were evaluated. Each pair consisted of liver and spleen sonograms of the same subject. Medical doctors were free to adjust the system parameters to attain the best scanned images. Of these 322 subjects, 155 subjects were cirrhotic, and 167 subjects noncirrhotic. Four assessments were carried out to evaluate the effectiveness and robustness of the proposed algorithm on the variations of regions-of-interest, ultrasound imaging systems, and scanned images. Four feature pairs were proposed. A logistic regression function was used as the classifier. All performances were evaluated by the leave-one-out cross-validation method. The proposed algorithm was compared with two previous CAD algorithms and all performance comparisons were based on paired-sample t tests. The mean A(z) values of the receiver operating characteristic curves and classification accuracies ranged as high as from 0.949 to 0.996 and from 91.58% to 97.30%, respectively, for the four assessments. At the 5% family-wise significance level, the proposed algorithm was shown to be superior to the two previous CAD algorithms and their modified versions in terms of the A(z) values.     

Enterprise-scale image distribution with a Web PACS

The integration of images with existing and new health care information systems poses a number of challenges in a multi-facility network: image distribution to clinicians; making DICOM image headers consistent across information systems; and integration of teleradiology into PACS. A novel, Web-based enterprise PACS architecture introduced at Massachusetts General Hospital provides a solution. Four AMICAS Web/Intranet Image Servers were installed as the default DICOM destination of 10 digital modalities. A fifth AMICAS receives teleradiology studies via the Internet. Each AMICAS includes: a Java-based interface to the IDXrad radiology information system (RIS), a DICOM autorouter to tape-library archives and to the Agfa PACS, a wavelet image compressor/decompressor that preserves compatibility with DICOM workstations, a Web server to distribute images throughout the enterprise, and an extensible interface which permits links between other HIS and AMICAS. Using wavelet compression and Internet standards as its native formats, AMICAS creates a bridge to the DICOM networks of remote imaging centers via the Internet. This teleradiology capability is integrated into the DICOM network and the PACS thereby eliminating the need for special teleradiology workstations. AMICAS has been installed at MGH since March of 1997. During that time, it has been a reliable component of the evolving digital image distribution system. As a result, the recently renovated neurosurgical ICU will be filmless and use only AMICAS workstations for mission-critical patient care.     

基于Web技术的医学图像发布系统

目的：应用Java技术开发一个基于Web技术的操作简易、通用性强的医学图像发布环境。方法：采用Web服务器来查询和提取存储在DICOM服务器中的医学图像，客户端使用嵌有JavaApplet小程序的Web浏览器来访问Web服务器，完成客户端对服务器端医学图像的提取，JavaApplet小程序利用Web浏览器实现其图像操作。结果：我们使用Java技术开发一个基于Web技术的医学图像发布环境，完成了客户机通过Intemet对服务器端医学图像的读取操作，实现了异地专家的在线交流。结论：与大多数传统的PACS相比．基于Web技术的PACS系统易于安装和维护，与运行平台无关，可以高效的显示、处理医学图像，容易和使用Web技术构建的PACS系统整合。设置适当的安全防范措施，用户可以在医院外部实现对该系统的访问。Intemet技术的简易性和可扩展性使得该系统与传统PACS系统相比有着更大的优越性。     

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.