基于Web的经济型PACS的构建与实现

目的:构建一套符合中小型医院实际的基于Web的经济型医学影像存档与传输系统(PACS)。方法:在院内局域网基础上,采用配备海量硬盘的普通PC机,架设Web及FTP服务器,应用ASP加Access数据库技术,撰写网页,实现影像报告的书写、打印,同时将影像数据导入服务器,实现院内共享及远程会诊。结果:以极为经济的方式实现了PACS的基本功能。结论:构建基于Web的经济型PACS在基层医院切实可行。     

PACS服务器架构在应急处理方案中的应用价值

目的探讨PACS服务器架构模式在应急处理方案中的应用价值。方法针对我院影像设备多及数据流量大的特点,PACS服务器设计采用分级体系管理架构。信息中心设立企业级服务器2台,1台为中心服务器,1台作为后备服务器,完成所有影像及病人资料接收、存储、调度及分发等服务,影像科及临床科分别设置2台(可扩充)影像前置服务器及1台临床前置服务器(可扩充),解决大并发访问对主服务器的压力及多个服务器之间的相互热备;开发提供一套科研教学前置服务器,用于教学及科研资料的存储及调阅。结果服务器分级体系架构在PACS遇到故障或灾难时,如中心服务器单点故障、中心服务器整体系统不可用或某个前置服务器系统不可用3种情况下,均能进行相应的应急处理,确保整个PACS系统正常运行。结论采用服务器分级架构体系强调多个服务器之间的相互热备,对于保障发生灾难性故障时整个系统的安全性具有重大的意义。     

分布式混合结构PACS系统设计及实施

近年来,医学影像存储和通讯系统(Picture archiving and communications system,PACS)开始出现在国内大型医院,是管理医疗影像设备如CT、MRI、DR等产生的医学图像的信息系统.PACS的先进性、实用性是不容置疑的,然而其推广的进程却十分缓慢,尤其是中小医院.究其原因:其一,整套全院PACS(C/S结构服务器/客户端)费用昂贵,报价数以百万计,而高档的影像服务器在购置后不能被完全利用,造成资源浪费,而随时间延长,计算机硬件的飞速发展而贬值[1].其二,由于医院信息系统(HIS)在国内的发展早于PACS,很多需要实施PACS的医院已有基础网络及硬件环境,就要求PACS的实施要充分利用HIS、RIS系统的硬件及网络.要加快中小医院数字化进程,迫切需要解决如何用最小成本实现具有较好扩展性的全院PACS问题.我们经过实践探索,在我们医院设计实施了分布式PACS系统.     

医学影像存储与传输系统中影像数据流的管理及其实现方式

目的：探讨医学影像存储与传输系统（PACS）影像数据流程的管理模式和实现过程。方法：作者医院PACS经过2期建设完成了全数字化改造，所有影像设备均已接入PACS系统。系统采用中央存储管理模式，并通过对系统工作流和影像数据流的控制和管理，提高了影像诊断执行过程的系统响应速率。作者将着重基于全数字化改造后PACS影像流程运行环境和管理模式，分析影像数据流程类型、过程及实现方式。结果：作者医院PACS系统影像数据流程管理主要涉及2类：影像归档存储过程的影像转存（forward）过程。前者采用集中管理模式，对不同的影像类型根据诊断过程的需求采用各异的归档存储时间表，如CT、MR等影像类型执行集中一次性存档，而对需要立即完成诊断过程的常规X线影像则执行即刻归档存储操作；后者通过PACS中央管理服务器上运行的工作流管理软件实现，即对完成归档存储的影像，通过自动路由的过程将其进一步送往具体实施诊断过程的部门和位置。结论：影像数据流管理是影响PACS系统功能执行效率的关键因素，应根据用户特定的运行环境、任务和需求进行设计和实现。     

HIS系统中实现快速医疗影像传输的解决方案

目前很多医院都采用了医院信息系统（HIS），医疗影像唐息是医疗档案的重要组成部分，本文依据临床实际应用要求，通过对医疗影像的分析，在HIS系统和PACS系统间架设影像转换工作站，将PACS影像存储服务器的影像进行快速的影像转换，形成等效分辨率的有损压缩数据，然后传输到HIS系统的患者医疗档案中，以获得HIS系统中实现快速医疗影像传输的解决方案。     

PACS系统的构建及临床应用

目的:通过构建PACS(picture arhiving and communication system,PACS)系统,探讨其临床应用价值。方法:采用上海汇硕智能科技有限公司开发的VISUN3.1软件,使影像信息数据服务器与各影像设备、诊断报告工作站、登记工作站、科室管理工作站、激光相机和医院影像站点,通过交换机连接成网络。结果:PACS系统实现了影像诊断设备的网络化、影像信息的数字化、医院管理的规范化,实现了影像信息的共享,使医学影像的采集、存储、传输、及图像处理变为现实。结论:PACS系统为医学影像的存储、传输、处理提供了便利,提高了影像科的工作效率,方便了工作、教学、科研和会诊,为建设数字化医院,打下了良好的基础。     

图像存储与传输系统的总体设计与分步实施

目的 探讨在组建图像存储与传输系统（picture archiving and communication system,PACS)过程中的总体设计及如何进行具体每一步的实施方案。方法 把具有医学数学成像及通讯（digital imaging and communication in medicine,DICOM)标准接口或非DICOM标准接口的影像设备进行联网，制定资源共享、系统存储的解决方案，建立典型的医院放射科PACS系统，连接目前医院现有的设备，服务器采用Windows NT SQL Server 7.0组成，解决管理及存储问题，工作站基于浏览（WEB）方式访问，扩大客户端的使用权限（license)，数量为100个，磁盘阵列（RAID 5）在线存储3个月，线性磁带库（DLT)离线海量存储；扩展全院并解决放射学信息系统（radiology information systems,RIS)、PACS的数据共享连接；建立地区影像数据交换中心。结果 建立了典型的医院放射科PACS系统，连接了目前医院现有的设备，实现了放射科初步的无胶片化方式；将PACS扩展到了全院的临床科室、手术室、急诊室等，以及实现了和已有的医院信息系统（hospital information systems,HIS)、其他医院网络联网，建立起了影像数据中心；实现了和本地区其他医院及其他地区的影像数据中心的联网，使用起来较为得心应手，方便了医生，提高了工作效率。结论 实践证明，上述PACS的总体设计与分步实施方案是可行的、成功的。     

RIS集成化PACS安全监控系统设计与实现

设计和实现基于DICOM supplement95和I HE ATNA规范的RIS集成化PACS自动监控系统AMS。监控客户端部署在RIS集成化PACS系统的各个节点上,收集基于DICOM supplement95和I HE ATNA规范编码的审计跟踪消息,并发送到监控服务器端。监控服务器接收消息并进行数据挖掘,最后通过Web方式提供整个RIS集成化PACS系统运行情况和病人医疗信息数据使用情况的审计报表。AMS监控系统建设在JAVA J2EE技术平台和上海华东医院RIS集成化PACS系统上。AMS监控系统不仅可以实时地监控整个RIS集成化PACS系统的运行情况,也可以提供满足supplement95、ATNA的服务和管理。AMS监控系统使得PACS系统管理人员和安全事务官员可以在网络上监控整个系统运行状况和病人医疗信息的使用情况。AMS监控系统可以帮助系统管理人员方便地管理和监控整个RIS集成化PACS系统,而且可以帮助医院在将来的几年中降低系统维护成本。     

PACS在临床上应用

随着计算机技术和网络技术的迅猛发展 ,世界范围内经历着一场数字化信息革命。医学影像存储与传输系统 ( Picture Archiving and CommunicationSystem PACS)逐渐引进与应用已成为影像科室发展的必然趋势。它以全数字化无胶片化方式采集、阅读、储存、管理和传输医学影像资料 ,实现影像资源共享 ,从整体上提高了医院的诊疗质量 ,开创了医学影像诊断与管理的新纪元。“军字一号”工程、医院信息系统 ( HIS)的应用 ,为 PACS的推广应用奠定了基础。1　材料与方法1 .1　硬件1主服务器采用 SONY PC机 (两个 60 G硬盘 )。 2交换设备 ;3CO…     

放射科RIS/PACS构建的技术应用探讨

目的:探索符合国情的RIS/PACS系统架构,推动RIS/PACS在中国的发展。材料和方法:以杭州邵逸夫医院的RIS/PACS系统为例,介绍RIS/PACS系统的软硬件框架。结果:RIS/PACS系统的实施给放射科和相关科室的工作带来了很大便捷,方便了工作、教学、科研和会诊。结论:在PACS的部署中结合医院的具体需求,采用了一些新的技术和新的理念,实现了病理自动获取、学生考试模式、机房工作站和QA工作站、电子排班等。     

History of PACS in Asia

First, history of PACS (picture archiving and communication system for medical use) in Japan is described in two parts: in part 1, the early stage of PACS development from 1984 to 2002, and in part 2 the matured stage from 2002 to 2010. PACS in Japan has been developed and installed by local manufacturers by their own technology and demand from domestic hospitals. Part 1 mainly focuses on quantitative growth and part 2 on qualitative change. In part 2, integration of PACS into RIS (radiology information system), HIS (hospital information system), EPR (electronic patient record), teleradiology and IHE (integrating healthcare enterprise) is reported. Interaction with other elements of technology such as moving picture network system and three dimensional display is also discussed. Present situation of main 4 large size hospitals is presented. Second, history of PACS in Korea is reported. Very acute climbing up of filmless PACS diffusion was observed from 1997 to 2000. The reasons for such evolution are described and discussed. Also changes of PACS installation and system integration with other systems such as HIS and role of them in radiological diagnoses in Korea since 2002 are described. Third, history in China is investigated by checking international academic journals in English and described as far as events are logically linked and consistently meaningful.     

Picture Archiving and Communication System (PACS) implementation, integration & benefits in an integrated health system

The availability of the Picture Archiving and Communication System (PACS) has revolutionized the practice of radiology in the past two decades and has shown to eventually increase productivity in radiology and medicine. PACS implementation and integration may bring along numerous unexpected issues, particularly in a large-scale enterprise. To achieve a successful PACS implementation, identifying the critical success and failure factors is essential. This article provides an overview of the process of implementing and integrating PACS in a comprehensive health system comprising an academic core hospital and numerous community hospitals. Important issues are addressed, touching all stages from planning to operation and training. The impact of an enterprise-wide radiology information system and PACS at the academic medical center (four specialty hospitals), in six additional community hospitals, and in all associated outpatient clinics as well as the implications on the productivity and efficiency of the entire enterprise are presented.     

基于虚拟专用网的互动式影像远程会诊体系的创建与初步应用

目的探讨互动式影像远程会诊系统的创建及其特点。方法下级医院局域网、防火墙[含虚拟专用网(virtual private network，VPN)功能]及不对称数字线路调制解调器(ADSL Modem)1套，联入Intemet，通过贵阳医学院附属医院防火墙接入本院VPN服务器，获得VPN隧道联入本院医学影像存储与传输系统(picture archiving and communication systems，PACS)服务器，使本院影像科诊断终端及下级医院能够共享同一影像数据。结果下级医院影像数据及检查信息能安全、无损的上传到本院PACS保存和管理，并进行会诊后将会诊结果以报告方式返回给下级医院。影像上传速度快，质量优良，操作互动性好。结论基于VPN的互动式远程会诊系统具有安全、快捷、互动性好、操作简便、实用可靠和优良的性价比等优点，值得推广。     

IHE profiles applied to regional PACS

PACS has been widely adopted as an image storage solution that perfectly fits the radiology department workflow and that can be easily extended to other hospital departments. Integrations with other hospital systems, like the Radiology Information System, the Hospital Information System and the Electronic Patient Record are fully achieved but still challenging aims. PACS also creates the perfect environment for teleradiology and teleworking setups. One step further is the regional PACS concept where different hospitals or health care enterprises share the images in an integrated Electronic Patient Record. Among the different solutions available to share images between different hospitals IHE (Integrating the Healthcare Enterprise) organization presents the Cross Enterprise Document Sharing profile (XDS) which allows sharing images from different hospitals even if they have different PACS vendors. Adopting XDS has multiple advantages, images do not need to be duplicated in a central archive to be shared among the different healthcare enterprises, they only need to be indexed and published in a central document registry. In the XDS profile IHE defines the mechanisms to publish and index the images in the central document registry. It also defines the mechanisms that each hospital will use to retrieve those images regardless on the Hospital PACS they are stored.     

Gradual PACS adoption

For more than a decade, radiology professionals have hoped that picture archiving and communications systems (PACS) would improve efficiency and reduce costs. However, pioneer PACS systems were extremely expensive, and they didn't always meet their users' needs. Recent changes mean that PACS are more accessible. Advances in technology have resulted in decreased costs and increased computer power, and many radiologists recognize that they must consider new tools, such as teleradiology, to compete. There are roughly five classes of digital image systems used by radiologists: modality clusters, on-call review and teleradiology, remote primary diagnosis, mini-PACS and PACS. Even though hospitals seem to view PACS as inevitable, the challenge is to manage PACS implementation economically. One answer is to install PACS incrementally. Once teleradiology and mini-PACS are in place, they can be used as the building blocks of full-fledged PACS. Because PACS have a broad impact on healthcare facilities, careful planning is needed. Design your system to support future, as well as current, applications. Another important planning step is to set goals for improved efficiency and cost reduction.     

The benefits of hospital-wide picture archiving and communication systems: a survey of clinical users of radiology services.

This paper describes one element of a broad evaluation of a hospital-wide picture archiving and communication system (PACS): an assessment of the views of users of the radiology service, their major causes of dissatisfaction with the service, the incidence of image unavailability, and the consequences of images being unavailable. The principal research design was a "before and after" comparison at Hammersmith Hospital, as the hospital site introducing PACS. Several other hospitals were included in this survey, for comparison. Questionnaires were distributed several times before PACS was operational at Hammersmith, and on one occasion after. The overall response rate was 54%. The main pre-PACS radiology-related problem areas were: the non-availability of images, the non-availability of written reports when clinically required, and the time devoted by junior staff to image searching. PACS greatly reduced the perceived problem of image non-availability. But Hammersmith's problems with the availability of radiological reports still remained when PACS was operational. The time junior doctors spent in image-searching was dramatically reduced by the introduction of PACS.     

PACS for imaging centers

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized interfaces such as HL-7, Web access and the choice of view stations.     

PACS development in Asia.

First, history of PACS in Japan from 1982 to 2002 has been investigated. By 2002 total of 1468 PACS units have been installed. Of these, 1174 are small-size PACS with less than four image display terminals, 203 are medium-size with 5-14 terminals, and 91 are large-size with 15 up to 1300 terminals. The main nine large-size PACS of 91 have been retrospectively investigated from 1984 for PACS experiments and from 1989 for PACS operation. Most of these nine hospitals have increased the number of PACS terminals by installing additional PACS units, instead of reinforcing the existing single PACS. The use of DICOM interfaces has increased the number of modalities connected to PACS and influenced the spreading of PACS installations in Japan. The status of HIS and RIS coupling to PACS, and the use of PACS in primary diagnosis or in image referral are discussed. Assessment of PACS is now in an early stage. Baseline studies of HIS/RIS/PACS effectiveness have been carried out to assess quantitatively the PACS merit. Second, history of PACS development in Korea is described. Very acute climbing up of filmless PACS diffusion was observed from 2000 to 2002. The reasons seem to be lack of domestic X-ray film industry, economic crisis in 1997 and PACS Reimbursement Act in health insurance in Korea. Third, the Hong Kong Wide Area Image Distribution/PACS Project is reported. It is now under phase 1 of design and partial implementation employing the latest and the highest ends of advanced technology such as failure resilience.     

建设适合中国国情的PACS

本文分析了我国医院信息系统应用的情况以及建立图像存档与传输系统（ＰＡＣＳ）的需求和可能性，研究了把微机用于ＰＡＣＳ的可行性并介绍了解放军总医院建立ＰＡＣＳ的规划和目前所建立部分系统的特点和建设中所遇到的问题。