融合PACS的医院信息系统的解决方案

目的:充分利用我院现有的软、硬件条件,实现医院信息系统(HIS)和PACS系统的无缝连接。方法:PACS与HIS采用独立并行开发方式,PACS内部遵循DICOM标准,各类影像诊断报告采用结构化报告形式;HIS内部采用MSMQ通讯方式,PACS与HIS之间采用WindowsSocket通讯。结果:经过近几年的修改和完善,我院的HIS已经能完成日常医疗信息化工作,同时确保了在PACS和HIS单方面故障时,另一系统仍能正常工作。结论:该解决方案在医院人力、物力条件有限的情况下不失为一种有效的方法,并可推动医院信息化的建设。     

Impact of PACS on the education of radiology residents: the residents' perspective

RATIONALE AND OBJECTIVES: Because digital imaging and the picture archiving and communication system (PACS) are replacing radiographic film, the effect of PACS on residents' perceptions and their educational experience was investigated. MATERIALS AND METHODS: Residents taking part in large diagnostic radiology training programs at two hospitals were surveyed. Approximately 75% of radiographic studies were reviewed with the use of PACS at both hospitals. Survey topics included technical and didactic issues based on direct and indirect comparison with analog (conventional film) images. RESULTS: Fifty residents were polled (20 respondents). The majority has been using PACS for more than 1 year (14 of 20, 70%) to interpret 75%-100% of cases (11 of 20, 55%). The majority believed that PACS improved patient care (15 of 20, 75%) and their educational experience (15 of 20, 75%). A minority believed that increased patient throughput was harmful to the educational experience (five of 20, 25%) because it permitted attending radiologists to review cases too quickly (four of 20, 20%). Residents favored PACS over hard-copy images for ease of manipulation, resolution, and ability to see pathologic conditions and normal anatomic characteristics. CONCLUSION: Residents believe that PACS has positively affected their learning experience and does not negatively affect the quality of resident education.     

Impact of PACS deployment strategy on dictation turnaround time of chest radiographs

RATIONALE AND OBJECTIVES: The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy. MATERIALS AND METHODS: The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital. RESULTS: In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites. CONCLUSION: Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.     

PACS: Speicherung und Abruf digitaler radiologischer Bilddaten

ZusammenfassungHintergrund Sowohl bei Neuanschaffungen als auch für technische Aktualisierungen von PAC-Systemen ist ein effizientes Handling von Bildarchivierung und -abruf besonders zu beachten.Material und Methoden Von 200 aktuellen Studien wurden Anzahl, Modalität sowie Körperregion verfügbarer Voruntersuchungen dokumentiert. Zusätzlich wurden Zugriffszeiten auf 100 CT-Untersuchungen von Festplatte (RAID), magnetooptischer Disk (MOD) und Bandarchiv (TAPE) für eine große PACS-Installation ermittelt.Ergebnisse In 61,1% existierten Voraufnahmen mit einer durchschnittlichen Anzahl von 7,7 Studien. Hiervon verteilten sich 56,3% auf 0–3 Monate vor der aktuellen Untersuchung, 84,9% auf 0–12 Monate, 91,7% auf 0–24 Monate und 96,2% auf 0–36 Monate. Der Zugriff auf Bilder im Festplattencache erfolgte durchschnittlich mehr als 100-mal so schnell wie von MOD oder TAPE.Schlussfolgerung Als einzige Möglichkeit eines Onlinebildzugriffs sollte der PACS-RAID-Cache aktuelle Bilder mindestens für 12 Monate zur Verfügung stellen. Ein korrekt funktionierender Prefetching-Algorithmus hilft den teuren Onlinecachebereich effektiv zu nutzen, setzt aber eine sehr enge Interaktion zwischen PACS, RIS und KIS voraus.     

Multi-detector computed tomography and 3-dimensional imaging in a multi-vendor picture archiving and communications systems (PACS) environment

RATIONALE AND OBJECTIVES: To show the impact of the introduction of multi-detector computed tomography (CT) on radiologic workflow and to demonstrate how this reflects on picture archiving and communications systems (PACS) requirements. MATERIALS AND METHODS: Production measurements were obtained from different CT scanners (first two single-slice CT scanners; from December 2001 single and 4-slice CT; from April 2002 single and 16-slice CT) in number of patients from the radiologic information system. Implications on our PACS were recorded in terms of images and studies stored. Furthermore, our PACS design was made so that optimal use of 3-dimensional imaging within the radiologic workflow was possible. Finally, the number of non-diagnosed studies were recorded every day since the start of the transition to a filmless radiology department. RESULTS: This PACS design achieved a high level of integration between simple viewing and advanced 3-dimensional imaging and is optimized for handling large amounts of data. Overall increase of patients scanned with CT from January 2002-December 2003 was 54%. The number of series increased by 286% from December 2001-April 2003 and by 130% from April 2002-December 2003. From January 2002-February 2003, the number of images per patient increased from 175 to 450 (157%). Non-diagnosed studies decreased from about 100-120 before to practically zero after PACS implementation. CONCLUSION: PACS significantly increases productivity because of availability of the images and elimination of certain manual tasks. These results show that although the amount of examinations increases significantly with the introduction of MDCT, simultaneous introduction of PACS and filmless operation allows radiologists to handle the growth in workload.     

IT services in a completely digitized radiological department: value and benefit of an in-house departmental IT group

To analyze the benefit of a departmental IT group in comparison to support by hospital IT groups or system manufacturers in a completely digitized radiological department. The departmental IT group comprises a fulltime IT specialist, two student assistants and four clinical employees participating 1 day/week. For 18 months IT problems were quantified and specified according to urgency, responsibility and affected system by use of an intranet-based reporting system. For each IT service provider the performance and duration of problem solution was evaluated. In 18 months 3,234 IT problems emerged. 88.7% were solved by the departmental IT group. In 474 cases (14.7%) a solution within 2 h was required. The departmental IT group solved 35.8% within 30 min, system manufacturers needed 18 h 38 min in mean. The departmental IT group solved 90.2% of the problems within a time limit. System manufacturers met the limit in 60.1% with a mean duration of 7 days 21 h. In 6.7% of the cases, support by system manufacturers was indispensable. A considerable proportion of IT problems in completely digitized radiological departments can be solved by a departmental IT group, providing a fast and cost-efficient first-level IT support with effective prevention of major breaks in the workflow. In a small number of cases support by system manufacturers remains necessary.This work was orally presented on ECR 2004 in Vienna.     

医学影像存储与传输系统中结构化报告的初步应用研究

目的研究医学数字影像通信标准(DICOM)下应用结构化报告(SR)的可行性和中文化实现，探讨DICOMSR对影像诊断报告当前应用现状的影响，以及对远程诊断的意义。方法根据2003版DICOM标准中SR的规范，利用现有的医学影像存储与传输系统(PACS)中影像诊断报告数据库，实施诊断报告的“基本文本”型的SR转化并提交至DICOM图像服务器，以及实施对应的超文本标记语言(HTML)和可扩展标记语言(XML)文档，HTML文档用于浏览，XML用于与医疗卫生信息传输标准(HL7)规范的交流。结果影像诊断报告转化成DICOMSR的文档后，将其附加在患者检查的对应图像序列中，实现诊断报告与图像的一致性存储和调阅。结论结构化的报告文件可以与DICOM图像存放在一起，这对于图像以及报告的归档具有极其重要的意义，它将改变我们传统的报告文件与图像文件相互独立存放的若干缺陷，将影像科的资料统一到PACS中，特别是对远程诊断和计算机辅助诊断结果的输出提供了便捷的方法。     

Fast image accessing based on an analysis of the picture archiving and communications system in Kochi Medical School

A large-scale picture archiving and communication system was developed by Kochi Medical School. Using JPEG to achieve 90% compression, this system was capable of storing several years worth of CT and MR examination records and eliminated the bottleneck in conventional systems caused by slow data access in the filing system. Under the new system, access of image files from client PCs was checked for bottlenecks. The image file retrieval from the image database on the server was found to require the longest time. Two methods were considered to eliminate this bottleneck. One was a multiimages filing into a file. Another was an image transmission with multiparallel transmission sessions, which is proposed in this article. By adopting the latter method, the system can transmit 50 CT images from the image database server to a client PC in about 10 s.     

Teleradiologie und PACS — das Konzept des Universitätsklinikums Innsbruck

Zusammenfassung Die Systeme zum digitalen Bilddatenmanagement haben große Bedeutung und weite Verbreitung an der Universitätsklinik Innsbruck und sind zentraler Bestandteil der IT-Strategie der Krankenhausbetreibergesellschaft TILAK (Tiroler Landeskrankenanstalten). Ziel dabei ist es insbesondere, sämtliche Bilddaten in die elektronische Krankengeschichte zu integrieren und von jedem der ca. 2500 klinischen Arbeitsplätze aus online zugreifbar zu machen sowie den elektronischen Datenaustausch mit anderen Gesundheitsdiensteanbietern zu gewährleisten. Seit 1995 bestehen Teleradiologieverbindungen der Universitätsklinik für Radiologie; diese wurden laufend ausgebaut und die Einbindung in das zentrale PACS hergestellt. Zur Kommunikation von Bild- und Befunddaten aus den Krankenhäusern der TILAK an andere Gesundheitseinrichtungen wurde kürzlich ein eHealth WebPortal geschaffen, über das sämtliche radiologischen Bilddaten durch zeitbefristete Freigaben für registrierte Benutzer zugänglich gemacht werden können.     

ORTHOPAEDIC MEASUREMENTS WITH COMPUTED RADIOGRAPHY: Methodological development, accuracy, and radiation dose with special reference to the weight-bearing lower extremity and the dislocating patella

Sanfridsson J.: Orthopaedic measurements with computed radiography. Methodological development, accuracy, and radiation dose with special reference to the weight-bearing lower extremity and the dislocating patella. Lund 2001. ISBN 87-16-16449-0.The overall aim of this study was to develop and evaluate a measurement system for computed radiography () and Picture Archiving and Communication Systems (), permitting measurements of long distances and angles in and between related images. The developed measurement system, which was based on the QUESTOR Precision Radiography () system, was applied to the weight-bearing knee with special reference to the dislocating patella.The QPR system modified for CR fulfilled the criteria for measuring the weight-bearing knee.The special measuring assistance tools that were developed were important for the implementation of CR and PACS, particularly in workstations programmed for musculoskeletal radiology.The energy imparted to the patient was reduced by 98% at the lowest exposure of the CR-system, compared with our conventional analogue method, without loss of diagnostic accuracy. The CR technique creates a possibility, to an extent not previously feasible, to differentiate the exposure parametres (and thus minimise the radiation dose to the patient) by carefully considering the purpose of the examination.A radiographic method for measuring the rotation of the femur and the tibia, the , and the patellar translation was developed and applied to healthy volunteers. The introduced patellar variables have yielded new insights into the complex sequence of motions between the femur, tibia, and patella.The patients with a dislocating patella were subdivided into one "clean" group of spontaneous dislocations and one group with various traumas in the history, which thus resulted in two groups with distinct radiographic differences. The Q-angle was decreased in knees that had suffered dislocations, and the traditional surgical treatment with a further reduction of the Q-angle must be challenged.The use of clinical measurements of the Q-angle was not an optimal way to evaluate the mechanical alignment in the patellofemoral joint under physiological conditions.In this study, we have proved that the developed method for CR and PACS is a useful technique for measurements in and between related images, and is superior to the conventional analogue technique ( ).     

Hard disk online caches in picture archiving and communication systems archives: how big is beautiful?

The objective of our study was to support algorithmic recommendations for the appropriate sizing of picture archiving and communication system (PACS) caches. For a large PACS installation, a detailed analysis of current radiographic (CR), CT and MRI studies (n=400 consecutive studies, respectively) was performed. In this process every available prior examination was also considered. A new algorithmic procedure for appropriate sizing of PACS caches was developed and applied to the given cache implementation. The number of all priors was 7.6±12.3. Of them, 61% were relevant priors with an average age of 203±385 days. A basic cache (BC) that covers 12 months of current imaging results in a pre-fetching quote of 15.4% (8.6% for 24 months). In the PACS installation examined, a minimal threefold increase in cache capacity was recommended. Studies that are retrieved, prior to viewing, from the long-term archive require additional space in the extended cache (EC). An intimate and mutual interaction between hospital information system (HIS), radiology information system (RIS) and PACS minimizes this requirement and increases the time during which actual image material from the BC is available online. A basic cache size covering actual imaging of 12 months up to 24 months is recommended. The parameters governing the individual dimensions of both cache spaces and a mathematical algorithm are demonstrated.     

Digital radiography of the chest: state of the art

Digital image acquisition possesses a number of advantages over conventional systems in radiographic examination of the chest, the most important of which is its greater dynamic range. In addition, one digital images are acquired, they can be processed by computer in ways that cannot be rivalled by conventional analog techniques. Finally, digital images can be stored, retrieved and transmitted to local or remote sites. Here the status of the different digital systems employed in chest radiology and commonly used image processing techniques are reviewed. Also discussed are the current clinical applications of integrating digital chest radiography with a picture archiving and communication system (PACS) along with the difficulties typically encountered. Studies with a variety of digital techniques have been carried out on several fronts. Computer radiography based on photostimulabe phosphor (CR) has replaced screen-film imaging in certain applications (i.e. bedside imaging). However, CR has limitations, namely its poor X-ray utilisation efficiency at high X-ray tube voltages and sensitivity to scatter; therefore, it is not ideal for all applications. Recently, a dedicated digital chest unit with excellent X-ray utilisation efficiency at high X-ray tube potentials has been introduced. On the basis during the past decade, recommendations are made regarding the most desirable equipment specifications for dedicated and bedside digital chest radiography.     

The integration of medical images with the electronic patient record and their web-based distribution

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system. Reports are usually stored in the electronic patient record of other information systems, such as the radiology information system (RIS) and the hospital information system (HIS). But high-quality services can only be provided if electronic patient record data is integrated with digital images in picture archiving and communication systems. Clinicians should be able to access both systems' data in an integrated and consistent way as part of their regular working environment, whether HIS or RIS. Also, this system should allow for teleconferencing with other users, eg, for consultation with a specialist in the radiology department. This article describes a web-based solution that integrates the digital images of picture archiving and communication systems with electronic patient record/HIS/RIS data and has built-in teleconferencing functionality. This integration has been successfully tested using three different commercial RIS and HIS products.     

Evaluating medical students on radiology clerkships in a filmless environment: use of an electronic test prepared from PACS and digital teaching collection images

RATIONALE AND OBJECTIVES: The competency of medical students in radiology clerkships is traditionally evaluated with film images, projected slides of photographed films, or printed reproductions of films. As radiology departments switch to filmless imaging, it seemed appropriate to determine the feasibility of an electronic evaluation prepared directly from digital images. MATERIALS AND METHODS: The image-based portion of a multiple-choice final examination was prepared as a PowerPoint presentation that included images downloaded from the departmental picture archiving and communication system (PACS) or digital teaching collections. The images were downloaded as bitmap files, imported to Adobe Photoshop for image editing, converted to tagged image file format, and finally imported to PowerPoint, where they were combined with text to create 50 questions. A liquid crystal diode projector displayed the questions, with a timer set to advance them automatically. RESULTS: The examination was easy and inexpensive to prepare (no photography costs). In an initial survey of 25 students, 17 (71%) of 24 students rated the resolution of images as excellent and five (21%) as good. No student gave an image a poor rating. Students preferred that images cover at least 40%-50% of the slides, and most approved of a blue background. An original allowance of 30 seconds per slide was reported to be too fast; the interval was increased to 45 seconds. CONCLUSION: An electronic final examination for medical students, prepared with images downloaded from PACS or digital teaching collections, is feasible, easy to prepare, and cost-effective, and it provides an excellent display of test images.     

Accuracy of digital imaging interpretation on an 1K × 1K PC-based workstation in the emergency department

The purpose of this study was to evaluate the accuracy of interpretation of digital radiographs on 1K × 1K PC-based workstations and compare it to that of 2K × 2K workstations in our filmless emergency department. We reviewed 1013 studies, of which 404 were chest, 133 abdominal, and 476 musculoskeletal. All studies were interpreted prospectively on the 1K × 1K workstation, and the findings were compared to those on the 2K × 2K diagnostic workstation which served as the control. Among all the studies performed, 515 were negative (255 chest, 91 abdominal, and 169 musculoskeletal). Another 498 had positive findings (149 chest, 42 abdominal, and 307 musculoskeletal). When the cases were reviewed on the 1K × 1K monitor, the diagnosis was missed in 5 of the 149 positive chest cases (3.35 %), in 5 of the 307 positive musculoskeletal cases (1.63 %), and in none of the 42 positive abdominal cases (0 %). In total, we misinterpreted 10 of the 498 positive cases (2.01 %). The miss rate of the 1K × 1K clinicians' review station is low and acceptable for its stated purpose. However, we doubt that it can be used for primary diagnostic purposes.     

Health technology assessment on the use of magnetic resonance imaging (MRI) and computed tomography (CT) in the diagnosis of multiple sclerosis (MS) and clinically isolated syndromes (CIS)

This work is the result of a health technology assessment for the Flemish regional government, Belgium, performed in 2006. A search of the available literature in the databases Medline and EMBASE was performed to find evidence for a rational choice between CT and MRI techniques in the work-up of patients with clinically isolated syndrome (CIS) with a suspicion for multiple sclerosis (MS), and in follow-up exams performed in such patients. From the presented evidence, in patients referred for CIS or MS, MR is superior to CT for detection and characterization of brain and spine lesions.     

DICOM demystified: a review of digital file formats and their use in radiological practice

Digital imaging and communications in medicine (DICOM) is the standard image file format used by radiological hardware devices. This article will provide an overview of DICOM and attempt to demystify the bewildering number of image formats that are commonly encountered. The characteristics and usefulness of different image file types will be explored and a variety of freely available web-based resources to aid viewing and manipulation of digital images will be reviewed. How best to harness DICOM technology before the introduction of picture archiving and communication systems (PACS) will also be described.