A key current objective in Medical Informatics is to impose structure on collections of healthcare data recorded in electronic form. A relevant example is the DICOM Structured Reporting (SR) data structure. Appropriate presentation of image and related data is essential for effective communication of information between clinicians. The effective use of display screens for clinical viewing of image and related data, within the imaging service department and in the broader domain, depends on the availability of means to ensure consistent presentation on different systems. Whilst some users, such as reporting clinicians, will need full control over selection of presentation content, layout and rendering parameters, others may be restricted to viewing data as originally prepared. In order to support this, generally accepted data structures are required that allow the specification of presentation details for medical image data, graphics data and text data. The implementation options for supporting the identified needs are discussed, including the scope for using XML to carry the structures and to support an open presentation model for use throughout all healthcare domains.
A model encompassing both PACS and medical records domains is described, wherein the entire patient record is represented by a collection of discrete information objects. These information objects can be stored DICOM Information Object Definitions (IODs) and the proposed HL7 Patient Record Architecture documents are found to fit this model. Relevant aspects of the both the proposed DICOM Structured Reporting and HL7 Document Patient Record Architecture standards are reviewed. The mapping of DICOM IODs to HL7 PRA documents is considered, and found to be one-to-one for all the use cases considered.
Proc. SPIE. 1899, Medical Imaging 1993: PACS Design and Evaluation
KEYWORDS: Human-machine interfaces, 3D image enhancement, 3D image reconstruction, Image processing, Image enhancement, Image storage, Radiology, Image display, 3D image processing, Picture Archiving and Communication System
Picture archival and communication (PACS) and teleradiology systems require workstations for image display, however not all clinical areas demand the same functionality and performance. Four workstations designed to fill different needs are compared to demonstrate the wide variation in functional requirements. In addition, the results of a survey conducted at InfoRad '92 during the 1992 annual meeting of the Radiological Society of North America are presented demonstrating that more than 90% of the respondents agreed that the two most important features of a workstation are the ability to review multiple studies for a patient at the same time and fast image display.
Proc. SPIE. 1785, Enabling Technologies for High-Bandwidth Applications
KEYWORDS: Imaging systems, Manufacturing, Computing systems, Imaging devices, Medical imaging, Digital imaging, Radiology, Data communications, Standards development, Picture Archiving and Communication System
Since 1983, the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) have been engaged in developing standards related to medical imaging. This alliance of users and manufacturers was formed to meet the needs of the medical imaging community as its use of digital imaging technology increased. The development of electronic picture archiving and communications systems (PACS), which could connect a number of medical imaging devices together in a network, led to the need for a standard interface and data structure for use on imaging equipment. Since medical image files tend to be very large and include much text information along with the image, the need for a fast, flexible, and extensible standard was quickly established. The ACR-NEMA Digital Imaging and Communications Standards Committee developed a standard which met these needs. The standard (ACR-NEMA 300-1988) was first published in 1985 and revised in 1988. It is increasingly available from equipment manufacturers. The current work of the ACR- NEMA Committee has been to extend the standard to incorporate direct network connection features, and build on standards work done by the International Standards Organization in its Open Systems Interconnection series. This new standard, called Digital Imaging and Communication in Medicine (DICOM), follows an object-oriented design methodology and makes use of as many existing internationally accepted standards as possible. This paper gives a brief overview of the requirements for communications standards in medical imaging, a history of the ACR-NEMA effort and what it has produced, and a description of the DICOM standard.
The implementation of Picture Archival and Communication Systems (PACS) within the contemporary radiology department is a complex procedure. Given the complexity of the total PACS environment with its advanced technology requirements, most sites will find it impractical to implement a filmless department with a total PACS solution at this time. Although many technical problems make a total PACS solution impractical in many situations, small, clinically useful, partial PACS (''miniPACS'') can be developed now and can provide experience for future development of more complete PACS. Planning for PACS and creating a supporting infrastructure are important and complex procedures. This paper describes an analysis performed as a neuroradiology PACS system was designed and implemented. Network bandwidth and image storage were evaluated; interfaces were specified; databases were designed; and plans were made to accommodate physical equipment requirements.
Teleradiology can be defined as the remote transmission of radiographic images for clinical use or expert interpretation. This definition indicates that there is a physical distance that impedes patient care between the interpreting expert and the primary physician, which can be overcome through electronic communications. The major benefit of such a system is faster communication of images with expert interpretation to remote sites. Depending on the application, teleradiology can extend the usefulness of the radiologist or make the primary physician's job much less time consuming by saving trips to radiology. In addition, patient interaction can be improved by eliminating the interval between the study and the availability of the images and report. It has not been satisfactorily determined that this more rapid system will lead to improved patient care but most students of the current delivery system recognize its limitations and the promise of electronic communications. The authors confine their remarks to the hospital and immediate clinics, leaving the wider area networks to the other presentations in this seminar, and they draw on the experience of the group at the University of Florida in establishing teleradiology to all the intensive care units two years ago and several other more limited, point-to-point electronic communication links. They have, during the past year, worked very hard at establishing several local area networks with digital archiving capability within their institution. This borders on the notion of picture archiving and communication systems (PACS), but has not reached that full potential. The authors find it is useful to concentrate on the teleradiology component because a number of projects can be undertaken without the need of a complete PACS environment. An extensive bibliography, compiled from select sources, is included.