Similar to DICOM for PACS (Picture Archiving and Communication System), standards for radiotherapy (RT) information have been ratified with seven DICOM-RT objects and their IODs (Information Object Definitions), which are more than just images. This presentation describes how a DICOM-based RT Information System Server can be built based on the PACS technology and its data model for a web-based distribution. Methods: The RT information System consists of a Modality Simulator, a data format translator, a RT Gateway, the DICOM RT Server, and the Web-based Application Server. The DICOM RT Server was designed based on a PACS data model and was connected to a Web application Server for distribution of the RT information including therapeutic plans, structures, dose distribution, images and records. Various DICOM RT objects of the patient transmitted to the RT Server were routed to the Web Application Server where the contents of the DICOM RT objects were decoded and mapped to the corresponding location of the RT data model for display in the specially-designed Graphic User Interface. The non-DICOM objects were first rendered to DICOM RT Objects in the translator before they were sent to the RT Server. Results: Ten clinical cases have been collected from different hopsitals for evaluation of the DICOM-based RT Information System. They were successfully routed through the data flow and displayed in the client workstation of the RT information System. Conclusion: Using the DICOM-RT standards, integration of RT data from different vendors is possible.
Proc. SPIE. 5371, Medical Imaging 2004: PACS and Imaging Informatics
KEYWORDS: Internet, Data modeling, Surgery, Synthetic aperture radar, Image processing, Control systems, Data archive systems, Telecommunications, Data communications, Picture Archiving and Communication System
We developed a Web-based system to interactively display image-based electronic patient records (EPR) for intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). We have successfully used this system two times for the teleconsultation on Severe acute respiratory syndrome (SARS) in Shanghai Xinhua Hospital and Shanghai Infection Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could interactively study, manipulate and navigate the EPR of the SARS patients to make more precise diagnosis on images with this system assisting. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.
In a hospital, various kinds of medical images acquired from different modalities are generally used and stored in different department and each modality usually attaches several workstations to display or process images. To do better diagnosis, radiologists or physicians often need to retrieve other kinds of images for reference. The traditional image storage solution is to buildup a large-scale PACS archive server. However, the disadvantages of pure centralized management of PACS archive server are obvious. Besides high costs, any failure of PACS archive server would cripple the entire PACS operation. Here we present a new approach to develop the storage grid in PACS, which can provide more reliable image storage and more efficient query/retrieval for the whole hospital applications. In this paper, we also give the performance evaluation by comparing the three popular technologies mirror, cluster and grid.
Proc. SPIE. 5033, Medical Imaging 2003: PACS and Integrated Medical Information Systems: Design and Evaluation
KEYWORDS: Medicine, Surgery, Solid state lighting, Telecommunications, Integration, System integration, Information security, Computer security, Network security, Picture Archiving and Communication System
In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.
Radiotherapy (RT) requires information and images from both diagnostic and treatment equipment. Standards for radiotherapy information have been ratified with seven DICOM-RT objects and their IODs (Information Object Definitions). However, the contents of these objects require the incorporation of the RT workflow in a logical sequence. The first step is to trace the RT workflow. The second step now is to direct all images and related information in their corresponding DICOM-RT objects into a DICOM RT Server and then ultimately to an RT application server.
Methods: In our design, the RT DICOM Server was based on a PACS data model. The data model can be translated to web-based technology server and an application server built on top of the Web server for RT. In the process, the contents in each of the DICOM-RT objects were customized for the RT display windows. Results: Six display windows were designed and the data model in the RT application server was developed. The images and related information were grouped into the seven DICOM-RT Objects in the sequence of their procedures, and customized for the seven display windows. This is an important step in organizing the data model in the application server for radiation therapy. Conclusion: Radiation therapy workflow study is a pre-requisite for data model design that can enhance image-based healthcare delivery.
Radiation therapy (RT) is an image intensive treatment. It requires images from projection X-rays, CT, MR, PET for tumor localization, treatment planning and verification of treatment plans. It also needs patient information, images and their processing for tumor localization and dose computation to ensure the delivery of uniform high dose to the target but avoidance of sensitive structures. In these processes, PACS and imaging informatics technologies are used extensively. However, they are not integrated with these technologies as a complete radiation treatment system. Currently RT treatment still relies mostly on tedious manual image and data transfer methods because the community as a whole has not championed the concept of system integration heavily. System integration of RT treatment has many benefits including lower equipment and operation costs, streamline treatment procedures, and better healthcare delivery to the patient. In this paper, we discuss the concept of a DICOM and imaging informatics-based RT server as an attempt to integrate diverse healthcare information systems, imaging modalities and RT equipment into one seamless treatment system.
Proc. SPIE. 4685, Medical Imaging 2002: PACS and Integrated Medical Information Systems: Design and Evaluation
KEYWORDS: Surgery, Image processing, Control systems, Image analysis, Data acquisition, Transparent conductors, Image storage, Failure analysis, Computer security, Picture Archiving and Communication System
In order to achieve the high and continuous availability in PACS operation, the PACS component status would be monitored seriously and quick responds would apply to the component if any failure happened to any PACS key component either in hardware or software level. In order to protect the data loss and also for security issue, the PACS data flow, e.g., from acquisition to final display, would be tracked carefully. All these measures will increase the total cost of ownership (TCO). We built an automatic monitoring system (AMS) on top of the PACS to assist the PACS management and to make the PACS component status and internal data flow more transparent to the administrators. The PACS AMS consists of two parts: monitoring agents running in each PACS component computer and a Monitor Server running in a remote computer. Monitoring agents are connected to all PACS processes running in each PACS component. The Monitor Server monitors each agent that allows the server to track the status of individual PACS process. The PACS managers can now monitor and control the entire PACS operation in real time, and also track patient and image data flow automatically.
Huadong hospital in Shanghai with 800 beds provides health care services for inpatients and outpatients, as well as special senior and VIP patients. In order to move to digital imaging based radiology practice, and also provide better intra-hospital consultation services for senior and VIP patients, we started to implement PACS for hospital wide services from 1999, and also designed and developed an automatic monitoring system (AMS) to monitor and control PACS operation and dataflow to decrease the total cost of ownership for PACS operation. We installed the AMS on top of the Huadong Hospital PACS in the May of 2001. The installation was painless, did not interrupt the normal PACS operation, and took only one month. The PACS administrators with the AMS can now monitor and control the entire PACS operation in real time, and also track patient and image data flow automatically. These features make administrators take proper action even before user's complaint if any failure happened in any PACS component or process, they reduce the size of the management team, and decrease total cost of PACS ownership.