我院PACS的设计及临床应用

目的通过构建医学影像存档与通讯系统（picture archiving and communicaltion systems，PACS），实现影像诊断设备的网络化，诊断报告书写计算机化、标准化。方法根据医院特点，利用公司开发的SSPACS，PACS影像服务器与诊断报告终端、登记终端、主任室终端、KODAK M160激光相机通过交换机连接成星形拓扑结构的Etheinet网络，并与医院“军卫1号”工程相连接。结果成功地实现了数字化医学图像在PACS内的传送、存储、易机图像处理、不同操作系统（UNIX和Windows98／2000／XP）在DICOM 3．0标准水平的相互兼容和图像交流传输，诊断报告语言规范化、标准化；“军卫1号”工程终端浏览cr图像及共享打印报告等功能。结论PALS智能化的诊断报告系统减少了医生的工作强度，数字化存储减少了档案管理的麻烦；PACS的建立提高了工作效率及管理水平，推动了医生工作模式的变革。     

基于PACS的彩超影像采集工作站的设计与应用

为了使医院模拟彩超诊断仪能够接入现有PACS系统,促进医院数字化与信息化发展,本文介绍了一种基于PACS系统的彩超影像采集工作站的设计方法及其应用.该系统使彩超诊断仪与PACS系统得以紧密地联系起来,实现了彩超图像的采集,同时按照DIC0M标准实现了彩超图像的存储与传输等一系列功能,推动了PACS系统的发展和医院信息系统的完善.     

医院信息管理在核医学科中的应用

目的构建笔者所在医院核医学影像图像获取与传输系统（PACS）,实现影像科室的数字化和网络化。方法从科室的实际情况出发,结合笔者医院放射科、CT、MRI等产生的图像的采集、显示、储存、传送和管理的成功经验．阐述了Medex系统在核医学科的建立及应用。结果PACS的实施提高了工作效率及管理水平,推动了医生工作模式的变革：方便了工作、科研和学习;提高了教学质量。规范化、计算机化的诊断报告质量优于人工书写报告。结论Medex系统的建立及应用促进核医学科工作的改观。     

影像辅助诊断学习系统的设计

医学数字化信息革命改变着传统的医学学习、工作、管理模式。本文探讨设计一套计算机化的影像辅助诊断教学系统的方法。结合了医用多媒体图文系统和图像存档与通讯系统 (PACS)的某些特点 ,该系统可用于医生书写数字化处方 ,方便快捷地管理影像资料 ,在计算机下多方位地分析影像从而辅助确定诊断结论并构建典型病例数据库使系统具备教学功能。系统采用面向对像程序设计开发工具开发并构建在通用的 Windows9X平台上 ,具有良好的界面和交互性。     

建立PACS系统的关键技术及应用

随着医学影像技术的发展,出现了各种医学成像方法和设备,如传统的X线透视和摄影、X线计算机断层术(X-CT)、数字减影血管造影术(DSA)、核医学(NM)、核磁共振成像(NMR)、超声成像(US)等。这些成像设备产生的医学影像成为医生诊断疾病的重要依据,但同时也使我们面临一个新的问题:如何处理这些堆积如山的有价值的信息。另一方面,各类图像常常需要在科室内部、各室之间、医院之间,甚至地区之间进行传递,以满足医疗诊断、治疗、远程会诊和教学的需要。为此,需要了解PACS系统的关键技术及其应用。1 PACS系统的技术要求与难点 PACS系统技术要求非常高,它可以说是集最先进的计算机与通讯技术之大成的应用:一个实用的PACS系统必须具有处理各种医学影像能力,这些影像种类繁多,包括DR、CR、CT、MR、US、PCT、ECT、各种光学影像(包括内窥镜、显微影像),甚至还有心电一类一维图像。在另一方面,医学影像的数据量极为庞大。例如一幅DR的图像可达16MB.一个病人的DSA资料可达GB数量极。一个中等规模医院仅放射影像部门一年的数据量就可高达4TB(1TB=1000GB)。如何储存与管理如此巨大的数据量,无疑是对     

多功能超声影像处理系统的设计与实现

1　前言超声检查是大中型医院常规检查项目。检查医师每天要接待大量的患者 ,还要为每位患者写出一份详细的检查报告 ,其劳动量是相当繁重的 ,而报告也只是医生对患者疾病的主观印象 ,临床医生若要了解诊断依据还要另外打印拖拉片 ,更不容易存档备查 ,很多有价值的病例信息也随之丢失。随着计算机网络技术在医学影像数据处理中的应用 ,计算机化的医院信息系统已成为现代化医院运营必不可少的基础设施与技术支撑环境。本文通过笔者的工作实践 ,设计并实现了一款多功能超声影像工作站 ,为医院建立小型PACS( Picture Archiving and Communic…     

802．11g无线局域网在PACS系统中的应用

目的测试PACS医学图像在802．11g无线局城网的实际传输情况，探讨无线局域周在建设医院PACS系统中的应用前景和存在的主要问题。方法使用NetIQ Chariot软件测试医生工作站和服务器之间的传输速率；结果利用医生工作站PACS客户稿软件从PACS服务器下载医学图像数据，测量下载时间。结论采用802．11g无线局域网和千兆以太网相结合的网络系统在传输速度、稳定性和安全性方面能满足医院PACS系统的需求。     

MRI乳腺影像报告及数据系统（BI-RADS）在乳腺病变诊断中的应用价值

目的对MRI乳腺影像报告及数据系统(BI-RADS)在乳腺病变诊断中的应用价值进行探讨。方法某医院选取了经手术和临床病理证实的125例患者作为研究对象,其中有75例乳腺癌患者,50例乳腺癌病变良性患者,经过一系列的常规检查后,并对结果进行分析研究,获取了诊断阈值。结果乳腺癌检查仪器对病因的诊断准确率、特异度、灵敏度,分别是92.3%、95.2%90.1%。结论 MRI乳腺影响报告及数据系统(BI-RADS)在乳腺病变的诊断中的应用价值很高,能够在一定程度上减少判断的主观性,这样一来,方便医生之间的相互讨论、研究。     

基于网格及IHE XDS/XDS-I技术框架和协议的区域影像电子健康记录系统的设计与实现

提出并实现了一种具有影像信息共享交换功能的区域电子健康记录系统（EHR），完全符合IHE XDS／XDS-I技术框架和协议，同时应用网格概念和SOA架构，实现区域间多家医疗机构的病人影像信息的共享交换和影像信息的预处理及智能流动。该系统由病人基本信息主索引服务器、注册中心、存储池、网格服务器、安全服务模块、网关及网格代理结点、PACS／EMR工作站和医院现有PACS系统或医学影像设备及RIS系统等8个组件组成，解决了采用ebXML标准与注册中心、存储池的通信和PACS／RIS或其他现有影像信息系统只能通过DICOM标准和HL7通信相冲突的难题。在上海市3家医院和科研单位进行了系统测试，主要有图像及报告的发布流程和用户的查询提取流程，结果表明该系统是在不增加网络带宽和存储资源的情况下，解决区域间影像信息共享交换的有效方案，具有安全可靠、可伸缩和易管理的特点。     

电子版三角函数眼异物定位诊断报告书的设计与制作

目的设计电子版三角函数眼异物定位诊断报告书模板。方法采用Delphi软件,对印刷版三角函数眼异物定位诊断报告书绘制电子版三角函数眼异物定位诊断报告书模板。通过计算机,在病例报告中生成数字报告书表。采用临床使用验证。功能包括能在影像科医生工作站计算机上书写三角函数眼异物定位诊断报告书,并能在模板上的三角函数眼异物定位坐标图上填画出相应的异物影像。结果利用此电子版三角函数眼异物定位诊断报告书模板,不仅能在影像工作站上将填写好的诊断报告书通过网络系统打印出来,还能通过影像存储与通信系统（PACS）传输到临床医生办公室工作站上。结论此电子版三角函数眼异物定位诊断报告书模板的应用,不仅方便了临床医生在网上的阅览,有利于眼异物的及时取出,而且达到了现代化医院需电子版病例和检查结果的要求。     

An Integrated Approach to a Teaching File Linked to PACS

To meet the educational needs of a medical imaging department with a strong teaching commitment, a teaching file that uses digital data supplied by the institutional picture archiving and communications system (PACS) was required. This teaching file had to be easily used by the end users, have a simple submission process, be able to support multiple users, be searchable on all data fields, and implementing the teaching file must not incur any additional software or hardware costs. The teaching file developed to address this problem takes advantage of the database structure and capabilities of several components included in the commercial PACS installed at the hospital. MS Access is used to seamlessly integrate with the digital imaging and communication in medicine (DICOM) database of a normal work station that is part of the PACS. This integration allows relevant patient and study demographics to be copied from images of interest and then to be stored in a separate database as the back-end of the digital teaching file. When images for a particular teaching file case need to be reviewed, they are automatically retrieved and displayed from the main PACS database using an open application programming interface (API) connection defined on the PACS web server. Utilizing this open API connection means the teaching file contains only the relevant demographic information of each teaching file case; no image data is stored locally. The open API connection allows access to imaging data usually not encountered in a teaching file, allowing more comprehensive imaging case files to be developed by the radiologist. Other advantages of this teaching file design are that it does not duplicate image data, it is small allowing simple ongoing backup, and it can be opened with multiple users accessing the database without compromising data access or integrity.     

Digital imaging and electronic patient records in pathology using an integrated department information system with PACS

Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.     

Medical Image Resource Center–making electronic teaching files from PACS

A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research.     

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.     

基于病案的教学查房结合PACS在影像科医师培养中的应用

目的探讨在影像科医师培养中,基于病案(CBL)的教学查房结合医学影像存储与通讯系统(PACS)对医师影像诊断能力培养的价值。方法对2018年在北京大学第三医院放射科轮转CT的41名培训医师,应用PACS对其进行CBL教学查房,对照组为2017年轮转CT的39名培训医师(未进行CBL教学)。从PACS随机抽取每名医师书写的10份报告(报告时间为培训最后1个月),对开展CBL教学前后培训医师的报告书写质量评分并计算优良率。评分标准包括病灶征象描述全面准确、报告内容条理清晰规范、诊断结论逻辑清晰合理、能回答临床提出的问题、提出的下一步诊疗建议合理准确以及无漏诊。同时采用调查问卷的方式评价培训医师对CBL教学查房的主观感受,包括全面系统的认识疾病、提高临床思维能力、读片能力和学习兴趣、PACS对学习的帮助5方面,采用百分比表示。结果1)进行CBL教学查房后,培训医师报告质量评分提高(P<0.01)。2)培训医师对调查问卷5方面满意率分别为90.2%、68.3%、80.5%、75.6%和80.5%。结论应用PACS进行CBL教学查房是培养影像科医师诊断能力的有效方法。     

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.     

An efficient architecture to support digital pathology in standard medical imaging repositories

In the past decade, digital pathology and whole-slide imaging (WSI) have been gaining momentum with the proliferation of digital scanners from different manufacturers. The literature reports significant advantages associated with the adoption of digital images in pathology, namely, improvements in diagnostic accuracy and better support for telepathology. Moreover, it also offers new clinical and research applications. However, numerous barriers have been slowing the adoption of WSI, among which the most important are performance issues associated with storage and distribution of huge volumes of data, and lack of interoperability with other hospital information systems, most notably Picture Archive and Communications Systems (PACS) based on the DICOM standard.This article proposes an architecture of a Web Pathology PACS fully compliant with DICOM standard communications and data formats. The solution includes a PACS Archive responsible for storing whole-slide imaging data in DICOM WSI format and offers a communication interface based on the most recent DICOM Web services. The second component is a zero-footprint viewer that runs in any web-browser. It consumes data using the PACS archive standard web services. Moreover, it features a tiling engine especially suited to deal with the WSI image pyramids. These components were designed with special focus on efficiency and usability. The performance of our system was assessed through a comparative analysis of the state-of-the-art solutions. The results demonstrate that it is possible to have a very competitive solution based on standard workflows.     

Magnetic resonance imaging of chest wall lesions

Magnetic resonance imaging (MRI) demonstrates surface anatomy, nerves, and soft tissue pathology. Selective placement of the cursor lines in MRI displays specific anatomy. The MR images can then be used as adjunct in teaching surface anatomy to medical students and to other health professionals. Because the normal surface anatomy could be imaged at UCLA's radiology department, it was decided to image soft tissue abnormalities with MR to assist in patient care. Patients imaged were scheduled for special procedures of the chest or staging lymphangiograms. Patients were placed into categories depending on known diagnosis or interesting clinical presentation. The diagnostic categories included Hodgkin's disease, melanoma, carcinomas (eg, lung or breast), lymphedema, sarcomas, dermatological disorders, and neurological disorders. All images were orchestrated by the radiologist. This article discusses both the teaching and clinical impact on patient care.     

数字化影像信息系统在医院的移动应用

目的：构建全套完整无线数字化影像信息系统，使各科医务人员能够操作该系统在整个医院范围内安全、快速、简便的进行医疗应用。材料和方法：基于医院现有GE Centricity PACS／RIS的企业级架构和WEB技术向临床发布影像的应用，以多台戴尔PowerEdge服务器分别用作PACS服务器、RIS服务器、HIS服务器和PACS—web服务器。网络连接设备使用戴尔Powerconnect交换机和TP—LINK无线宽带路由器。用户终端移动设备使用戴尔Latitude笔记本电脑。首先依托医院现有的有线网络构架，选择具有代表性的科室，如放射科、神经外科、神经内科、预防保健科、质控科，并将无线宽带路由器通过双绞线连接至以太网接口，设置无线宽带路由器指定IP地址、子网掩码，设置路由器工作模式，MAC地址过滤、SSID并且禁用SSID广播、频道和加密属性。建立起集中控制式无线网络。在用户终端设置无线适配器，设置为与路由器相同的SSID、频道和加密属性。测试终端移动设备和服务器之间的连接，并且交给最终用户使用。结果：用户使用终端移动设备进行医疗工作日常操作移动性便携性明显优于原系统。而医疗软什的使用与原系统相同，无须另外培训。神经外科和神经内科的临床医生可以手持终端移动设备在患者床前边查房边做病程记录，并且同时通过浏览器基于IHE规范要求优先调阅关键帧影像，通过TruRez增量传输技术降低对无线网络带宽的要求，以web浏览的形式快速从GE Centricity PACS—web服务器实时渊用患者的影像资料。预防保健科和质控科通过HIS和RIS查询进行疾病分类、例数统计，快速生成报表，进行传染病监控和质罱控制。放射科医生需要经常从PACS服务器调用大量的DICOM格式文件，由于无线宽带路由器的带宽为54M，是原有线网络100M带宽的一半，调用时间有所延长。结论：使用医用无线网络系统的通信交流方式较传统方式更加迅速便捷。各种医务人员使用终端移动设备可以在医疗机构内任意漫游、高速传输影像、报告、病历以及其他电子文档。当影像浏览信息极大丰富时（如扩展对心电信息、电生理、超声、病理等信息），正确的操作者可以在正确的时间、安全的获得正确的、完善的临床诊断应用需要的综合诊断信息。对操作者而言简单明了，能够在所有医疗通信系统中使用而无需考虑制造商的因素。