Page 1. 988 U Computer Primer Volume 17 Number 4 Part Two: An Introduction to Computer Networking... more Page 1. 988 U Computer Primer Volume 17 Number 4 Part Two: An Introduction to Computer Networking1 David S. Channin, MD #{149}Paulj Chang, MD U INTRODUCTION A computer alone is like the sound of one hand clapping. ...
ABSTRACT Since 1983, the American College of Radiology (ACR) and the National Electrical Manufact... more ABSTRACT 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.
This article has introduced the nature, generation, use, and future of digital imaging. As digita... more This article has introduced the nature, generation, use, and future of digital imaging. As digital technology has transformed other aspects of our lives--has the reader tried to buy a conventional record album recently? almost all music store stock is now compact disks--it is sure to continue to transform medicine as well. Whether that transformation will be to our liking as physicians or a source of frustration and disappointment is dependent on understanding the issues involved.
OBJECTIVE. The purposeof thestudywasto developquantitativeandqualitativecriteria for diagnosing f... more OBJECTIVE. The purposeof thestudywasto developquantitativeandqualitativecriteria for diagnosing fatty liver on contrast-enhancedhelical CT. SUBJECTS AND METHODS. Differential liverâ€"spleen attenuationwas evaluatedbe tween 80 and I 20 sec after injection in 76 patients who underwent contrast-enhancedhelical CT. UnenhancedCT images had earlier establishedfatty liver when the liver minus spleen at tenuation difference was less than or equal to â€"¿ 10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presenceof geographic areassparedfrom fatty infi tration, and the relative liverâ€"spleen attenuation. The diagnostic accuraciesof various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS. Sensitivity,specificity, andreceiveroperatingcharacteristic curveareasfor ob servers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differ ential liverâ€"spleen attenuation (80â€"100sec; â€"¿ 20.5 H discriminatory value), the values were
Georgetown University Hospital has been operating an image management and communications system (... more Georgetown University Hospital has been operating an image management and communications system (IMACS or PACS) for three-and-a-half years. This work was initially funded under the Army Medical Research and Development Command Digital Imaging Network Systems (DINS) project. The system was taken from a research system supporting only radiology tasks to one extended to clinical use, and has been used in clinical work for two-and-a-half years. This paper will summarize our PACS clinical experience and will describe the operational features implemented and those still necessary.
Objective. To review our experience with the use of sonography in evaluating potential candidates... more Objective. To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia. Methods. This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia. Results. For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long‐term follow‐up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned. Conclusions. Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above‐described 4 congenital anomalies.
A very common task for a radiologist is to compare a previous examination with a current one. Wit... more A very common task for a radiologist is to compare a previous examination with a current one. With film, the typical method varies somewhat, but usually involves putting up comparable views on two adjacent lightboxes. The reader then looks back and forth between the two films to assess changes. For images that can be placed on adjacent lightboxes, this method works reasonably well, but if images are placed several lightboxes apart, the task becomes difficult. A method that may help improve the comparison operation is possible with a workstation, but difficult (at best) with film. That is, to present the images to be compared as if they were on top of each other. The reader then uses a cursor to move a reveal bar or region of interest that shows the images `underneath.' This application has some potential for simplifying the comparison task for the radiologist. It avoids the extremes of head movement, and may keep the area of interest nearly coincident.
During our design of a workstation for diagnostic radiology, and having studied other designs bei... more During our design of a workstation for diagnostic radiology, and having studied other designs being produced either commercially or institutionally, it became evident that a number of questions existed regarding the number and physical arrangement of CT images which a radiologist likes to have during interpretation. We wished to answer the questions about number and physical arrangement, and at the same time, determine how much difference there was concerning these parameters among the subspecialty sections. We approached this problem by using different numbers and arrangements of CT scan images presented to the radiologist on film. This paper will discuss the findings of this study, and explain some of the reasons given by the radiologists for their answers. The implications for workstation designs will also be discussed.
The purpose of this study was to determine if the use of a picture archiving and communications s... more The purpose of this study was to determine if the use of a picture archiving and communications system (PACS) in ultrasonography increased the number of images acquired per examination. The hypothesis that such an increase does occur was based on anecdotal information; this study sought to test the hypothesis. A random sample of all ultrasound examination types was drawn from the period 1998 through 1999. The ultrasound PACS in use (ACCESS; Kodak Health Information Systems, Dallas, TX) records the number of grayscale and color images saved as part of each study. Each examination in the sample was checked in the ultrasound PACS database,.and the number of grayscale and color images was recorded. The comparison ®lm-based sample was drawn from the period 1994 through 1995. The number of examinations of each type selected was based on the overall statistics of the section; that is, the sample was designed to represent the approximate frequency with which the various examination types are done. For ®lm-based image counts, the jackets were retrieved, and the number of grayscale and color images were counted. The number of images obtained per examination (for most examinations) in ultrasound increased with PACS use. This was more evident with some examination types (eg, pelvis). This result, however, has to be examined for possible systematic biases because ultrasound practice has changed over the time since the authors stopped using ®lm routinely. The use of PACS in ultrasonography was not associated with an increase in the number of images per examination based solely on the use of PACS, with the exception of neonatal head studies. Increases in the number of images per study was otherwise associated with examinations for which changes in protocols resulted in the increased image counts.
Despite the rapid progress made in the electronic design of imaging work stations for medicine, m... more Despite the rapid progress made in the electronic design of imaging work stations for medicine, much lees effort has gene into the deeign of environments in which euch eyetems will be used. Baeed on etudies of radiologist film reading seseions, considerable time will be epent working at such viewing systeme. If the rooms in which the work stations are placed are not conducive to comfortable work, it will certainly not favor electronic viewing over film reading. In examining existing reading environments, ir is aleo apparent that they are not optimal, even for film. Since come of the problems for film and electronic viewing overlap, such as heat generation (by the alternators, viewboxes, or work station electronics) and glare from light sources, it should be poesible to develop solutions that are applicable to both environments, of to rooms that will feature both viewing systems. This paper will discuss some of the approaches to designing environments in which viewing of images is supported by the room architecture and engineering, rather than being degraded by it. To illustrate these points a design, based on the constraint of a real room size and available architectural materiale, will be developed.
In order to provide a PAC system which will appeal to, and be used by our Radiology staff, we hav... more In order to provide a PAC system which will appeal to, and be used by our Radiology staff, we have surveyed their attitudes about digital imaging in general and viewing sta-tions in particular. We anticipate installing a number of these stations in the full PACS, and we want these stations to provide improvement over the way we currently handle digital images. For these reasons, we felt it necessary to ask the radiologists who will be using the viewing systems what features and functions they would like to have available. The faculty, fellows, and residents in our Radiology department were asked to complete a questionnaire about digital imaging and workstations for viewing. They were asked to comment on existing viewing systems (i.e. CT consoles , nuclear imaging systems, and DIVA consoles). This paper discusses the results of the survey along with our ideas on how best we can implement the functions needed and requested.
International Journal Of Medical Informatics, May 1, 1992
Georgetown University Hospital has been operating an image management and communications system (... more Georgetown University Hospital has been operating an image management and communications system (IMACS or PACS) for three-and-a-half years. This work was initially funded under the Army Medical Research and Development Command Digital Imaging Network Systems (DINS) project. The system was taken from a research system supporting only radiology tasks to one extended to clinical use, and has been used in clinical work for two-and-a-half years. This paper will summarize our PACS clinical experience and will describe the operational features implemented and those still necessary.
In this paper we present a specific example of the current state-of-the-art in desktop image acce... more In this paper we present a specific example of the current state-of-the-art in desktop image access in the GI section of the Department of Radiology at the Hospital of the University of Pennsylvania. We describe a system which allows physicians to view and manipulate images from a Philips digital fluoroscopy system at the workstations in their offices. Typically they manipulate and view these images on their desktop Macs and then submit the results for slide making or save the images in digital teaching files. In addition to a discussion of the current state-of-the-art here at HUP, we also discuss some future directions that we are pursuing.
Medical Imaging IV: PACS Systems Design and Evaluation, Aug 1, 1990
ABSTRACT The exchange of information between a Radiology Information System (RIS) and a PACS is e... more ABSTRACT The exchange of information between a Radiology Information System (RIS) and a PACS is essential to optimizing the utility of a PACS. Some of the benefits awarded by implementing an interface include a reduction or elimination of repetitious data entry, the availability of more accurate information on the PACS, a reduction in workload for the technologists, registration clerks, transcriptionists, etc, and the availability of more accurate data for automating the PACS. This paper discusses the Georgetown experience of interfacing an HIS/RIS and PACS, by describing the development of the interface and its impact on clinical operations.
Page 1. 988 U Computer Primer Volume 17 Number 4 Part Two: An Introduction to Computer Networking... more Page 1. 988 U Computer Primer Volume 17 Number 4 Part Two: An Introduction to Computer Networking1 David S. Channin, MD #{149}Paulj Chang, MD U INTRODUCTION A computer alone is like the sound of one hand clapping. ...
ABSTRACT Since 1983, the American College of Radiology (ACR) and the National Electrical Manufact... more ABSTRACT 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.
This article has introduced the nature, generation, use, and future of digital imaging. As digita... more This article has introduced the nature, generation, use, and future of digital imaging. As digital technology has transformed other aspects of our lives--has the reader tried to buy a conventional record album recently? almost all music store stock is now compact disks--it is sure to continue to transform medicine as well. Whether that transformation will be to our liking as physicians or a source of frustration and disappointment is dependent on understanding the issues involved.
OBJECTIVE. The purposeof thestudywasto developquantitativeandqualitativecriteria for diagnosing f... more OBJECTIVE. The purposeof thestudywasto developquantitativeandqualitativecriteria for diagnosing fatty liver on contrast-enhancedhelical CT. SUBJECTS AND METHODS. Differential liverâ€"spleen attenuationwas evaluatedbe tween 80 and I 20 sec after injection in 76 patients who underwent contrast-enhancedhelical CT. UnenhancedCT images had earlier establishedfatty liver when the liver minus spleen at tenuation difference was less than or equal to â€"¿ 10 H (n = 18). Four observers who had not seen the unenhanced images used contrast-enhanced CT images to assess the presence of fatty liver on a five-point Likert scale, the presenceof geographic areassparedfrom fatty infi tration, and the relative liverâ€"spleen attenuation. The diagnostic accuraciesof various imaging criteria were compared using McNemar's chi-square test (for sensitivity and specificity) and analysis of receiver operating characteristic curves. RESULTS. Sensitivity,specificity, andreceiveroperatingcharacteristic curveareasfor ob servers' qualitative judgments were 54%, 95%, and .91, respectively; for quantitative differ ential liverâ€"spleen attenuation (80â€"100sec; â€"¿ 20.5 H discriminatory value), the values were
Georgetown University Hospital has been operating an image management and communications system (... more Georgetown University Hospital has been operating an image management and communications system (IMACS or PACS) for three-and-a-half years. This work was initially funded under the Army Medical Research and Development Command Digital Imaging Network Systems (DINS) project. The system was taken from a research system supporting only radiology tasks to one extended to clinical use, and has been used in clinical work for two-and-a-half years. This paper will summarize our PACS clinical experience and will describe the operational features implemented and those still necessary.
Objective. To review our experience with the use of sonography in evaluating potential candidates... more Objective. To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia. Methods. This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia. Results. For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long‐term follow‐up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned. Conclusions. Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above‐described 4 congenital anomalies.
A very common task for a radiologist is to compare a previous examination with a current one. Wit... more A very common task for a radiologist is to compare a previous examination with a current one. With film, the typical method varies somewhat, but usually involves putting up comparable views on two adjacent lightboxes. The reader then looks back and forth between the two films to assess changes. For images that can be placed on adjacent lightboxes, this method works reasonably well, but if images are placed several lightboxes apart, the task becomes difficult. A method that may help improve the comparison operation is possible with a workstation, but difficult (at best) with film. That is, to present the images to be compared as if they were on top of each other. The reader then uses a cursor to move a reveal bar or region of interest that shows the images `underneath.' This application has some potential for simplifying the comparison task for the radiologist. It avoids the extremes of head movement, and may keep the area of interest nearly coincident.
During our design of a workstation for diagnostic radiology, and having studied other designs bei... more During our design of a workstation for diagnostic radiology, and having studied other designs being produced either commercially or institutionally, it became evident that a number of questions existed regarding the number and physical arrangement of CT images which a radiologist likes to have during interpretation. We wished to answer the questions about number and physical arrangement, and at the same time, determine how much difference there was concerning these parameters among the subspecialty sections. We approached this problem by using different numbers and arrangements of CT scan images presented to the radiologist on film. This paper will discuss the findings of this study, and explain some of the reasons given by the radiologists for their answers. The implications for workstation designs will also be discussed.
The purpose of this study was to determine if the use of a picture archiving and communications s... more The purpose of this study was to determine if the use of a picture archiving and communications system (PACS) in ultrasonography increased the number of images acquired per examination. The hypothesis that such an increase does occur was based on anecdotal information; this study sought to test the hypothesis. A random sample of all ultrasound examination types was drawn from the period 1998 through 1999. The ultrasound PACS in use (ACCESS; Kodak Health Information Systems, Dallas, TX) records the number of grayscale and color images saved as part of each study. Each examination in the sample was checked in the ultrasound PACS database,.and the number of grayscale and color images was recorded. The comparison ®lm-based sample was drawn from the period 1994 through 1995. The number of examinations of each type selected was based on the overall statistics of the section; that is, the sample was designed to represent the approximate frequency with which the various examination types are done. For ®lm-based image counts, the jackets were retrieved, and the number of grayscale and color images were counted. The number of images obtained per examination (for most examinations) in ultrasound increased with PACS use. This was more evident with some examination types (eg, pelvis). This result, however, has to be examined for possible systematic biases because ultrasound practice has changed over the time since the authors stopped using ®lm routinely. The use of PACS in ultrasonography was not associated with an increase in the number of images per examination based solely on the use of PACS, with the exception of neonatal head studies. Increases in the number of images per study was otherwise associated with examinations for which changes in protocols resulted in the increased image counts.
Despite the rapid progress made in the electronic design of imaging work stations for medicine, m... more Despite the rapid progress made in the electronic design of imaging work stations for medicine, much lees effort has gene into the deeign of environments in which euch eyetems will be used. Baeed on etudies of radiologist film reading seseions, considerable time will be epent working at such viewing systeme. If the rooms in which the work stations are placed are not conducive to comfortable work, it will certainly not favor electronic viewing over film reading. In examining existing reading environments, ir is aleo apparent that they are not optimal, even for film. Since come of the problems for film and electronic viewing overlap, such as heat generation (by the alternators, viewboxes, or work station electronics) and glare from light sources, it should be poesible to develop solutions that are applicable to both environments, of to rooms that will feature both viewing systems. This paper will discuss some of the approaches to designing environments in which viewing of images is supported by the room architecture and engineering, rather than being degraded by it. To illustrate these points a design, based on the constraint of a real room size and available architectural materiale, will be developed.
In order to provide a PAC system which will appeal to, and be used by our Radiology staff, we hav... more In order to provide a PAC system which will appeal to, and be used by our Radiology staff, we have surveyed their attitudes about digital imaging in general and viewing sta-tions in particular. We anticipate installing a number of these stations in the full PACS, and we want these stations to provide improvement over the way we currently handle digital images. For these reasons, we felt it necessary to ask the radiologists who will be using the viewing systems what features and functions they would like to have available. The faculty, fellows, and residents in our Radiology department were asked to complete a questionnaire about digital imaging and workstations for viewing. They were asked to comment on existing viewing systems (i.e. CT consoles , nuclear imaging systems, and DIVA consoles). This paper discusses the results of the survey along with our ideas on how best we can implement the functions needed and requested.
International Journal Of Medical Informatics, May 1, 1992
Georgetown University Hospital has been operating an image management and communications system (... more Georgetown University Hospital has been operating an image management and communications system (IMACS or PACS) for three-and-a-half years. This work was initially funded under the Army Medical Research and Development Command Digital Imaging Network Systems (DINS) project. The system was taken from a research system supporting only radiology tasks to one extended to clinical use, and has been used in clinical work for two-and-a-half years. This paper will summarize our PACS clinical experience and will describe the operational features implemented and those still necessary.
In this paper we present a specific example of the current state-of-the-art in desktop image acce... more In this paper we present a specific example of the current state-of-the-art in desktop image access in the GI section of the Department of Radiology at the Hospital of the University of Pennsylvania. We describe a system which allows physicians to view and manipulate images from a Philips digital fluoroscopy system at the workstations in their offices. Typically they manipulate and view these images on their desktop Macs and then submit the results for slide making or save the images in digital teaching files. In addition to a discussion of the current state-of-the-art here at HUP, we also discuss some future directions that we are pursuing.
Medical Imaging IV: PACS Systems Design and Evaluation, Aug 1, 1990
ABSTRACT The exchange of information between a Radiology Information System (RIS) and a PACS is e... more ABSTRACT The exchange of information between a Radiology Information System (RIS) and a PACS is essential to optimizing the utility of a PACS. Some of the benefits awarded by implementing an interface include a reduction or elimination of repetitious data entry, the availability of more accurate information on the PACS, a reduction in workload for the technologists, registration clerks, transcriptionists, etc, and the availability of more accurate data for automating the PACS. This paper discusses the Georgetown experience of interfacing an HIS/RIS and PACS, by describing the development of the interface and its impact on clinical operations.
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