RESUMEN
Information technology is becoming a vital component of all health care enterprises, from managed care services to large hospital networks, that provides the basis of electronic patient records and hospital-wide information. The rationale behind such systems is deceptively simple: physicians want to sit down at a single workstation and call up all information, both clinical data and medical images, concerning a given patient. Picture archiving and communication systems (PACS) are responsible for solving the problem of acquiring, transmitting, and displaying radiologic images. The major benefit of PACS resides in its ability to communicate images and reports to referring physicians in a timely and reliable fashion. With the changes in economics and the shift toward managed and capitated care, the teleradiology component of PACS is rapidly gaining momentum. In allowing remote coverage of multiple sites by the same radiologists and remote consultations and expert opinion, teleradiology is in many instances the only option to maintain economically viable radiologic settings. The technical evolution toward more integrated systems and the shift toward Web-based technology is rapidly merging the two concepts of PACS and teleradiology in global image management and communication systems.
Asunto(s)
Intensificación de Imagen Radiográfica , Sistemas de Información Radiológica , Costos y Análisis de Costo , Humanos , Internet , Aplicaciones de la Informática Médica , Sistemas de Información Radiológica/economía , Sistemas de Información Radiológica/tendencias , Telerradiología/economía , Telerradiología/tendenciasRESUMEN
The aim of this study was to evaluate on-line performance of a real-time digital imaging system based on amorphous silicon technology and to compare it with conventional film-screen equipment. The digital detecting imager consists of (1) a converter, which transforms the energy of the incident X rays into light; (2) a real-time digital detecting system, capable of producing as many as 10 pictures per second using a large-area pixel matrix (20 x 20 cm2) based on solid-state amorphous silicon sensor technology with a pitch of 400 microns; and (3) appropriate computer tools for control, real-time image treatment, data representation, and off-line analysis. Different phantoms were used for qualitative comparison with the conventional film-screen technique, with images obtained with both systems at the normal dose (used as a reference), as well as with dose reduction by a factor of 10 to 100. Basic image quality parameters evaluated showed that the response of the detector is linear in a wide range of entrance air kerma; the dynamic range is higher compared with the conventional film-screen combination; the spatial resolution is 1.25 lp per millimeter, as expected from the pixel size; and good image quality is ensured at doses substantially lower than for the film-screen technique. The flat-panel X-ray imager based on amorphous silicon technology implemented in standard radiographic equipment permits acquisition of real-time images in radiology (as many as 10 images per second) of diagnostic quality with a marked reduction of dose (as much as 100 times) and better contrast compared with the standard film technique. Preliminary results obtained with a 100-micron pitch imager based on the same technology show better quality but a less substantial dose reduction. Applications in craniofacial surgery look promising.
Asunto(s)
Cara/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Intensificación de Imagen Radiográfica/métodos , Cráneo/diagnóstico por imagen , Conversión Analogo-Digital , Diseño de Equipo , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Sistemas en Línea , Fantasmas de Imagen , Dosis de Radiación , Intensificación de Imagen Radiográfica/instrumentación , Silicio , Tecnología Radiológica/instrumentación , Película para Rayos X , Pantallas Intensificadoras de Rayos XRESUMEN
Since its birth in 1978, DIOGENE, the hospital information system of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. For a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The hospital information system DIOGENE plays a significant role by integrating four axes of knowledge: medico-economical context for better understanding and influencing resources consumption; the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.), patient-dependent knowledge, in a vision integrating time and space; external knowledge bases such as Medline (patient-independent knowledge); integration of these patient-dependent and independent knowledge in a case-based reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision.
Asunto(s)
Sistemas de Información en Hospital , Sistemas de Computación , Bases de Datos Bibliográficas , Historia del Siglo XX , Sistemas de Información en Hospital/historia , Sistemas de Información en Hospital/organización & administración , Hospitales Universitarios , MEDLINE , Sistemas de Registros Médicos Computarizados , Innovación Organizacional , Calidad de la Atención de Salud , SuizaRESUMEN
A hospital-wide Picture Archiving and Communication System (PACS) is currently under development at the University Hospital of Geneva. After a first implementation including two oneterabyte optical libraries, the system is expanded to integrate all the imaging modalities of the hospital. The new storage requirement is 10 terabytes to cover three year archive. A large distributed image archive has been designed including new archive servers for long-term storage and display servers for medium-term storage. The acquisition, archive and distribution cycles are performed using separated networks combining Fast Ethernet and Ethernet. Image files are distributed to the wide-hospital using a prefetching strategy or an Intranet server, RADIOLAB. The first mode takes advantage of the fully integrated hospital information system DIOGENE 2 to allow the automatic retrieval of studies in advance. The second mode provides a convivial study selection from any conventional WWW (World Wide Web) browser. Image files are then transmitted to the user's display station using HTTP (HyperText Transfer Protocol) and handled by OSIRIS software, which acts as a helper or viewer. Such a system is expected to meet the time requirement, which is less than three seconds per image.
Asunto(s)
Redes de Comunicación de Computadores , Sistemas de Información Radiológica/organización & administración , Sistemas de Información en Hospital , Hospitales Universitarios , Humanos , Almacenamiento y Recuperación de la Información , Redes de Área Local , Suiza , Integración de SistemasRESUMEN
World Wide Web (WWW) standards have been established for the transmission of and remote consultation on medical information and records, including medical images, extracted from an existing hospital information system. A software package called Osiris is being used for the display and manipulation of medical images in a hospital-based picture archiving and communication system. Recent extensions of Osiris, through the integration of WWW navigational tools, allow easy access to a variety of clinical data from patient records. A special interface allows access to radiologic images, laboratory results, and related textual information through public-domain software programs. These technologic advances offer medical professionals the convenience and ease of use that have made WWW and Internet navigation so popular in the academic community.
Asunto(s)
Multimedia , Sistemas de Información Radiológica , Redes de Comunicación de Computadores , Programas InformáticosRESUMEN
The development of a hospital wide PACS is in progress at the University Hospital of Geneva and several archive modules are operational since 1992. This PACS is intended for wide distribution of images to clinical wards. As the PACS project and the number of archived images grow rapidly in the hospital, it was necessary to provide an easy, more widely accessible and convenient access to the PACS database for the clinicians in the different wards and clinical units of the hospital. An innovative solution has been developed using tools such as Netscape navigator and NCSA World Wide Web server as an alternative to conventional database query and retrieval software. These tools present the advantages of providing a user interface which is the same, independent of the platform being used (e.g. Mac, Windows, UNIX), and an easy integration of different types of documents (e.g. text, images). A strict access control has been added to this interface. It allows user identification and access rights checking, as defined by the in-house hospital information system, before allowing the navigation through patient data records.
Asunto(s)
Redes de Comunicación de Computadores , Sistemas de Información Radiológica , Sistemas de ComputaciónRESUMEN
The article describes a teleradiology system intended to provide a user-friendly environment for exchanging images and working cooperatively on them. With the development of a hospital-wide picture archiving and communication system (PACS), the University Hospital of Geneva and several other health institutions in the region became interested in teleradiology. Because of the heterogeneous needs of the potential participants, the following requirements were identified: (1) remote consultation and interpretation of images; and (2) cooperative interpretation of medical images, allowing real-time interaction between physicians. To satisfy these needs, a multipoint teleradiology system has been implemented that incorporates an innovative image display and manipulation software program known as OSIRIS, which supports the full spectrum of imaging modalities. Images and data are transmitted over the public telecommunications Integrated Services Digital Network (ISDN). To accommodate different computing environments at the various locations, platform-independent software has been designed that has the same "look and feel" for PC-Windows, Macintosh, and UNIX-X11 work-stations. The teleradiology system can be used in two modes: synchronous (cooperative) or asynchronous. Special efforts have been made in the development of the synchronous mode. Within the European Telemed Project, a specific protocol has been designed to allow cooperative work between remotely located workstations.
Asunto(s)
Geriatría , Hospitales Especializados , Hospitales Universitarios , Relaciones Interinstitucionales , Consulta Remota/organización & administración , Telerradiología/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Sistemas de Información Radiológica/organización & administración , Programas InformáticosRESUMEN
We designed a general-purpose computer program, Osiris, for the display, manipulation, and analysis of digital medical images. The program offers an intuitive, window-based interface with direct access to generic tools. Characterized by user-friendliness, portability, and extensibility, Osiris is compatible with both Unix-based and Macintosh-based platforms. It is readily modified and can be used to develop new tools. It is able to monitor the entries made during a work session and thus provide data on its use. Osiris and its source code are being distributed, free of charge, to universities and research groups around the world.
Asunto(s)
Procesamiento de Imagen Asistido por Computador , Sistemas de Información Radiológica , Programas Informáticos , Microcomputadores , Diseño de SoftwareRESUMEN
A special software package for interactive display and manipulation of medical images was developed at the University Hospital of Geneva, as part of a hospital wide Picture Archiving and Communication System (PACS). This software package, called Osiris, was especially designed to be easily usable and adaptable to the needs of noncomputer-oriented physicians. The Osiris software has been developed to allow the visualization of medical images obtained from any imaging modality. It provides generic manipulation tools, processing tools, and analysis tools more specific to clinical applications. This software, based on an object-oriented paradigm, is portable and extensible. Osiris is available on two different operating systems: the Unix X-11/OSF-Motif based workstations, and the Macintosh family.
Asunto(s)
Presentación de Datos , Diagnóstico por Imagen , Sistemas de Información Radiológica , Programas Informáticos , Redes de Comunicación de Computadores , Gráficos por Computador , Sistemas de Computación , Sistemas de Administración de Bases de Datos , Sistemas de Información en Hospital , Humanos , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Diseño de Software , Interfaz Usuario-ComputadorRESUMEN
With the rapid development of digital imaging modalities in medicine, there is an increasing need for an efficient management and archival of medical images in digital form. Picture Archiving and Communication Systems (PACS) are becoming an essential component of medical imaging equipment, allowing for medical images to be accessed and stored directly in digital form. This paper describes a hospital-wide PACS currently under development at the University Hospital of Geneva, based on an open architecture, regrouping equipment from different vendors in a distributed topology. The image archival is organized in multiple locations geographically distributed in the hospital. The PACS database is fully integrated with the concurrent Radiology Information System (RIS) and Hospital Information System (HIS). A standard image storage format called the PAPYRUS format was developed for the storage of medical images from a variety of imaging modalities. To provide a more uniform user interface on a variety of different workstations, a common platform for image display and manipulation called OSIRIS was developed.
Asunto(s)
Diagnóstico por Imagen , Sistemas de Información Radiológica , Redes de Comunicación de Computadores , Equipos de Almacenamiento de Computador , Sistemas de Computación , Presentación de Datos , Sistemas de Administración de Bases de Datos , Procesamiento de Imagen Asistido por Computador , Sistemas Integrados y Avanzados de Gestión de la Información , Programas Informáticos , Suiza , Interfaz Usuario-ComputadorRESUMEN
A hospital-wide picture archiving and communication system (PACS) project is currently under development at the University Hospital of Geneva. The visualization and manipulation of images provided by different imaging modalities constitutes one of the most challenging component of a PACS. It was necessary to provide this visualization software on a number of types of workstations because of the varying requirements imposed by the range of clinical uses it must serve. The user interface must be the same, independent of the underlying workstation. In addition to a standard set of image-manipulation and processing tools, there is a need for more specific clinical tools that can be easily adapted to specific medical requirements. To achieve this goal, it was elected to develop a modular and portable software called OSIRIS. This software is available on two different operating systems (the UNIX standard X-11/OSF-Motif based workstations and the Macintosh family) and can be easily ported to other systems. The extra effort required to design such software in a modular and portable way was worthwhile because it resulted in a platform that can be easily expanded and adapted to a variety of specific clinical applications. Its portability allows users to benefit from the rapidly evolving workstation technology and to adapt the performance to suit their needs.