Download Analog Images

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Medical Imaging
Digital Imaging
Image or Magic ???
Analog Images
Analog vs. Digital Image
New Paradigm
Moving from traditional
film-screen(analog)
toward electronic media
In electronic imaging
the functional parts of
conventional radiology
have been separated:
 Image Capture ,
Storage & Display
Digital System
Film
Developed
And
Fixed
Detector
Reading
Digital
Processing
Stored
PACS
Viewed
Display
QC of the digital systems is an additional requirement
– in addition to the usual x-ray performance tests
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Image Characteristics
Each pixel is assigned a
numeric value
(bit depth) that represents
a shade of gray based
on the attenuation
characteristics of the
volume of tissue
imaged
Advanced Applications
Multiplanar Navigation
MIP
Conventional PACS
Archiving
Media
Hospital
Diagnostic
Modality
PACS
Server
Archiving
Device
Modern View on PACS
 PACS is the “Imaging” part of Healthcare Information and
Communication Technology (HICT). Can be integrated
into EPR via RIS/HIS.
 The coverage is virtual location independent: Intra- and
Multi-site working area of PACS. More than radiology
alone.
 Technological basis: “PACS rides many horses” from
web-based light PACS to dedicated performant systems
is depending on the customer’s wishes and needs.
Historical Evolution
 80-ties: MODALITY PACS = CT & MRI
radiologists,advanced 3D systems.
 90ties: departmental PACS + RIS = film-less
radiology and organ-based radiology specialties, film
still used documents in clinics. Cost-effective??
 >2000: Enterprise-PACS+RIS+PACS = film-less
hospitals.
 >2007: Newest achievements: Multi-site PACS using
MPI (Master Patient Index) to allow the patient’s
access on all sites
 Hospitals will skip historical steps and adopt to state
of the art PACS and HIS.
Parallel evolution of all PACS
2012
functions 1980
PICTURES
Archiving
Communication
2D
tapes
ATM, video
Represent 5D
datasets
SAN/NAS/grids
Internet/web/
Wifi
Systems
Hardware +
show an image
Functionality+
knowledge
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Patient arrives
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Study ordered and scheduled
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2
HIS
Report
transcription
ADT
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4
Order/schedule
status notification
Report
status
notification
RIS
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Modality
7
Report
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Connectivity Manager
Workflow Management
Study
status notification
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Report approval
Modality worklist
5
Order/schedule
status notification
10a
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Verification
Report
status notification
PACS
QC
Pre-fetching (images)
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10
8
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Image store
Diagnostic review and
report dictation
Patient is examined
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Images to long term archive
1Ob Images wavelet
compressed by curator
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In hospital, Out hospital Distribution
Non diagnostic review
Information systems in the hospital workflow
 HIS (Hospital Information System)
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Central administration and financial system of the hospital
Keeps the central patient registration
patient identification
holds the demographic data
HIS
HL7
 RIS (Radiology Information System)
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Dedicated radiology information system, taking care of
exam ordering
exam planning
study reporting
passing billing related information

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not automatically included
not available for every country
RIS
HL7
Connectivity Manager
Holds the study information
 PACS (Picture Archiving and Communication System)
Dedicated system for archiving and
communication of study related images
 Communicates with the outside world
DICOM

PACS
Information exchange standards
 HL7 (Health Level 7)
 Provides standards for the exchange, management and integration of
data that support clinical patient care and for the management,
delivery and evaluation of healthcare services.
E.g. patient demographics, appointment schedules, insurance
policies, financial transactions, clinical data, clinical treatment plans,
observation reports, …
 DICOM (Digital Imaging and Communication in Medicine)
 DICOM is a standard, to enable efficient and flexible integration and
communication of image data between components (modalities,
printers, storage, databases, …) in a medical network
However: DICOM does not guarantee the interoperability of systems
that claim to be DICOM conformant
Translate HIS/RIS messages (e.g. HL7) to DICOM
PACS Connectivity Services (Connectivity Manager)
PV1||E|TRAUMA|A||||^DOE
^JOHN^W.^DR.^|||WAITING
ROOM
RIS
???
CM
Do you speak
DICOM ?
Image acquisition Objective
• Consolidation of image data information provided by multiple
sources
• Multi-modality (MRI, CT, Ultrasound…)
• Multi-Vendor
How ?
• DICOM gateway : Paxport (for non DICOM modalities)
• Film scanner
Image data storage and archiving
• Storage (.dcm files)
•Type of media (disks, UDO, LTO)
•Everything on line solutions, nearline, off-line
• Data compression
• Data availability
PACS Architecture
RIS
Internal &
External
Clients
Database
HIS
Application
Server
Connectivity
Manager
Workflow
Manager
Curator
Modality
Archive
Server
Web Viewer
Webserver
At Modality
PACS Viewing
Station
PACS and Network
Workstation 1
Workstation 2
…..
Hub Switch
Workstations
RAID
CD/DVD Robot
Archive
PACS Beyond Radiology
 Other Types of Images:

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Vascular Angiography
Cardiac Angiography
Echocardiography
Obstetric Ultrasound
Medical Photography
Retinal Imaging
Colposcopy / Cytology…..
 May be more of a RIS Issue than PACS
New Advances
Imaging Informatics Laboratory
The Bottom Line
• Modern Image Processing
• Automated CAD with interpretation and reporting
• Portable medical records – perhaps imbedded in patient
• Integrated RIS-PACS-HIS through I.T.
• Robotic imaging
• Molecular Imaging
• Image guided chemotherapy and gene therapy
• ………….
Take Home Point:
Beyond Bytes & Bits :
Healthcare IT ;
When needed , Where needed
Integrated & Enterprise
Take Home Point:
Healthcare IT ;
Beyond one person , one
department , one ….. , it is across
…
It needs collaboration ,
communication & decision making
THANK YOU
FOR YOUR
NICE
ATTENTION