A Second Generation PACS Concept : Hospital Integrated Picture Archiving and Communication Systems

The term picture archiving and communications system (PACS) was initiated during the first International conference and workshop on the topic sponsored by The International Society for Optical Engineering (SPIE) in Newport Beach, California in 1982. The research and development (R&D) progress for PACS has been slow until 1988. The earlier PACS modules were mostly off the shelf components connected together to solve a very specific clinical problem. The three major players in PACS R&D are the European countries, United States of America, and Japan. For various reasons, the European coun­ tries concentrated in modeling and simulation, U.S.A. pre­ ferred in-house development or purchased PACS modules from a manufacturer, whereas Japan organized the PACS as a national project. Between 1989 and 1990 PACS R&D took a dramatic positive turn. Large scale P ACS projects were planned and some are of implementation, especially in newly con­ at various stages structed hospitals. Examples are the Hokkaido University, Japan; Hammersmith Hospital, United Kingdom; Social and Medical Center East (SMZO), Vienna, Austria; the U.S. Armed Force Medical Diagnostic Imaging Support (MDIS) project; and the UCLA Medical Plaza ambulatory care center. Another phenomenon is the organization of the EC-countries which provides a tremendous impetus for the European PACS R&D efforts. This book "Hospital Integrated Picture Archiving and Communication Systems: edited by Professor M. Osteaux and others is a direct product from these efforts.

1 Introduction, Definition, and Historical Background of Picture Archiving and Communication Systems.- 1.1 Background.- 1.2 Description.- 1.2.1 Image Entry.- 1.2.2 Communication.- 1.2.3 Storage.- 1.2.4 Data Compression.- 1.2.5 Presentation.- 1.2.6 Data Base Management.- 1.2.7 Organization and Procedures.- 1.3 Genesis.- 1.4 PACS Research.- 1.4.1 Workstations.- 1.4.2 Storage Devices.- 1.4.3 Network.- 1.4.4 Teleradiology.- 1.4.5 System Integration.- 1.4.6 Standardization.- 1.4.7 Diagnostic Image Quality.- 1.4.8 Technology Assessment.- 1.4.9 PACS Manufacturers.- 1.5 Clinical Implementation and Evaluation.- 1.6 Organizations and Conferences.- 1.6.1 Organizations.- 1.6.2 Conferences.- References.- 2 Medical Requirements for Clinical Integration.- 2.1 Introduction.- 2.1.1 The Clinical Advantages of PACS Technology.- 2.2 The Structure of Imaging Activities Within the Hospital.- 2.2.1 Some Definitions: Radiology, Diagnostic Imaging, Medical Imaging, Microscopy, Endoscopy.- 2.2.2 The Relationship Between Hospital and Its Diagnostic Imaging Activity: The AZ-Vrije Universiteit Brussels as a Case Study.- 2.2.3 Flow of Images Produced by the Radiology Department.- 2.2.4 The Different User Clusters of Diagnostic Imaging and Their Specific Needs.- 2.3 Medical Requirements in Terms of Access to Images.- 2.4 Medical Needs in Terms of Spatial Resolution.- 2.4.1 Spatial Resolution Required for Digital Thorax Radiology.- 2.4.2 Digital Skeletal Radiography.- 2.4.3 Digital Gastrointestinal Imaging.- 2.4.4 CT and MRI.- 2.4.5 Ultrasound.- 2.4.6 Conclusion.- 2.5 Medical Needs in Terms of User Friendliness.- 2.6 Medical Needs in Terms of Patient Data Consistency.- 2.7 Medical Need for Image Manipulation: Image Compression.- References.- 3 Looking for Indicators of a Reference Hospital.- 3.1 Introduction.- 3.2 Questionnaire.- 3.3 Basic Schema of Possible Indicators.- 3.4 Preliminary Results.- 3.4.1 Some Results for the Dutch Situation.- 3.4.2 First Steps Outside the Netherlands.- 3.5 Indications for Further Inquiries.- References.- 4 Communication Between Hospital and Radiology Information Systems and Picture Archiving and Communication Systems.- 4.1 Integrated Information Systems in the Hospital.- 4.1.1 Background.- 4.1.2 Computers in the Hospital: The Concept of HIS.- 4.1.3 Potential Benefits of HIS: Some Examples.- 4.1.4 Objectives of an HIS.- 4.1.5 Short History of HIS.- 4.1.6 Problems Encountered in HIS Realization.- 4.1.7 Approaches to HIS Realization.- 4.1.8 Realising HIS: Choosing an Approach.- 4.1.9 Common Characteristics of HIS.- 4.1.10 Structure of HIS.- 4.1.11 IMIA Working Group 10 “Hospital Information Systems”.- 4.1.12 Main Obstacles for the Further Development of HIS.- 4.1.13 HIS and Data Protection.- 4.1.14 HIS Workload: A Case Description.- 4.2 Radiology Information Systems.- 4.2.1 Introduction.- 4.2.2 PACS, HIS and RIS: Natural Couples.- 4.2.3 Radiology Information Systems.- 4.2.4 The Relationship of PACS to HIS.- 4.2.5 Distributed Radiology Systems: A Possible Architecture.- 4.3 Integration of PACS, RIS, and HIS.- 4.3.1 Introduction.- 4.3.2 Specifications of a Global HIPACS.- 4.3.3 Decomposition of HIPACS into its Components HIS, RIS, and PACS.- 4.3.4 Conclusions and Prospects for a Second Generation PACS Concept.- References.- 5 Networking.- 5.1 Image Network Technology.- 5.1.1 Introduction.- 5.1.2 Quantitative Requirements.- 5.1.3 Present State of LANs.- 5.1.4 Network Requirements for PACS Applications.- 5.1.5 ImNet: Specialized Image Network for PACS.- 5.2 Network Management.- 5.2.1 Why Network Management?.- 5.2.2 PACS Architecture.- 5.2.3 PACS Network Management Kernel.- 5.2.4 Network Model.- 5.2.5 Traffic Manager.- 5.2.6 Flow Manager.- 5.2.7 Simulator.- 5.2.8 Case Study AZ-VUB.- 5.2.9 Conclusion.- 5.3 Potential Benefits and Critical Issues of Prefetching.- 5.3.1 Introduction.- 5.3.2 A Model of Prefetching.- 5.3.3 The Algorithm and its Effectiveness.- 5.3.4 Pilot Study of Potential Effectiveness in Leiden University Hospital.- 5.3.5 Design of the Prefetch Component.- 5.3.6 Suggestions for the Second Generation of PACS.- References.- 6 Digital Image Workstations.- 6.1 Workstation Design Considerations.- 6.1.1 User Interfaces to Picture Archiving and Communication Systems.- 6.1.2 Workstation Design in the Transition to Fully Digital Imaging Departments.- 6.1.3 Methodology for the Design of User-Friendly Digital Image Workstations.- 6.1.4 Elements of Image Workstation User Interfaces.- 6.1.5 Technical Design Considerations.- 6.2 Adaptive User Interfaces for PACS Image Workstations.- 6.2.1 Why Adaptive User Interfaces?.- 6.2.2 State of the Art in Adaptive User Interface Design.- 6.2.3 Scenario for Adaptive, Co-operative PACS Workstations.- 6.2.4 Sources of Evidence for the Adaptation Process.- 6.2.5 Context-Sensitive Models of Diagnostic Information Requirements.- 6.2.6 Architectures for Implementing Adaptive PACS Workstations.- 6.2.7 Discussion and Perspective for Future Work.- 6.2.8 Acknowledgement.- References.- 7 Data Bases.- 7.1 Distributed Multimedia Data Base Systems.- 7.1.1 Introduction.- 7.1.2 Starting Point.- 7.1.3 Multimedia Data Bases.- 7.1.4 An Architecture for MMIP.- 7.1.5 Linking HIS and Image Data Bases Using These Architectures.- 7.1.6 Open Issues of Working Systems.- 7.2 Distributed Image Archival.- 7.2.1 Introduction.- 7.2.2 Analysis of the Current Situation.- 7.2.3 A Generic Concept for Distributed Digital Image Archives.- 7.3 Image Indexing by Content.- 7.3.1 Introduction.- 7.3.2 Image Representation.- 7.3.3 The Object-Oriented Approach.- 7.3.4 Image Retrieval.- 7.3.5 Description of the System Model.- 7.3.6 Evaluation.- 7.3.7 Possible Enhancements of the System.- 7.3.8 Conclusions.- References.- 8 Standardization.- 8.1 Trends.- 8.1.1 The Information Technology Industry.- 8.1.2 The Need for Standards.- 8.1.3 Open System Approach.- 8.1.4 Functional Profiles.- 8.1.5 Key Elements for Standardization.- 8.1.6 Decomposition of the Imaging Standard.- 8.2 Formal European Standardization Bodies.- 8.2.1 CEN/CENELEC.- 8.2.2 CENTC 251: Medical Informatics.- 8.3 European Bodies Promoting Standardization.- 8.3.1 European Workshop for Open Systems.- 8.3.2 X/Open.- 8.3.3 European Community Framework Programme.- 8.3.4 European Committee for Recommendations and Standards in Computer Aspects in Diagnostic Imaging.- 8.3.5 European Co-operation in the Field of Scientific and Technical Research.- 8.4 Standardization Actions Related to Medical Informatics and Imaging.- 8.4.1 Food and Drug Administration.- 8.4.2 American National Standardization Institute.- 8.4.3 Medical Data Interchange Committee.- 8.4.4 American Society for Testing and Materials E31 Committee.- 8.4.5 Health Level Seven Group.- 8.4.6 Open Document Architecture.- 8.4.7 EDIFACT.- 8.5 Standardization Actions for Medical Image Interchange.- 8.5.1 ACR/NEMA.- 8.5.2 Medical Image Processing System RC 109.- 8.5.3 Image Save and Carry Committee.- 8.5.4 Standard Product Interconnect.- 8.6 Conclusion.- References.- 9 Second Generation PACS Concept: A Global View.- 9.1 The First Generation PACS: Reasons for Their Failure.- 9.2 The New Generation: Medically Determined PACS Concept.- 9.3 Adaptive User Interface.- 9.4 Distributed Data Base.- 9.5 Integrated PACS/HIS/RIS Environment.- 9.6 Prefetching.- 9.7 Intelligent Distribution of Images: Knowledge-Based Networking.- 9.8 Modular Architecture; Phased Approach.- 9.9 Conclusion.