Table Of ContentPictorial Information Systems in Medicine
NATO ASI Series
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Series F: Computer and Systems Sciences Vol. 19
Pictorial Information Systems
in Medicine
Edited by
Karl Heinz Hahne
Institute of Mathematics and Computer SCience In Medicine
University of Hamburg, MartlnlstraBe 52
2000 Hamburg 20, Federa Republic of Germany
Springer-Verlag Berlin Heidelberg New York Tokyo
Published Ir' cooperatlO1 with NATO SCientific Affairs DIvIsion
Proceedings of the NATO Advanced Study Institute on Pictorial Information Systems in
Medicine held in Braunlage/FRG, August 27-September 7,1984
ISBN-13 978-3-642-<'l2386-2 e-ISBN-13 978-3-642-<'l2384-8
OOI10.10071978-3-642-<'l2384-8
Library of Congress Cataloging in Publication Data. NATO Advanced Study Institute on Pictorial Information Systems
In Medicine (t 984 Braunlage, Germany) Pictorial information systems in medicine. (NATO ASI series. Series F,
Computer and systems sciences, vo!. 19) "Proceedings of the NATO Advanced Study Institute on Pictorial
Information Systems in Medicine, held in Braunlage/FRG, August 27 -September 7,1984"-Tp. verso. "Published in
cooperation with NATO Scientific Affairs Division." Includes bibliographies. 1.lmaging systems in medicine-Data
processing-Congresses. 2. Computer graphics-Congresses.!. Hahne, K. H. (Karl-Heinz), 1937-.11. North Atlantic
Treaty Organization. SCientific Affairs Division. III. Title. IV. Series NATO ASI series. Series F, Computer and system
sciences, no. 19. [DNLM 1 Computers-congresses. 2. Information Systems-congresses. 3. Medicine-con
gresses. 4. Technology, Radlologlc-Instrumentation-congresses. W 26.5 N279p 1984J R85706N38 1984
610'28'5 85-32111
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© Springer-Verlag Berlin Heidelberg 1986
Softcover reprint of the hardcover 1s t edition 1986
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1m ge data b se
psychovisu I is ues
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expert y t m
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computer graphic
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man-m chine
data compre sion interaction
Preface
This volume contains the proceedings of the NATO Advanced Study Institute on "Pictorial Information
Systems in Medicine" held August 27-September 7, 1984 in Hotel Maritim, Braunlage/Harz, Federal
Republic of Germany. The program committee of the institute consisted of KH Hohne (Director), G.T
Herman, G. S. Lodwick, and D. Meyer-Ebrecht. The organization was in the hands of Klaus Assmann and
Fritz Bocker
In the last decade medical imaging has undergone a rapid development New imaging modalities
such as Computer Tomography (CT), Digital Angiography (DSA) and Magnetic Resonance Imaging
(MRI) were developed using the capabilities of modern computers. In a modern hospital these
technologies produce already more then 25% of image data in digital form. This format lends itself to the
design of computer assisted Information systems Integrating data acquisition, presentation, communi
cation and archiving for all modalities and users within a department or even a hospital. Advantages such
as rapid access to any archived Image, synoptic presentation, computer assisted image analysis to
name only a few, are expected.
The design of such pictorial information systems, however, often called PACS (Picture Archiving and
Communication Systems) In the medical community is a non-trivial task involving know-how from many
disciplines such as
- Medicine (especially Radiology),
- Data Base Technology,
- Computer Graphics,
- Man Machine Interaction,
- Hardware Technology and others.
Most of these disCiplines are represented by disjunct scientific communities. It was the aim of the
meeting to get experts In the different fields together to review the fundamentals, to identify the problems
and to discuss the possible solutions.
It was an experiment without any guarantee of success. Would the participants talk to each other?
Would they understand their different terminologies? The organizers felt a lot of relief when they
recognized a few days after the beginning of the meeting that the communication really succeeded.
The lectures and discussions of the institute fell Into quite heterogenous categories. Starting from the
fact that the design of pictorial Information systems certainly requires a careful analysis of the users
needs on one hand and the special properties of the Imaging modalities on the other, G. S. Lodwick
looked at the task from the radiologists view, while S. Nudelman gave a detailed review of the specific
properties of the different Image aqulsition devices.
The following paper of A R. Bakker on hospital informatIOn systems was important for the following
reason When bUilding PACS it IS not only necessary to include know-how from hospital Information
system methodology, in fact PACS will not be of any value without a link to a patient information system.
D. Meyer-Ebrecht followed In presenting his ideas on developing architectures for pictorial information
systems in medicine.
Some of the most striking new possibilities opened up by digital imaging techniques are new kinds of
image presentation such as 3D-displays. G. T Herman reviewed this topic based on his long experience
in this field, S. M. Pizer complemented his talk with an overview of 3D-imaging hardware. The large variety
of available display techniques offered by Image processing and computer graphics raises the new
VIII
question of which is the optimal presentation. S. M. Pizer therefore also discussed the psychovisual
issues in the display of medical images.
There is no doubt that a pictorial information system will not be successful unless it is as easy to use as
a conventional film reading environment. The design of a suitable man machine interface is already non
trivial in general purpose computing. Man machine communication problems become even more
severe when pictorial data are included. J. Nievergelt covered therefore the various issues in the design
of man machine interfaces.
In addition complex systems such as pictorial information systems cannot be designed without
appropriate software tools. J. W. Schmidt reported on novel concepts for supporting data intensive data
base applications. K. Assmann and K. H. Hahne presented an implemented experimental programming
environment for pictorial data management as a possible software solution.
Although the problem of designing systems, that can compete with the conventional image handling,
is not yet solved, it is tempting to take a look into the future. While present PACS attempts deal with patient
and pictorial data, future systems will also make use of knowledge about image interpretation, thus
assisting the physician in the diagnostic process. I. Hoffmann gave a review of the state-of-art in the field
of knowledge-based and expert systems.
The lecturer's papers were complemented by papers contributed by participants. Yet not all aspects
could be discussed in depth. So the institute did not discuss very much the more technological aspects
of storage and communication technology. Suitable hardware will certainly be developed by the
engineers because it is also required urgently for other data intensive applications aside from medical
imaging. The problem of image standardization was not covered. Although its solution is not trivial, it was
not considered a scientific topic for this meeting.
One remarkable effect of the institute was the formation of a new interdisciplinary scientific community.
As a visible result, EUROPACS, an association of European PACS researchers was founded during the
meeting.
Many people contributed to the success of this institute. I am very grateful to the members of my
department for their continuous help in the preparation of the meeting. The organizers would also like to
express their gratitude to Dr. C. Sinclair, NATO Scientific Affairs Division, for his support and Dr. Tilo Kester,
Intemational Transfer of Science and Technology, for the help in the logistics. Last, but not least, the
organizing committee would like to thank all the lecturers and participants, upon whose enthusiasm and
technical expertise the institute was based.
Hamburg, September 1985 Karl Heinz Hahne
Table of Contents
Long Papers
Radiological Background
G.S. LODWICK, Pictorial Information Systems and Radiology Improving the Quality of Com
munications
1 Introduction 1
2. Radiology Information management and costs 5
3. File management 7
4. Communications problems with refernng physIcians 10
5. How can we Improve communications in Radiology? 11
6. Advantages of PACS 19
7 Conclusions 24
References 25
S. NUDELMAN, Image Acquisition Devices and Their Application to Diagnostic Medicine 29
Introduction 29
Devices and applications 31
1. light and photoelectronlc imaging devices 31
a. Types 31
b. Applications 39
2. X-ray Imaging devices and systems for radiology 46
a. Shadowgraphs 46
b. Device structures 48
c. Subtraction Imaging 56
References 98
Information System Aspects
A R. BAKKER, Integrated Hospital Information Systems . 105
1. On data In a hospital and their use 106
2. The concept HIS and ItS position ir the hospital 108
3. Integratior, 113
4. Application of a HIS 114
5. Performance aspects 117
6. Data protection aspects 123
7. An example of a HIS 126
8 Costs of a hospital Information system 131
9. Benefits and evaluation 136
10. Lessons to be learned 137
x
11. On the relations between a HIS and a PACS 140
12. Further HIS developments and problems involved 141
References 148
D. MEYER-EBRECHT, On the Architecture for Pictorial Information Systems 151
BasIc ideas on Architecture 151
The particular role of architecture in the medical Image domain 153
A modelling concept 157
An overall PACS philosophy 161
A hierarchical image mass storage concept 164
A unifying image coding concept 167
A modular image processor architecture for high power work stations 169
References 179
Aspects of Image Presentation
GT HERMAN, Three-Dimensional Computer Graphic Display In Medicine: The MIPG Perspec-
tive 181
Introduction 181
Discrete 3D scenes 185
Objects and their surfaces 187
Surface detection of 1-objects in binary scenes 192
Display of object surfaces 193
Recent advances in the cuberille approach 196
The computer program 3083 . 198
Summary 206
References 208
S. M. PIZER, Psychovisual Issues in the Display of Medical Images 211
1. Introduction 211
2. Spatial issues of display 212
3. Intensity issues of display 217
4. Other visual dimensions: Motion and 3D 230
5. Summary . 232
References 232
S. M. PIZER, Systems for 3D Display in Medical Imaging 235
1. Introduction 235
2. Reflective display systems 237
3. Self-luminous display systems 242
4. Conclusion 247
References 248
Computer Science Tools
J. NIEVERGEL T, Issues in the Design of Human-Computer Interfaces 251
1. The computer-driven screen as a communications medium 253
2. Survey and classification of errors 253
3. An interactive system as seen by the user 255
4. Is a standard man-machine interface possible? 259
XI
5. Programming the man-machine interface 261
References 262
JW SCHMIDT, W LAMERSDORF, Programming Support for Data-Intensive Applications 263
1 Introduction database programming 263
2. A programmer's approach to the relational model of data 264
3. Some high level language constructs for relations 268
4. Support for database Integrity, recovery and concurrency 274
5. Requirements for compound object modelling 278
6. Extended constructs for compound object definition 282
7. Extended constructs for compound object operation 286
8. Concluding remarks 288
References 289
I. HOFMANN, H. NIEMANN, G. SAGERER, Knowledge-Based and Expert Systems: Represen
tation and Use of Knowledge . 293
1 Introduction 294
2. An overview of knowledge-based and expert systems 297
3. Representation and use of knowledge 306
4. A speCial application: a pictorial knowledge-based system 315
5. Results and future aspects 326
References 329
K. ASSMANN, R. VENEMA, K. H. HOHNE, Software Tools for the Development of Pictorial
Information Systems in Medicine - The ISOL Experience -
1. Objectives and Problems 333
2. The ISOL Approach 336
3. PACS - Functions, Concepts and Realization with the tooilSOL . 340
1. Integration into the departmental or hospital organization 340
2. Management of images 344
3. Human computer communication 345
4. User environments 348
5. Further developments 350
6. Software properties of the tool ISOL 352
4. Conclusion 352
References 353
First Experiences
D.F. PRESTON, S.J. DWYER, WH. ANDERSON et ai, Experience with a Prototype PACS
System in a Clinical EnVIronment 357
On-line radiology networking 357
Daily generation of digital data 358
Daily requirements of digital transmission 359
Interactive diagnOSIs display station 360
Hard copy recording. 361
Long-term archiving 361
PACS standards 362
Summary 363
References 364
