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

335 Pages·1992·6.68 MB·English

by  Ph.D., F. P. Ottes, A. R. Bakker, J. M. L. Kouwenberg (auth.), Prof. Dr. Michel Osteaux, A. R. Bakker Prof. Eng., D. Bell Prof. Eng., R. Mattheus M. Sc., D. Meyer-Ebrecht Prof. Eng., S. Orphanoudakis Prof. Ph.D., R. Van de Velde Eng., Th. Wendler Ph.D. (e

Michel Osteaux (Ed.)
A.R. Bakker, D. Bell, R. Mattheus, D. Meyer-Ebrecht,
S. Orphanoudakis, R. Van de Velde, Th. Wendler (Co-editors)
Hospital Integrated Picture Archiving
and Communication Systems ____
A Second Generation
PACS Concept __
With 112 Figures and 23 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Prof. Dr. MICHEL OSTEAUX
Head Radiology Department
Director: Pluridisciplinary Research Institute
for Medical Imaging Science, Academic Hospital,
Vrije Universiteit Brussel, Laarbeeklaan 101,
B-1090 Brussel, Belgium
ISBN-13: 978-3-642-76965-8 e-ISBN-13: 978-3-642-76963-4
DOl: 10.1007/978-3-642-76963-4
Library of Congress Cataloging-in-Publication Data
Hospital integrated picture archiving and communication systems: a second
generation PACS concept/Michel Osteaux (ed.). p. cm. Includes biblio-
graphical references and index. ISBN 0-387-54592-1 (U.S.) 1. Picture archiv-
ing and communication systems in medicine-Congresses. I. Osteaux, M.
(Michel), 1944- . R857.P52H671992 616.07'54'0285-dc20 91-37203 CIP
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Foreword
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
at various stages of implementation, especially in newly con-
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.
In addition to this book, there are currently three other
references available: PACS Handbook, 89, Japanese PACS
Research Association, Japan; Picture Archiving and Com-
munication Systems (PACS) in Medicine NATO ASI Pro-
ceedings, Springer-Verlag, 1991; Integrated Diagnostic Imaging-
Digital PACS in Medicine, Elsevier, 1991. Also, there is a special
PACS issue in the Journal of Computerized Medical Imaging
and Graphics, November, 1991. Each of these references has a
different emphasis, the PACS Handbook, 89 and the Digital
vi Foreword
PACS in Medicine are a collection of PACS papers of various
topics. The PACS in Medicine is a proceedings resulted from
a two week NATO Advanced Study Institute. Professor
Osteaux's book, on the other hand, is a systematic treatment
of a new concept on Hospital Integrated PACS. Its theme is to
stress that PACS can no longer be treated as an imaging
system alone. It has to be integrated to other hospital informa-
tion systems in order for it to be useful and recognized. This
concept along with another new concept "PACS infrastruc-
ture" will, no doubt, lay the foundation for a new era of PACS
research and development.
H.K. HUANG, D.Sc.
Professor
Department of Radiological Sciences
University of California, Los Angeles
Preface
This book presents the results of a multidisciplinary, cooper-
ative project which was jointly undertaken by research teams
from universities, industry, and university hospitals in five
European Community countries. The research consortium was
founded within the Advanced Informatics in Medicine (AIM)
program issued by the Directorate XIII of the Commission
of the European Communities (Research and Technological
Innovation) .
The name of the research project, Hospital Integrated Pic-
ture Archiving and Communication System, (HIPACS), indi-
cates the objective of the study, namely, to make the digital
management of diagnostic imaging pictures effective in the
clinical environment. We deal in detail with the distinct issues
of PACS integration such as medical requirements, communi-
cation with other systems, networking, workstations, data
bases, indexing methods, and standards. We then synthesize a
clear collective view on the architective required of a second-
generation PACS, taking into account the diverse features of
the present state of the art and expected future enhancements
of PACS technology.
The authors wish to thank the AIM team of the Commission
of the European Communities, which, under the leadership of
Dr. Niels Rossing, initiated the formation of a real European
medical informatics community in a friendly and relaxed, but
highly effective manner. This program as a whole induced
fruitful contacts, communication, and collaboration. We thank
"our" HIPACS-AIM officer, Mr. M. Wilson, for his support
and positive advice in our project. We would also like to thank
all other officers of the AIM office, who were always suppor-
tive and gave concrete help when it was needed. The input of
AIM to achieve European standardization-under the leader-
ship of Mr. J. Noothoven van Goor-was particularly import-
ant for the future of our work. We also thank our colleagues
from the other AIM projects for their spirit of collaboration
and useful suggestions which were indeed incorporated into
our general philosophy. HIPACS is only a small part of the
VIII Preface
AIM accomplishments, which are already very substantial.
Finally, it would be unfair not to acknowledge the far-
reaching influence of the knowledge and wide experience
acquired by our colleagues from the United States and Japan
on the work reported here. We wish to express our particular
gratitude to Dr. M. Greberman (CDRH, Food and Drug
Administration), Dr. Seong K. Mun (Georgetown University
Medical Center), and Prof. M. Akisada, chairman of the
Japan Association of PACS for their international spirit of
collaboration.
MICHEL OSTEAUX
Contents
1 Introduction, Definition, and Historical
Background of Picture Archiving and
Communication Systems
F.P. OITES, A.R. BAKKER, and
J .M.L. KOUWENBERG .......... . 1
1.1 Background ........................ . 1
1.2 Description ........................ . 3
1.2.1 Image Entry ........................ . 4
1.2.2 Communication ..................... . 5
1.2.3 Storage ........................... . 5
1.2.4 Data Compression .................... . 6
1.2.5 Presentation ........................ . 6
1.2.6 Data Base Management ................ . 7
1.2.7 Organization and Procedures ............. . 8
1.3 Genesis ........................... . 8
1.4 PACS Research ..................... . 9
1.4.1 Workstations ....................... . 10
1.4.2 Storage Devices ..................... . 11
1.4.3 Network .......................... . 12
1.4.4 Teleradiology ....................... . 12
1.4.5 System Integration ................... . 13
1.4.6 Standardization ...................... . 14
1.4.7 Diagnostic Image Quality ............... . 14
1.4.8 Technology Assessment ................ . 14
1.4.9 PACS Manufacturers .................. . 15
1.5 Clinical Implementation and Evaluation ...... . 15
1.6 Organizations and Conferences ........... . 17
1.6.1 Organizations ....................... . 17
1.6.2 Confer.ences ........................ . 18
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2 Medical Requirements for Clinical Integration
M. OSTEAUX, R. VAN DEN BROECK,
Y. TEMMERMAN, and B. WEIN ............ . 23
2.1 Introduction ........................ . 23
2.1.1 The Clinical Advantages of P ACS Technology .. 23
x Contents
2.2 The Structure of Imaging Activities Within
the Hospital . . . . . . . . . . . . . . . . . . . . . 24
2.2.1 Some Definitions: Radiology, Diagnostic Imaging,
Medical Imaging, Microscopy, Endoscopy ... 24
2.2.2 The Relationship Between Hospital and Its
Diagnostic Imaging Activity: The AZ-Vrije
Universiteit Brussels as a Case Study . . . . . . . .. 26
2.2.3 Flow of Images Produced by the Radiology
Department . . . . . . . . . . . . . . . . . . . . . . . .. 30
2.2.4 The Different User Clusters of Diagnostic Imaging
and Their Specific Needs. . . . . . . . . . . . . . . .. 34
2.3 Medical Requirements in Terms of Access
to Images .......................... 36
2.4 Medical Needs in Terms of Spatial Resolution . .. 37
2.4.1 Spatial Resolution Required for Digital Thorax
Radiology .......................... 38
2.4.2 Digital Skeletal Radiography . . . . . . . . . . . . .. 39
2.4.3 Digital Gastrointestinal Imaging . . . . . . . . . . .. 39
2.4.4 CT and MRI ........................ 40
2.4.5 Ultrasound ......................... 40
2.4.6 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . .. 40
2.5 Medical Needs in Terms of User Friendliness ... 40
2.6 Medical Needs in Terms of Patient Data
Consistency ......................... 41
2.7 Medical Need for Image Manipulation: Image
Compression ........................ 41
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 43
3 Looking for Indicators of a Reference Hospital
H. LODDER, B.M. VAN POPPEL,
and A.R. BAKKER .................... . 45
3.1 Introduction......................... 45
3.2 Questionnaire........................ 45
3.3 Basic Schema of Possible Indicators ......... 46
3.4 Preliminary Results .. . . . . . . . . . . . . . . . . .. 47
3.4.1 Some Results for the Dutch Situation ........ 47
3.4.2 First Steps Outside the Netherlands ......... 51
3.5 Indications for Further Inquiries . . . . . . . . . . .. 52
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 53
4 Communication Between
Hospital and Radiology Information Systems and
Picture Archiving and Communication Systems 55
4.1 Integrated Information Systems in the Hospital
A.R. BAKKER ...................... . 55
Contents xi
4.1.1 Background ....................... . 55
4.1.2 Computers in the Hospital: The Concept
of HIS ........................... . 55
4.1.3 Potential Benefits of HIS: Some Examples ... . 56
4.1.4 Objectives of an HIS ................. . 57
4.1.5 Short History of HIS ................. . 57
4.1.6 Problems Encountered in HIS Realization ... . 58
4.1.7 Approaches to HIS Realization .......... . 58
4.1.8 Realising HIS: Choosing an Approach ...... . 60
4.1. 9 Common Characteristics of HIS .......... . 60
4.1.10 Structure of HIS ............... . 61
4.1.11 IMIA Working Group 10 "Hospital
Information Systems" ............ . 62
4.1.12 Main Obstacles for the Further
Development of HIS ........ . 62
4.1.13 HIS and Data Protection ...... . 64
4.1.14 HIS Workload: A Case Description ........ . 66
4.2 Radiology Information Systems
R. VAN DE VELDE ................... . 67
4.2.1 Introduction ....................... . 67
4.2.2 PACS, HIS and RIS: Natural Couples ...... . 68
4.2.3 Radiology Information Systems .......... . 68
4.2.4 The Relationship of PACS to HIS ......... . 76
4.2.5 Distributed Radiology Systems: A Possible
Architecture . . . . . . . . . . . . . . . . . . . . . . 77
4.3 Integration of PACS, RIS, and HIS
H. LODDER, B.M. VAN POPPEL, and
A.R. BAKKER ................... . 79
4.3.1 Introduction ....................... . 79
4.3.2 Specifications of a Global HIPACS ........ . 83
4.3.3 Decomposition of HIPACS into its Components
HIS, RIS, and PACS ................. . 89
4.3.4 Conclusions and Prospects for
a Second Generation PACS Concept ....... . 96
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
5 Networking ............... . 99
5.1 Image Network Technology
D. MEYER-EBRECHT, A. KEIZERS,
W.J.J. STUT Jr., and F. VOSSEBURGER ........ 99
5.1.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . .. 99
5.1.2 Quantitative Requirements . . . . . . . . . . . . . .. 100
5.1.3 Present State of LANs .................. 104