Table Of ContentWalter Hruby (ed.)
Digital (R)Evolution
in Radiology
Springer-Verlag Wien GmbH
Univ.-Prof. Dr. Walter Hruby
Chairman, Department of Radiology, Danube Hospital, Vienna, Austria
This work is subject to copyright.
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reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machines or similar means, and storage
in data banks.
© 2001 Springer-Verlag Wien
Originally published by Springer-Verlag Wien New York in 2001
Softcover reprint of the hardcover 1st edition 2001
Typesetting: Scientific Publishing Services (P) Ltd., Madras
Printed on acid-free and chlorine-free bleached paper
SPIN: 10796873
With numerous partly coloured Figures
CIP data applied for
ISBN 978-3-7091-3709-3 ISBN 978-3-7091-3707-9 (eBook)
DOI 10.1007/978-3-7091-3707-9
To my children Stephan, Lukas, Lisa, Laura and my wife, Elke,
for their support and understanding
Preface
Three decades have passed since my first personal experiences, influences and contacts with computer ap
plications in the field of medicine. These experiences were influenced by diverse presentations, publications
and seminars concerning various applications of information technology as early as in 1970 (Univac Inter
national Executive Centre, Rome). The first clinical proposals and discussions during the first "World Congress
of Intensive Care Medicine" (London 197 4) strongly impressed me, since they demonstrated that the future of
medicine would be changed rapidly by the use of computer technology.
In 1975, when I started my radiology residency, my clinical and academic interests were focused on two
major topics: (i) interventional radiology and the clinical responsibility of the radiologist for the patient and (ii)
the improvement of radiological services for both the clinician and the patient through the use of digital
technology. These two topics, firstly interventional radiology and, secondly, computer technology along with
all digital techniques developed in respect to examinations and modalities have been the basis for my "per
sonal evolution" of medicine, especially of digital radiology.
In the late 1970s, my interests were focused on how digital modalities such as computertomography, digital
subtraction angiography and the first clinical use of Hospital Information Systems (HIS) and Radiology In
formation Systems (RIS) were the initial changes in the way radiological examinations were performed. More
and more clinical indications for radiological examinations and interventional procedures forced radiologists to
use adequate technology to communicate online i.e. to electronically exchange examinations and reports and
to be virtually available not only near the modalities but in the entire hospital.
In the early 1980s, with the first PACS-Conference (Ronald Arenson, A.J. Duerinckx, Samuel Dwyer Ill,
H.K. Huang, Gerald Qu. Maguire jun. and M.P. Zeleznik), and the establishment of the CAR (Computer
Assisted Radiology) by Prof. H.U. Lemke, I was pleased to know, that the basic technical research work in
telematic technology was shifted to user-driven and user-orientated developments.
In 1988 when all chairmen had been appointed and designated to build the Danube Hospital in the
Sociomedical Care Center East in Vienna, I strongly supported the decision made to design, develop and
implement a filmless digital radiology department in a digital hospital. The aims, goals and objectives of 1988
have remained the same until today: to improve the quality of patient care, to overcome inherent problems of
film-based systems, to improve the efficiency of patient data management, of image acquisition, image dis
tribution, archiving, teaching, research, quality assurance, communication, and to create synergistic effects for
an efficient and sufficient healthcare network. Additionally, to generate online communication and conse
quently integrate dose reduction, decreasing hospitalization time, speeding up the therapeutic reaction time by
speeding up the report turn around time. In summary, to improve radiological services.
From the vision in 1988 to implementation in 1991 and since the opening of the hospital in 1992 until now
(September 2000) 450,000 patients have been admitted to the hospital and 3,500,000 outpatients have been
treated. 1,170,000 patients have undergone radiological examinations and procedures in this film less radiology
department. Since then, many publications, presentations, workshops and many visitors demonstrated that we
went beyond all segments and limitations with dynamic progress to develop the system into an integrated
health care enterprise.
Many people have contributed to the digital (r)evolution in radiology, and it is a great honor as an editor that
most of them contributed to this book. In addition, all the other experts in this field who were not able to
contribute for various reasons have influenced and guided our approach in many common conferences and
personal discussions and visits. Our philosophy of improving the patient-orientated medical care from an
ethical and sociomedical-legal, but also from an "electronic" point of view have been profoundly influenced by
all these events and personal contacts and friendships.
The authors who are outstanding in their clinical and scientific work in digital radiology will share with you
their knowledge and their expertise in the chapters following. Therefore this book consists of profound in
formation provided by these outstanding radiologists and scientists. You will learn a variety of individual and
different steps to transmit and handle the knowledge of information technology, digital radiography, hospital
VIII Preface
information systems, radiological information systems, digital archiving, teleconsultation, virtual reality, the
integrated health care enterprise, the benefits of the World Wide Web and so on.
This book will address a wider audience than only radiologists or physicists, but also hospital adminis
trators, health care consultants, insurance companies, and state and city administrators. Altogether the target
audience consists of all readers reflecting on current trends and future aspects of digital radiology.
In accordance with our Hippocratic oath of improving health care with low risk at reasonable costs this
book should be a little help fur further steps and implementations.
Vienna, September 2000 W. Hruby
Acknowledgements
I wish to express my sincere gratitude to all my staff for the encouragement to pursue this project. I would also
like to express my deep gratitude to Dr. H. Mosser and Dipl.lng. A. Maltsidis for their organizational skills and
their enthusiasm, since their initial editing provided the framework for the entire book. I also want to ac
knowledge the superb editing and extraordinary patience of Mr. Petri-Wieder and Dr. Kienast of Springer
Verlag. I want to offer special thanks to all authors who spontaneously accepted to contribute to this book and
delivered their chapters professionally, well-prepared and on time.
It is a pleasure to express my long-standing gratitude to the Administration of the City of Vienna, the Mayor of
Vienna Dr. M. Haupl, the former Mayor of Vienna Dr. H. Zilk, city councilor Dr. Rieder, and the hospital
administration of Vienna, Prof. Hauke and Dr. Kaspar.
I owe thanks to all my scientific friends who also supported the Ludwig Boltzmann Research Institute for
Digital Radiography and lnterventional Radiology (Prof. N. Vanier, Prof. H.U. Lemke, Prof. H.K. Huang, Prof.
U. Pokieser, Prim. Dr. W. Brandtner, Prof. Dr. Bandion). Furthermore, I must express my thanks to Ronald
L. Arenson, Prof. Cell, Donald V. Smith from the PACS and the CAR community. For all the encouragement
and support from Prim. Univ. Prof. Dr. K.H. Tragi, RR W. Reinagl, the Board of Chairman at the Danube
Hospital and all my staff members, my gratitude.
I would like to take this opportunity to extend my thanks to the secretary of the department, Mrs. Wimmer, and
for the preparation of the manuscripts Mrs. Maierschmidt.
Above alii would like to express my love and sincere thanks to my children Stephan, Lukas, Lisa, Laura and
my wife, Elke, for their understanding and support and their way of dealing with my busy clinical, scientific,
administrative and congress schedule.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII
Introduction (W. Hruby) ............................................................ .
Basics of digital radiology
Basics of computer technology and digital imaging (W. Krampla) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Internet in medicine: source of a new reality? (S. Hermann) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
PACS 2000+ from networks to workflow and beyond (S. Bocionek) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Planning digital radiology: practical approaches
Request for proposal for PACS and evaluation of tenders (H. U. Lemke, H. Heuser, T. Pollack, and
W. Niederlag) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Radiology information systems in the digital hospital (G. Gel/) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Radiology information system and picture archiving and communication system: interfacing and
integration (0. Piraino) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Horizontal PACS deployment in an integrated system (0. Edmunds, R. Khorasani, and P. Ros) . . . . . . . . 57
Going filmless in a new hospital setting (G.D. Hurley and D.P. Mcinerney) . . . . . . . . . . . . . . . . . . . . . . . 65
Large PACS projects (S. Peer, R. Peer, and W. }aschke) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
A view to the past of the future- A decade of digital (r)evolution at the Danube hospital (W. Hruby and
A. Maltsidis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Applications using new digital technologies
Workflow
Reporting from monitors (R. Mayrhofer and G. P;:i"rtan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Synergy effects of a high-end 3D-workstation within a digital environment (M. Deutschmann) ........ 109
Medical reporting using speech recognition (T. Ybinger, W. Appel, and W. Kumpan) . . . . . . . . . . . . . . . 111
Physiological tests and functional diagnosis with digital methods (R. Rienmliller and U. Reiter) . . . . . . . . 119
Image fusion (W. Backfrieder, R. Hanel, M. Diemling T. Lorang,}. Kettenbach and H. Imhof) ....... 131
Expanding the digital revolution to anthropology (W. Recheis, G. W. Weber, K. Scha"fe( H. Seidler, and
D. zur Nedden) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
PMDA- Personal Medical Digital Assistants Mobile computing in medical environments (N. Schaefer) . 149
Information Technology (IT) in radiology tele-consultation (W./. Wieser) ......................... 155
Teleconsultation in medicine and radiology- theory and legal aspects (W. Hruby) ................. 161
Practical applications of digital radiology
Digital fluororadiography (G. Padan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Practical aspects of computed radiography (CR) (G. Padan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 75
Digital radiology in chest imaging (B. Partik and C. Schaefer-Prokop) . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Digital pediatric radiology (K. Gindl) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
The therapeutic value of mapping and 3D modeling of cartilage lesions in the knee (K.-H. Kristen and
A. Engel) ....................................................................... 211
Experiences and future aspects of neuronavigation (W. Pfisterer and E. Knosp) .................... 223
F-18-FDG PET in Oncology (P. Lind and 0. Unterweger) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Digital revolution in cardiac imaging (0. Ratib) ............................................ 247
From single slices to volume imaging: (r)evolution in computed tomography (A.F. Kopp, K. Klingenbeck-
Regn, B. Ohnesorge, and C. D. Claussen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
XII Contents
New advances for imaging of laryngotracheal stenosis by post processing of spirai-CT data (E. Sorantin,
C. Halmai, B. Erdhelyi, L. Martonossy, K. Palagy, and B. Geiger) ............................ 275
Current development and economic issues
Flat panel detectors- closing the (digital) gap in chest and skeletal radiology (K.}. Reiff) ............. 289
Scanhead technology (H. Schaller) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Economic aspects of digital radiology (W. Reinag/) ......................................... 301
Investing in PACS using real option theory (W. Rueger) ...................................... 307
Epilogue
Virtual reality- symbiosis of science and art (R. Bulirsch and M. Hardt) ......................... 317
