Table Of ContentPACS
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Springer Science+Business Media, LLC
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KE IT H J. 0R E YE R
AMIT MEHTA
JAMES H. THRALL
EDITORS
Springer
Keith J. Dreyer, DO, PhD
Amit Mehta, MD
James H. Thrall, MD
Department of Radiology
Massachusetts General Hospital
Boston, MA 02114, USA
Library of Congress Cataloging-in-Publication Data
Dreyer, Keith J.
PACS : a guide to the digital revolution / Keith J. Dreyer, Amit Mehta, James H. Thrall
p. cm.
Includes bibliographical references and index.
ISBN 978-1-4757-3653-3 ISBN 978-1-4757-3651-9 (eBook)
DOI 10.1007/978-1-4757-3651-9
1. Picture archiving and communication systems in medicine. 2. Diagnostic imaging.
I. Mehta, Amit. II. Thrall, James H. III. Title.
R857.P52 D74 2002
616.07'54-dc21 2001032835
Printed on acid-free paper.
© 2002 Springer Science+Business Media New York
Originally published by Springer-Verlag New York, Inc. in 2002
Softcover reprint of the hardcover 1s t edition 2002
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sibility for any errors or omissions that may be made. The publisher makes no warranty, express
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9 8 7 6 5 432 1
SPIN 10838544
To my parents and family who have always sup
ported my efforts, my friends who have provided
the humor, and my colleagues who have inspired
and taught.
AM
To my close friends and family who have always
been there through the years.
KJD
To my wife Jean, who manages information tech
nology in our household and my children, Trevor
and Keely, who have joined me in working in the
digital world.
JHT
PREFACE
R
adiologists have held a vision for
practicing in an all-digital environ
ment for well over twenty-five years. Now, as we enter the twenty-first cen
tury, radiology has progressed to the point where we have achieved the re
ality of this vision, and we are well underway toward an even larger goal-the
all-digital healthcare enterprise.
The achievement of an all-digital radiology practice requires the ac
quisition of images in digital form, and the ability to view, archive, and trans
mit digital image data sets on a large scale, as well as the ability to interact
with activities outside of departments of radiology by digital means. By bene
ficial coincidence at the time of this publication, all radiological modalities
are now either intrinsically digital (MRI, CT, PET) or have been modified
to allow direct digital image capture (nuclear medicine, ultrasound, con
ventional radiography, angiography, and mammography). This front-end
digital acquisition capability sets the stage for the creation of the all-digital
radiology department. This book begins with the capture of the digital im
age and encompasses all of the events from that point to completion of the
radiological process.
•
Preface
While radiologists have been working toward the all-digital depart
ment, remarkable parallel developments have occurred in enterprise infor
mation systems and the networking capability that enables electronic inter
change between departments of radiology and all other departments and
services within a hospital or healthcare system. For twenty years, the dream
in radiology focused on the ability to acquire digital images and manage
them within departments of radiology. The challenge today-in the age of
the Internet-has been extended to the integration of radiological activities
with the rest of the care process across healthcare systems.
Leading institutions now offer clinicians the capability to use electronic
order entry systems on their desktops, with autorouting of radiological re
quests through the hospital information system to the radiology informa
tion system. This is followed by further autorouting of study data to the rel
evant imaging device, then transmission of image data sets to the PACS for
soft copy interpretation using voice recognition, and finally return of the
image data sets and reports to the physician's desktop through connectivity
from the RIS and PACS to the hospital information system and electronic
medical record. When all of the elements are in place, the entire process
occurs as an unbroken series of events protecting the integrity of patient
data through electronic connectivity.
Picture Archiving and Communications Systems (P ACS) are now part
of the fundamental technological infrastructure supporting radiology prac
tice in the digital age. Every radiologist and every department will be touched
by the concepts embodied in PACS. Even those who do not become experts
in the arcana of PACS will be well served to have a working knowledge of
fundamental design elements and deployment strategies. Thus, this book is
intended to provide information necessary for radiologists, computer scien
tists, and administrative personnel to understand PACS from a technical
perspective, and to see its substantial potential benefits in the management
of the departments of radiology and the delivery of image-based healthcare
servIces.
We are all embarked on an exciting adventure as the practice ofradi
ology is being redefined in the digital era. We wish our readers success in
their undertakings with the hope that this book provides useful information
of both a theoretical and practical nature to help guide them along the way.
CONTENTS
PREFACE vii
SECTION I INTRODUCTORY CONCEPTS
INTRODUCTION 3
Amit Mehta
2 FINANCIAL MODELING 9
Syrene R. Reilly and David Avrin
SECTION II COMPUTING FUNDAMENTALS 29
3 COMPUTING FUNDAMENTALS 31
J.
Keith Dreyer
4 NETWORKING FUNDAMENTALS 41
Scott M. Rogala
5 DICOM 73
David A. Clunie and John A. Carrino
•
Contents
SECTION III ADVANCED IMAGING TECHNOLOGIES 121
S IMAGE ACQUISITION 123
Katherine P. Andriole
7 IMAGE WORKFLOW lSI
Eliot L. Siegel and Bruce Reiner
8 WORKSTATIONS 191
Steven C. Horii
9 STORAGE AND ARCHIVES 237
Douglas Tucker and Amit Mehta
10 IMAGE COMPRESSION 257
Stephen Mann
II VOICE RECOGNITION 281
Amit Mehta
12 ENTERPRISE IMAGING 303
J.
Keith Dreyer
13 TELERADIOLOGY 315
James H. Thrall and Giles Boland
SECTION IV FUTURE OPPORTUNITIES 349
14 LEGAL ISSUES AND FORMAL POLICIES 351
John J. Smith and Harry Zibners
15 RESEARCH AND EDUCATION 375
David Avrin
IS MEDICAL UTILIZATION AND MANAGEMENT 395
Robert T. Bramson
CONTRIBUTORS 415
INDEX 419
[[J
INTRODUCTORY
CONCEPTS
