Table Of ContentPACS‐Based Multimedia Imaging Informatics
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PACS‐Based Multimedia Imaging Informatics
Basic Principles and Applications
Third Edition
H.K. Huang, D.Sc., FRCR (Hon), FAIMBE
Professor Emeritus of Radiology and Biomedical Engineering
University of Southern California
Honorary Professor, Shanghai Institute of Technical Physics
Chinese Academy of Sciences
Former Chair Professor of Medical Informatics
Hong Kong Polytechnic University
Former Professor
University of California, San Francisco
Former Professor
University of California, Los Angeles
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This edition first published 2019
© 2019 John Wiley & Sons, Inc.
Edition History
Wiley‐Blackwell (2e, 2010)
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Set in 10/12pt Warnock by SPi Global, Pondicherry, India
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To my wife, Fong, for her support, understanding, and help.
To my daughter, Cammy, for her growing wisdom, ambitious spirit, and an established career.
To my grandchildren Tilden and Calleigh, for their calming innocence.
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vii
Contents in Brief
Foreword 1 xxix
Foreword 2 xxxi
Foreword 3 xxxiii
Preface to the Third Edition xxxv
Preface to the Second Edition xxxix
Acknowledgments xliii
H.K. Huang Short Biography xlv
List of Acronyms xlvii
Part 1 The Beginning: Retrospective 1
1 Medical Imaging, PACS and Imaging Informatics: Retrospective 3
Part 2 Medical Imaging, Industrial Guidelines, Standards, and Compliance 37
2 Digital Medical Imaging 39
3 PACS Fundamentals 97
4 Industrial Standards: Health Level 7 (HL7), Digital Imaging and Communications
in Medicine (DICOM) and Integrating the Healthcare Enterprise (IHE) 123
5 DICOM‐Compliant Image Acquisition Gateway and Integration of HIS, RIS,
PACS and ePR 155
6 Web‐Based Data Management and Image Distribution 179
7 Medical Image Sharing for Collaborative Healthcare Based on IHE XDS‐I Profile 191
Part 3 Informatics, Data Grid, Workstation, Radiotherapy, Simulators, Molecular Imaging,
Archive Server, and Cloud Computing 215
8 Data Grid for PACS and Medical Imaging Informatics 217
9 Data Grid for Clinical Applications 233
viii Contents in Brief
10 Display Workstations 253
11 Multimedia Electronic Patient Record (EPR) System in Radiotherapy (RT) 291
12 PACS‐Based Imaging Informatics Simulators 325
13 Molecular Imaging Data Grid (MIDG) 347
14 A DICOM‐Based Second-Generation Molecular Imaging Data Grid (MIDG)
with the IHE XDS‐i Integration Profile 365
15 PACS‐Based Archive Server and Cloud Computing 389
Part 4 Multimedia Imaging Informatics, Computer-Aided Diagnosis (CAD),
Image-Guide Decision Support, Proton Therapy, Minimally Invasive
Multimedia Image-Assisted Surgery, Big Data 417
Prologue – Chapters 16, 17 and 18 417
16 DICOM-Based Medical Imaging Informatics and CAD 419
17 DICOM‐Based CAD: Acute Intracranial Hemorrhage and Multiple Sclerosis 435
18 PACS‐Based CAD: Digital Hand Atlas and Bone Age Assessment of children 463
19 Intelligent ePR System for Evidence‐Based Research in Radiotherapy 503
20 Multimedia Electronic Patient Record System for Minimally Invasive
Image‐Assisted Spinal Surgery 525
21 From Minimally Invasive Spinal Surgery to Integrated
Image‐Assisted Surgery in Translational Medicine 559
22 Big Data in PACS‐Based Multimedia Medical Imaging Informatics 575
Index 591
ix
Contents
Foreword 1 xxix
Foreword 2 xxxi
Foreword 3 xxxiii
Preface to the Third Edition xxxv
Preface to the Second Edition xxxix
Acknowledgments xliii
H.K. Huang Short Biography xlv
List of Acronyms xlvii
Part 1 The Beginning: Retrospective 1
1 Medical Imaging, PACS and Imaging Informatics: Retrospective 3
PART I TECHNOLOGY DEVELOPMENT AND PIONEERS 4
1.1 Medical Imaging 4
1.1.1 The Pattern Recognition Laboratory and Professor Robert S. Ledley 4
1.1.2 The ACTA: The Whole Body CT Scanner 8
1.1.3 Dr Ledley’s Lifetime Accomplishments 8
1.2 PACS and its Development 8
1.2.1 PACS 8
1.2.2 The Department of Radiological Sciences and the Biomedical Physics Graduate
Program 10
1.2.3 Professor Moses Greenfield 11
1.2.4 Professor Hooshang Kangarloo 12
1.2.5 The Image Processing Laboratory (IPL) at UCLA 13
1.3 Key Technologies: Computer and Software, Storage, and Communication Networks 15
1.3.1 The VAX 11/750 Computer System 15
1.3.2 Multiple Display Controller 15
1.3.3 Hierarchical Storage System 16
1.3.4 Personal Image Filing System 16
1.3.5 Image Compression 16
1.3.6 Laser Film Printer for X‐Ray Images 16
1.3.7 Asynchronous Transfer Mode (ATM) Communication Technology 17
1.4 Key Technologies: Medical Imaging Related 17
1.4.1 Laser Film Scanner 17
1.4.2 Computed Radiography (CR) 17
1.4.3 Direct Digital Input from CR to PACS 18
x Contents
1.4.4 Digital Radiography 20
1.4.5 Interactive Display with Multiple Monitors 20
PART II COLLABORATIONS AND SUPPORTS 22
1.5 Collaboration with Government Agencies, Industry and Medical Imaging
Associations 22
1.5.1 The US Government Agencies 22
1.5.2 The Netherlands National Foundation and the UCLA PACS 23
1.5.3 The NATO Advanced Science Institute (ASI) and the UCLA PACS 23
1.5.4 Collaboration of the UCLA Team with the US Medical Imaging Industry 25
1.5.5 Japan Medical Imaging Technology and the UCLA PACS 26
1.5.6 SPIE, EuroPACS, CARS and UCLA PACS Team 27
1.5.6.1 SPIE 27
1.5.6.2 EuroPACS 28
1.5.6.3 CARS 29
1.5.7 Patents and Copyrights 29
1.6 Medical Imaging Informatics 29
1.6.1 Biomedical Informatics 29
1.6.2 The 1970s Concept: Chromosome Karyotyping 30
1.6.3 Medical Imaging Informatics Today 30
1.7 Summary 32
1.7.1 The Golden Era of Medical Imaging Technology Research Support 32
1.7.2 After the First 10 Years of PACS 33
1.7.3 The PACS End Users 33
1.7.4 The Diligent Contributors 34
1.8 Acknowledgments 34
References 35
Part 2 Medical Imaging, Industrial Guidelines, Standards, and Compliance 37
2 Digital Medical Imaging 39
2.1 Digital Medical Imaging Fundamentals 39
2.1.1 Digital Image 39
2.1.2 Digital Medical Image 40
2.1.3 Image Size 40
2.1.4 Image Display 40
2.1.5 Density Resolution, Spatial Resolution, and Signal‐To‐Noise Ratio 41
2.1.6 Radiology Workflow 44
2.2 Two‐Dimensional Medical Imaging 46
2.2.1 Conventional Direct Digital 2‐D Projection Radiography 46
2.2.2 Examples of the CR (Computed Radiography) Systems 46
2.2.3 Full-Field Direct Digital Mammography 46
2.2.3.1 Screen/Film Cassette and Digital Mammography 46
2.2.3.2 Slot‐Scanning Full‐Field Direct Digital Mammography 47
2.2.4 Nuclear Medicine Imaging 48
2.2.4.1 Principles of Nuclear Medicine Scanning 48
2.2.4.2 The Gamma Camera and Associated Imaging System 51
2.2.5 Two‐Dimensional (2‐D) Ultrasound Imaging (US) 51
2.2.5.1 B‐Mode (Brightness) Ultrasound Scanning 51
2.2.5.2 Sampling Modes and Image Display 52
Contents xi
2.2.5.3 Color Doppler Ultrasound Imaging 53
2.2.5.4 Cine Loop Ultrasound 53
2.2.6 Two‐Dimensional (2‐D) Light and Endoscopic Imaging 54
2.2.6.1 2‐D Light Imaging 54
2.2.6.2 2‐D Endoscopic Imaging 54
2.3 Three‐Dimensional Medical Imaging 55
2.3.1 Two‐Dimensional Transmission X‐Ray Computed Tomography (CT)
from 1‐D Projections 55
2.3.2 Transmission X‐Ray Computed Tomography (3D‐CT) 58
2.3.2.1 Convention Transmission X‐Ray Computed Tomography (CT) 58
2.3.2.2 Whole Body CT Scan 59
2.3.2.3 Components and Data Flow of a 3‐D CT Scanner 59
2.3.2.4 CT Image Data 60
2.3.3 Emission Computed Tomography (ECT) 61
2.3.3.1 Single Photo Emission CT: Rotating Camera System 63
2.3.3.2 Positron Emission Tomography (PET) 65
2.3.4 Three‐Dimensional Ultrasound Imaging (3‐D US) 68
2.3.5 Magnetic Resonance Imaging (MRI) 68
2.3.5.1 MRI Basics 68
2.3.5.2 Magnetic Resonance Image Production 69
2.3.5.3 Steps in Producing an MRI 70
2.3.5.4 MR Imaging (MRI) 71
2.3.5.5 Other Types of Images from MR Signals 72
2.3.6 3‐D Fluorescence Confocal Microscopy: Light Imaging 76
2.3.7 3‐D Micro Imaging and Small Animal Imaging 76
2.4 Four‐Dimensional, Multimodality, and Fusion Imaging 78
2.4.1 Basics of 4‐D, Multimodality, and Fusion Medical Imaging 78
2.4.1.1 From 3‐D to 4‐D Imaging 78
2.4.1.2 Multimodality 3‐D and 4‐D Imaging 79
2.4.1.3 Image Registration 82
2.4.1.4 Image Fusion 82
2.4.1.5 Display of 4‐D Medical Images and Fusion Images 82
2.4.2 4‐D Medical Imaging 83
2.4.2.1 4‐D Ultrasound Imaging 83
2.4.2.2 Selected Data from 4‐D X‐Ray CT Imaging 83
2.4.2.3 4‐D PET‐CT Imaging 85
2.5 Image Compression 85
2.5.1 Some Terminology 85
2.5.2 Acceptable Compression Ratio 87
2.5.3 The Wavelet Transform Method 88
2.5.3.1 2‐D Wavelet Transform 90
2.5.3.2 3‐D Wavelet Transform 90
2.5.3.3 Examples of 3‐D Wavelet Transform 91
Further Reading 93
3 PACS Fundamentals 97
3.1 PACS Components and Network 97
3.1.1 PACS Components 97
3.1.2 Data and Image Acquisition Gateways 98
xii Contents
3.1.3 PACS Server and Archive 99
3.1.4 Display Workstations 99
3.1.5 Application Servers 100
3.1.6 System Networks 100
3.2 PACS Infrastructure Design Concept 101
3.2.1 Industry Standards 101
3.2.2 Connectivity and Open Architecture 102
3.2.3 Data Reliability 102
3.2.4 Security 103
3.3 Generic PACS‐Based Multimedia Architecture and Workflow 103
3.4 PACS‐Based Architectures 105
3.4.1 Stand‐Alone PACS‐Based Model and Data Flow 105
3.4.1.1 Advantages 105
3.4.1.2 Disadvantages 106
3.4.2 PACS‐Based Client–Server Model and Data Flow 106
3.4.2.1 Advantages 106
3.4.2.2 Disadvantages 107
3.4.3 Web‐Based Model 107
3.4.4 Teleradiology Model 108
3.4.4.1 Pure Teleradiology Model 108
3.4.4.2 PACS and Teleradiology Combined Model 109
3.4.5 Enterprise PACS‐Based Multimedia and ePR System with Image
Distribution 110
3.5 Communication and Networks 110
3.5.1 Network Standards – OSI and DOD 110
3.5.2 Network Technology 113
3.5.2.1 Ethernet and Gigabit Ethernet 113
3.5.2.2 ATM (Asynchronous Transfer Mode) Technology 115
3.5.2.3 Wireless Networks 115
3.5.2.4 Ethernet and Internet 116
3.5.2.5 Internet 2 117
Further Reading 121
4 Industrial Standards: Health Level 7 (HL7), Digital Imaging and Communications
in Medicine (DICOM) and Integrating the Healthcare Enterprise (IHE) 123
4.1 Industrial Standards 124
4.2 The Health Level 7 (HL7) Standard 124
4.2.1 Health Level 7 124
4.2.2 An Example 125
4.2.3 The Trend in HL7 126
4.2.3.1 Benefits 127
4.2.3.2 Challenges 127
4.3 From ACR‐NEMA to DICOM 127
4.3.1 ACR‐NEMA and DICOM 127
4.3.2 Digital Imaging and Communications in Medicine (DICOM 3.0) 128
4.3.3 DICOM Standard PS 3.1 ‐ 2008 128
4.3.4 DICOM Supplements 129
4.4 DICOM 3.0 Standard 129
4.4.1 DICOM Data Format 129
4.4.2 DICOM Model of the Real World 129
