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Picture archiving and communication system: prospective study.

OBJECTIVES: To evaluate the use of a picture archiving and communication system and user satisfaction in order to further improve its quality. DESIGN: Prospective study. SETTING: Medical college hospital, Japan. MATERIALS AND METHODS: An automated computerised method was used to collect the data from March 1999 to February 2000. MAIN OUTCOME MEASURES: Each workstation automatically recorded data on the rank of the user, purpose of use, use of postprocessing tools, and user satisfaction. RESULTS: The number of resident users in the radiology reading room increased and those outside the reading room decreased, but the number of staff users changed little. The purpose of use and the use of postprocessing functions in the reading room were not significantly different from those outside it (P=0.179 and P=0.269, respectively). The average numbers of images accessed to per workstation monthly in the reading room, the general practice ward, and the gastroenterology ward were 1081, 970 and 741, respectively. Only 12 images in the orthopaedic surgery out-patient clinic and 70 images in the orthopaedic surgery ward, however, were accessed per month. The percentages of satisfied users decreased both inside and outside the reading room. The degree of satisfaction of users in the reading room was significantly different from that outside it (P=0.004). The most common reason for dissatisfaction was the length of time necessary to retrieve images. CONCLUSIONS: It is necessary to shorten response times of picture archiving and communication system workstations. Repeated data collection and evaluation, however, are also important.

Hospital Departments↗

Integrating postprocessed functional MR images with picture archiving and communication systems.

We describe a method of converting postprocessed functional MR images to the Digital Imaging and Communications in Medicine (DICOM) standard and sending these DICOM images directly into any picture archiving and communication system (PACS) or stand-alone DICOM database. This method provides system-wide access and archiving of previously research-only applications, it permits the clinical review of postprocessed data on DICOM-compliant workstations, and it can be used to move functional MR data onto intraoperative neuronavigational workstations for surgical guidance. The procedure can be used with any MR postprocessed dataset, and it can be extended to other imaging modalities.

Computer Communication Networks↗

A project plan for construction and cabling of picture archiving and communication system network.

OBJECTIVE: To determine a network solution to meet the network requirements of the heavy data flow, load balance, and potential network storms from expansion of picture archiving and communication system (PACS) application. METHODS: Intel Netstructure 480T Giga Switch was used as the main switch and connected to each building by fiber channel at 1 Giga speed to archive 100 MB/s to each port. At the same time, the in-dependence of the original network construction was physically kept. The layer 3 and 4 switchers were used as load balance to reduce the heavy load of the network, and all the cabling for PACS used the super CAT5 along with the Intel NetStructure 1520 to prepare for potential network storms. RESULTS: An advanced intranet was set up to fully meet the high standard requirement of the PACS. The foundation for upgrading the whole network system to 1 Giga application was built to achieve sharing and transmission of images, information, and patient data within the hospital. The base was established for the standardized management of the hospital. CONCLUSION: Good planning is the first step in setting up PACS, and the equipment forms the necessary platform to run PACS and all kinds of hospital information system (HIS). The networking construction is the foundation of e-hospital.

Computer Communication Networks↗

Detection of human papillomavirus type 16 DNA sequences in archival cervical tissues by the polymerase chain reaction.

We have evaluated the polymerase chain reaction for the detection of viral DNA sequences in paraffin-embedded archival tissues. In 63 frozen cervical biopsy specimens that were taken from premalignant and invasive lesions, Southern blotting detected human papillomavirus (HPV) type 16 DNA in 28 (44%) of the samples. In the polymerase chain reaction analysis of the formalin-fixed, paraffin-embedded mirror biopsy specimens, 46 (73%) of the tissues were found to be positive for HPV type 16. In three Southern blotting-positive cases, the DNA of the paraffin-embedded sections was too scant or too degraded to allow the detection of HPV DNA by the polymerase chain reaction. In 21 Southern blotting-negative cases, HPV type 16 DNA could be demonstrated in the archival sections by the polymerase chain reaction technique--a sensitivity improvement of more than 80% over the standard method of HPV detection in tissues.

Base Sequence↗

Estrogen and progesterone receptor detection in archival formalin-fixed, paraffin-embedded tissue from breast carcinoma: a comparison of immunohistochemistry with the dextran-coated charcoal assay.

The steroid receptor (estrogen (ER) and progesterone receptor (PR] status was studied in 94 cases of invasive breast carcinoma from three separate institutions. All cases had fresh tissue examined for ER and PR by the dextran-coated charcoal cytosolic assay (DCC), and each case was examined immunohistochemically for ER and PR from archival formalin-fixed, paraffin-embedded tissue. Immunohistochemical assays (IH) were reviewed blinded to the DCC results and scored in a semiquantitative fashion prior to comparison to the DCC results. Overall, there was agreement between DCC and IH in 89% of ER and in 87% of PR assays. Some 50% of the ER discorrelations were of the IH-positive DCC-negative type, while 27% of the PR discorrelations were of this type. In four cases, both ER and PR did not correlate between IH and DCC determinations, with two being IH (ER and PR) positive and DCC negative, and two of the opposite type. The results of the study show that steroid receptor assays performed on routinely processed formalin-fixed archival material are reliable and closely recapitulate the results of traditional biochemical assays. Results suggest that, in the cases where IH is positive while DCC is negative, the IH result may actually provide a more reliable receptor status of the tumor than does the DCC result. Semiquantitation of fixed tissue IH assays shows a trend toward quantitative correlation with DCC results, but this correlation is weak, and factors concerning fixation and processing are most likely to be responsible.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗

Distance learning on the Internet: web-based archived curriculum.

Web-based education through archived educational modules offers a significant opportunity to provide didactic education. By archiving lectures and teaching materials, it reduces the educators' time of preparation, especially when many students will need to take the same curriculum over a long period of time. The site can package educational material in multiple formats including audio, video, and readable text, allowing the student to tailor the educational experience to his/her learning preferences. This can be a stand-alone program, or integrated into a program combining distance and in-person education. Assessment through on-line tests can also be conducted, but these must be considered open-book assessments where collaboration cannot be prevented. As such, this vehicle can be utilized effectively for continuing education programs in health care, where open book is permitted and credits are generally awarded on the honor system. However, tests for certificate courses should only be given with a proctor in attendance. In this instance, on-line tests can be used as pre-tests for the student, while being structured to enhance further learning.

Computer-Assisted Instruction↗

Picture archiving and communication system--Part one: Filmless radiology and distance radiology.

Picture archiving and communication system (PACS) is a collection of technologies used to carry out digital medical imaging. PACS is used to digitally acquire medical images from the various modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and digital projection radiography. The image data and pertinent information are transmitted to other and possibly remote locations over networks, where they may be displayed on computer workstations for soft copy viewing in multiple locations, thus permitting simultaneous consultations and almost instant reporting from radiologists at a distance. Data are secured and archived on digital media such as optical disks or tape, and may be automatically retrieved as necessary. Close integration with the hospital information system (HIS)--radiology information system (RIS) is critical for system functionality. Medical image management systems are maturing, providing access outside of the radiology department to images throughout the hospital via the Ethernet, at different hospitals, or from a home workstation if teleradiology has been implemented.

Hospital Information Systems↗

Comparison of archival plasma and formalin-fixed paraffin-embedded tissue for genotyping in hepatocellular carcinoma.

Biobanks containing formalin-fixed paraffin-embedded tissue, as well as frozen serum or plasma, are important resources for molecular epidemiologic studies. However, few studies have compared the reliability of formalin-fixed tissue samples and archival plasma samples for genotyping. We determined the genotype of four proposed genetic risk factors for hepatocellular carcinoma [hereditary hemochromatosis (HFE 63 and 282), alpha(1)-antitrypsin deficiency (AAT 342) and cystic fibrosis (CFTR 508)] on formalin-fixed tissue samples, stored for up to 25 years, from 318 patients diagnosed with hepatocellular carcinoma and on plasma or serum samples from 31 of these patients. The genotypes were analyzed by RFLP or allele-specific amplification as well as by TaqMan assays. In addition, genotyping was attempted after whole genome amplification by multiple displacement amplification (MDA). Genotyping was successful in 94% of the tissue samples and successful and identical to the tissue samples from the same subjects in 98% of the plasma/serum samples. DNA from plasma samples could be amplified >5,000-fold by MDA and genotyping after MDA gave identical results to the genotyping of the same subjects before whole genome amplification. MDA amplification of the tissue samples was not successful. In summary, archival plasma was found to be an adequate source of efficiently amplifiable DNA. MDA on plasma samples allows analysis of multiple genotypes in epidemiologic studies.

Carcinoma, Hepatocellular↗

Androgen & vitamin D nuclear receptor expression in archival breast tumour samples.

BACKGROUND & OBJECTIVE: Breast tumour cells have receptors for androgen and vitamin D and their clinical significance is not completely understood. Therefore, the present study was undertaken to analyze androgen and vitamin D receptor levels in human primary infiltrating ductal breast carcinomas (IDC) and benign breast tumour archival samples and to find out their correlation, if any, with the clinical findings. METHODS: Paraffin blocks of benign and malignant breast tumours were sectioned, deparaffinized, and nuclei released by pepsin digestion. After antigen retrieval, nuclei were stained with primary antibodies for androgen or vitamin D receptors and secondary fluorescein isothiocyanate (FITC) labeled antibodies and propidium iodide respectively, to quantitative receptor expression and DNA content by flow cytometry. RESULTS: Androgen receptor positive nuclei ranged from 16-66 per cent in the IDC tumours as compared to 36-67 per cent in the benign tumours. Based on flow cytometric comparison of AR expression in AR positive and negative cell lines established earlier, 24 of 28 tumours from postmenopausal women were AR positive compared to all benign tumours and 32 of 33 tumours from pre-menopausal patients. Vitamin D receptor positive nuclei ranged from 14-89 and 2-75 per cent in IDC and benign tumours, respectively. All pre- or post-menopausal tumours were VDR positive as compared to 10 of 15 benign tumours that were VDR positive. No correlation was seen between nuclear androgen and vitamin D receptor expression of the IDC or benign tumours. There was a positive correlation between per cent of receptor positive nuclei and antigen density as measured by ratio of the mean log fluorescence channel value (MFC). No statistically significant correlation was found between nuclear receptor expression (per cent positive nuclei or antigen density) with that of tumour stage, lymph node status, tumour grade, patient age or menopausal status. INTERPRETATION & CONCLUSION: There was no significant correlation between androgen or vitamin D receptor expression and clinical findings. The expression of AR and VDR and the antigen density in the nuclei of the archival breast tumour samples were highly variable because of the tumour heterogeneity. Future studies with fresh biopsy samples of tumour on AR and VDR levels and their up- or down-regulation may be useful while stratifying the patients for hormonal therapy.

Adult↗

Archival analysis of p53 genetic and protein alterations in Chinese esophageal cancer.

A strategy and methods for archival analysis of genetic and protein alterations in the p53 tumor-suppressor gene are presented. The tumor series includes 43 paraffin-embedded esophageal carcinomas from two high-incidence regions in the People's Republic of China. More than half contained elevated p53 protein levels which were detected by a high-titer polyclonal antiserum and a sensitive immunohistochemical method. To estimate the frequency of underlying mutations, DNA was isolated from conventional paraffin sections, amplified by the polymerase chain reaction, and examined by dideoxy termination sequencing. Analysis of exons 5-8 in a subset of 10 tumors revealed mis-sense point mutations in 4 out of 5 immunostain-positive tumors and a mutation encoding a stop codon in 1 of 5 immunostain-negative tumors. In this report of archival material, we conclude that detectable levels of p53 protein correlate closely with the occurrence of mis-sense mutations. Furthermore, these methods render large repositories of paraffin-embedded tumor and non-tumor tissues accessible to analysis. Immunohistochemical screening for elevated protein levels followed by sequence analysis represents an efficient strategy for the evaluation of the p53 mutational spectrum.

Adenocarcinoma↗

Digital imaging and picture archiving and communication systems.

Great progress has been made in digital imaging of the chest. Most studies are dealing with computed radiography. Chest radiography in the intensive care unit may, in most cases, be performed using computed radiography. However, subtle pulmonary interstitial disease can be demonstrated less confidently using computed radiography. Significantly better detection of calcified lung nodules can be obtained by using simplified single-exposure dual-energy technique that uses storage phosphor. The wide latitude of computed radiography permits images of high quality in areas other than chest radiography. Encouraging results are presented especially in the diagnostic evaluation of scoliosis and other musculoskeletal abnormalities. An important technical innovation in digital radiography is an improved method for single-exposure dual-energy digital imaging using prefiltration with gadolinium, a cassette consisting of four photostimulable phosphor plates, spatially dependent scatter and beam hardening corrections, and noise reduction algorithm. Other groups tested algorithms for enhancement of digital images that allowed significant data compression. The implementation of picture archiving and communication systems (PACS) is inevitable; the question concerning PACS implementation is not why, but when. A comparison of the cost-effectiveness of PACS with conventional film archiving and communication systems shows that PACS should provide indirect savings when regarding the hidden costs of conventional systems. Much more experience will be needed before there is general agreement on the best design for the radiologist's workstation. Teleradiology should contribute to radiologic consultation for remote locations, because it improves the efficacy of management of patients in such locations.

Child↗

Chest radiography in the intensive care unit. Indications for radiography and effects of selective archiving of films.

Consecutive chest radiographs (n = 2,303) in 601 patients in the intensive care units (ICU) were analyzed with regard to main disease and indication. Two thirds of the patients were transferred for routine post-operative treatment, 14 per cent mainly for cardiopulmonary insufficiency. The remainder were referred because of various clinical conditions. The main indications for chest radiography were routine radiographic follow-up and/or control of the position of catheters, tubes, drainages etc. (50%). Obvious clinical indications appeared in only about 1/4 of the patients. When the patients were discharged from the ICU all chest radiographs were analyzed with regard to their predicted future value. Films considered not worth storing were removed and stored in a separate archive (57%). During a 15-month follow-up period none of the removed films were requested, indicating that a substantial number of films can be sorted out continuously. The possibility to reduce and to 'clinically compress' the amount of data in a future digital picture archive is emphasized.

Humans↗

[Description of an acquisition, management and archiving system for digital images].

The authors present a digitalizing and archiving system, for radiologic pictures. This system is composed by a camera, a microcomputer (MacIntosh II) with a digitalizing card and a great capacity optical disk (WORM) for storage. Acquiring and archiving are automatically driven by a special soft. The principal qualities of this system are simplicity for the user, speed and low cost.

Hospital Information Systems↗

[PACS (picture archiving and communication systems) or the future workplace of the radiologist].

PACS (picture archiving and communication systems) is a synonym for the replacement of the traditional photographic film by means of technologies that will communicate and store images exclusively in digital form. Digital mass storage will replace the film archives and will be linked to all image sources by means of a data communication network. More significantly, PACS will also introduce a novel type of image-evaluation modality, the diagnostic image work station. Images will be displayed on TV monitors. In addition, a variety of support functions will become available for image handling and processing. The replacement of the light box by a digital work station will definitely cause dramatic changes in the radiologist's work.

Germany, West↗

[DACS--a cost-advantageous nuclear medical document archiving and communication system].

A simple and inexpensive solution for the complete digital management of a nuclear medical institution is presented. The starting point was provided by five different gamma cameras, one of which was equipped with a PC-based ICON computer. The remaining cameras were first adapted to ICONs and subsequently integrated into a Macintosh LAN, of 15 computers, allowing the entire image acquisition, processing, interpretation, documentation and archiving to be performed on the same comfortable menu-guided surface. Complete patient management is accomplished by a specific commercially available data base to which a specially developed image and document archive was connected. The system described provides complete digital management without the conventional filing systems at the moderate price of approximately DM 11 x 10(4) plus the cost of the new camera computers.

Computer Graphics↗

Detection of clonal immunoglobulin heavy chain gene rearrangements by polymerase chain reaction in scrapings from archival hematoxylin and eosin-stained histologic sections: implications for molecular genetic studies of focal pathologic lesions.

Using a simple scraping technique to obtain DNA directly from archival hematoxylin and eosin-stained slides, we successfully amplified clonal immunoglobulin heavy chain gene rearrangements (IGR) from lymphomatous infiltrates, as small as 1 mm2. The fragments amplified by the polymerase chain reaction (PCR) were identical in size to those from corresponding whole unstained sections freshly cut from the paraffin-embedded blocks. Using this technique, we detected clonal IGR from the scraping of a small lymphomatous nodule in the colon, although no amplified fragments were detected from the whole section. Furthermore, we demonstrated that two morphologically different areas in a case of B-cell lymphoma have identical amplified fragments. It is important that no amplified fragments were detected in scrapings from adjacent nonneoplastic areas. Although DNA recovered from scrapings was partially degraded, fragments as large as 725 base pairs were successfully amplified from a slide stored more than 11 years. This technique thus allows detection of clonal IGR in tissues focally involved by B-cell lymphoma and molecular genetic studies of focal pathologic lesions as an alternative to in situ hybridization or in situ PCR. Finally, this technique can be applied to archival slides when tissue blocks are not available.

Base Sequence↗

Detection of keratinocyte growth factor (KGF) transcripts from normal human and archival canine benign prostatic hyperplastic tissues.

This study examined the expression of keratinocyte growth factor (KGF) gene in human and canine prostatic tissues. KGF transcript was detected in normal human prostatic tissues by reverse transcription and polymerase chain reactions (RT-PCR). PCR-generated human KGF complementary DNA (cDNA) clone was confirmed by restriction enzyme digestion analysis and partial DNA sequencing. Expression of KGF in archival canine benign prostatic hyperplastic tissues was also examined. In a pilot experiment, RNAs isolated from formalin-fixed (FF) and formalin-fixed and paraffin-embedded (FFPE) canine prostatic tissues were shown to be of sufficient quality to permit amplification of KGF mRNA by RT-PCR. The transcript of a housekeeping gene, glucose-6-phosphate dehydrogenase (G6PD), was detected by RT-PCR indicating the quality of RNAs to be more than adequate for RNA expression analysis. Later, total RNA from two archival canine FF prostate tissue types, benign prostatic hyperplasis and mild glandular hyperplasia, were used to amplify canine KGF transcripts. Southern hybridization analysis using rat and human KGF cDNAs as probes confirmed the fidelity of the amplified PCR product and it was indeed canine KGF.

Animals↗