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Validating DICOM content in a remote storage model.

Verifying the integrity of DICOM files transmitted between separate archives (eg, storage service providers, network attached storage, or storage area networks) is of critical importance. The software application described in this article retrieves a specified number of DICOM studies from two different DICOM storage applications; the primary picture archiving and communication system (PACS) and an off-site long-term archive. The system includes a query/retrieve (Q/R) module, storage service class provider (SCP), a DICOM comparison module, and a graphical user interface. The system checks the two studies for DICOM 3.0 compliance and then verifies that the DICOM data elements and pixel data are identical. Discrepancies in the two data sets are recorded with the data elements (tag number, value representation, value length, and value field) and pixel data (pixel value and pixel location) in question. The system can be operated automatically, in batch mode, and manually to meet a wide variety of use cases. We ran this program on a 15% statistical sample of 50,000 studies (7500 studies examined). We found 2 pixel data mismatches (resolved on retransmission) and 831 header element mismatches. We subsequently ran the program against a smaller batch of 1000 studies, identifying no pixel data mismatches and 958 header element mismatches. Although we did not find significant issues in our limited study, given other incidents that we have experienced when moving images between systems, we conclude that it is vital to maintain an ongoing, automatic, systematic validation of DICOM transfers so as to be proactive in preventing possibly catastrophic data loss.

Computer Communication Networks↗

The strategic and operational characteristics of a distributed phased archive for a multivendor incremental implementation of picture archiving and communications systems.

The long-term (10 years) multimodality distributed phased archive for the Medical Information, Communication and Archive System (MICAS) is being implemented in three phases. The selection process took approximately 10 months. Based on the mandatory archive attributes and desirable features, Cemax-Icon (Fremont, CA) was selected as the vendor. The archive provides for an open-solution allowing incorporation of leading edge, "best of breed" hardware and software and provides maximum flexibility and automation of workflow both within and outside of radiology. The solution selected is media-independent, provides expandable storage capacity, and will provide redundancy and fault tolerance in phase II at minimum cost. Other attributes of the archive include scalable archive strategy, virtual image database with global query, and an object-oriented database. The archive is seamlessly integrated with the radiology information system (RIS) and provides automated fetching and routing, automated study reconciliation using modality worklist manager, clinical reports available at any Digital Imaging and Communications in Medicine (DICOM) workstation, and studies available for interpretation whether validated or not. Within 24 hours after a new study is acquired, four copies will reside within different components of the archive including a copy that can be stored off-site. Phase II of the archive will be installed during 1999 and will include a second Cemax-Icon archive and database using archive manager (AM) Version 4.0 in a second computer room.

Computer Communication Networks↗

Integrating HIS-RIS-PACS: the Freiburg experience.

With the integration of different formerly isolated information systems, such as Hospital Information System (HIS). Radiology Information System (RIS), Picture Archiving and Communication System (PACS) and modalities, we evolve towards an architecture of distributed information processing in radiology, the data being stored in distributed databases. The frontier between the cooperative information systems becomes more subtle than in the past, and it seems more convenient to distinguish the different computer functionalities or services used in radiology than to detail the functions of RIS and PACS. This paper opens with a description of the different computer services used in radiology and how they relate one to another. It also shows how these functionalities could be integrated within a global Radiology Information and Archiving System. Finally, it shows the degree of systems interconnection that can be achieved presently, using the PACS-RIS installation at the University Hospital of Freiburg as an example.

Computer Communication Networks↗

iScout: an intelligent scout for accessing and navigating large image sets in a PACS.

A new software tool for PACS, called iScout (intelligent scout), has been developed and optimized for a radiology workstation. The purpose of iScout is to display an overview of a large image series, allowing the user to select images for priority downloading from a PACS server to a PACS workstation. This allows radiologists to reduce the delays that are associated with downloading hundreds or even thousands of images. Several schemes that semiautomatically manage the download process are presented along with tests to measure performance. The results of the tests confirm that priority downloading provides faster access to images in large image series and that the time savings increase in proportion to the study size.

Computer Systems↗

Image management and communication--a legal perspective.

This paper outlines the legal issues that arise in the context of digital diagnostic image management and communication. At the heart of the study is the digital image which is manipulated, processed, communicated, stored compressed and archived, and which is difficult to ascertain from a legal point of view because of its intangible nature. At issue is, on the one hand, data protection and security and, on the other hand, legal problems as to the images' evidential force, procedural and legal admissibility and most important uncertainties about the liabilities of those involved in handling the digital image.

Computer Communication Networks↗

Integrated software system for improving medical equipment management.

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot evaluation trial.

Database Management Systems↗

MEDIM - software system for content-based visual retrieval study in databases with medical images.

This paper presents the MEDIM software system created for the study of a number of methods used in the content-based visual retrieval, based on color characteristics. The problems studied with the help of this system are content-based image query and extraction of color regions. The study of the implemented algorithms was conducted from the point of view of the retrieval quality and complexity, in different cases of transformation and quantization of color spaces, on a database with color medical images from the digestive apparatus sphere, collected with the help of an endoscope.

Algorithms↗

Health Services Technology/Assessment Text (HSTAT).

Health Services Technology/Assessment Text (HSTAT), an online collection of documents pertaining to clinical practice guidelines, HIV/AIDS treatment information, and health care decision making, was recently introduced by the National Library of Medicine. Access to HSTAT is available through the NLM Full-Text Retrieval System (FTRS), a document search and retrieval system developed by the Information Technology Branch of NLM. Internet FTP, Gopher, and World Wide Web clients may also be used to obtain documents from the HSTAT collection.

Acquired Immunodeficiency Syndrome↗

Creating an environment for linking knowledge-based systems to a clinical database: a suite of tools.

A difficulty in using knowledge-based systems has been linking them to clinical databases. The challenge is in making a correct mapping from the data in the knowledge base to the data in the database. At Columbia-Presbyterian Medical Center, we have built a suite of tools developed to create queries that address this challenge. The tools were designed to allow users to easily retrieve data from the database without requiring the users have extensive database and vocabulary knowledge. The tools help users write correct queries (Query Builder), find correct terms in the clinical database (MED Browser), aggregate the resulting data into a useful form (Clinical Database Browser), and allow the user to test the query within the environment of the knowledge-based system (Event Playback). The tools have been in use for one year.

Artificial Intelligence↗

A new look at information retrieval evaluation: proposal for solutions.

This is the fourth and the final in the series of the papers on an application of the systems analytic approach to evaluation of information retrieval (IR). In the previous papers terminological and evaluation problems associated with IR were identified and discussed, and it was proposed that the systems analytic approach could provide solutions to these problems. A review of existing systems analytic approaches in IR was given, and a conceptual framework and two models of IR were presented. This paper discusses how the proposed conceptual framework and the models can be used to improve terminology of IR, to analyze the relevance-based method of recall and precision, and to propose new approaches to evaluate relevance relationships and search engines. The proposed evaluation approaches are compared amongst each other and with the existing methods. The paper is concluded by a summary of the contributions of the research and an identification of the directions for a future research in IR evaluation.

Canada↗

Requirements for PACS: users' perspective.

The applications for which picture archiving and communication systems (PACS) will be used must dictate the technological requirements. Technology-driven integrated PACS have been implemented and tested in a variety of clinical environments. PACS do not generate new revenues, albeit they may affect the bottom line of health care delivery systems through increased efficiency of radiology and, perhaps more important, of the other physicians who use radiologic services. User performance expectations require that trade-offs are evaluated and compromises are made when PACS are designed using currently available technology. In this report, functional requirements for clinical PACS are discussed. These include reliability, speed, ease of use, connectivity, and upgradability. The advantages and disadvantages of specific choices are presented from a utility perspective of an end user.

Computer Communication Networks↗

Customized medical image databases: a low-cost approach.

The increasing use of digital images in medicine creates a demand for efficient but simple methods to store, retrieve and display images. The ideal solution for this might be a large-scale hospital-integrated picture archiving and communication systems, but this is not applicable under all conditions. A small-scale, user-defined image database running on a desktop computer may fit the individual needs better, while yielding optimal cost-effectiveness. We will present a way to create customized image databases using a general-purpose desktop database system and a specialized, dedicated image handling component programmed in C++.

Cost-Benefit Analysis↗

Cost-effective health information systems: user-driven internal development at the University of Iowa.

GOALS: The Information Network For Online Retrieval & Medical Management (INFORMM), health information system (HIS) for the University of Iowa Hospitals and Clinics (UIHC), was analyzed with regard to development of a Computer-Based Patient Record (CBPR) in a cost-effective manner. The analysis: i) profiles INFORMM system functionality; ii) displays INFORMM use and satisfaction among physicians, nurses, and other hospital employees; iii) characterizes dynamics affecting INFORMM growth; and iv) evaluates the cost of a system of internal-development of software. DATA SOURCES: INFORMM utilization for 1989, 1994, and 1995; service requests from users for the years 1985, 1990, and 1994; 1994 MECON-PEERx data; gap analysis user survey conducted by an independent consulting firm. MAIN RESULTS: 1) Physician use has been dominated by a single function: retrieval of laboratory results. 2) Nurse use of the system was more diverse. A recent surge of nurse and physician use resulted from the introduction of online documentation of nursing care. 3) Overall use has been predominantly by non-clinician users, no one function dominating their pattern of use. 4) User service requests were predominantly from the non-clinician group of users. Requests from non-physician groups have been coordinated by a limited number of representatives of those groups, unlike requests from physicians. 5) The UIHC HIS ranked high in user satisfaction. 6) The overall cost of the UIHC HIS system is relatively low as a percentage of the gross operating budget or as a ratio to the volume of patient activities in this medical center. CONCLUSIONS: Internal development of INFORMM has been a cost-effective solution to the information demands of nursing staff and other users. INFORMM system composition reflects the quantity and organization of user requests. Satisfying the needs of physicians requires a change in the manner in which physician needs are assessed.

Attitude to Computers↗

A conversational information computer system for health and safety operation: the occupational surveillance interactive system (OSIS).

Collection, storage and retrieval of health and safety information is critical in occupational settings in making decisions about safety of employees and the healthful nature of the work environment. Computer surveillance programs have been utilized previously, but have been too complicated, too mathematical, and not directly accessible to health and safety personnel. This paper discusses the Occupational Surveillance Interactive System (OSIS), a conversational system which utilizes English instead of a computer language, and which provides immediate feedback to the health and safety practitioner through fact retrieval and statistical inference. Additionally, an algorithm is introduced which provides a predictive cueing for the development of some disease processes. The hypothetical example illustrated herein introduces a prototypal computer surveillance system, operating under an interactive mode, to provide the health and safety professional with a decision-making tool in occupational settings.

Computers↗

[Applications of tree-shaped structure in DICOM based on XML].

In order to improve the sharing of DICOM, a proposal is offered to introduce XML into DICOM on the SPIE 2005 and in this way, better readability and expansibility of DICOM files have been achieved. On this basis, the DICOM data structure is improved further by replacing the one-dimension linear data structure with multilayer tree-shaped data structure. And thus the nesting and dependence relationships between information object and data elements are much clearer and it is more convenient and easy to browse DICOM image files.

Database Management Systems↗

Benefits of coordinated action in PACS evaluation.

PACS, a health care technology still in its developmental stage, aims to improve the management of diagnostic imaging investigations. As the technology has not been comprehensively assessed, data and facts to justify its clinical, economic and other benefits are to date insufficient. Through internationally coordinated action, it is expected to obtain a faster and more comprehensive technology assessment of PACS as well as recommendations for optimization of the system and guidelines for its rational use in various health care environments.

Attitude of Health Personnel↗

Speech recognition and the clinical microbiology laboratory.

Keyboard entry of large amounts of diagnostic data is a laborious task. Any transcription errors that occur may pass undetected by 'non-technical staff' employed to input these data. The object of this project was to design a system, based on a Marconi 'Macrospeak' Speech Recogniser, for 'on line' laboratory entry of data generated from the microbiological examination of specimens of urine. Six parameters considered important to the success of the system were assessed: accuracy, speech recognition, reproducibility, speed, user friendliness, and cost effectiveness. The system performed well under the test conditions examined. 'On line' hands free entry of diagnostic data, using speech recognition, may be a practical alternative to more conventional means of data entry.

Clinical Laboratory Information Systems↗

[Study on network architecture of a tele-medical information sharing platform].

In the article,a plan of network construction which satisfies the demand of applications for a telemedical information sharing platform is proposed. We choice network access plans in view of user actual situation, through the analysis of the service demand and many kinds of network access technologies. Hospital servers that locate in LAN link sharing platform with node servers, should separate from the broadband network of sharing platform in order to ensure the security of the internal hospital network and the administration management. We use the VPN technology to realize the safe transmission of information in the platform network. Preliminary experiments have proved the plan is practicable.

Computer Communication Networks↗