2. New Advences & Horizons
2nd ICT Med Workshop
Informatics in Medical Imaging
New Advences & Horizons
Alireza Shakibafard MD
Shiraz University of Medical Sciences(SUMS)

3. Medical Imaging

4. Digital Imaging

5. Digital Imaging
Image or Magic ???

6. Analog Images

7. Analog vs. Digital Image
AD Conversion
For computer
viewing
For human viewing

8. Digital
Image
is ready
for any
Change
Storage
Transfer

9. New Paradigm Image Capture , Storage & Display
Moving from traditional film-screen(analog) toward electronic media
In electronic imaging the functional parts of conventional radiology have been separated:
Image Capture , Storage & Display

10. Digital System
Film
Developed
And
Fixed
Detector
Reading
Digital
Processing
Stored
PACS
Viewed
Display
QC of the digital systems is an additional requirement
– in addition to the usual x-ray performance tests

12. Image Characteristics
Each pixel is assigned a numeric value
(bit depth) that represents a shade of gray based on the attenuation characteristics of the volume of tissue imaged

13. Advanced Applications
Medical Imaging
Advanced Applications

14. Multiplanar Navigation

15. MIP

17. Conventional PACS Hospital Archiving Media Diagnostic Modality
Archiving Device
PACS Server

19. Modern View on PACS
PACS is the “Imaging” part of Healthcare Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS.
The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone.
Technological basis: “PACS rides many horses” from web-based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.

20. Historical Evolution
80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems.
90ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective??
>2000: Enterprise-PACS+RIS+PACS = film-less hospitals.
>2007: Newest achievements: Multi-site PACS using MPI (Master Patient Index) to allow the patient’s access on all sites
Hospitals will skip historical steps and adopt to state of the art PACS and HIS.

21. Parallel evolution of all PACS functions
PICTURES
Archiving
Communication
Systems
Represent 5D datasets
SAN/NAS/grids
Internet/web/
Wifi
Functionality+ knowledge 2D
tapes
ATM, video
Hardware + show an image

22. In hospital, Out hospital Distribution
Patient arrives 1
Study ordered and scheduled 3
Report
transcription 12
HIS
RIS
Report approval 14
ADT 2
Report 13
Report
status
notification 15
Order/schedule
status notification 4
Workflow Management
Connectivity Manager
Study
status notification 9
Modality worklist 7
Order/schedule
status notification 5
Verification
10a
Report
status notification 16
PACS
Modality QC
Diagnostic review and report dictation 11
Pre-fetching (images) 6
Image store 10
Patient is examined 8
Images to long term archive 17
Images wavelet compressed by curator
1Ob
In hospital, Out hospital Distribution
Non diagnostic review 19

23. Information systems in the hospital workflow
HIS (Hospital Information System)
Central administration and financial system of the hospital
Keeps the central patient registration
patient identification
holds the demographic data
RIS (Radiology Information System)
Dedicated radiology information system, taking care of
exam ordering
exam planning
study reporting
passing billing related information
not automatically included
not available for every country
Holds the study information
PACS (Picture Archiving and Communication System)
Dedicated system for archiving and
communication of study related images
Communicates with the outside world
HIS
HL7
RIS
HL7
Connectivity Manager
DICOM
PACS

24. Information exchange standards
HL7 (Health Level 7)
Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services.
E.g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, …
DICOM (Digital Imaging and Communication in Medicine)
DICOM is a standard, to enable efficient and flexible integration and communication of image data between components (modalities, printers, storage, databases, …) in a medical network
However: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant

25. PACS Connectivity Services (Connectivity Manager)
Translate HIS/RIS messages (e.g. HL7) to DICOM
RIS
PV1||E|TRAUMA|A||||^DOE^JOHN^W.^DR.^|||WAITING ROOM
Do you speak
DICOM ? CM
???

26. Image acquisition Objective
Consolidation of image data information provided by multiple sources
Multi-modality (MRI, CT, Ultrasound…)
Multi-Vendor
How ?
DICOM gateway : Paxport (for non DICOM modalities)
Film scanner

27. Image data storage and archiving
Storage (.dcm files)
Type of media (disks, UDO, LTO)
Everything on line solutions, near-line, off-line
Data compression
Data availability

28. PACS Architecture Internal & External Clients RIS Database Application
Server
HIS
Connectivity
Manager
Archive
Server
Workflow
Manager
Curator
Modality

29. Web Viewer
Webserver
PACS Viewing
Station
At Modality

30. ….. PACS and Network Hub Switch Archive Workstation 1 Workstation 2
SERVER
Hub Switch
SERVER
…..
Workstations
CD/DVD Robot
RAID
Archive

32. PACS Beyond Radiology Other Types of Images:
Vascular Angiography
Cardiac Angiography
Echocardiography
Obstetric Ultrasound
Medical Photography
Retinal Imaging
Colposcopy / Cytology…..
May be more of a RIS Issue than PACS

33. Imaging Informatics
New Advances

34. Imaging Informatics Laboratory

38. The Bottom Line Modern Image Processing
Automated CAD with interpretation and reporting
Portable medical records – perhaps imbedded in patient
Integrated RIS-PACS-HIS through I.T.
Robotic imaging
Molecular Imaging
Image guided chemotherapy and gene therapy
………….

39. When needed , Where needed Integrated & Enterprise
Take Home Point:
Beyond Bytes & Bits :
Healthcare IT ;
When needed , Where needed
Integrated & Enterprise

40. Take Home Point: Healthcare IT ;
Beyond one person , one department , one ….. , it is across …
It needs collaboration , communication & decision making

41. THANK YOU FOR YOUR NICE ATTENTION