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1. Medical Imaging Digital Imaging Image or Magic ???

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Presentation on theme: "1. Medical Imaging Digital Imaging Image or Magic ???"— Presentation transcript:

1 1


3 Medical Imaging

4 Digital Imaging

5 Image or Magic ???

6 Analog Images

7 Analog vs. Digital Image


9 New Paradigm 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 DetectorReading Viewed Display Digital Processing Stored PACS QC of the digital systems is an additional requirement – in addition to the usual x-ray performance tests

11 11

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

14 Multiplanar Navigation

15 MIP


17 Hospital Conventional PACS Diagnostic Modality Archiving Device Archiving Media 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 80-ties 80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems. 90ties: 90ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective?? >2000 >2000: Enterprise-PACS+RIS+PACS = film-less hospitals. >2007 >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. Historical Evolution

21 Parallel evolution of all PACS functions P ICTURES A rchiving C ommunication S ystems 2D tapes ATM, video Hardware + show an image Represent 5D datasets SAN/NAS/grids Internet/web/ Wifi Functionality+ knowledge

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

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 RIS PACS HL7 DICOM Connectivity Manager

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

26 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 Image acquisition Objective

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

29 At Modality PACS Viewing Station Web Viewer Webserver

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


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 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 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



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