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U-HealthCare System 5. 의료영상 및 PACS 2011. 4. 13 안병익

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Presentation on theme: "U-HealthCare System 5. 의료영상 및 PACS 2011. 4. 13 안병익"— Presentation transcript:

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2 U-HealthCare System 5. 의료영상 및 PACS 안병익

3 U-HealthCare System Medical Imaging Tech & PACS CT MRI PET/CT PACS DICOM

4 U-HealthCare System Why use different methods of imaging ? Cost Effectiveness A good guiding principle in many walks of life is … Always pick the simplest solution for your problem. In many cases the cheapest solution is the best. You do not need to give every pregnant mother in the country an MRI scan. The capital cost of installation varies widely: UltrasoundX-ray CTMRIPET £20k - £100k £500k - £1M£2M - £4M>£5M

5 U-HealthCare System What is the CT? Mathematical transform to the measured data. Reconstruct n dimension function (image) => projection data of n – 1 dimension Radon Transform (1917) “Two dimension and three dimension object can be reconstructed from the infinite set of projectio n data”. The First CT: 1973 in the U.S. 4 minutes scan, thickness of 10mm

6 U-HealthCare System Concept of CT ・ Getting the shape by back projection of the projection data. ・ For example, outward view is the quadrangle => it is the cylinder CT Algorithm

7 U-HealthCare System CT (From Picker) (From Siemens)

8 U-HealthCare System X Basic principle of CT -Reconstruction of 2 dimensional image- Simple Backprojection Projection Data Blur x y x y curvilinear integral of absorption coefficient regarding Y object X-ray tube X-ray detector array Data Acquisition field Reconstruction field X X Y

9 U-HealthCare System Basic principle of CT -Reconstruction of 2 dimensional image- Filtered Backprojection Projection Data x y * x Multidirectional Backprojection Reconstruction Filter ω or x Filtered Projection data x X

10 U-HealthCare System Reconstruction process

11 U-HealthCare System Reconstruction process Data acquisition at angle : 0 – 180 degree Obtain F(u,v) and then 2D IFFT -> reconstruction Radon Transform is equivalent to Filtered backprojection !

12 U-HealthCare System Example of Simulation Model ImageSimple Backprojection Filtered Backprojection

13 U-HealthCare System Magnetic Resonance Imaging

14 U-HealthCare System Magnetic Resonance Uses equipment prod ucing magnetic fields from 0.5 Tesla to 3 Te sla Earths magnetic field i s 50 microtesla Cost of equipment is approx £700k per Tes la

15 U-HealthCare System Obtaining the Data All atoms have a magnetic field or orientation When placed in a strong magnetic field the atomi c nuclei align with that field Pulses of Radio Frequency aimed at area of inte rest in the body Imparts high energy state to the nuclei of those a reas Relaxation of that state produces resonance whi ch can be detected Location and intensity will translate into pixel loc ation and intensity

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17 Slices

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19 Image Processing

20 U-HealthCare System Image Manipulation and Enhancement Two time frames T1 and T2 relate to perce ntages of nuclei which have resumed nor mal state T1 improves resolution T2 improves sensitivity Contrast media can be introduced fMR can monitor specific physiology

21 U-HealthCare System Anatomy or Physiology?

22 U-HealthCare System Using Data Manipulation

23 U-HealthCare System Image Manipulation

24 U-HealthCare System When Do We Use MRI? Excellent for soft tissu e imaging Resolution is good Does NOT use ionisin g radiation but does h ave some safety issu es

25 U-HealthCare System MR Versus CT MR Digital manipulation Non-ionising Non-invasive Good for soft tissue Can image physiology Technique can be altered to account for data requir ed Expensive CT Digital manipulation Ionising Xrays Non-invasive Good for range of tissue t ypes, soft tissue to a less er extent Can only image physiolog y when used with other m odalities Variation in technique pos sible Relatively Cheap

26 U-HealthCare System 25 PET / CT System

27 U-HealthCare System PET / CT 란 ? PET / CT 란 양전자 방출 촬영기 (Positron Emission Tomography) 와 컴퓨터 단층촬영기 (Computed Tomography) 를 하나로 합친 장비이다. PET / CT 장비는 암 진단에 효과적으로 사용되고 특히 종양을 CT, 감마카메라 등에 비해 월등히 앞선 시기에 진단할 수 있게 되어 암의 조기 진단을 가능하게 한다. 검사시간을 크게 단축하여 환자의 고통을 덜어주고 환 자에 대한 병원의 의료서비스의 질이 한층 높아질 것 으로 예상된다.

28 U-HealthCare System PET / CT 란 ?? PET 은 양전자 방출하는 방사성의약품을 이용하여 체 내의 미세한 변화를 영상화 하는 최첨단 검사이고, 이 용하는 약품에 따라 당 대사, 단백질 대사, 핵산대사, 혈류 등의 다양한 체내변화를 영상으로 얻을 수 있으 며, 이중 포도당대사를 관찰하는 검사가 가장 흔히 쓰 인다. PET/CT 는 이러한 PET 과 CT 를 동시에 시행하는 검사 이다. PET 만 시행했을 때 생길 수 있는 정상조직에 의한 진 단오류를 최소화하고 진단성능을 향상시킬 수 있게 한 다.

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30 PET / CT 검사원리 PET/CT 에서는 양전자를 방출하는 포도당 유사체를 이용합니다. 인체 내에 주사 된 포도당 유사체는 암세포에 집적되고 방출된 양전자 (+) 는 주변의 전자 (-) 를 만나서 소멸반응을 일으킨 후 서로 반대방향을 가지는 511 KeV 에너지의 두 개의 감마선으로 변환 됩니다. 이 감마선들은 PET/CT 의 원형동시계측회로에서 검출되 어서 컴퓨터에 위치 정보를 전달하게 되고 컴퓨터에서는 인체 내 에 어느 곳에 이상이 있는지를 영상으로 표현해 줍니다.

31 U-HealthCare System PET / CT 장점 – 암의 조기발견 크기가 작아 CT 나 초음파 등 기존의 검사에서 놓치기 쉬을 정확 히 진단하는데 큰 도움이 된다. – 암의 분포진단 암이 어디까지 퍼져있는지 판단. 암의 재발진단. – 암 치료 계획에 이용 암이 발견될 경우, 바로 치료방침을 세울 수 있는 정보까지 제공 받을 수 있다. – 검사시간의 감소 최대 40% 절약하여 불편한 환자의 불편을 감소시키고 병원의 생산성도 높이고있다. 한 번의 촬영으로 전신을 검사할 수 있다.

32 U-HealthCare System PET / CT 단점 – 분화도가 좋은 간암이나 조기위암 등의 진단성능은 조금 떨 어진다. – 신장, 요관, 방광, 전립선 등 비뇨생식기계 암은 소변으로 인 해 진단에 주의해야 한다. – 대사항진이 높지 않은 3~4 mm 이하의 작은 암은 발견되지 않 을 수도 있다는 한계점을 고려해야 한다.

33 U-HealthCare System PET / CT 로 알 수 있는 질환 PET/CT 의 가장 대표적인 적응증은 암 입니다. 암에서 PET/CT 는, 암의 발견, 양성 및 악성의 감 별, 치료를 위한 병기 설정, 치료 후 재평가, 재발 진 단 등, 암 진료의 전 영역에서 활용되고 있습니다. 일단 암으로 진단 받고 치료 및 추적 과정에 들어 가면 담당 의료진의 책임 하에 중요한 진단 평가 수단으로 당연히 이용되지만, 최근에는 암을 발견하는 검진에 PET/CT 를 이용하는 것이 관심을 끌고 있습니다.

34 U-HealthCare System PET / CT 검사종류 전신 PET / CT 뇌신경계 PET / CT 심장 PET / CT

35 U-HealthCare System 전신 PET / CT 방사선의약품을 팔에 정맥주사하고 40 분 후에 몸 전체 를 CT 촬영을 하고, 이어서 PET 검사를 시행한다. 폐암, 유방암, 대장암, 두경부암, 림프종, 흑색종, 근골 격계암, 자궁경부암, 난소암 등의 조기발견 및 전이여 부, 양성과 악성 종양의 감별, 암의 병기결정, 재발여부 판정, 항암화학요법제와 수술의 치료효과 한정, 환자 의 예후 예측등이 가능하다.

36 U-HealthCare System 신세포암으로 수술 후 별 증 상 없었으나, PET/CT 시행 후 복부에 임파선 재발을 확 인할 수 있다. PET/CT 시행 후 간 좌우엽 전 반에 퍼져 있는 암 조직과, 동 시에 우측 갑상선에서 대사 증 가를 보이는 종양이 발견되었 고, 간암으로 확정된 환자이 다

37 U-HealthCare System 뇌신경계 PET / CT 간질환자의 수술전 검사, 파킨슨씨병, 치매 ( 알츠하이 머병 ) 의 진단. 뇌종양, 뇌혈관질환의 진단에 사용한다. 기억력 감퇴 등 치매가 의심되는 증상이 있어 이를 조 기발견해서 질병진행 억제 치료를 한다면 치매를 예방 하는데 도움이 됩니다. 일부 운동신경계 질환의 감별진단을 원할 때 이용한다. 뇌암 진단 받고 방사선치료를 받은 뒤 잔존하는 암이 있는지의 여부를 MRI 에서 알기 어려울 때 이용한다.

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39 심장 PET / CT 협심증과 심근경색과 같은 관상동맥 질환을 진단한다. 허혈성 심장질환에서 보다 정확한 생존심근부위의 판정 을 원할 때 심근 생존능력을 평가하여 치료방법을 결정하 는데 시용한다.

40 U-HealthCare System What is PACS ? P: Picture, Images & Reports A: Archive, Online, Near line, Offline C: Communication, Networking, Transfer Protocols S: System, Components & Architecture PACS: for storage and distribution of images and in formation when necessary

41 U-HealthCare System PACS: Small or Large Web Server Distribution

42 U-HealthCare System Scale of PACS No. of Beds in Hospital/ Exams per year No. of Modalities No. of Switches Considerations: System connectivity, expandability, reliability and cost-effectiveness

43 U-HealthCare System Types of images 1D, 2D, 3D, 4D Different DICOM Modality type: Cardiac / PET / 4D U/ S….. Image size: Resolution and bit depth Image quality: Bit Depth and resolution Color / Monochromatic Exam. Size: image size x no. of images Structured Reports New DICOM IOD: Endoscopic & Microscopic images / ECGs / Security Prof iles…..

44 U-HealthCare System 1D, 2D, 3D, 4D, fusion

45 U-HealthCare System 1D, 2D, 3D, 4D, fusion

46 U-HealthCare System Image Resolution/ Bit depth U/S DF CR CR Mammogram 256 x bit 65 KBytes 1k x 1k 10 bit 1.25 MByte 2k x 2.5k 12 bit 7.5 MByte 4k x 5k 12 bit 30 MByte

47 U-HealthCare System Properties of image Bit depth Bit depth Grayscale or color Grayscale or color Resolution in pixel Resolution in pixel  Example image si ze of mammogra m = 4k x 5k x 12 b it = 30 MB

48 U-HealthCare System PACS Architecture

49 U-HealthCare System Data Base Server CR/ DR QA Workstation Computed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server RIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS – Central Architecture Diagnostic Workstation

50 U-HealthCare System Central Architecture Image Server and Database Manager is th e HEART Any image, any where, any time Unique central copy Easy update of data Requires high performance servers Potential single point of failure at server Bandwidth demanding

51 U-HealthCare System Data Base Server CR QA Workstation Computed Radiography Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server Diagnostic Workstation RIS Diagnostic Workstations (DICOM) Clinical Workstations (DICOM) PACS – Distributed Architecture

52 U-HealthCare System Distributed Architecture Exams are routed from modality to selecte d workstations Complex routing algorithms based on dep artment / user preference Difficult to support concurrent review of im ages Less destructive for failure at database ser ver

53 U-HealthCare System Components of PACS HIS/ RIS Broker ePR gateway Database Server Image Server (RAID) Long Term/ Near line Archive Networks Digitizer

54 U-HealthCare System Components of PACS Acquisition Gateways Non-DICOM modality gateway DICOM Print Server Media Server Reporting Server Monitor QC Server Web Server Workstations

55 U-HealthCare System PACS layout 1

56 U-HealthCare System PACS layout 2

57 U-HealthCare System PACS layout 3

58 U-HealthCare System Data Base Server CR/ DR QA Workstation Computed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality LTS Archive SAN/NAS DICOM Modality Web Server Broker for RIS/HIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS Components Diagnostic Workstation Media Server ePR gateway W/S QA Server Enterprise Archive Through Acq. g ateway

59 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Acquisition (DICOM) Gateway

60 U-HealthCare System Role of Acquisition gateway Compression/ decompression and security Check the images for integrity Convert to PACS format (header, byte-orde r, matrix size) Queue for images (priority) to database ser ver (background) Share the workload and no point of failure f or multiple Acquisition gateway

61 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Database Server and Image Server DatabaseServer RAID

62 U-HealthCare System Database Server (PACS controller) The Heart of the system Integration cross point between HIS/RIS and PACS (status update) Create and manages patient folders Manage reading worklists and user profiles Manage data transfer within the system Support data mining and teaching folders

63 U-HealthCare System Image Server (RAID) Online (rapid access) exam storage and di stribution device Support simultaneous exam input and out put transfer operations Up to Three months of storage capacity Scalable capacity

64 U-HealthCare System Redundant Array of Independent Disks Bandwidth equal to sum of disk transfer rates Highest speed disk storage available Image Disk Array 2 MB/s MB/s Hot Swap Parity What is RAID

65 U-HealthCare System RAID 5 configuration If disk fails, disk can be r ebuilt- fault tolerant High data transfer rate fo r read, write slower Min. 3 disks to start Array capacity is N-1

66 U-HealthCare System Bandwidth is a measure of the information (data) carrying capacity of a network 10/100/1000 MB/sec Information Flow Data Pipe (Network) Bandwidth

67 U-HealthCare System Network Bottleneck The bandwidth of an information delivery system is l imited to the bandwidth of the slowest component in the system Network Bottleneck

68 U-HealthCare System Data compression reduces the information rate a network must support Uncompressed Data Compressed Data Data Compression

69 U-HealthCare System Decompressed image is identical to original imag e JPEG lossless compression Average compression of 2:1 for x-ray images I C D I - D = 0 Lossless Image Compression

70 U-HealthCare System JPEG 2000 Compression Selected parts of the image can be defined as R egions of Interest, they can then be delivered bef ore other parts of the image, or losslessly, whilst other parts of the image that are less critical use normal lossy compression JPEG 2000 codestream can be ordered to delive r images of lower resolution before the full image can be transmitted Motion JPEG 2000 does not have any form of ex trapolation (and hence potential distortion) in the time domain. Each frame is a separate JPEG coded image

71 U-HealthCare System JPEG 2000 images

72 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Storage Device (Long Term) DatabaseServer RAID MODDLT

73 U-HealthCare System Types of storage media MediaDVDMODWORMDLT9840AIT2 GB Cost Less Expen. Expen.Expen.Cheap Most Expen. Load + Assess Very fast 113 sec 15 sec 45 sec Max. T rate MB/s

74 U-HealthCare System Long Term Archive Used to store digital data for longer period s of time Storage ranges from 100 MB to 10 TB Optical disk most common media - 5 1/4” MOD GB and 5.2 GB Capacity DLT used for longer term storage and redu ndancy ISP module

75 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Storage Device (Near line) DatabaseServer RAID MODDLT SAN/NAS

76 U-HealthCare System Storage Area Network SAN is a high-speed sub-ne twork of shared storage dev ices Contains storage device (di sk) for storing data SAN's architecture works in a way that makes all storag e devices available to all ser vers Use of Fiber Channel High scalability for additiona l storage and redundant net works PCs Storage devices

77 U-HealthCare System Network Area Storage NAS is a class of dedicated hard disk-based storage dev ices which provide LAN users with additional disk storag e through a standard network connection In most cases, a NAS device (or NAS server) receives a n IP address, connects to the LAN through an Ethernet c able, and resides on the LAN as an independent network device Users are not demanding the server's processing time fo r mundane storage tasks -- often improving the performa nce of local application servers NAS systems also include some onboard memory (RAM) to cache network data to or from the disks

78 U-HealthCare System SAN Vs NAS Difference between NAS and SAN is subtle NAS devices are big, single purpose storage ap pliances that you plug into network NAS sits between your application server and yo ur file system As perform only 1 task, can serve files very fast NAS is network-centric SAN is a defined architecture that sits between y our file system and your underlying physical stor age SAN is data-centric

79 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Display DatabaseServer RAID MODDLT SAN/NAS Diagnostic W/S Dedicate W/S

80 U-HealthCare System Workstations Four Primary Categories - Advanced Analysis: Used by specialists for advanced diagnosis - 3D, volume rendering -Diagnostic: For primary diagnosis; located in reading r ooms; high-end 2K monitors -Clinical: Used by clinicians and staff to consult; ICU / ER applications; less costly than diagnostic; 1K monit ors -At Home Review: low-end; PC based; cost-effective; r eview application; lossy compressed for faster transm it

81 U-HealthCare System Standalone Vs direct PACS w/s Standalone WorkstationDirect PACS Client Workstation Hard Disk StorageYes, variesMinimal Query PACS number All PACS system (CT, ACC, Angio.) Single PACS system (ACC PACS) Retrieval mechanism DICOM Q/R and association made with different vendors Direct attached, same vendor Retrieval timeSlowerFaster Diagnostic valueDepends on Monitor Grade and Modules like MPR, 3D etc Suggested usage1.for meeting/museum purpose 2.for single modality image reviewing and reporting like Radworks in U/S Rm Direct PACS workstation for reporting

82 U-HealthCare System Web distribution High availability, low cost Reports / select images to referring physici an desktop Point of integration with electronic patient r ecord Lossy compression for performance Potential for TeleRadiology Security issues to be resolved

83 U-HealthCare System RIS, HIS, ePR and PACS integr ation

84 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Broker HIS/RIS and PACS interfac e

85 U-HealthCare System Hospital Information System Support clinical and medical patient care a ctivities in the hospital Administer the hospital’s daily business tra nsactions like finance, payroll etc Evaluate hospital performances and costs and make long-term forecast

86 U-HealthCare System Clinical System in HA, HK Patient Administration In-Patient and Out-Patient Administration System Accident & Emergency Information System Medical Record Abstract System Medical Record Tracking System Clinical Support Laboratory Information System Radiology Information System Pharmacy Management System Dietetics Catering Management System Clinical Management Clinical Management System (In-Patient) Discharge Summary Clinical Management System (Out-Patient) Electronic Patient Records Clinical Data Analysis and Reporting System

87 U-HealthCare System Non-Clinical System in HA Human Resources and Payroll Systems Hospital Based Financial System Materials Management System Patient Billing and Revenue Collection Sys tem Executive Information System Code 9 and view codes

88 U-HealthCare System Radiology Information Systems Similar to HIS but of smaller scale Interfaces to PACS based on HL7 Department administrative management - Scheduling and Film tracking - Resource management and reporting - Monitor patient status Link to Hospital Information System (HIS) - Billing and Master Record Link to Clinical Management System (CMS) - Prefetch for Clinical visit - ePR integration

89 U-HealthCare System Exam Order Exam Order Exam Scheduled Exam Scheduled RIS Patient Exam Is Performed Patient Exam Is Performed Modality Worklist Demographics Downloaded Database server /Archive Database server /Archive Order Event Prefetch Exams From Storage Images transferred in STS PACS Worklist Updated PACS Worklist Updated Images / Prior Reports Image migration STS to LTA Exam Transcribed Exam Transcribed Report Verified Report Verified Final report available Final report available Exam Read Exam Read Dictated status Preliminary status Images copied on web-server Web distribution to referring physicians RIS workflow

90 U-HealthCare System Broker service HA HIS HA RIS HA CMS Clinical visit ADT Mitra PACS Broker interface Appt., X-ray reques t DR CR US DF Modalities: Get WORKLIST Get REPORT, Get INFO Database s erver

91 U-HealthCare System Broker service A restricted access account will be created at Sy base that gives limited authority for the DICOM Broker solely for the purpose of the interfaces In general, for data flow from RIS to the Broker, t he RIS write the supported events to the table, a nd the Broker polls against the events table and calls the associated stored procedures for the co nversion to DICOM messages

92 U-HealthCare System Broker service Broker main function: - Worklist generation - Reports storage Registration + Post exa m data capture (RIS) Acc # generation + ca ll broker for update Broker poll RIS event table and convert to D ICOM info Modalities query Bro ker for worklist upda te Need SOME time!!

93 U-HealthCare System ePR Architecture Selected images from individual hospital’s P ACS are sent make use of the ePR record indexing and b rowsing capabilities to read the radiology im ages through CMS w orkstations

94 U-HealthCare System Data Flow Diagram RISePR RIS operational data RIS statistical d ata ePR Data wareh ouse Appointment Attendance Exam records Reports (15mins) Attendance Exam & workloa d units (daily) HA system CMS Non clinical syste m Web Se rver PACS

95 U-HealthCare System Characteristics of ePR Near instant image review Web distribution can be within hospital, to other hospitals or even private clinics TeleRadiography possible Update of patient information Lossy Vs lossless Broken pathway 15 minutes time lag

96 U-HealthCare System Guidelines for HIS, RIS, PACS interfac e Each system remain unchanged in its conf iguration and function, only data are share d Identify the subset data to be shared and s et up access rights/ authorization Convert the subset data to HL7 standard Define transfer protocol (TCP/IP or DICO M)

97 U-HealthCare System Typical patient and data flow Admission: Patient registration, notify HIS (HL7) Order entry/Arrival: Schedule exam and notify RIS Broker notified and PACS database server updated (pref etch) DICOM worklist to modality Exam completed: data to DICOM gateway (MPPS) Information/images to database/image server through ga teway (DICOM store) Images stored in PACS archive Images to workstations from PACS archive Dictation, transcription etc: workstation to RIS/PACS RIS reporting and PACS updated for reports Transfer: HIS/RIS to PACS, images to other PACS Discharge: HIS/RIS to PACS, images rub out

98 U-HealthCare System Mobile PACS

99 U-HealthCare System What is DICOM? The standard for Digital Imaging and Communications in Medicine. Developed by the National Electrical Manufacturers Association (NEMA) in conjunction with the American College of Radiology (ACR). Covers most image formats for all of medicine. Specification for messaging and communication between imaging machines.

100 U-HealthCare System A little history The first version was ACR-NEMA, released in Its goal in developing a standard was –To enable users to retrieve images and associated information from digital imaging equipment in a standard format using point-to-point connection. –To hide differences same across multiple image equipment manufacturers. To handle developing network and image standarts, a new standard, DICOM, was proposed in 1981.

101 U-HealthCare System DICOM Application Domain MAGN ETOM Information Management System Storage, Query/Retrieve, Study Component Query/Retrieve Results Management Print Management Media Exchange LiteBox

102 U-HealthCare System Summary of DICOM Features NETWORK PROTOCOL ● DICOM incorporates negotiation to permit peers to agree on the functions to be performed MESSAGE ENCODING ● DICOM defines 24 data types (V2.0 had 4) ● DICOM message encoding includes JPEG compression (17 varients) ● DICOM supports multiple character repertoires

103 U-HealthCare System Summary of DICOM Features OBJECT DATA MODEL ● DICOM is based on a completely specified data model ● DICOM includes a robust UID mechanism DATA DICTIONARY ● DICOM includes a large number of new data elements SERVICE CLASSES ● DICOM defines classes of service for specific applications (e.g. image management, printing) and conformance levels

104 U-HealthCare System DICOM Objects Things such as images, reports, and patients are all objects and are called information objects. Two kinds of objects in DICOM: –Composite objects (Old objects inherited from NEMA). –Normalized objects (New objects defined in DICOM). All objects and their format constitutes Data Dictionary. DICOM uses UIDs to identify information objects, such as the images, reports, or transfer syntaxes. The form of the UID conforms to an international standard. – is the root and the same for every DICOM UID. –Example: UID for the DICOM explicit VR little endian transfer syntax is

105 U-HealthCare System DICOM Service Classes Composite ● Verification ● Storage ● Query/Retrieve ● Study Content Notification Normalized ● Patient Management ● Study Management ● Results Management ● Basic Print Management

106 U-HealthCare System Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Reporting: RIS-Based Transcription / Validation of Narrativ e Report RIS-Based Report Storage and Management –Send Reports –Query Prior Reports Hardcopy Image Reading + Dictation/Transcription (Use Case 1)

107 U-HealthCare System Hardcopy Image Reading + Dictation/Transcription (Use Case 1) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation Transcription & Correction Transcription & Correction prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Report Storage / Mgmt. Filming

108 U-HealthCare System Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management –Send Reports –Query Prior Reports Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 2)

109 U-HealthCare System Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 2) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation stor e Report Storage / Mgmt. Transcription & Correction Transcription & Correction Selected Images Filming

110 U-HealthCare System Image Acquisition: RIS-based Acquisition Workflow Support (Modality Worklist) Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading DICOM Store Images -> Burn CD/DVD Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management –Send Reports –Query Prior Reports –Optional DICOM Store Reports -> Burn CD/DVD Acquisition Workflow Support + Burn CD/DVD (Use Case 3)

111 U-HealthCare System Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 3) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation Report Storage / Mgmt. Transcription & Correction Transcription & Correction Modality Worklist Burn CD/DVD Off-Line Archive stor e Selected Images store Filming

112 U-HealthCare System Image Acquisition: RIS-based Acquisition Workflow Support (Modality Worklist) Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading DICOM Store Images for Burning CD/DVD PACS-based Storage and Management of DICOM Persistent Objects –Archive Imaging Studies –Query Prior Imaging Studies Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management –Send Reports –Query Prior Reports –Optional DICOM Store Reports for Burning CD/DVD PACS for Management of DICOM Persistent O bjects (Use Case 4)

113 U-HealthCare System Image Repository PACS PACS for Management of DICOM Persistent Objects (U se Case 4) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation Object Storage / Mgmt. Transcription & Correction Transcription & Correction Modality Worklist Burn CD/DVD Off-Line Archive stor e Selected Images store Filming store q/ r store


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