PACS-foundation of medical imaging Informatization

PACS is short for the picture archiving & communication system, PACS has extended from image storage and communication between several simple radiology and imaging devices to operations between all hospital imaging devices and even images of different hospitals. Therefore, many classification methods have emerged, for example, the networking of several radiology devices is called minipacs (micro PACS); the networking of all radiology devices is radiologypacs (radiology department pacs); the whole hospital integrated PACS enables the sharing of image resources in the whole hospital, it is called hospitalpacs. The degree of integration between PACS and RIS and HI has become an important criterion for measuring whether the functions are powerful or not. The future of PACS will be the formation of regional PACs. It will build a regional and cross-regional Wide Area Network (PACS) to achieve the network of medical images in the whole society.

Since PACS needs to be connected to all the hospital's imaging equipment, a unified communication standard must be established to ensure that the imaging equipment of different manufacturers can be connected. Therefore, in 1983, the North American radiology Society (ACR) the ACR-NEMA digital imaging and Communication Standards Committee was established under the initiative. In response to the initiative, many manufacturers have agreed to adopt common interface standards in the medical radiation devices produced so that different manufacturers can exchange image data with each other. On April 9, ACR/nema1.0 standard version was released. On April 9, the standard was revised again. On April 9, the third version of ACR/SCN was officially renamed dicom3.0 (Digital lmaginzand communicationin medicine ), chinese can be translated into "medical digital images and communication standards ". At present, dicom3.0 has been widely followed by international medical imaging equipment manufacturers, and all produced photo and video devices provide dicom3.0 standard communication protocols. Image devices that comply with this standard can communicate with each other and can communicate with other network communication devices.

The dicom3.0 standard must be supported for system output and input. It has become an international specification for PACS. Only the PACS established under the dicom3.0 standard can provide users with the best system connection and expansion functions.

Currently, the computer systems established by hospitals are mainly MIS Systems, which focus on finance and involve registration, charging, and Drug Database processes, and information systems that truly involve clinical medical services for patients (PACS, RIS, Lis) Almost none, and the construction of a digital hospital must be patient-centric information, so that medical information is shared between different departments and between hospitals, in this way, the patient information is paperless and non-film (electronic medical records ). Therefore, in the future, the focus of the hospital's computer management system is to build a patient-centered medical information system, that is, the PACS, RIS, and Lis systems. They are the core components of hospital informatization.

I. Value of hospital construction PACS

For hospitals:

(1) Digital Storage of images, no film management, saving a lot of manpower and material resources for developing, storing films and records; for example: costs of chemicals, processing and maintenance, storage, placement, labor, inspection, and film delivery.

(2) provide the ability to enable more doctors to work collaboratively online.

(3) the remote consultation function is provided, saving manpower and material resources, and improving the hospital consultation capability and increasing awareness.

(4) automation of data statistics can be achieved, which is of great significance for scientific research and analysis. At the same time, statistics can be made on the workload and status of Department staff to discover weak management links and better evaluate employees, motivate employees to create greater benefits for departments.

(5) The diagnostic reports can be standardized, and graphic medical records can be printed. At the same time, electronic medical records can be generated to formCommunityThe electronic medical record center provides electronic medical record storage and query services for patients to increase influence on users.

(6) shared output devices save device investment, such as laser cameras and DICOM cameras.

(7) Reduce/eliminate repetitive work.

(8) higher productivity, lower operating costs and higher income.

(9) inspection materials and films will not be lost.

For clinical:

(1) provide faster and more effective ways to obtain patient information from hospitals.

(2) provide more medical services through joint cooperation with surrounding hospitals.

(3) Enable clinicians to take care of their patients.

For radiologists:

(1) convenient. You can read a piece at home or at your desk, instead of concentrated reading.

(2) quickly obtain the patient's previous film. Check data is obtained in a few seconds.

(3) A variety of images, such as ultrasound, nuclear magnetic resonance, CT, DSA and other images, can be directly referenced and compared, and the corresponding image processing is convenient for diagnosis.

(4) greater workload and higher work efficiency.

(5) images can be used permanently.

(6) directly obtain original images without distortion for academic communication.

For patients:

(1) reduce hospitalization time.

(2) Faster diagnosis and treatment.

(3) refer to multiple inspection results at the same time.

(4) Faster reporting time.

(5) be able to receive expert services.

Ii. Current status of domestic and foreign PACS

(1) Currently, Chinese PACS vendors are mainly concentrated in Beijing, Guangzhou, Shanghai, and other places, such as Shenzhen Anke, Dongda Alpi, Beijing tianjian, Beijing zhongke hengye, and Shanghai daijia. Foreign companies are mainly some large medical companies, such as GE, Siemens, and Philips.

(2) Since the PACS system is a personalized system product, it is necessary to adjust the Workflow Based on the standard DICOM protocol adopted by different hospitals, in order to meet the needs of different hospitals, most PACS products outside China cannot meet personalized needs, and their foreign work processes, habits, languages, etc. are too far different from those in China, therefore, its PACS products are not fully applicable to hospital use in China. At the same time, its products are expensive. In general, the PACS market is mainly controlled by domestic manufacturers.

(3) However, the products of PACS vendors in China are quite different. First of all, there are very few vendors with the underlying DICOM development capabilities, and even some large vendors have no underlying developers themselves, the underlying DICOM module is bought from outside China and has no intellectual property rights. This is like building a house. The foundation is owned by others. Therefore, the product stability is poor. Once the DICOM standard is upgraded, there is a problem with the compatibility of its products (the DICOM standard is upgraded every year ). Secondly, there are few network-based PACs. Most of the products are actually various workstations, especially some analog video workstations. The so-called network is the physical connection of several workstations, file Sharing is not a real network system, let alone information sharing and remote transmission. Moreover, most network PACS adopt the C/S structure, which is a popular network structure in 1990s and is gradually eliminated, the best and most advanced network structure is the B/S structure. Therefore, Chinese PACS vendors need to make further efforts to improve their products and keep up with the times.

(4) there are still some system integrators in China who do not have the development and maintenance capabilities by acting as a foreign PACS.

(5) about the C/S structure and B/S structure.

The C/S structure, that is, the Client/Server structure, is a well-known software system architecture. by assigning tasks to c1ent and server, reduces the communication overhead of the system and makes full use of the advantages of the hardware environment on both ends. Early software systems often use this as the preferred design standard.

The B/S structure, that is, the Browser/Server structure, is a change or improved structure of the C/S structure with the rise of Internet technology. In this structure, the user interface is fully implemented through the WWW browser. Some transaction logic is implemented at the front end, but the main transaction logic is implemented at the server end, forming a so-called 3-tier structure. B/S structure, mainly by using the mature WWW browser technology, combined with a variety of browser script languages (VBScript, Java Script ...) And ActiveX technology, the use of general browsers to achieve the original need for complex special software to achieve the powerful functions, and reduce development costs, is a new software system construction technology. As Windows 98/Windows 2000 embeds browser technology into the operating system, this structure has become the preferred architecture for today's application software.

Iii. Methods of PACS development

There are currently two ways to divide the history of PACS.

1. method 1

(1) The workstation is simply pieced together into a simple network by sharing data. This method has no standards, low efficiency, and poor scalability.

(2) divide the functions of each PACs to form each functional block for data exchange standardization. Then, a PACS network is formed through these functional blocks. The biggest difference between this PACS and the PACS described in (1) is standardization.

(3) combine various functions and personnel management to form office automation and integrate PACS functions into work. The biggest difference between this PACS and (2) is that it combines personnel activities and automates Information Publishing.

2. method 2

(1) manually obtain the image. That is to say, if the staff needs an image, they need to obtain it at the designated location. This is an original method that requires the staff to understand the image storage process.

(2) The image is automatically routed to the specified location. Through configuration, the image can be automatically stored to the desired location. This semi-automated method is suitable for fixed-point work. Once the location changes, the system configuration needs to be changed. This method is not suitable for subsequent work flows, and the personnel efficiency is obviously not as high as the third method described below.

(3) route the image to the specified person. By combining configuration and personnel work management, you can create workflows to simplify the work process and improve work efficiency.

In the information society, most of the work is the process of publishing and collecting information. In the face of huge image data, how to automate the collection and publishing of such data is a task of PACS. Both of the preceding methods reflect this idea.

Iv. Principles of PACS construction and design

(1) simple and practical: The operation is simple, easy for doctors to master, and the doctors can complete the operation as quickly as possible.

(2) standard, advanced, and scalable: international standards are used to utilize the latest computer and network technologies to ensure the advancement of the system. Considering the development of information technology, it focuses on system expansion.

(3) integrity includes RIS: follows the overall design principles of hardware, system software, application software and user interface, and adopts an object-oriented design method to facilitate system maintenance and upgrade.

(4) reliability and stability: the reliable and stable operation of the system is crucial. Fault tolerance capability should be provided and data backup and recovery mechanisms should be set up.