PACS is only in the Beginning of Being Used as Clinical Research Tools

The PACS concept was introduced in 19821, after more than twenty years of technical advancements;it has become an integrated component of today’s healthcare delivery system.PACS is now in the beginning of being used as a clinical research tool.2Among others,this paper describes four PACS-based research activities: medical imaging informatics, medical imaging Data Grid, combining PACS and teleradiology operations, and computer-assisted detection and diagnosis(CAD). In medical imaging informatics (MII), we first introduce its infrastructure and the five layer of software architecture. The description of a new MII training program supported by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), National institutes of Health (NIH), USA is followed. The training program accepts candidates with medical and or biomedical engineering background. The goal is to cross-train multi-disciplinary individuals to be future leaders in the field of medical imaging informatics. Grid computing is a new paradigm combining computing, networking, information and storage technologies to advance the conventional distributing computing to the next level. One resource in Grid Computing is the Data Grid. We describe the use of Data Grid concept in medical imaging applications based on the five layer of the open source Globus toolkit 4 (GT4). Three examples are given. First, a Data Grid specifically designed for PACS image backup and disaster recovery developed at the Imaging and Informatics Laboratory (IPI), USC is illustrated. The second application is for image-based clinical trials using three international sites at IPI, USC, USA; the PACS Lab, Hong Kong Polytechnic University, Hong Kong; and the Heart Institute, Sao Paulo, Brazil In combining PACS and teleradiology operations , a Data Grid model is proposed to combinetwo disjoint ,and yet ,daily used PACS and telera-diology operations as one integrated system in a large-scale enterprise level . Methods of combining workflows ,storage ,and reading of PACS and teleradiology i mages are detailed .The last work-in-progress research is the in-tegration of CAD results with daily PACS workflow. The integration methods are based on DICOMScreen Captured and Structured Report Stan-dards ; and several IHE (Integrating the Healthcare Enterprise) Workflow Profiles .

Technological innovations in digital data management and changing roles of imaging specialists in Japan

Technical innovations in digital data management pose a threat to radiologists in that can we remain in the process of clinical decision making or be assigned to a secondary role in future clinical practice.The value added to the imaging studies by diagnostic radiologists,or imaging specialists,has never been questioned more seriously.

Intra and Inter-Observer Reliability of Mobile Tablet PACS Viewer System vs. Standard PACS Viewing Station-Diagnosis of Acute Central Nervous System Events

Background and Purpose: The display resolution of the Apple iPad? is 1024 × 768 pixels, which is greater than that required for generating the typical CT or MRI images. The purpose of this study is to determine if specific CT and MR sequences can be interpreted accurately on mobile device/PACS software platforms when compared to a traditional stationary high resolution monitor/PACS radiological workstation. If so, this allows radiologists to provide comparable interpretation as if they were onsite at an imaging center or hospital. Materials and Methods: This study is an investigator initiated, single site, retrospective, nonrandomized, IRB approved study. Five radiologists were included in this study. Each independently interpreted specific CT and MR sequences on traditional high-resolution LCD monitors via eFilm? software as well as an iPad? mobile device using Osirix? software program. Repeat interpretations were performed, with 4 weeks minimum interval between interpretations of each patient. This investigation included: 50 patients with CTA perfusion imaging, 50 patients with MRI of the brain, and 50 patients with MRI of the spine, which were image study orders generated through emergency room requests. Subsequently, interpretive results of each radiologist for each patient were statistically compared to evaluate for intra-observer and inter-observer reliability. Results: The parameters set within the CTA perfusion brain studies demonstrated excellent intra-observer variability. All of the parameters within the MRI brain studies demonstrated excellent intra-observer variability with a Cohen’s kappa value > 0.75. The Cohen’s kappa values for the board certified neuroradiologist demonstrated excellent variability for all parameters;the resident radiologists had good variability, with a majority of kappa values near 0.75. Conclusions: The data and statistical analysis demonstrated that portable mobile devices such as the Apple iPad? can display adequate resolution of CT and MRI sequences to accurately diagnose acute central nervous system injuries and other non-acute pathology.