Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access to digital imaging and communication in medicine persistent object protocol

AIM:To address issues in interoperability between different fundus image systems,we proposed a web eyepicture archiving and communication system(PACS)framework in conformance with digital imaging and communication in medicine(DICOM)and health level 7(HL7)protocol to realize fundus images and reports sharing and communication through internet.METHODS:Firstly,a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise(IHE)Eye Care technical framework.Then,a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object(WADO)protocol,which contains three tiers.RESULTS:In any client system installed with web browser,clinicians could log in the eye-PACS to observe fundus images and reports.Multipurpose internet mail extensions(MIME)type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians.Some functions provided by open-source Oviyam could be used to query,zoom,move,measure,view OICOM fundus images.CONCLUSION:Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports,therefore is of great significance for teleophthalmology.

Can a Ris/Pacs System Really Improve Execution and Reporting Times?

A study of the process timing and organization has been done in a Radiology Department where Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) are working. The workflow times have been directly read from RIS database. In particular, Execution and Reporting steps were considered. Afterwards, data have been analyzed through a statistical elaboration and results were compared with data, coming from studies performed on similar process, collected with a stopwatch method. Possible “bottlenecks” can be evidenced in the process structure. Moreover, comparing hospitals with the same RIS/PACS system, different internal organization is emphasized.

医学影像学教学模式的现状与实践

医学影像学是临床医学中一门实践性极强辅助学科,同时也是发展迅猛,日新月异的学科,在现代医疗中扮演着越来越重要的角色。文章通过对影像医学教学的基本要求、教学目标和目的进行说明,采用影像存储和传输系统(picture archiving and communication system,PACS)结合以问题为基础的教学法(problem-based learning,PBL)及以案例为基础的教学法(case-based learning,CBL)教学法进行实践。针对非影像专业学员学习时间短、学习任务重,学员影像基础和需求迥异,部分非影像专业学员自身对医学影像学的重视不足以及放射基地重视不足等问题。文章阐述了PACS与PBL、CBL教学法、钉钉、微信及SPARK学习平台等学习沟通平台相结合,并增加专职人员对基地管理、带教老师一对一指导,以及不断加强科室建设、安排名师上课来提高科室影响力等多种混合教学模式的解决对策,来唤起学员学习影像相关知识的内驱力,达到提高学员轮转学习效果的目的。

数字化模式下医学影像学CBL教学法的应用

目的:探讨数字化模式下以病例为基础的医学影像学教学模式在临床教学工作中的应用价值。方法:利用医院影像存储及传输系统和放射科信息系统,构建医学影像学数字化教学病例库,将该病例库中的示教病例应用于北京大学医学部八年制医学影像学的临床教学。比较数字化模式与传统胶片模式的教学效果。结果:成功构建了能满足教学需要的数字化教学病例库,该病例库收集了1300余例典型示教病例,将这些示教病例应用于临床教学工作,取得良好的教学效果,明显提高了学生对教学工作的满意度,并取得了较理想测试成绩。结论:数字化模式下CBL教学法改变了医学影像学传统胶片式教学模式,实现了在PACS/RIS环境下的数字化医学影像学教学,教学质量得到明显提高。

模块式教学联合基于PACS的CBL教学法在医学影像学见习中的应用

目的探讨模块式教学联合基于数字化影像存储及传输系统(picture archiving and communication systems,PACS)的以案例为导向的教学法(case-based learning,CBL)在医学影像学见习教学中的应用价值。方法2022年9—12月,选择中南大学湘雅二医院学习的2019级五年制临床医学133名学生作为研究对象,按学号顺序分组,试验组66名,采用基于PACS系统的CBL联合模块教学模式。对照组67名,采用传统多媒体幻灯片(powerpoint,PPT)面授式教学方法,通过专业考核和问卷调查评估教学效果。结果试验组学生的读片测验和卷面测验成绩均高于对照组,差异有统计学意义(P<0.05)。问卷调查各项指标显示试验组的满意度高于对照组,差异有统计学意义(P<0.05)。结论模块式教学联合基于PACS的CBL教学法能激发医学生的学习兴趣,更深入地学习影像学知识,提高了医学影像学见习教学的效果。

新形势下医学影像专业线上实践教学模式的应用探讨

医学影像专业实践教学的主要内容是浏览大量的医学图像,分析图像特征并给出诊断意见。随着当今信息时代和硬件设备的发展,实践教学的模式已经不局限于常规医院科室内胶片阅片,而是传统模式与新型高效的、内容丰富的依托互联网的实践学习模式互相结合与补充。不同新型的线上实践模式近年来得到了迅猛发展并逐渐发展完善,有利于学生高效地掌握学科的基础及前沿知识,对教师教学能力及业务能力的提高也有促进作用。教师通过融合线上实践教学的新模式对学生进行讲授、讨论、互动交流,可激发学生的学习兴趣,活跃课堂的教学氛围,更重要的是提升了学生影像思维和临床思维的能力和水平。文章根据医学影像实践教学的要求并结合本单位的线上实践教学经验对近年来不同的线上教学模式进行介绍,为其他教学医院提供参考。

A project plan for construction and cabling of picture archiving and communication system network

Objective To determine a network solution to meet the network requirements of the heavy data flow, load balance, and potential network storms from expansion of picture archiving and communication system (PACS) application.Methods Intel Netstructure 480T Giga Switch was used as the main switch and connected to each building by fiber channel at 1 Giga speed to archive 100 MB/s to each port. At the same time, the in-dependence of the original network construction was physically kept. The layer 3 and 4 switchers were used as load balance to reduce the heavy load of the network, and all the cabling for PACS used the super CAT5 along with the Intel NetStructure 1520 to prepare for potential network storms.Results An advanced intranet was set up to fully meet the high standard requirement of the PACS. The foundation for upgrading the whole network system to 1 Giga application was built to achieve sharing and transmission of images, information, and patient data within the hospital. The base was established for the standardized management of the hospital.Conclusion Good planning is the first step in setting up PACS, and the equipment forms the necessary platform to run PACS and all kinds of hospital information system (HIS). The networking construction is the foundation of e-hospital.

三明治教学法联合PACS系统在医学影像诊断学教学中的应用

目的 探讨医学影像诊断学教学中采用三明治(Sandwich)教学法联合图像存储与传输(picture archiving communication system,PACS)系统的效果。方法 选取2020年9月—2021年8月遵义医科大学医学影像学院共计45名本科学生作为对照组,采用传统教学模式,选取2021年9月—2022年8月遵义医科大学医学影像学院共计45名本科学生作为研究组,采用Sandwich教学法联合PACS系统,对2组考核成绩、学习兴趣、批判思维能力及教学质量满意度进行比较。结果研究组基础理论、影响分析、报告书写、鉴别诊断评分[(89.19±3.26)分(、95.76±2.85)分(、89.06±2.74)分、(91.58±4.09)分]较对照组[(81.06±3.11)分(、84.73±3.67)分、(80.39±3.25)分、(81.89±4.11)分]更高,差异均有统计学意义(P <0.001);2组教学后学习兴趣评分提高,研究组[(8.79±1.02)分]评分较对照组[(7.34±0.95)分]更高,差异均有统计学意义(P <0.001);2组教学后批判性思维量表中文版(critical thinking disposition inventoryChinese version,CTDI-CV)评分提高,研究组评分较对照组更高,差异均有统计学意义(P <0.001);研究组教学质量满意度评分较对照组更高,差异均有统计学意义(P <0.001)。结论 Sandwich教学法联合PACS系统应用于医学影像诊断学教学中,可提高考核成绩及学习兴趣,改善批判思维能力,提高教学质量满意度。

Malignant solitary pulmonary nodules: size and attenuation measured on a PACS and CT workstation

Objective: The aim of our study was to determine the efficiency and effectiveness of picture archiving and communication system(PACS) workstation in detecting the sizes and attenuation of malignant solitary pulmonary nodules(SPNs). Methods: Forty patients with malignant SPNs(diameter ≤ 3 cm) underwent multidetector-row computed tomography(CT) of the chest in a single-breath-hold technique. The raw data were acquired with a collimation of 0.625 mm. The diameters and attenuation of malignant SPNs were measured on PACS and CT workstation respectively. The diameter was defined as the average value of the anteroposterior, lateral and superoinferior diameters on CT scans obtained with a mediastinal window setting. The superoinferior diameters were measured on MPR image. The diameters and attenuation of malignant SPNs and spending time in measuring were recorded. Results: The diameters of malignant SPNs measured on a PACS and CT workstation were 2.09 cm ± 0.87 cm, 2.07 cm ± 0.79 cm, respectively. There was not statistically significant difference in the diameters of malignant SPNs between that measured on a PACS workstation and that on a CT workstation(t = 1.580, P = 0.210 > 0.05). The attenuation of malignant SPNs measured on a PACS and CT workstation were 40.15 HU ± 7.53 HU, 39.99 HU ± 8.13 HU, respectively. There was not statistically significant difference in the attenuation of malignant SPNs between that measured on a PACS workstation and that on a CT workstation(t = 1.008, P = 0.298 > 0.05). The spending time in measuring on a PACS and CT workstation were 55 s ± 4.03 s, 56 s ± 3.95 s, respectively. No statistically significant difference was found in spending time in measuring between that on a PACS workstation and that on a CT workstation(t = 0.958, P = 0.315 > 0.05). Conclusion: The efficiency and effectiveness of PACS workstation is as same as those of CT workstation in detecting the sizes and attenuation of malignant SPNs. It is suggested that the size and attenuation of malignant SPNs are measured on a PACS and CT workstation.

Peripheral bronchogenic carcinoma: Enhancement pattern evaluation on PACS and CT workstations

Objective: The aim of the study was to determine the efficiency and effectiveness of picture archiving and communication system(PACS) workstation in detecting enhancement pattern of peripheral bronchogenic carcinoma. Methods: The 62 patients with peripheral bronchogenic carcinoma underwent two-phase contrast material-enhanced multislices computed tomography(MSCT) of the chest in a single-breath-hold technique. Two spiral CT scans were obtained at 25 s and 90 s respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 4 m L/s by using an autoinjector. Precontrast and postcontrast attenuation on every scan were measured on PACS and CT workstations respectively and peak height was calculated. Enhancement pattern was evaluated on the image obtained at 90 s after injection of contrast medium on PACS and CT workstations respectively. Results: No statistically significant difference in precontrast attenuation, postcontrast attenuation at 25 s and 90 s was found between these measured on a PACS workstation [(40.21 ± 7.03) HU;(55.53 ± 11.09) HU;(75.95 ± 13.45) HU] and those [(39.01 ± 8.95) HU;(56.01 ± 10.91) HU;(76.03 ± 11.95) HU] on a CT workstation(t = 1.140, P = 0.256 > 0.05; t = 1.580, P = 0.149 > 0.05; t = 1.505, P = 0.150﹥0.05). The peak height that calculated on a PACS workstation was 35.74 HU(20 HU). There was not statistically significant difference in peak height between that calculated on a PACS workstation and that on a CT workstation [(37.02 ± 12.05) HU; t = 2.001, P = 0.099 > 0.05]. The tumors showed same enhancement pattern on PACS workstation and CT workstation. Of the 62 cases, 38 showed homogeneous enhancement, 17 showed heterogeneous enhancement, five showed peripheral enhancement, two showed central enhancement, at 90 s. The enhancement pattern revealed on PACS workstation was consistent with feature of peripheral bronchogenic carcinoma. Conclusion: The efficiency and effectiveness of PACS workstation is as same as those of CT workstation in detecting enhancement pattern of peripheral bronchogenic carcinoma.

PACS辅助PBL教学模式在心血管专科医生心血管罕见病教学中的探索

目的:探讨图像存储及传输系统(PACS)辅助以问题为基础的学习(PBL)模式在心血管专科医生心血管罕见病教学中的应用效果。方法:选取进行心血管专科医师规范化培训(专培)学员16名作为研究对象,分为观察组和对照组,每组8人。观察组基于PACS系统进行PBL教学,对照组仅进行PBL教学。所有专培学员于授课前后分别进行罕见病理论测试,评估对于罕见病相关知识的了解程度;授课后,所有学员进行课程成绩考核(包括平时成绩和理论考试)和课程满意度问卷调查。结果:2组专培学员授课前罕见病理论测试成绩差异无统计学意义(P>0.05),授课后观察组成绩明显优于对照组(P<0.01)。平时成绩中,观察组的个人发言积极性和小组协作性得分均明显高于对照组(P<0.01);理论考试中,观察组客观题、影像分析和病例分析得分均明显高于对照组(P<0.01)。问卷调查显示,观察组在心血管影像的读图能力提高方面满意度优于对照组(P<0.05)。结论:PACS辅助PBL模式教学有助于提高专培学员对心血管罕见病的认知,提高教学质量。

PACS联合多模态教学在放射科住培学员早读片中的应用

目的探讨影像归档和通信系统(picture archiving and communication system,PACS)结合基于问题的学习(problem-based learning,PBL)、基于病例的学习(casebased learning,CBL)、基于团队的学习(team-based learning,TBL)及任务驱动法,利用线上(微信群)及线下资源的多模态教学模式在放射科住院医师规范化培训(简称住培)学员早读片中的应用价值。方法选取2014年6月—2020年12月在放射科参加住院医师规范化培训的住培学员70名作为研究对象,其中46名作为试验组,早读片采用PACS结合PBL、CBL、TBL及任务驱动法,利用线上(微信群)及线下资源的多模态教学;24名作为对照组,采用传统早读片教学模式。均在完成第一阶段住培结束后进行理论考核、实践技能考核及调查问卷评价。结果试验组理论考核成绩、实践技能考核成绩分别为(86.72±3.54)分、(88.59±4.02)分,对照组理论考核成绩、实践技能考核成绩分别为(79.75±6.43)分、(80.25±6.17)分,两组间成绩差异有统计学意义(P<0.05)。教学模式调查问卷评分试验组(86.13±4.33)分高于对照组(70.25±7.11)分,差异有统计学意义(P<0.05)。结论PACS结合PBL、CBL、TBL及任务驱动法,利用线上及线下资源的多模态教学模式在早读片中的应用,能够提高放射科住培学员的学习效果及综合能力。

国内医学图像处理技术的最新动态

阐述了医学图像处理技术的发展动态,介绍了目前国内在三维医学图像的可视化和基于PACS的医学图像压缩在医学图像处理方面的进展。在比较各种技术在相关领域中应用的基础上,提出了医学图像处理技术发展所面临的相关问题及其发展方向。

PACS与HIS/RIS集成方法的研究

介绍了PACS和HIS/RIS所管理的信息对象及遵循的标准 ,详细阐述了PACS与HIS/RIS之间的集成方法 ,并结合实例说明了如何用DICOM标准实现它们之间的无缝连接。

构建基于PACS的医学影像教学资源中心提升教学质量

[目的]构建基于图像存档与传输系统(picture archiving and communication system,PACS)的数字化医学影像教学资源中心,提升医学影像学教学质量。[方法]设计电子教案(electronic teaching file,ETF)生成模块,并把它整合在PACS系统报告工作站,配置电子教案服务器,建立电子教案数据库,并通过与PACS系统交互的接口模块,实现影像电子教案的制作,然后利用医院PACS系统中海量的数字化医学影像资料,建立数字化医学影像教学资源中心。[结果]通过整合在PACS系统报告工作站中的电子教案生成模块,选择典型病例、感兴趣病例,并经过简单的处理后自动快速地生成电子教案,成功构建数字化医学影像教学资源中心。[结论]基于PACS系统成功构建数字化医学影像教学资源中心,最大限度实现医学影像教学资源共享,将改变医学影像学教学模式,极大地提升医学影像学教学质量。

医院影像归档与存储系统中影像数据长期存储问题的研究

目的解决海量医学影像数据在医院PACS网络中的长期安全存储问题。方法将医院DICOM3 0和非DI COM3 0影像检查设备采集到的不同医学影像转换成影像数据的存储格式、元数据的标识、表示方式等由DICOM3 0标准规定的数字影像 ,并按照影像数据的使用与存储要求 ,依据性价比最优的原则 ,采取在线、近线和离线三级存储的方式 ,合理配置分级存储设备容量 ,通过编簇 ,科学分配影像数据在PACS网络中合理流动。结果本方法构建的医院PACS存储系统 ,既能满足海量影像数据长期存储与管理 ,同时具有超强容错能力 ,实现永久无限制存储 ,检索查询迅速 ,存取快速、方便、可靠。结论分级存储是实现PACS海量医学影像数据长期安全存储的有效方法。

基于PACS多元立体化教学模式在医学影像本科实习教学中的应用

医学影像学是一门实践性很强的应用学科,图像存档与传输系统(PACS)系统存储大量临床和影像学信息,且具有高效率、高质量影像图像处理功能。利用PACS系统可将多种教学资源、教学方法和教学手段融入实习教学过程中,实现以学生学习为中心、教师教学为主导多元化和立体化教学模式,有助于提高影像实习生的报告书写能力、读片能力及临床操作能力。

基于医学影像存档与传输系统的独立教学系统的研发

目的开发一种基于PACS的独立的教学系统,便于不同层次学生方便地学习各系统疾病的诊断与鉴别诊断。方法使用放射科信息系统(RIS)服务器作为系统服务器,总体采用B/S架构,Microsoft SQL 2005作为数据库,以ASP.NET为基本开发技术。使用JavaScript+DOM(文档对象模型)实现客户端的人机对话。软件构建完毕后,根据不同学习对象输入教学大纲、知识点和鉴别诊断知识点,并将PACS中的教学病例与知识点相关联。结果系统成功建立,主要包括软件架构和教学内容两大部分。授权用户登录后可进入"学习应用"界面,包含"学习中心"和"在线测试"。学习中心包括:教学大纲、知识点(含临床、病理、流行病学、影像学等内容)、鉴别诊断要点、PACS中相关病例链接。在线测试则包含不同难度的题库,系统自动评判对错。管理员拥有"数据维护"和"系统管理"两大权限,可对教学相关的目录、大纲、教学资源、试题和试卷进行维护,也可管理用户身份和权限。结论成功地建立了一种基于PACS的独立教学系统,能满足不同层次学生的需求,有助于提高医学影像学教学水平。

医学影像学见习应用PACS教学法与传统读片教学法的对比研究

将中南大学湘雅医学院2010级临床医学五年制197名学生随机分成两组,在医学影像学见习教学过程中分别应用影像存储及传输系统(PACS)教学法(98人)及传统读片教学法(99人),学期结束时对两组学生考试成绩进行分析,并对PACS组学生进行问卷调查及结果分析。统计数据显示,PACS组学生读片测验及卷面考试中,病例分析题成绩显著高于传统读片组,问卷调查显示PACS组学生大多数认可该教学方法。因此,应用PACS教学有助于提高学生的临床分析能力及主动学习的能力,是学生欢迎的教学方式。但对医学影像学基本知识的传授,应用PACS法较传统读片法并无明显优势。