医疗PACS影像系统的数据存储性能优化

医疗影像归档与通信系统(PACS)影像数据是典型的海量小文件场景,其面临的挑战主要为高效的海量元数据管理和有效解决碎片化导致的性能下降.通过分析医疗PACS影像存储系统路径的全IO(input/output)各个关键环节,从PACS软件调阅算法、存储协议网关高并发设计、小文件聚合以及数据存储服务并发模型4个维度进行优化设计,实现对PACS调阅性能的大幅提升.实际测试表明,优化设计后PACS影像系统的调阅性能可达到每秒300幅图像,为传统存储调阅速度的3倍以上,有效解决了PACS影像数据调阅卡顿的问题.

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.

眼科PACS专科工作平台设计与实践

目的:提高临床眼科专科服务能力,优化患者就诊流程。方法:分析医院现有眼科业务流程的不足,结合医院实际情况,采用面向服务的架构及模块化设计方法构建眼科影像存储与传输系统(PACS)专科工作平台。结果:该平台涵盖眼科科室日常业务,实现了眼科专科与全院信息化的互联互通,全流程医疗文书无纸化;形成眼科专科化数据库,便于分析患者信息、指标数据和就诊信息等,提高了眼科服务水平和效率。结论:眼科PACS专科工作平台极大提高了眼科影像管理效率和质量,提升了临床工作效率,可为同类专科信息化建设提供参考。

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.

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.

一种基于B/S模式的PACS的研究与实现

我们采用 B/ S模式及其构建技术 ,给出了一个完整 PACS体系结构的设计方案 ,并介绍了在此体系结构基础上实现的 PACS各部分的功能应用。此 B/ S模式的 PACS具备安全、稳定、易维护、易升级等优点 。

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.

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。

B超图象PACS系统的研制

介绍了Ｂ超图象ＰＡＣＳ系统的研制过程中的一些主要技术，分别从影象的获取与分析，信息存档及访问，系统通信及ＤＩＣＯＭ标准化几个方面加以详细解释．并针对当前ＰＡＣＳ系统存在的一些缺陷提出了解决方法．

PACS在颈椎后方结构测量及其临床意义

目的利用图像存储传输系统(PACS)结合CT片测量颈椎后方解剖学结构,为临床颈椎椎弓根置钉提供资料。方法利用PACS结合CT片,由5名脊柱外科医师对2000例正常人颈椎椎弓根的矢状位及横断为进行精确测量,得出椎弓根的长度、宽度、高度、向内侧倾斜、向头、尾侧倾斜角度的数据值,并分别计算各节段左右侧椎弓根测量值的均值和标准差,进行统计学分析。结果寰椎入钉点距离一般在后弓中点旁开17～20mm,在C2～7各椎弓根均有髓腔,C2～7椎弓根的高度大于宽度,C3、C4椎弓根直径最小,仍可置入3.5mm的螺钉。寰枢椎螺钉在矢状面入钉角向头侧倾斜为正角,下颈椎螺钉向尾侧倾斜为负角,C4接近水平,C5～7负角逐渐增大,C7可达-19°左右。在横断位上测量的椎弓根的进钉角度显示,其中C2最小,下颈椎椎弓根具有变异性,术前利用CT片通过PACS进行精确测量,指导术中准确选钉与安全置钉具有指导性意义。结论应用PACS系统结合CT片术前测量,能够指导术中安全置入颈椎椎弓根螺钉,明显减少并发症,是一种值得推广的方法。

融合PACS的远程影像教学系统在影像科室间的应用

目的充分利用三甲医院专家资源优势,通过高清会议视频技术及PACS系统对基层医院影像科室的医师进行同步远程影像教学,以探讨远程影像教学模式在医学影像科的应用价值。方法将PACS影像、视频、语音等信息综合在一起,通过20M公网宽带远距离实时传输到基层医院影像科室会场中心,实现医学影像的远程实时同步教学与会诊。结果远程影像会诊和教学模式提升了基层医师的专业诊断水平,节省了专家资源,降低了人才培养成本。结论未来远程影像教学模式将是集医疗、教学、科研为一体的医学交流平台,具有一定的应用价值。

PACS中的图象管理与预取技术的研究

介绍医学图象的分类 。

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。

利用PACS病例检索实施案例式教学在医学影像学示教中的作用

目的探索利用数字化影像存档与传输系统(picture archiving and communication system,PACS)病例检索实施案例式教学在医学影像学实践教学活动中的作用。方法对临床医学专业二个小班进行医学影像学示教(A、B班,共80人,每班40人)。A班作为研究组,采用让学生利用PACS自己检索示教内容相关病例并做出分析和总结的教学法;B班作为对照组,采用传统PPT面授式教学法;通过随堂小测试及教学满意度调查问卷评估两种方法的教学效果。结果研究组小测验成绩和教学满意度分别为(90.2±3.4)和(92.0%±3.5%);对照组分别为(85.5±4.6)和(85.0%±6.5%)。研究组的小测验成绩及教学满意度均高于对照组(P=0.038,P=0.014)。结论利用PACS病例检索实施案例式教学在医学影像学实践教学活动中能更好地提高教学效果,具有较高的应用价值。

基于病案的教学查房结合PACS在影像科医师培养中的应用

目的探讨在影像科医师培养中,基于病案(CBL)的教学查房结合医学影像存储与通讯系统(PACS)对医师影像诊断能力培养的价值。方法对2018年在北京大学第三医院放射科轮转CT的41名培训医师,应用PACS对其进行CBL教学查房,对照组为2017年轮转CT的39名培训医师(未进行CBL教学)。从PACS随机抽取每名医师书写的10份报告(报告时间为培训最后1个月),对开展CBL教学前后培训医师的报告书写质量评分并计算优良率。评分标准包括病灶征象描述全面准确、报告内容条理清晰规范、诊断结论逻辑清晰合理、能回答临床提出的问题、提出的下一步诊疗建议合理准确以及无漏诊。同时采用调查问卷的方式评价培训医师对CBL教学查房的主观感受,包括全面系统的认识疾病、提高临床思维能力、读片能力和学习兴趣、PACS对学习的帮助5方面,采用百分比表示。结果1)进行CBL教学查房后,培训医师报告质量评分提高(P<0.01)。2)培训医师对调查问卷5方面满意率分别为90.2%、68.3%、80.5%、75.6%和80.5%。结论应用PACS进行CBL教学查房是培养影像科医师诊断能力的有效方法。

一种新型PACS系统存储方案设计

在PACS系统存储应用特征分析的基础上,提出对医学图像实施多层存储的思想,并具体设计了医学图像高速存储中数据替换的方法。

PACS系统在实现放射科完全数字化中的应用体会

目的:通过分析几年来我院PACS系统的组建和应用经验,探讨PACS系统在放射科数字化建设中的作用。方法:运用PACS实现了CR、CT、MRI、DSA等医学影像存储、传输,医生通过PACS影像工作站对图像进行多种后处理等。结果:经过多年的工作实践,我科医生已熟练掌握了PACS的一般应用方法,运用该系统实现了无胶片阅片,诊断质量得到提高,诊断报告生成速度加快,患者的候诊时间明显缩短。结论:运用PACS系统实现了影像数字化、无胶片化,能大大提高医院的医疗技术水平和工作效率,更好地为患者服务。

在我国建立PACS体系要解决的问题

医学影像存档与通信系统（ＰＡＣＳ）是当前在医学影像学中具有广阔发展前景的技术领域。我国正处在建立ＰＡＣＳ的起步阶段，借鉴国外的经验，我们提出在建立ＰＡＣＳ时应注意的问题和亟待解决的问题。包括标准化问题、使用方便问题、大容量存储问题以及经济问题等。这些问题的有效解决对促进ＰＡＣＳ在我国的建立将起到推动作用．同时也向我国从事医学影像计算机图像处理和计算机放射科管理工作人员提出需要研究的课题。