(a) Physical level
From the physical hierarchy, PACS can be divided into four layers: network user layer, access layer, core layer, resource provision layer, constituting a "pyramid" structure from the bottom up. Among them: the network user layer is the network of many terminals or workstations; access layer refers to the network user layer with the terminal or workstation connected to these terminals or workstations for network interconnection of network equipment collection (such as secondary switches, hubs, etc.); the core layer refers to the access layer of network equipment together to form a full interconnection of the collection of network equipment, such as servers, routers, firewalls, etc.); resource provisioning layer refers to the PACS. ; Resource Provisioning Layer refers to the numerous medical device terminals in the PACS network, such as (CT, US, DR, etc.).
(2) Application Hierarchy
From the application hierarchy, PACS can be divided into three layers: MINI-PACS, department-level PACS, and hospital-wide PACS, which constitute an "embedded" structure from the inside out. MINI-PACS refers to the system planned for small medical institutions or a single department, and the MINI-PACS system must also include ultrasound, endoscopy, and other graphic and textual professional image reporting systems; department-level PACS refers to the departmental structure proposed for medium-sized hospitals, and tightly integrates with the hospital's existing HIS/RIS system to establish a patient-centered departmental imaging center; Hospital-wide PACS is a hospital-wide structure proposed for large hospitals, which fully realizes the digital reading and diagnosis workflow of all imaging departments and the electronic management of all imaging departments in the hospital. Existing mainstream PACS vendors, at the beginning of the development of the PACS system, have complied with the following standard processes. (a) Registration and entry of examination information
The registration workstation at the front desk enters the basic information of the patient and the examination application information, and it can also retrieve the HIS system (if there is a HIS and it is integrated with the PACS/RIS) for the automatic entry of the patient information, and carries out the registration of the patient's triage, re-registration of the patient's consultation, the scanning of the application form, the printing of the application form, and the arrangement of the patient's triage, and other work.
(2) WorkList Service
Once the patient information is entered, other workstations can directly and automatically recall it from the main database of the PACS system without having to manually re-enter it; medical imaging equipment with WorkList service can directly extract the list of relevant basic patient information from the server, and medical imaging equipment without WorkList function can enter patient information data through the medical imaging equipment operator console. Medical imaging equipment with WorkList service can extract the list of relevant basic patient information directly from the server.
(3) Image Acquisition
For standard DICOM devices, the acquisition workstation can automatically (or manually) forward images to the main PACS server after or during the examination.
(iv) Non-DICOM Conversion
For non-DICOM devices, the acquisition workstation can use the MiVideo DICOM Gateway to receive the registration information and then perform image acquisition during the examination process, and the acquired images are automatically ( or manually forwarded by the device operating technician) forwarded to the main PACS server.
(E) Image Access
After the patient completes the image examination in the examination room, the physician can access, browse and process the image through the network of the reading room, and can print out the film and deliver it to the patient.
The PACS system automatically recalls images from the main server disk array or the front server connected to it according to the path set in the background.
In the image display interface, the physician can generally carry out some measurements of length, angle, area and other image post-processing, in the mainstream PACS, in addition to the measurement function, will provide scaling, moving, mirroring, inverted, rotating, filtering, sharpening, pseudo-coloring, playback, window width and window position adjustment and other image post-processing functions.
(F) Report Editing
After the patient completes the imaging examination the image quality is reviewed by the professional staff and quality analysis is performed. After completing the quality review and control of the image, the diagnostic doctor can edit the diagnostic imaging report, and according to the diagnostic physician's authority, respectively, the initial diagnosis report, report review work. In the process of writing the report, a template of commonly used diagnostic words can be used to reduce the physician's keyboard input workload. In the process of diagnostic report auditing, the modified content can be modified to retain the traces, can obtain the clinical diagnosis, detailed medical history, historical diagnosis and other information, can store the report as a typical case for other similar diagnosis, for the entire department to learn to improve the use of the department.
Audit completed report through the printer output by the physician's signature and submit, while the diagnostic report is uploaded to the main server storage backup. After printing the completed report can not be modified, but can be read-only access to reference.