With the arrival of the information age, digital, standardized, networked operations have entered the medical imaging community, and the rapid development of the momentum of the gallop, accompanied by a number of new digital imaging technologies have been applied to clinical, such as CT, MRI, digital subtraction angiography (digital subtraction angiography (DSA)), positive electron beam imaging (positive electron beam imaging), digital subtraction angiography (DSA), and digital subtraction angiography (DSA). Body layer imaging (positive electron tomography, PET), computerized radiography (computed radiography, CR) and digital radiography (digital radiography, DR), etc., the network of medical imaging diagnostic equipment has gradually become the inevitable development trend of the imaging department. At the same time, it is objectively required to computerize, standardize and regulate the writing of medical imaging diagnostic reports. Medical image archiving and communication systems (picture archiving and communication systems, PACS) and medical imaging diagnostic reporting system came into being and has been the rapid development of the whole radiology department has undergone a great change, improve the status and role of the imaging discipline in clinical medicine.
Overview
PACS is an integrated system designed to comprehensively address the acquisition, display, storage, transmission and management of medical images, which has been rapidly developed in recent years along with the advancement of digital imaging technology, computer technology and network technology [1-4].PACS is categorized into the acquisition of medical images, high-capacity data storage, image display and processing, database management, and transmission of images. PACS is divided into five units such as medical image acquisition, high-capacity data storage, image display and processing, database management, and local or wide-area network for image transmission [2, 4].
PACS is a computer network for transmitting medical images, and protocols are a prerequisite for information transfer. The Digital Imaging Transmission in Medicine (DICOM) standard is the first widely accepted global standard for medical digital imaging and communication, which utilizes the standard TCP/IP (transfer control protocol/internet protocol) network environment to enable direct networking between medical imaging devices [3]. Therefore, PACS is the core architecture of digital medical imaging systems, and the DICOM 3.0 standard is an important network standard and protocol to ensure that PACS becomes a fully open system.
In 1998, the Department of Radiology of our hospital cooperated with GE Hangwei Medical Systems (GEHW) to build a network system of medical imaging diagnostic equipment, which takes DICOM server as the central server and networks digital imaging equipment in accordance with the DICOM3.0 standard for digital imaging medical image acquisition, transmission, processing, storage, and centralized storage. acquisition, transmission, processing, central storage and management. SCSI CD-ROM, Yamaha 6×4×2 CD-RW×2, EtherExpress PRO/100+ network card; 500W uninterruptible power supply (UPS).
2. Digital medical image acquisition equipment: Spiral CT: GE HiSpeed CT/i, DICOM 3.0 interface; Magnetic **** vibration: GE Signa Horizon LX MRI, DICOM 3.0 interface.
3. Medical image display processing workstation: Sun Advantage Windows (AW for short) 2.0, 128MB static memory, 20 in (1 in=2.54 cm) color display, 1280 × 1024 display resolution, DICOM 3.0 interface.
4. Laser Film Printer: 3M Imation 969 HQ Dual Printer .
5. Medical Image Viewing Terminal: 7 units, Pentium Ⅱ 350 ~ 400MHz / Pentium Ⅲ 450MHz CPU, 64 ~ 128MB RAM, 8MB video memory, 6GB ~ 8.4GB hard disk, 15 in ~ 17 in monitor, 10Mbps Ethernet (Ethernet) network card, Ethernet interface.
Medical image archiving and communication system development and initial application from: the first model of the network
6. medical imaging diagnostic report print server: two image browsing terminals and as a print server.
7. laser printer: Hewlett-Packard (HP) LaserJet 6L Gold × 2.
8. hub (HUB): D-Link DE809TC, 10Mbps.
9. transmission media: thin cable (thinnet); Category 5 unshielded twisted-pair cable (UTP); fiber optic cables.
10. network structure: star bus topology (star bus topology) structure.
(B) software
1. Operating system: spiral CT, MRI, AW workstations: UNIX; DICOM server: Windows NT 4.0 Server (English version); image browsing and diagnostic report writing terminal: Windows NT 4.0 WorkStation (Chinese version).
2. Network transmission protocol: standard TCP/IP.
3. Web browser: Netscape Communicator 4.6.
4. Database management system: Interbase Server/Client 5.1.1.
5. Medical Image Viewing and Diagnostic Imaging Reporting System Development Software: Borland C++ Builder 4.2.
The development and preliminary application of the thesis medical image archiving and communication system from
6. Medical Image Viewing Terminal: GEHW Advantage Viewer Server/Client 1.01.
7. Medical Image Diagnosis Reporting System: GEHW Medical Diagnostic Report 1.0.
8. Burner Driver Software: Gear 4.2.
(C) System Structure
Spiral CT, MRI and AW workstations are connected to the backbone cable (thin cable) in accordance with DICOM 3.0 standards to form a DICOM network with bus topology; DICOM server connects with each image viewing and diagnostic reporting system via thin cable. The DICOM server and the image viewing and diagnostic report writing terminals are connected into a star topology Ethernet network through twisted pairs of cables with a hub as the center; the two are then connected into a star bus topology PACS through the hub. the spiral CT, MRI, and AW workstations are connected to the laser film printers through fiber-optic cables to carry out ****-enjoyable printing. This PACS consists of the following subsystems:
CT/I: GE Hispeed CT/I; AW 2.0: SUN Advantage Windows 2.0; MRI: GE Signa Horizon LX MRI; DICOM: digital imaging and communications in medicine; Ethernet network: Ethernet network: digital imaging and communications in medicine. communications in medicine; Ethernet network: Ethernet network; T-BNC: coaxial cable connector T-connector; terminator: terminator; transceiver: transceiver; UTP: unshielded twisted pair; thinnet coaxial cable: thin coaxial cable
2. Digital Image Return Subsystem: Return the image data stored in the center to the spiral CT, MRI and other digital imaging equipment for printing, comparison reference and post-processing (3D reconstruction, etc.).
3. Medical Image Processing Subsystem: Adjust window width/position, single/multiple display, local/full magnification, quantitative measurement (CT value, distance, angle, area), continuous playback, and various image annotations on AW workstations and various image browsing and diagnostic report writing terminals.
4. Medical imaging diagnostic report writing subsystem: writing standardized and standardized medical imaging diagnostic reports.
5. image center storage subsystem: image short-term (5 to 7 days) saved in the hard disk of the DICOM server, when the image data accumulated to a certain number (650MB), it will be burned to CD-R (compact disk-recordable, burning disk) disk as long-term storage.
II. Medical Image Viewing and Diagnostic Imaging Reporting System
The software package used by the medical image viewing and diagnostic imaging reporting system is Advantage Viewer Server/Client 1.01 provided by GEHW (GEHW for short). Server/Workstation 4.0 as the operating platform, divided into server-side and client-side two parts: server-side software is responsible for completing the transmission of medical images, central storage, database management and other tasks; the client software has a medical image browsing and diagnostic imaging report writing function.
The server-side software includes four modules: image browsing, image management, CD-ROM database and system settings. (1) Image browsing module has simple image browsing function; (2) Image management module includes sub-modules for storage, deletion, image output, etc. In these sub-modules, the required images are queried on the hard disk and CD-ROM of DICOM server and related processing by using the patient's name, age, gender, CT No., examination serial number, type of examination, date of examination, etc. as the keywords; (3) CD-ROM database module Stored with each CD-ROM image retrieval information for query; (4) system setup module to manage the IP address of each input/output device, etc..
Medical image browsing software has a powerful image processing capabilities, can be accessed through the network from the DICOM server hard disk, CD-ROM required images, and image browsing and post-processing. It includes window width window position, image, geometry, network, display format, continuous playback and other functional modules: (1) window width window position module through the predefined, user-defined and precise setting of the window width window position, so that the image to get the best display, and in addition can be adjusted by the left mouse button; (2) image function module can be zoomed in on the image (1 to 300 times), filtering, contrast (-100 to 100), rotation (0 to 360 °), and the image can be displayed on the screen, so that the image is displayed on the screen. ), rotation (0～360°), three primary colors (RGB) color processing; (3) Geometry function module can flip the image vertically or horizontally, add grid, negative processing, quantitative measurement (CT value, distance, area, angle) and labeling. The post-processed images can be directly output to the diagnostic reporting system or stored in different file formats for making slides.
The development and preliminary application of medical image archiving and communication system from: the first model of the network
Medical imaging diagnostic report system software embedded in the medical image browsing software, you can browse the image directly after the diagnostic report. Medical diagnostic report on the main form of input items such as name, gender, age, CT number, check the serial number and check the date can be obtained directly from the database, the date of the report is automatically generated by the system, the section, report templates and other items through the drop-down menu selection. The two items of examination observations and impressions can be extracted directly from the diagnostic support library for normal or common diseases and multifarious diseases, and form the main body of the diagnostic report directly or after local modification. The program provides editing functions such as undo, cut, copy, paste, clear, select all and font. The program can output diagnostic reports in 4 formats, which can contain 1 or 2 typical illustrations. Users can search and access the diagnostic report by 1 or more key fields.
Results
After the installation and networking of the hardware equipment of the above PACS were completed, the overall debugging of the PACS was carried out at the 2 levels of basic network connection (TCP/IP) and DICOM horizontal transmission, and the transmission of digitized images within the PACS, the central storage, the easy-to-use image processing, the image (Adaptive Image Processing) of different formats for different operating systems (UNIX and In early 1999, PACS was formally used in the CT and MRI rooms of our department, which significantly improved the efficiency and management level of the department.
Discussion
The rapid development of digital technology, computer technology and network technology has led to the rapid development of medical imaging technology, and also promoted the change of doctors' work mode: doctors are gradually accustomed to viewing medical images on the fluorescent screen of the monitor; retrieving and accessing medical images through the computer and adjusting the window width and window position; and obtaining required medical images and diagnostic reports at any time through the computer network. The medical images and diagnostic reports and other related information required by the computer network.
I. Problems of traditional medical image processing
(1) Save the film requires a lot of storage space. (2) In the development, fixing, developing, drying, archiving and other links to spend a lot of human and financial resources. (3) The manual management of the film library is inefficient, slow and easy to query the film to the wrong file. (4) After several years, the aging of the film makes the image on it blurred, which brings great inconvenience to the re-examination and scientific research work. (5) CT, MRI and other images hard copy to film, fixed window width, window position has been lost most of the original information, retained only the operating physician that useful information, the image can not be post-processing, the loss of the patient follow-up and other physicians believe that the diagnostic information is useful.
Second, the application of PACS in the imaging discipline value
(1) the use of PACS network technology, CT, MRI and other imaging departments can be quickly transmitted between images and related information, so that the resources **** enjoy the convenience of the physician to call, consultation, as well as comparative imaging research, more conducive to the patient to get the highest diagnostic and therapeutic benefits. (2) PACS adopts large-capacity recordable compact disc (CD-R) storage technology, realizes partial filmlessness, reduces film usage and management, reduces the wear and tear of laser cameras and film processors, lowers the consumption of developing and fixing fluids, saves the space required for film storage, and lowers operating costs. (3) It avoids the borrowing procedures of photos and the loss and misplacement of photos, improves the management of medical image materials and enhances the work efficiency. (4) Multiple images of different periods and different imaging means can be accessed in different places at the same time, and image reprocessing can be carried out to facilitate comparison and contrast, providing convenient working, scientific research and learning conditions for medical staff and researchers engaged in medical imaging. (5) It is conducive to computer-assisted teaching and further improves the quality of teaching. The use of PACS can be stored without loss of image data, to be accessed later to find valuable and in line with the requirements of the teaching content of the image, labeled with Chinese and English annotations, the use of PowerPoint software to create a teaching slide, using a large screen multimedia projector to teach.
The standardized medical imaging diagnostic report writing function can print out the diagnostic imaging report with illustrations and text.
Third, the diagnostic report standardization, computerization
(1) the standardization of basic project requirements. Diagnostic reports reflect the condition of the general project is complete, the preparation of the project is more complete. (2) The report of the standardization of terminology. The content of the report is clearly expressed, the main and secondary, first describe the positive signs, then describe the negative signs, first describe the main lesions, then describe the secondary lesions, the description of the part and the conclusion of the same. (3) Standardize the basic format. First general items, then describe the image situation, and then make a conclusion statement, and finally there are other recommendations for further examination.
Medical imaging diagnostic report system has many significant advantages compared with manual writing: (1) medical imaging diagnostic report writing system can be more complete to save a variety of diagnostic imaging data, to avoid repetitive labor. (2) The report format is standardized, the handwriting is clear, overcoming the defects of handwritten report scribbles [5]. (3) Diagnostic imaging reports can be printed out with illustrations and text. (4) Patient query and statistical analysis of research cases quickly.
PACS for radiology and computers and computer networks combined science, relying solely on radiologists or computer and network experts unilateral force is difficult to complete the design and use of the task, so multi-party cooperation is extremely important.