Medical imaging information systems initially evolved from processing digital images in radiology departments. The predecessor of the medical imaging information system was the medical image archiving and communication system (PACS, Picture Archiving & Communication System), and the first impetus for the development of PACS came from the traditional camera manufacturers. This is because when the wave of digitization arrived, they were the first to realize that it was an irreversible and huge impact on their products. They had the clearest understanding of each manufacturer's device connectivity capabilities; however, as traditional machine manufacturers, they did not have sufficient computer skills, nor did they have sufficient understanding of imaging devices and image processing.
Initially, there was a great deal of resistance from many equipment manufacturers to open network connectivity. Because they thought it made little sense and conflicted with their interests, they didn't realize that they had fallen behind in the development of information technology, much less understand what it would bring to the medical imaging industry.
With the high-speed development of computer hardware and software technology, multimedia technology and communication technology and the growing demand for medical development, the PACS standardization process continues to advance, especially ACR-NEMA (American College of Radiology & National Electrical Manufactures ′ Association, American College of Radiology & National Electrical Manufactures ′ Association, American College of Radiology & National Electrical Manufactures ′ Association) DICOM (digital imaging and communications in medicine, digital imaging and communications in medicine) 3.0 standard of the general acceptance of the current PACS has been extended to all medical PACS has been extended to all medical imaging fields, such as cardiology, pathology, ophthalmology, dermatology, nuclear medicine, ultrasonography, and dentistry, etc. PACS content and capabilities have gone beyond the original meaning of the term, and is now commonly referred to as PACS, which includes a radiology information system (RIS) and a medical image archiving and communication system (PACS, PACS). Nowadays, PACS is generally referred to as a medical imaging information system that contains a radiology information system (RIS, Radiology Information System) and a medical image archiving and communication system (PACS, Picture Archiving & Communication System). PACS medical imaging information system technology development is mainly reflected in the following aspects:
1, internal storage format standardization for DICOM3.0
At present, almost all advanced PACS manufacturers in Europe and the United States are using the official DICOM3.0 file format to store images. Design of older PACS also use ACR-NEMA2.0 or SPI, only very old PACS to use the manufacturer's own definition of the format. DICOM3.0 format has many advantages, one of which is to replace the PACS in the future when you do not have to find the old PACS manufacturers to convert data. More importantly, with DICOM3.0 file format can be added at any time image mode, add or subtract and change the content of the image file. The traditional fixed field length image format to add something to the whole change.
2, the use of standard compression algorithms to compress image files.
Most of the new generation of PACS using DICOM support for standard compression algorithms, such as JPEG, JPEGLossless, JPEG2000, JPEG-LS and Deflate. It is becoming less common for manufacturers to use custom algorithms to compress images.
3, three-stage storage model (online, near-line and offline) into two levels (online and backup)
Currently, advanced PACS manufacturers in Europe and the United States are implementing two levels of online and backup storage. Backup is just to prevent accidents, such as fire, earthquake, etc.. Online with hard disk, with RAID (redundant storage disk array) plus NAS (NetworkAttachedStorage) or SAN (StorageAreaNetwork). And in previous years, the PACS community most commonly used a three-tiered image storage model: online (online), near-line (near-line) and off-line (off-line). New images are stored online on the hard disk, older images are stored near-line in a web server, and older images are stored off-line in a MOD or tape.
4, intelligent medical imaging platform
Intelligent imaging IT platform is the main development direction of the hospital information system. The ability to obtain all diagnostic information in the fastest way is the only criterion for evaluating the merits of an imaging workstation. syngo.via is the world's first "thinking" imaging workstation, which changes the traditional image post-processing concept, abandons the software-oriented traditional CT workstation workstyle, and opens up a new work perspective oriented to anatomical or disease diagnosis, breaking through the traditional image post-processing concept. It changes the traditional image post-processing concept, abandons the software-oriented traditional CT workstation work style, and opens up a new work perspective oriented on anatomy or disease diagnosis, and breaks through to become an imaging work platform that directly serves disease diagnosis. This allows doctors to free themselves from tedious image post-processing and focus on medical diagnosis.
The Siemens syngo.via imaging IT platform features image pre-processing, where image processing is seamlessly linked to the scanning sequence and carried out automatically without any human intervention; it has a disease-oriented workflow that automatically enters into work modules customized according to the disease or anatomical site; it customizes the diagnostic work modules needed by each doctor and integrates related image processing software in any order; it has a diagnostic bookmarking function; and it integrates the relevant image processing software in any order. It is equipped with a diagnostic bookmark function, which can automatically record each lesion measurement and lesion marking by doctors, facilitating the communication between doctors across departments and the review of reports by higher-level doctors.
Because of the late development and introduction of PACS systems in China, there are not many PACS systems that have been established and are operating effectively (especially in the inland provinces and cities). The main reason for this is the low degree of standardization, poor compatibility, generally for the closed proprietary system, neither economic, expensive, the configuration of the hardware is not reasonable enough, the workload of the hospital lacks a strong storage subsystem, can not support the huge amount of data routine radiological images, and therefore can not really realize the "no film" management. Most PACS systems do not have effective workflow and automated management functions, nor can they provide all the necessary information for clinical diagnosis, as evidenced by the small amount of online information and slow response time. They are also unreliable in terms of network security, confidentiality and compliance with legal requirements. Most of the existing PACS system designs do not take into account the possibility of technological development and expansion needs, and are difficult to integrate with the existing HIS/RIS into one system. The research and development of PACS systems in various countries have their own characteristics: the research and development of PACS systems in the United States is funded by the government and vendors; PACS systems in Europe are supported by multinational consortiums, national or regional funds, and the research groups tend to collaborate with one of the major vendors, focusing on the research of PACS modeling and simulation and image-processing components; and Japan has made PACS system research and development Japan's PACS system research and development as a national program, by manufacturers and university hospitals to *** with the completion of the vendor is responsible for PACS system integration and hospital installation, hospitals are responsible for the system clinical evaluation, and the system technical indicators are fixed, not much room for hospital researchers to modify the space; South Korea's PACS system is in the large private sector funded by the completion of the system.
PACS in the domestic development direction focuses on: should strictly comply with international technical standards of system design and completely open architecture, based on IHE, DICOM3.0 and HL-7 (health care) and other international standards; browser / server structure, should have good compatibility; Internet / Intranet technology based on the network structure, need to support the local area network (LAN), the Intranet, and the network structure of the Internet / Intranet technology. Support for Local Area Network (LAN), Wide Area Network (WAN), remote consultation; TB or even PB storage subsystems to improve responsiveness; fault tolerance, error correction and better data security and disaster recovery capabilities, high-performance data compression technology; user-friendly system interface, strong Chinese language support, easy to learn and easy to use; seamless integration of multiple technologies, such as voice, image and data transmission; complete system solutions. Seamless integration of various technologies such as voice and data transmission; complete system solutions, system-friendly maintenance and technical support. In the last century, along with the development of science and technology, the level of medical care has been improving, and various new medical imaging equipment has been emerging. 50's ultrasound technology is used in the field of medicine; in the 70's CT and 80's MRI has been applied to the clinic. Since then, new types of medical imaging equipment have been invented basically every two to three years. The increasing number of medical imaging devices has improved the accuracy of diagnosis on the one hand, but on the other hand, it has brought new problems. That is, how to manage the data generated by these medical imaging devices, in order to obtain the data generated by medical imaging devices within a certain range, and to ensure that the data from different manufacturers of imaging devices can be interconnected. 1982, the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) jointly organized a study group (ACR-NEMA Digital Imaging and Communication Standards Committee) to study how to develop a A set of unified communication standards to ensure that different manufacturers of imaging equipment can interconnect information. After consensus, a set of format standards for digital medical imaging was developed, namely ACR-NEMA 1.0, followed by the completion of ACR-NEMA 2.0 in 1988, and the release of version 3.0 formally named DICOM 3.0 (Digital Imaging and Communications in Medicine: Medical Digital Imaging and Communications) in 1993. Medical: Digital Imaging and Communications in Medicine). However, for various reasons, this standard was not accepted by medical imaging equipment manufacturers until 1997. Since then, there have been major changes to the standard every year, covering every corner of medical imaging, especially SR (Structured Reporting), which has recently been added to the standard, covering areas that other standards have not dared to cover. At the same time, the standard also puts a lot of effort into security (privacy and authorization) by adding TSL/SSL, digital signatures, digital authorization, and data encryption support. In order to support the exchange of data in different areas, but also added XML support. In short, the DICOM standard continues to evolve with each passing day.
At present, DICOM3.0 has been generally followed by international medical imaging equipment manufacturers, and the imaging equipment produced by major manufacturers all provide DICOM3.0 standard communication protocols.
The DICOM3.0 standard must be supported on the output and input of the system, and has become the international norm for PACS. Only PACS built under the DICOM3.0 standard can provide users with the best system connectivity and extended functionality.
(I) DICOM3.0
DICOM standard is the full name of the "medical digital imaging and communication" (digital imaging and communication in medicine) standard, is in accordance with NEMA procedures for the formulation and development. It is developed in accordance with the NEMA program. It is actually the third version of ACR-NEMA. The reason why it is not called ACR-NEMA3.0 but DICOM3.0 is because: ① the standard is not only developed by the joint committee of ACR-NEM, but some other standardization organizations in the world are also involved in its formulation and development. These standardization organizations include the European Committee for Standardization Technical Committee 251 (i.e., CENTC251), which has long been based on DICOM to develop a fully compatible standard with DICOM - MEDICOM; and Japan's JIRA (Japanese industry radiology Apparatus) and the Medical Information Systems Development Center (medical informatics). There are also the Japanese JIRA (Japanese industry radiology Apparatus) and the Medical Information Systems Development Center (medical informationsy stem development center). The main contribution of these two organizations to DICOM is to propose a standard for the use of removable media (CD-ROM, etc.) to store and exchange medical images. In the process of developing the standard, also referred to other organizations, including IEEE, HL7 and ANSI and other relevant standards. ② The standard not only supports medical radiology images, it is extensible and oriented to all medical images, as long as the corresponding service object class (SOP) can be simply added. Extension to electrocardiography (cardiology, endoscopy), dentistry, pathology and other types of images is currently underway. As with its predecessors, versions 1.0 and 2.0, DICOM began its development by taking into account the findings of a number of relevant standardization organizations, not only to avoid duplication of effort, but also to provide important context and technology for DICOM. Since it is a communication standard for networked environments, the most significant influence on DICOM has been the International Organization for Standardization's Open Systems Interconnection Reference Model (ISO-OSI).
(ii) HL7
HL7 is a standard for exchanging electronic data in a healthcare environment, especially for in-hospital patient care.
In May 1987, at the University of Pennsylvania Hospital, a committee consisting of healthcare units (and users), manufacturers, and healthcare consultants was formed. The purpose of the HL7 effort was to simplify the implementation of interfaces between different vendors (especially competing vendors) for computing applications in the medical field. Its primary application area is HIS/RIS.
HL7 currently standardizes the communication of the following information between HIS/RIS systems and their devices: patient admission/registration, discharge or transfer data (collectively referred to as ADT-admissions/registration, discharge, transfer) and queries, patient scheduling, booking, finance, clinical observation, and patient care. , booking, finance, clinical observation, medical records, patient's treatment, master file update information, etc.
Functional specifications
With the development of information technology and the transformation of the hospital operation mechanism, the hospital information system has become an essential and important infrastructure and support environment for modern hospitals. The Ministry of Health, in order to actively promote the development of information network infrastructure and accelerate the construction and management of hospital informationization, has formulated the "Basic Functional Specification for Hospital Information System". Among them, the following specifications are set for medical imaging information system functions.
(I) Image Processing
1. Data Receiving Function: Receive and acquire image data in DICOM3.0 and non-DICOM3.0 formats from imaging devices, and support the conversion of images from non-DICOM imaging devices into DICOM3.0 standard data.
2. Image processing functions: customize the display of image-related information, such as name, age, equipment model and other parameters. Provide scaling, moving, mirroring, inverting, rotating, filtering, sharpening, pseudo-coloring, playback, window width and window position adjustment and other functions.
3. Measurement: Provides measurement of ROI value, length, angle, area and other data; as well as labeling and annotation functions.
4. Save function: support JPG, BMP and other formats to store, as well as converted to DIDICOM3.0 format.
5. Management functions: support for the transfer of images between devices, to provide simultaneous access to different periods of the patient, different imaging equipment images and reports. It supports DICOM3.0 printout, massive data storage and migration management.
6. Remote medical function: support for remote sending and receiving of image data.
7. System parameter setting function: support for user-defined window width window position value, magnification ratio of the magnifying glass and other parameters.
(II) Report Management
1. Appointment registration function.
2. Triage function: patient's basic information, examination equipment, examination parts, examination methods, price charging.
3. Diagnostic report function: generating examination reports, supporting the second level of physician review. Support typical case management.
4. Template function; users can easily and flexibly define the template to improve the speed of report generation.
5. Query function: support name, image number and other forms of combination of query.
6. Statistical function: user workload, outpatient volume, film volume and cost information can be counted.
(C) operational requirements
1. **** enjoy the patient information in the hospital information system.
2. Network operation: accurate and reliable data and information, fast.
3. Security management: set access rights to ensure data security.
4. Establishment of reliable storage system and backup program to realize long-term preservation of patient information.
5. The reporting system supports the common medical terminology set at home and abroad.