PACS and Digital Medicine: Essential Principles and Modern Practice

PACS and Digital Medicine......Page 2
PACS and Digital Medicine: Essential Principles and Modern Practice
......Page 4
Dedication
......Page 6
Brief Contents......Page 8
Contents......Page 10
Preface......Page 30
Acknowledgments......Page 32
Authors......Page 34
1.1.1 From Paper and Film to Computers and Digital Imaging......Page 36
1.1.3 Early Research, Development, and Pioneers in PACS......Page 37
1.2 TECHNOLOGY ADVANCEMENTS ENABLING TODAY'S PACS......Page 38
1.2.2 Data Storage Technology History......Page 39
1.2.5 Availability of IT Expertise......Page 40
1.3.3 Workfl ow Changes after Implementation of PACS......Page 41
1.4.1.3 Clinical Information Systems......Page 42
1.4.3 Toward Fully Integrated Healthcare Enterprises......Page 43
BIBLIOGRAPHY......Page 44
2.1.2 Load- Balancing......Page 46
2.1.4 Server Load- Balancing and Fail Over Combined......Page 47
2.2.1 Primary Diagnostic Workstation
......Page 50
2.2.3 Advanced Image Analysis Workstation......Page 52
2.2.5 Digitization, Printing, CD- Burning Workstation......Page 53
2.3 PACS WORKSTATION ARCHITECTURE......Page 56
2.3.2.1 CPU......Page 57
2.3.2.4 Graphics Card......Page 58
2.3.3.2 Application Software......Page 59
2.3.4 Typical Features of Diagnostic Image Display Workstation......Page 60
2.3.4.2 Pan and Zoom......Page 61
2.3.4.5 Distance and Area Measurement......Page 62
2.3.4.9 Importing Results of Advanced Image Post- Processing......Page 63
2.4.2 The Hardware Confi guration of Display Workstations: Number of Monitors......Page 64
2.5.3 Filmless Workfl ow with PACS/ RIS......Page 65
2.6.1 Benefits of Speech Recognition for Reporting......Page 67
2.6.2.2 Rear- End Speech Recognition with Delegated Editing......Page 68
2.6.5 Integrating Speech Recognition Technology into Radiology Workfl ow......Page 69
2.7 NEW DEVELOPMENTS......Page 70
BIBLIOGRAPHY......Page 71
3.1.2 A Brief History of Digital Medical Image Display Systems......Page 72
3.2.3 Data Flow in Image Display Devices......Page 74
3.3 OVERVIEW OF IMAGE DISPLAY TECHNOLOGIES......Page 76
3.3.1 History of CRT Monitors......Page 77
3.3.2 LCD Monitors......Page 78
3.4 QUALITY STANDARDS FOR DISPLAY DEVICES......Page 80
3.4.1 Class 1 and Class 2 Image Display Devices......Page 81
3.4.2 Color versus Monochrome Displays......Page 82
3.4.4 Factors Determining Display Device Quality......Page 83
3.4.4.4 Display Area......Page 84
3.4.4.7 Luminance......Page 85
3.4.4.8 Luminance Uniformity......Page 86
3.4.5 DICOM Standard GSDF......Page 87
3.5.2 Image Display Device QC and QA Procedures......Page 88
3.5.2.1 Ambient Lighting Level......Page 89
3.5.2.2 Minimum and Maximum Luminance Levels......Page 90
3.5.2.4 Contrast Resolution and Noise Tool Required......Page 92
3.5.2.6 Geometric Distortion......Page 93
3.5.2.7 Display Refl ection Tool Required......Page 94
3.5.2.10 Color Temperature......Page 95
3.5.4 Frequency of QC for Display Devices......Page 96
BIBLIOGRAPHY......Page 97
4.1.2 Ethernet......Page 100
4.1.3 Function of Ethernet......Page 101
4.1.4.2 IP......Page 102
4.1.4.5 Dynamic Host Confi guration Protocol ( DHCP)......Page 103
4.1.6.2 Gigabit and 10 Gigabit Ethernet......Page 104
4.2.1 ATM......Page 105
4.3.1.1 Linear Bus......Page 106
4.3.4.1 Router and Gateway......Page 107
4.4 NETWORK DESIGN CONSIDERATION......Page 108
4.4.6 Network Planning Considerations......Page 109
4.5 OPTICAL FIBRE COMMUNICATION......Page 110
4.5.2 Characteristics of Optical Fibre Communication......Page 111
4.5.2.2 Single- Mode Transmission......Page 112
4.5.3.1 Transmitter......Page 113
4.5.3.4 Wavelength- Division Multiplexing......Page 114
4.5.4.1 Optical Fibre Cable Structure......Page 115
4.5.4.4 Cable Bending......Page 116
4.5.5.2 Ground Loops......Page 117
4.6.2 Authentication and Data Integrity Check......Page 118
4.6.4 Digital Certifi cate......Page 119
4.6.6 Secure Socket Layer and Transport Layer Security......Page 120
4.6.6.1 Objectives of SSL......Page 121
4.6.7 Virtual Private Network......Page 122
4.6.7.1 Virtual Private LAN/ WAN Services......Page 123
4.7.1 Wireless Application Protocol......Page 124
4.7.2.4 IEEE 802.11n......Page 125
4.8 BACKUP AND ALTERNATIVE NETWORK USING THE INTERNET......Page 126
4.8.2 Cable Internet Access......Page 127
4.8.4 Satellite Internet Access......Page 128
BIBLIOGRAPHY......Page 129
5.1.1.1 Example of AIT Magnetic Tape– Based Storage System......Page 132
5.1.2.1 CD- R and CD- RW......Page 134
5.1.2.3 Blu- Ray......Page 136
5.1.3.1 Reliability of Spin Disks......Page 137
5.1.4.2 Flash Memory– Based SSD......Page 138
5.2.2 SATA......Page 139
5.2.5 iSCSI......Page 140
5.2.6.1 FC Layers......Page 141
5.2.6.3 FC Bandwidth......Page 143
5.3.1.2 Advantages of DAS......Page 145
5.3.2.1 Defi ning SAN......Page 146
5.3.2.4 SAN Servers and Storage Devices......Page 147
5.3.2.6 Considerations for Planning SAN......Page 148
5.3.3.2 Benefi ts of Using NAS......Page 149
5.3.4 Grid- Oriented Storage......Page 150
5.3.4.2 Grid Architecture......Page 151
5.3.4.3 Grid Storage Characteristics and Benefi ts......Page 152
5.4 REDUNDANT ARRAYS OF INDEPENDENT DISKS......Page 153
5.4.3 RAID- 1......Page 154
5.4.5 RAID- 5......Page 155
5.4.8 Hot Spare Disk and Rebuilding......Page 156
5.5.1 JPEG......Page 157
5.6 CONTENT- ADDRESSED STORAGE......Page 158
5.7 SHORT- TERM AND LONG- TERM STORAGE FOR PACS/ EHR......Page 159
5.7.1.2 Tiered Storage for PACS......Page 160
BIBLIOGRAPHY......Page 161
6.1.2.2 HL7 Version 2. x Data Structure......Page 164
6.1.2 HL7 Version 2. x......Page 165
6.1.3.1 HL7 Reference Information Model......Page 166
6.1.3.4 CDA Structure......Page 167
6.1.3.6 Clinical Context Object Workgroup......Page 168
6.1.3.8 HL7 Conformance and What Users Need to Know......Page 169
6.2 DICOM......Page 170
6.2.2 Various DICOM Service Classes......Page 171
6.2.2.3 Print......Page 172
6.2.2.4 Modality Worklist......Page 173
6.2.2.7 Structured Reporting......Page 174
6.2.3 Media Storage for Interchange......Page 175
6.2.4 DICOM GSDF Display Function......Page 177
6.2.5 Web Access to DICOM Persistent Objects......Page 178
6.2.6.3 AE Title......Page 179
6.2.7 DICOM Conformance Statements......Page 180
6.2.9 Future of DICOM......Page 181
6.3.3 IHE Domains......Page 182
6.3.4 IHE Process......Page 183
6.3.7 IHE Connectathon......Page 184
6.4 IHE TECHNICAL FRAMEWORKS......Page 185
6.4.2 IHE Radiology......Page 186
6.4.2.2 Postprocessing Workfl ow......Page 187
6.4.2.6 Access to Radiology Information......Page 188
6.4.3.1 IHE User's Handbooks......Page 189
6.4.3.2 How to Understand IHE Integration Statement......Page 190
BIBLIOGRAPHY......Page 191
7.1.1 History of Telemedicine and Teleradiology......Page 194
7.1.1.2 Financial Model of Early Telemedicine Projects......Page 195
7.1.2.1 Driving Forces for Teleradiology Development......Page 196
7.1.3 Applications and Benefi ts of Teleradiology......Page 197
7.1.4 Remote Image Access......Page 199
7.2.5 Image Transmission in Teleradiology......Page 203
7.2.7 ACR Technical Guidelines for Data Storage......Page 204
7.3.3 Data Security and Patient Privacy......Page 205
7.4.1 Considerations of Remote Reading in Teleradiology......Page 206
7.4.4 International Teleradiology Guidelines......Page 207
7.5.2 Faster Image Transmission......Page 208
7.5.6 Future Growth of Telemedicine and Teleradiology......Page 209
BIBLIOGRAPHY......Page 210
8.1.1 Cost Analysis......Page 214
8.1.2 Benefit Analysis......Page 215
8.2.1 Forming the Right Team......Page 216
8.2.3 Coordinating Efforts and Consolidating Resources among Various Departments......Page 217
8.2.5 Workfl ow Analysis......Page 218
8.2.8 Network Infrastructure......Page 219
8.2.9.5 Computed Radiography and Digital Radiography......Page 220
8.3.1 PACS Selection......Page 221
8.3.1.1 Hardware Considerations......Page 222
8.3.1.2 Software Considerations......Page 223
8.3.1.3 System Integration Issues......Page 224
8.3.1.4 Image Display System Requirements......Page 225
8.3.2 Writing Specifi cations for the Request for Proposal......Page 226
8.3.5 Contract Negotiation......Page 227
8.4.2 Timelines and Clinical Area Downtime Planning......Page 228
8.4.4 Transition and Continuous User Training......Page 229
8.5.1.1 Defi ning Goals and Expectations......Page 230
8.5.1.4 Network Requirement Analysis......Page 231
8.5.2 PACS Implementation in a 950- Bed Tertiary Care Hospital......Page 232
8.5.2.4 Imaging Modality DICOM Connectivity......Page 233
8.5.2.6 Training......Page 235
BIBLIOGRAPHY......Page 236
9.1.1 Reasons for Replacing PACS......Page 238
9.2.2 Independent Enterprise Long- Term Archive......Page 239
9.3.1 Replacement System Selection and Evaluation......Page 240
9.3.1.2 Replacement System Vendor Selection......Page 241
9.3.1.3 Replacement System Evaluation......Page 242
9.3.1.6 Multivendor PACS and RIS......Page 243
9.3.1.9 Replacement System Integration Considerations......Page 244
9.4.1 Network Upgrade......Page 245
9.4.4 Benefi ts of Ethernet WAN......Page 246
9.4.5 Ethernet WAN Services......Page 247
9.5.2 Scope of Data Migration......Page 248
9.5.4 Data Migration Approaches......Page 249
9.5.4.4 Data Migration Service Considerations......Page 250
9.6 REPLACEMENT SYSTEM GO- LIVE AND TRAINING......Page 251
9.6.2.1 Dual- Send Approach......Page 252
9.6.3 Testing and Simulation before Replacement System Launch......Page 253
9.6.5 Replacement System Acceptance Testing......Page 254
BIBLIOGRAPHY......Page 255
10.2.1 Cardiology Workfl ow......Page 258
10.2.3.1 Data and Dynamic Display......Page 259
10.2.4 DICOM Cardiology Extensions and Reports......Page 260
10.2.4.6 Quantitative Arteriography and Ventriculography Structured Report......Page 261
10.2.4.9 CT/ MR Cardiovascular Report......Page 262
10.2.5.1 Benefi ts of IHE Cardiology Implementation......Page 263
10.2.5.2 Cardiac Catheterization Workfl ow......Page 264
10.2.5.5 Stress- Testing Integration Profi les......Page 265
10.2.5.9 Urgent Implantable Rhythm Control Device Identifi cation......Page 268
10.2.6.1 CIS Benefi ts......Page 269
10.3 PATHOLOGY PACS......Page 270
10.3.1 Pathology Workfl ow......Page 271
10.3.2.7 Digital Records for EHR/ PHR......Page 272
10.3.3 Digital Pathology Challenges and Considerations......Page 273
10.3.3.2 Image Data Compression......Page 274
10.3.3.4 Tile Image Organization......Page 275
10.3.4.1 Pyramid Image Data Model for WSI......Page 276
10.3.4.2 Slide Image Orientation......Page 277
10.3.5.1 Integration Profi les in the Anatomic Pathology Domain......Page 278
10.3.5.2 Anatomic Pathology Workfl ow......Page 279
10.3.5.3 Anatomic Pathology Reporting to Public Health......Page 280
10.4.2.1 Basic DICOM RT Objects......Page 281
10.4.2.5 RT Course Introduction......Page 283
10.4.3.4 RT Treatment Delivery Discrete Positioning and Delivery Workfl ow......Page 284
10.4.3.5 Future Developments......Page 285
10.5.1 Endoscopy- Specifi c Requirements and Technical Challenges......Page 286
10.5.2 Legacy Systems......Page 287
10.5.3 DICOM Visible Light Standard and Video Formats......Page 288
10.5.4 IHE- J Endoscopy Workfl ow Integration Profi le......Page 289
BIBLIOGRAPHY......Page 291
11.1.1 Electronic Medical Record and Electronic Health Record......Page 296
11.2.1 HL7 EHR Functional Model......Page 297
11.2.1.1 Functional Outline......Page 298
11.2.1.4 Conformance Criteria......Page 299
11.2.2.2 Semantic Interoperability......Page 300
11.2.3 HL7 EHR Interoperability Model......Page 301
11.2.3.1 EHR Interoperability Model Components......Page 302
11.2.4 Certifi cation Commission for Healthcare Information Technology......Page 303
11.3.3 Information Infrastructure Functions......Page 304
11.3.4 Components of PHR Functions......Page 305
11.3.7.2 Payer- Linked PHR Systems......Page 306
11.4.1.2 Patient Demographics Query......Page 307
11.4.1.5 Cross- Enterprise Document Sharing for Imaging......Page 308
11.4.2.1 Systematized Nomenclature of Medicine: Clinical Terms......Page 309
11.4.2.4 Logical Observation Identifi ers Names and Codes......Page 310
11.4.3.1 CCR Content......Page 311
11.5 GUIDE FOR EHR IMPLEMENTATIONS......Page 312
11.5.1 Financial and Needs Analysis......Page 313
11.5.2.1 Application Service Provider and Client/ Server EHR......Page 314
11.5.2.2 EHR System Hardware Selection......Page 315
11.5.4 Site Visit and Contract Negotiation......Page 316
11.5.5 System Installation and System Go- Live......Page 317
11.5.6 Paper Medical Record Conversion and Abstraction to EHR......Page 318
11.5.8 Enterprise Integration......Page 319
11.6.1.1 RHIO Centralized Model......Page 320
11.6.2 RHIO Business Sustaining Model......Page 321
11.6.4 The Federal Health Information Technology Strategic Plan......Page 322
11.6.5.2 Challenges to Global Healthcare IT Implementation......Page 323
BIBLIOGRAPHY......Page 324
12.2 DOWNTIME PLANNING......Page 328
12.2.2 Unscheduled Downtime......Page 329
12.3 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT......Page 330
12.3.2 Security Rule......Page 331
12.3.2.1 Administrative Safeguards......Page 332
12.3.2.2 Physical Safeguards......Page 333
12.3.4 Policies and Procedures Evaluation......Page 334
12.4.1 Disaster Recovery......Page 335
12.4.3 Data Backup Plan......Page 336
12.5 SECURITY MANAGEMENT PROCESS......Page 337
12.5.2 Risk Mitigation and Management......Page 338
12.5.4 Workforce Security......Page 339
12.5.6 Security and Privacy Considerations for Remote Services......Page 341
12.5.8 Security Incident Procedures and Responses......Page 342
12.6.2 Laptop Computers......Page 343
12.6.4 Device and Media Control......Page 344
12.7 DICOM AND IHE SECURITY MECHANISM......Page 345
12.7.1.2 Basic TLS Secure Transport Connection Profi le......Page 346
12.7.2.1 Basic Patient Privacy Consents......Page 347
12.7.2.4 Audit Trail and Node Authentication......Page 348
12.7.2.5 IHE Security Measures for Cross- Enterprise Exchange of Information......Page 349
BIBLIOGRAPHY......Page 350