Hardware and software requirements for a picture archiving and communication system's diagnostic workstations

Augmentation of the think aloud method with users' perspectives for the selection of a picture archiving and communication system

OBJECTIVES

Users attitude toward a picture archiving and communication system (PACS) and their interaction with this system are among the most important factors that influence its acceptance. This study aimed to augment the user's interaction with the user's perspective to select a usable PACS among three systems available on the market.

METHODS

We augmented the think aloud (TA) usability evaluation method with the Post-Study System Usability Questionnaire (PSSUQ) to compare user interaction problems of three PACS user interfaces. Four radiologists and four internist physicians participated in this study. Usability characteristics including efficiency, effectiveness, learnability, error, and satisfaction were used to assess the usability of each PACS.

RESULTS

There was a significant difference in efficiency (p = 0.01), effectiveness (p = 0.005), learnability (p = 0.001), and satisfaction (p = 0.009). However, no significant difference in the number of errors (p = 0.18), mouse clicks and keystrokes (p = 0.12), and the number of usability problems (p = 0.6) were observed among the three PACS systems studied.

CONCLUSIONS

This study showed that applying the proposed approach to augment TA with the user's perspective addresses almost all of the theoretical aspects of usability and can be employed to select the most usable PACS.

Fast JPEG 2000 decoder and its use in medical imaging

Over the last decade, a picture archiving and communications system (PACS) has been accepted by an increasing number of clinical organizations. Today, PACS is considered as an essential image management and productivity enhancement tool. Image compression could further increase the attractiveness of PACS by reducing the time and cost in image transmission and storage as long as 1) image quality is not degraded and 2) compression and decompression can be done fast and inexpensively. Compared to JPEG, JPEG 2000 is a new image compression standard that has been designed to provide improved image quality at the expense of increased computation. Typically, the decompression time has a direct impact on the overall response time taken to display images after they are requested by the radiologist or referring clinician. In this paper, we present a fast JPEG 2000 decoder running on a low-cost programmable processor. It can decode a losslessly compressed 2048 x 2048 CR image in 1.51 s. Using this kind of a decoder, performing JPEG 2000 decompression at the PACS display workstation right before images are displayed becomes viable. A response time of 2 s can be met with an effective transmission throughput between the central short-term archive and the workstation of 4.48 Mb/s in case of CT studies and 20.2 Mb/s for CR studies. We have found that JPEG 2000 decompression at the workstation is advantageous in that the desired response time can be obtained with slower communication channels compared to transmission of uncompressed images.

Picture archiving and communication system bandwidth and storage requirements

The purpose of this work was to determine the requirements for image storage and network bandwidth for a total digital department in a moderate sized academic radiology department. Data from the radiology information system was combined with image production information to produce a model of image acquisition. Destinations of images to reading rooms were studied to determine the final distributions of film. All findings were used to model the flow of data that would be expected if the images in the department were completely digital. Using today's standards, the department would produce approximately 15.7 Gbytes of data per day or 3.5 Tbytes of data per year if all acquisitions were digital. The peak acquisition rate would be 1.8 Gbytes per hour with a sustained rate greater than 1 Gbyte per hour for most of the working day. The anticipated bandwidth for the total digital department exceeded the capabilities of the existing picture archiving and communication system equipment. A distributed networked archive solution was shown to optimize access to images by radiologists and referring clinicians.

Lossless medical image compression by multilevel decomposition

Lossless image coding is important for medical image compression because any information loss or error caused by the image compression process could affect clinical diagnostic decisions. This paper proposes a lossless compression algorithm for application to medical images that have high spatial correlation. The proposed image compression algorithm uses a multi-level decomposition scheme in conjunction with prediction and classification. In this algorithm, an image is divided into four subimages by subsampling. One subimage is used as a reference to predict the other three subimages. The prediction errors of the three subimages are classified into two or three groups by the characteristics of the reference subimage, and the classified prediction errors are encoded by entropy coding with corresponding code words. These subsampling and classified entropy coding procedures are repeated on the reference subimage in each level, and the reference subimage in the last repetition is encoded by conventional differential pulse code modulation and entropy coding. To verify this proposed algorithm, it was applied to several chest radiographs and computed tomography and magnetic resonance images, and the results were compared with those from well-known lossless compression algorithms.

Evaluation of the medical diagnostic imaging support system based on 2 years of clinical experience

The Medical Diagnostic Imaging Support (MDIS) system at Madigan Army Medical Center (MAMC) has been operational in a phased approach since March 1992. Since then, nearly all image acquisition has been digital with progressively increasing primary softcopy diagnosis used. More than 375,000 computed radiography (CR) images as well as other modality images have been archived. Considerable experience in installation and implementation phasing has been gained. The location and ergonomic aspects of equipment placement were refined with time. The original clinical scenario was insufficiently detailed and additions were made to facilitate smoother and more complete transition toward a filmless environment. The MDIS system effectiveness and performance have been good in terms of operational workload throughout, background operations, and reliability. The important areas regarding reliability are image acquisition, output, display, database operations, storage, and the local area network. Fail-safe strategies have been continually improved to maintain continuous clinical image availability during the times when the MDIS system or components malfunction. Many invaluable lessons have been learned for effective quality assurance in a hospital-wide picture archiving and communication system. These issues include training, operational quality control, practical aspects of CR image quality, and increased timeliness in the generation and distribution of radiographic reports. Clinical acceptability has been a continuous process as each phase has been implemented. Clinical physicians quickly used the workstations soon after the start of MDIS at MAMC. The major advantage for clinicians has been the amount of time saved when retrieving multimodality images for review. On the other hand, the radiologists have been slower in their acceptance of the workstation for routine use.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality control of cathode-ray tube monitors for medical imaging using a simple photometer

As computer monitors are used more in medical imaging and the use of picture archiving and communication system workstations with multiple monitors is increasing, quality control protocols become necessary to track subtle variations in performance characteristics. Several tests based on previously published work were applied to 10 monitors of three different types over a period of 5 months. Each test is explained, and the results are shown. For example, without corrective adjustments, 2 monitors from the same workstation showed a small but steady decline in maximum luminance of 8.1% and 7.6% over the course of 11 weeks that was not perceptible. From this experience, we took the first step toward developing a practical and useful quality control protocol. The proposed protocol requires only a photometer and the ability to generate the Society of Motion Picture and Television Engineers (SMPTE) test pattern, and takes approximately 5 minutes per monitor per week to gather data.

Redirection of client/server relationship of X Window system as a simple, low-cost, departmental picture archiving and communication system solution for nuclear medicine

Picture archiving and communication systems (PACS) offer significant advantages over current film-management techniques. However, PACS are complex and expensive, factors that have limited their entry into the radiology and nuclear medicine communities. We present a simple, low-cost PACS solution that allows viewing of images from different computer systems by redirection of the X Window system. In this technique, multiple copies of the imaging software are remotely opened from generic UNIX workstations interfaced to the main computer system via Transmission Control Protocol/Internet Protocol over Ethernet. The X Window system that provides the windowing system for the main computer is redirected to the workstations' displays. With this technique, viewing and processing of images on a remote station is virtually identical to working at the main computer's console. The technique requires that the commercial imaging system's hardware, operating system, and imaging software support multiuser multitasking and the execution of multiple copies of its imaging software, and that they use X Windows as the graphical system. Advantages of the technique include low cost, ease of maintenance, ease of interconnecting different types of computers, the capacity to view images regardless of file format, and the capacity to both view and process images. The latter is a necessity for modalities such as nuclear medicine. A disadvantage of the technique is that the number of nodes that can be supported is limited.

Desktop publishing and medical imaging: paper as hardcopy medium for digital images

Desktop-publishing software and hardware has progressed to the point that many widely used word-processing programs are capable of printing high-quality digital images with many shades of gray from black to white. Accordingly, it should be relatively easy to print digital medical images on paper for reports, instructional materials, and in research notes. Components were assembled that were necessary for extracting image data from medical imaging devices and converting the data to a form usable by word-processing software. A system incorporating these components was implemented in a medical setting and has been operating for 18 months. The use of this system by medical staff has been monitored.

Picture archiving and communications systems (PACS)

Although there has been a recent increase in interest in picture archiving and communications systems (PACS) topics, little has been published to assist the non-technical person in understanding the complexities of the technologies required for a PACS implementation. This issue of Current Problems in Radiology defines each PACS component and explains why each is important in a system design. PACS installations at the University of Florida are used as examples to tie the concepts together. The infrastructure required for PACS consists of the information system interfaces, networks, and databases. Information system interfaces guarantee consistent patient data across all platforms and reduce labor requirements by eliminating duplicate data entry. Data networks move information from the originating location to users around the hospital, clinic, campus, city, or world. In the PACS environment, the data consist of patient and study information as well as images and information about these images. Databases organize the data from multiple sources into a coherent package that can be queried for many different purposes, such as retrieving images, reviewing patient and study information, studying practice statistics, and performing outcomes analysis. PACS components consist of acquisition nodes, archives, and output devices. Acquisition nodes may include "digital modalities" such as CT, MRI, nuclear medicine, and computed radiography (CR), along with devices to convert from analog to digital, such as digitizers and frame grabbers. Options for archives are discussed along with configuration schemes. Output devices include both hard copy (film and paper prints) and soft copy (workstations for display and diagnosis). Finally, a description of the PACS installations at the University of Florida is presented, with comments on some of the difficulties and complexities encountered. A discussion of the cost and benefits of PACS is included, along with a forecast of the future of PACS.