Do Cone Beam CT Picture Archiving and Communication Systems Viewer Interfaces Meet the Expectations of Dental Professionals From a Usability Perspective?

Background Cone beam computed tomography (CBCT) has revolutionized dental and maxillofacial imaging by providing high-resolution 3D visualizations, essential for accurate diagnosis and treatment planning. Despite its clinical advancements, the usability of CBCT viewer interfaces, which play a crucial role in the effective interpretation of imaging data, remains a critical concern. Objective This study aims to evaluate the usability of a CBCT viewer interface in clinical settings, focusing on the effectiveness, efficiency, and satisfaction perspectives, to identify potential areas for improvement. Methods Twenty-two participants (N=22) were assigned the task of locating the mental foramen in a mandible dataset, selected randomly, using the multiplanar reconstruction (MPR) mode of a CBCT viewer interface on a local network. The task's effectiveness was gauged by the completion rate, while efficiency was measured through the duration of the task, the number of mouse clicks, and the cursor's path in both pixels and meters. Satisfaction or perceived usability was evaluated using the system usability scale (SUS-TR), and computer system usability questionnaire (T-CSUQ), among other scales, with participants also providing open-ended feedback. Demographic characteristics served as classification variables. Results All participants completed the given task. No demography-related differences in efficiency were observed. Perceived usability (SUS-TR: 60.68±19.58, T-CSUQ: 43.63±16.34) was below the industry standards, categorizing the system as a detractor. Commonly reported issues included accessing the MPR window, cursor behavior, and unclear error messages. The mean SUS-TR score negatively correlated with efficiency-related variables (p<0.05 for each). Conclusions The study's findings indicate that the CBCT viewer interface does not fully meet dental professionals' usability expectations, as evidenced by the task's completion rate, efficiency metrics, and below-average usability scores. Despite the successful task completion by all participants, the identified issues in interface design, such as difficulties in accessing the MPR window and unclear error messages, highlight significant areas for improvement. To enhance user satisfaction and efficiency, future developments of CBCT viewer interfaces should incorporate feedback from end-users and prioritize user-friendly design principles.

Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study

BACKGROUND

Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently.

OBJECTIVE

This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography.

METHODS

We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed.

RESULTS

A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer's intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection.

CONCLUSIONS

Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size.

Combining Register and Radiological Visits Data Allows to Reliably Identify Incident Wrist Fractures

Purpose

To evaluate how comprehensively wrist fractures can be tracked from the national medical registers, and to propose a method for complementing the register data using time stamps of wrist radiography visits recorded in the radiological image archive.

Patients and Methods

For the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort of 14220 post-menopausal women, we analysed the data from the Care Register for Health Care, Register for Primary Health Care Visits, self-reports, radiological image archive PACS, and patient records to identify the wrist fractures occurred between 2011 and 2021. Using this gold standard of fractures, we validated the coverage of the registers and image archive and created algorithms to automatically identify fracture events from the registers and/or metadata of wrist radiography visits.

Results

We show that wrist fractures cannot be comprehensively identified based on national registers. To remedy this, our proposed method of combining register and image archive data can lift the coverage from 81% to 94% and reduce false discoveries from 6% to 2%.

Conclusion

The proposed method offers a more reliable way of gathering fracture information. Comprehensive fracture identification is essential in many research settings, such as incidence statistics, prevention studies, and risk assessment models.

Design and Implementation of a Cloud PACS Architecture

The limitations of the classic PACS (picture archiving and communication system), such as the backward-compatible DICOM network architecture and poor security and maintenance, are well-known. They are challenged by various existing solutions employing cloud-related patterns and services. However, a full-scale cloud-native PACS has not yet been demonstrated. The paper introduces a vendor-neutral cloud PACS architecture. It is divided into two main components: a cloud platform and an access device. The cloud platform is responsible for nearline (long-term) image archive, data flow, and backend management. It operates in multi-tenant mode. The access device is responsible for the local DICOM (Digital Imaging and Communications in Medicine) interface and serves as a gateway to cloud services. The cloud PACS was first implemented in an Amazon Web Services environment. It employs a number of general-purpose services designed or adapted for a cloud environment, including Kafka, OpenSearch, and Memcached. Custom services, such as a central PACS node, queue manager, or flow worker, also developed as cloud microservices, bring DICOM support, external integration, and a management layer. The PACS was verified using image traffic from, among others, computed tomography (CT), magnetic resonance (MR), and computed radiography (CR) modalities. During the test, the system was reliably storing and accessing image data. In following tests, scaling behavior differences between the monolithic Dcm4chee server and the proposed solution are shown. The growing number of parallel connections did not influence the monolithic server's overall throughput, whereas the performance of cloud PACS noticeably increased. In the final test, different retrieval patterns were evaluated to assess performance under different scenarios. The current production environment stores over 450 TB of image data and handles over 4000 DICOM nodes.

[Application of picture archiving and communication systems in lateral wedge osteotomy for cubitus varus deformity in teenagers]

Objective

To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers.

Methods

A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected.

Results

There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%.

Conclusion

Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.

Comparing Computed Tomography-Derived Augmented Reality Holograms to a Standard Picture Archiving and Communication Systems Viewer for Presurgical Planning: Feasibility Study

Background

Picture archiving and communication systems (PACS) are ubiquitously used to store, share, and view radiological information for preoperative planning across surgical specialties. Although traditional PACS software has proven reliable in terms of display accuracy and ease of use, it remains limited by its inherent representation of medical imaging in 2 dimensions. Augmented reality (AR) systems present an exciting opportunity to complement traditional PACS capabilities.

Objective

This study aims to evaluate the technical feasibility of using a novel AR platform, with holograms derived from computed tomography (CT) imaging, as a supplement to traditional PACS for presurgical planning in complex surgical procedures.

Methods

Independent readers measured objects of predetermined, anthropomorphically correlated sizes using the circumference and angle tools of standard-of-care PACS software and a newly developed augmented reality presurgical planning system (ARPPS).

Results

Measurements taken with the standard PACS and the ARPPS showed no statistically significant differences. Bland-Altman analysis showed a mean difference of 0.08% (95% CI –4.20% to 4.36%) for measurements taken with PACS versus ARPPS’ circumference tools and –1.84% (95% CI –6.17% to 2.14%) for measurements with the systems’ angle tools. Lin’s concordance correlation coefficients were 1.00 and 0.98 for the circumference and angle measurements, respectively, indicating almost perfect strength of agreement between ARPPS and PACS. Intraclass correlation showed no statistically significant difference between the readers for either measurement tool on each system.

Conclusions

ARPPS can be an effective, accurate, and precise means of 3D visualization and measurement of CT-derived holograms in the presurgical care timeline.

Integrating AI into radiology workflow: levels of research, production, and feedback maturity

We present a roadmap for integrating artificial intelligence (AI)-based image analysis algorithms into existing radiology workflows such that (1) radiologists can significantly benefit from enhanced automation in various imaging tasks due to AI, and (2) radiologists' feedback is utilized to further improve the AI application. This is achieved by establishing three maturity levels where (1) research enables the visualization of AI-based results/annotations by radiologists without generating new patient records; (2) production allows the AI-based system to generate results stored in an institution's picture-archiving and communication system; and (3) feedback equips radiologists with tools for editing the AI inference results for periodic retraining of the deployed AI systems, thereby allowing continuous organic improvement of AI-based radiology-workflow solutions. A case study (i.e., detection of brain metastases with T1-weighted contrast-enhanced three-dimensional MRI) illustrates the deployment details of a particular AI-based application according to the aforementioned maturity levels. It is shown that the given AI application significantly improves with feedback coming from radiologists; the number of incorrectly detected brain metastases (false positives) decreases from 14.2 to 9.12 per patient with the number of subsequently annotated datasets increasing from 93 to 217 as a result of radiologist adjudication.

The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth

PURPOSE

Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction.

METHODS

A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope.

RESULTS

Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator's measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator's measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs.

CONCLUSIONS

Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction.

LEVEL OF EVIDENCE

III.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Views of Users Towards the Quality of Picture Archiving and Communication System (PACS) in a Developing Country

PACS as a medical imaging technology is an information system that provides quick and convenient access to the medical images, as well as the quick and easy exchange of images and electronic reports among specialists in different departments. The objective of the study was to evaluate the PACS from the point of view of users in hospitals affiliated to Mashhad University of Medical Sciences. The study population consisted of the PACS' users (radiologists and the radiology technologists) in the radiology departments (103 staff). Data were collected through a questionnaire that was designed based on previous studies and published literature. From the views of users, quality of information of PACS had the highest average (Mean = 3.57±1.02), while quality of services had the lowest average (Mean = 2.99±0.19). About the quality of information, the highest and lowest averages were dedicated to information security (Mean = 4±0.69) and quality of pictures (Mean = 3.28±0.87), respectively. Generally, the findings of study indicate that there are problems in different parts of PACS quality in Iran and according to the high cost of purchasing, implementation, maintenance, and updating the PACS in hospitals, proper selection and use of software and hardware as well as proper maintenance of the system may lead to not only return on investment but also provision of telemedicine.

DeepLesion: automated mining of large-scale lesion annotations and universal lesion detection with deep learning

Extracting, harvesting, and building large-scale annotated radiological image datasets is a greatly important yet challenging problem. Meanwhile, vast amounts of clinical annotations have been collected and stored in hospitals' picture archiving and communication systems (PACS). These types of annotations, also known as bookmarks in PACS, are usually marked by radiologists during their daily workflow to highlight significant image findings that may serve as reference for later studies. We propose to mine and harvest these abundant retrospective medical data to build a large-scale lesion image dataset. Our process is scalable and requires minimum manual annotation effort. We mine bookmarks in our institute to develop DeepLesion, a dataset with 32,735 lesions in 32,120 CT slices from 10,594 studies of 4,427 unique patients. There are a variety of lesion types in this dataset, such as lung nodules, liver tumors, enlarged lymph nodes, and so on. It has the potential to be used in various medical image applications. Using DeepLesion, we train a universal lesion detector that can find all types of lesions with one unified framework. In this challenging task, the proposed lesion detector achieves a sensitivity of 81.1% with five false positives per image.

Digital Imaging and Communications in Medicine Whole Slide Imaging Connectathon at Digital Pathology Association Pathology Visions 2017

As digital pathology systems for clinical diagnostic work applications become mainstream, interoperability between these systems from different vendors becomes critical. For the first time, multiple digital pathology vendors have publicly revealed the use of the digital imaging and communications in medicine (DICOM) standard file format and network protocol to communicate between separate whole slide acquisition, storage, and viewing components. Note the use of DICOM for clinical diagnostic applications is still to be validated in the United States. The successful demonstration shows that the DICOM standard is fundamentally sound, though many lessons were learned. These lessons will be incorporated as incremental improvements in the standard, provide more detailed profiles to constrain variation for specific use cases, and offer educational material for implementers. Future Connectathon events will expand the scope to include more devices and vendors, as well as more ambitious use cases including laboratory information system integration and annotation for image analysis, as well as more geographic diversity. Users should request DICOM features in all purchases and contracts. It is anticipated that the growth of DICOM-compliant manufacturers will likely also ease DICOM for pathology becoming a recognized standard and as such the regulatory pathway for digital pathology products.

An Evaluation Protocol for Picture Archiving and Communication System: a Systematic Review

Introduction:

Picture archiving and communication system (PACS) serves to store, transmit, communicate and manage medical images. A logical evaluation protocol assists to determine whether the system is technically, structurally and operationally fit. The purpose of this systematic review was to propose a logical evaluation protocol for PACS, particularly useful for new hospitals and other healthcare institutions in developing countries.

Methods and Materials:

We systematically reviewed 25 out of 267 full-length articles, published between 2000 and 2017, retrieved from four sources: Science Direct, Scopus, PubMed and Google Scholar. The extracted data were tabulated and reviewed successively by three independent panels of experts that oversaw the design of this study and the process by which the PACS evaluation protocol was systematically developed.

Results:

The outcome data were ranked by expert panels and analyzed statistically, with the reliability established at 0.82 based on the Pearson’s correlation coefficient. The essential components and the best options to establish an optimal PACS were organized under nine main sections: system configuration;system network;data storage; datacompression;image input; image characteristics; image presentation; communication link; and system security, with a total of 20 components, each of which capable of working optimally with one or more program options.

Conclusions:

This systematic review presents an objective protocol that is an ideal tool for the evaluation of new or existing PACS at healthcare institutions, particularly in developing countries. Despite the significant advantages, the protocol may face minor limitations, largely due to lack of appropriate technical resources in various clinical settings and the host countries.

Comparative Analysis of Radiographic Hip Joint Geometry Using Measurement Tools on Picture Archiving and Communication System: A Prospective Study of 100 Pelvic Radiographs of Koreans

BACKGROUND

A contralateral normal hip joint has been often used as a reference standard in preoperative planning and intraoperative assessment of hip arthroplasty, with the assumption that bilateral hip joint geometries have no significant differences. However, one previous study using analog measurements on hardcopy films reported significant bilateral variation in hip joint geometry. We therefore investigated the level of agreement between the right and left hips for each measurement and determined index values and the range of normal bilateral variations.

METHODS

We assessed 100 standard anteroposterior radiographs of the pelvis in this study. Two independent observers measured the actual value of femoral head diameter, location of the femoral head center, acetabular offset, femoral offset, hip offset, greater trochanteric height, neck-shaft angle, medullary canal diameter, and proximal femoral diameter. Intraclass correlation coefficients (ICCs) and values of mean difference were calculated for each measurement.

RESULTS

The results demonstrated perfect agreement (ICC >0.8) between the right and left hips for most parameters and substantial agreement for greater trochanteric height (ICC = 0.735) and femoral offset (ICC = 0.773). The mean difference and standard deviation in the measurement between the right and left hips for the location of the femoral head center and the acetabular offset were 0.60 ± 0.48 mm and 0.42 ± 0.30 mm, respectively.

CONCLUSION

Hip joint geometry is not influenced by side. In hip arthroplasty, a contralateral normal hip can be reliably used as a guide for preoperative planning using measurement tools on a picture archiving and communication system.

Effect of Picture Archiving and Communication System Image Manipulation on the Agreement of Chest Radiograph Interpretation in the Neonatal Intensive Care Unit

OBJECTIVE

Variability in image interpretation has been attributed to differences in the interpreters' knowledge base, experience level, and access to the clinical scenario. Picture archiving and communication system (PACS) has allowed the user to manipulate the images while developing their impression of the radiograph. The aim of this study was to determine the agreement of chest radiograph (CXR) impressions among radiologists and neonatologists and help determine the effect of image manipulation with PACS on report impression.

MATERIALS AND METHODS

Prospective cohort study included 60 patients from the Neonatal Intensive Care Unit undergoing CXRs. Three radiologists and three neonatologists reviewed two consecutive frontal CXRs of each patient. Each physician was allowed manipulation of images as needed to provide a decision of "improved," "unchanged," or "disease progression" lung disease for each patient. Each physician repeated the process once more; this time, they were not allowed to individually manipulate the images, but an independent radiologist presets the image brightness and contrast to best optimize the CXR appearance. Percent agreement and opposing reporting views were calculated between all six physicians for each of the two methods (allowing and not allowing image manipulation).

RESULTS

One hundred percent agreement in image impression between all six observers was only seen in 5% of cases when allowing image manipulation; 100% agreement was seen in 13% of the cases when there was no manipulation of the images.

CONCLUSION

Agreement in CXR interpretation is poor; the ability to manipulate the images on PACS results in a decrease in agreement in the interpretation of these studies. New methods to standardize image appearance and allow improved comparison with previous studies should be sought to improve clinician agreement in interpretation consistency and advance patient care.

Implementation methods of medical image sharing for collaborative health care based on IHE XDS-I profile

IHE XDS-I profile proposes an architecture model for cross-enterprise medical image sharing, but there are only a few clinical implementations reported. Here, we investigate three pilot studies based on the IHE XDS-I profile to see whether we can use this architecture as a foundation for image sharing solutions in a variety of health-care settings. The first pilot study was image sharing for cross-enterprise health care with federated integration, which was implemented in Huadong Hospital and Shanghai Sixth People's Hospital within the Shanghai Shen-Kang Hospital Management Center; the second pilot study was XDS-I-based patient-controlled image sharing solution, which was implemented by the Radiological Society of North America (RSNA) team in the USA; and the third pilot study was collaborative imaging diagnosis with electronic health-care record integration in regional health care, which was implemented in two districts in Shanghai. In order to support these pilot studies, we designed and developed new image access methods, components, and data models such as RAD-69/WADO hybrid image retrieval, RSNA clearinghouse, and extension of metadata definitions in both the submission set and the cross-enterprise document sharing (XDS) registry. We identified several key issues that impact the implementation of XDS-I in practical applications, and conclude that the IHE XDS-I profile is a theoretically good architecture and a useful foundation for medical image sharing solutions across multiple regional health-care providers.

Improved method for calculating hepatic steatosis using the hepatorenal index

OBJECTIVES

Marshall et al (AJR Am J Roentgenol 2012; 199:997-1002) initially demonstrated that the hepatorenal index is an effective and noninvasive tool to screen patients for hepatic steatosis. The aim of this study was to determine whether the hepatorenal index can be accurately calculated directly from a picture archiving and communication system (PACS) quickly and efficiently without the need for the multiple steps and specialized software used to calculate hepatorenal index in the study by Marshall et al.

METHODS

We evaluated 99 of the 101 patients included in the study by Marshall et al: patients being followed by hepatologists with plans for liver biopsy. The hepatorenal index was calculated by using Digital Imaging and Communications in Medicine (DICOM) images from a PACS and a markup region-of-interest tool. We compared this value to the value that Marshall et al derived by using specialized software and to standard histologic estimates. We created similar subgroups: patients with steatosis based on histologically estimated intracellular fat exceeding 5% and patients without steatosis.

RESULTS

The mean hepatorenal index ± SD for those with steatosis according to histologic findings was 1.87 ± 0.6, and for those without, it was 1.14 ± 0.2. A hepatorenal index of 1.34 or higher had 92% sensitivity for identifying fat exceeding 5%, 85% specificity, a 94% negative predictive value, and a 79% positive predictive value. Substantial agreement was found between the hepatorenal index calculated from DICOM images and macrovesicular fat categorized at the cut point of 1.34 or higher (κ = 0.76; 95% confidence interval, 0.62-0.88; P < .001).

CONCLUSIONS

The hepatorenal index can be quickly and accurately calculated from DICOM images directly on a PACS without supplementary software.

Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access to digital imaging and communication in medicine persistent object protocol

AIM

To address issues in interoperability between different fundus image systems, we proposed a web eye-picture archiving and communication system (PACS) framework in conformance with digital imaging and communication in medicine (DICOM) and health level 7 (HL7) protocol to realize fundus images and reports sharing and communication through internet.

METHODS

Firstly, a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise (IHE) Eye Care technical framework. Then, a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object (WADO) protocol, which contains three tiers.

RESULTS

In any client system installed with web browser, clinicians could log in the eye-PACS to observe fundus images and reports. Multipurpose internet mail extensions (MIME) type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians. Some functions provided by open-source Oviyam could be used to query, zoom, move, measure, view DICOM fundus images.

CONCLUSION

Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports, therefore is of great significance for teleophthalmology.

Practical issues in picture archiving and communication system and networking

Picture Archiving and Communication System (PACS) is a key workflow tool in the functioning of radiology departments worldwide, today, and its utilization is rapidly growing in India. The key challenges in PACS implementation are related to vendor and feature selection, integration with the existing HIS, user training, maintenance and scalability to meet increasing demands. Additionally, the networking requirements that PACS imposes on hospital networks are not insignificant. This article attempts to review these issues from the standpoint of what a prospective or new user needs to know.

Patient information extraction in digitized radiography

Digital imagery is gradually replacing the traditional radiograph with the development of digital radiography and film scanner. This report presents a new method to extract the patient information number (PIN) field automatically from the film-scanned image using image analysis technique. To evaluate the PIN field extraction algorithm, 2 formats of label acquired from 2 different hospitals are tested. Given the available films with no constraints on the way the labels are written and positioned, the correct extraction rates are 73% and 84%, respectively. This extracted PIN information can link with Radiology Information System (RIS) or Hospital Information System (HIS), and the image scanned from the film then can be filed into the database automatically. The efficiency this method offers can simplify greatly the image filing process and improve the user friendliness of the overall image digitization system. Moreover, compared with the bar code reader, it solves the automatic information input problem in a very economical way. The authors believe the success of this technique will benefit the development of the PACS (Picture Archiving and Communication System) and teleradiology.

Clinical input into designing a PACS

The purpose of this study was to evaluate clinical attitudes and expectations in the implementation of a neuroradiology picture archiving and communication system (PACS). A 1-page survey of expectations and clinical attitudes toward a neuroradiology mini-PACS was distributed to 49 full-time faculty members in the departments of neurosurgery, neurology, and otorhinolaryngology at an academic center. Interest in viewing soft-copy images was moderate to very high for over 89% of clinicians. All clinicians were comfortable with phone consultations with radiologists while viewing soft-copy images. Clinicians preferred retrieving images from personal computers over workstations and film libraries by 72.9%, 27.1%, and 0%, respectively. However, 38.5% of surgeons felt the need for hard copy in the operating room. Clinicians estimated that in 18.3% of cases, patients took their in-house films to outside institutions for consultations. Clinicians were enthusiastic about implementing PACS. Although acceptance of soft-copy viewing among clinicians is high, some provision for supplying hard-copy images appears to be necessary.

PACS databases and enrichment of the folder manager concept

Current challenges facing picture archiving and communication systems (PACS) center around database design and functionality. Workflow issues and folder manager concepts such as autorouting, prefetching, hanging protocols, and hierarchical storage management are driven by a properly designed database that ultimately directly impacts the clinical utility of a PACS. The key issues in PACS database design that enable radiologist-friendly, cost-effective, and data-secure systems will be discussed, including database difficulties of the DICOM standard, HIS/RIS/PACS (hospital information system/radiology information system) connectivity, and database issues in data acquisition, data dissemination, and data display.