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Integrated radiology information system, picture archiving and communications system, and teleradiology - Workflow-driven and future-proof

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 199-200页

作者： Shieh, YY Roberson, GH Texas Tech Univ Hlth Sci Ctr Dept Radiol Lubbock TX 79430 USA

The proliferation of integrated radiology information system/picture archiving and communication system (RIS/PACS) and teleradiology has been slow because of two concerns: usability and economic return. A major dissatisfaction on the usability issue is that contemporary systems are not intelligent enough to support the logical workflow of radiologists. We propose to better understand the algorithms underlying the radiologists' reading process, and then embed this intelligence into the software program so that radiologists can interact with the system with less conscious effort. Regarding economic return issues, people are looking for insurance against obsolescence in order to protect their investments. We propose to future-proof a system by sticking to the following principles: compliance to industry standards, commercial off-the-shelf (COTS) components, and modularity. An integrated RIS/PACS and teleradiology system designed to be workflow-driven and future-proof is being developed at Texas Tech University Health Sciences Center. Copyright (C) 1999 by W.B. Saunders Company.

关键词：算法人工智能计算机系统诊断显像预测投资放射学放射学信息系统/经济学放射学信息系统/组织和管理软件系统综合远程放射学得克萨斯用户计算机接口工作负荷量人类

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Parlaying digital imaging and communications in medicine and open architecture to our advantage: The new Department of Defense picture archiving and communications system

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 64-66页

作者： Cawthon, MA Brooke Army Med Ctr San Antonio TX USA

The Department of Defense (DoD) undertook a major systems specification, acquisition, and implementation project of multivendor picture archiving and communications system (PACS) and teleradiology systems during 1997 with deployment of the first systems in 1998. These systems differ from their DoD predecessor system in being multivendor in origin, specifying adherence to the developing Digital Imaging and Communications in Medicine (DICOM) 3.0 standard and all of its service classes, emphasizing open architecture, using personal computer (PC) and web-based image viewing access, having radiologic telepresence over large geographic areas as a primary focus of implementation, and requiring bidirectional interfacing with the DoD hospital information system (HIS). The benefits and advantages to the military healthcare system accrue through the enabling of a seamless implementation of a virtual radiology operational environment throughout this vast healthcare organization providing efficient general and subspecialty radiologic interpretive and consultative services for our medical beneficiaries to any healthcare provider, anywhere and at any time of the night or day. Copyright (C) 1999 by W.B. Saunders Company.

关键词：计算机系统诊断显像政府机构卫生服务易得程度医院信息系统/组织和管理医院军队/组织和管理因特网微型计算机军事科学放射学信息系统/组织和管理转诊和会诊远程放射学/组织和管理美国用户计算机接口人类

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Reengineering the picture archiving and communication system (PACS) process for digital imaging networks PACS

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 59-61页

作者： Horton, MC Lewis, TE Kinsey, TV USN Joint Imaging Technol Project Off Ft Detrick MD 21702 USA

Prior to June 1997, military picture archiving and communications systems (PACS) were planned, procured, and installed with key decisions on the system, equipment, and even funding sources made through a research and development office called Medical Diagnostic Imaging Systems (MDIS). Beginning in June 1997, the Joint Imaging Technology Project Office (JITPO) initiated a collaborative and consultative process far planning and implementing PACS into military treatment facilities through a new Department of Defense (DoD) contract vehicle called digital imaging networks (DIN)-PACS. The JITPO reengineered this process incorporating multiple organizations and politics. The reengineered PACS process administered through the JITPO transformed the decision process and accountability from a single office to a consultative method that increased end-user knowledge, responsibility, and ownership in PACS. The JITPO continues to provide information and services that assist multiple groups and users in rendering PACS planning and implementation decisions. Local site project managers are involved from the outset and this end-user collaboration has made the sometimes difficult transition to PACS an easier and more acceptable process for all involved. Corporately, this process saved DoD sites millions by having PACS plans developed within the government and proposed to vendors second, and then having vendors respond specifically to those plans. The integrity and efficiency of the process have reduced the opportunity for implementing nonstandard systems while sharing resources and reducing wasted government dollars. This presentation will describe the chronology of changes, encountered obstacles, and lessons learned within the reengineering of the PACS process for DIN-PACS. This is a US government work. There are no restrictions on its use.

关键词：行政管理人员生物医学工程资本筹集计算机通信网络/分类计算机通信网络/经济学计算机通信网络/组织和管理计算机用户培训费用节省决策诊断显像效率组织在职培训职业间关系军事医学所有权放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理系统综合人类

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The philosophy of change and adaptation of radiology to the information age

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 67-70页

作者： Chacko, A Cook, J Contreras, M Lollar, B Radvany, M Shah, R Cawthon, M Timbloe, HL Brooke Army Med Ctr Dept Radiol Ft Sam Houston TX 78234 USA

Abstract not available.

关键词：诊断显像医学信息学应用哲学医学放射学/组织和管理放射科医院/经济学放射科医院/组织和管理放射学信息系统/组织和管理工艺学放射学/组织和管理人类

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Technology assessment and requirements analysis: A process to facilitate decision making in picture archiving and communications system implementation

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 62-63页

作者： Radvany, MG Chacko, AK Richardson, RR Grazdan, GW USA Med Mat Agcy Technol Support Div Ft Detrick MD 21702 USA Brooke Army Med Ctr Dept Radiol Ft Sam Houston TX 78234 USA

In a time of decreasing resources, managers need a tool to manage their resources effectively, support clinical requirements, and replace aging equipment in order to ensure adequate clinical care. To do this successfully, one must be able to perform technology assessment and capital equipment asset management. The lack of a commercial system that adequately performed technology needs assessment and addressed the unique needs of the military led to the development of an in-house Technology Assessment and Requirements Analysis (TARA) program. The TARA is a tool that provides an unbiased review of clinical operations and the resulting capital equipment requirements for military hospitals. The TARA report allows for the development of acquisition strategies for new equipment, enhances personnel management, and improves and streamlines clinical operations and processes. This is a US government work. There are no restrictions on its use.

关键词：资本筹集决策设备和供应医院/经济学卫生资源/经济学卫生资源/组织和管理医院军队/经济学医院军队/组织和管理人员管理医院放射学信息系统/经济学放射学信息系统/组织和管理技术评估生物医学人类

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Sophisticated hospital information system radiology information system picture archiving and communications system (PACS) integration in a large-scale traumatology PACS

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 99-102页

作者： Peer, S Vogl, R Peer, R Jaschke, W Univ Innsbruck Hosp Dept Radiol A-6020 Innsbruck Austria

Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribution to the surgeon. During installation of the Innsbruck PACS, special aspects of traumatology had to be realized, such as imaging of unconscious patients without identification, and transferred to the electronic environment. Even with up-to-date PACS hardware and software, special solutions had to be developed in-house to tailor the PACS/hospital information system (HIS)/radiology information system (RIS) interface to the needs of radiologic and clinical users, An ongoing workflow evaluation is needed to realize the needs of radiolgists and clinicians. These needs have to be realized within a commercially available PACS, whereby full integration of information systems may sometimes only be achieved by special in-house solutions. Copyright (C) 1999 by W.B. Saunders Company.

关键词：门诊医疗设施/组织和管理计算机通信网络计算机系统医院信息系统/组织和管理医务人员病人识别系统放射学放射学信息系统/组织和管理软件系统综合创伤诊治中心/组织和管理意识丧失人类

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Evaluating the impact of workstation usage on radiology report times in the initial 6 months following installation

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 152-154页

作者： Tamm, EP Raval, B West, OC Dinwiddie, S Holmes, R Univ Texas Sch Med Dept Radiol Houston TX 77030 USA

Picture archiving and communications systems (PACS) workstations are reported to improve workflow by making studies immediately available for review upon their completion. This study tested the hypothesis that a workstation would decrease the time from completion of a study to dictation of results (report time). A four-monitor, 2K x 2K workstation (Imation Cemax-Icon, Fremont, CA), was installed in a body imaging computed tomography (CT) reading room. Use of the workstation by the staff radiologists was voluntary. Images were also printed on film and films continued to be hung at the routine hanging times. To evaluate the workstation's maximum impact, data were collected for report times for studies completed during the routine day shift of the staff radiologist (Monday to Friday, 8 AM to 5 PM). Data were collected before workstation installation (August 1997 to November 1997) and for the subsequent 6 months. Histograms of the number of studies (743 v 103) versus report time (mean, 11.7 v 7.4 hours) showed a bimodal distribution, with peaks at approximately 6 and 24 hours, both before (8/97-11/97) and after (6/98) the workstation's installation. However, the number of studies dictated greater than 60 hours (25.2% v 20.4%) and the percentage of studies in the second peak (16 to 48 hours;4.4% v 0%) both decreased. In conclusion, the workstation decreased the mean (11.7 v 7.4 hours) and standard deviation (19.8 v 9.1 hours) for report times, This was due to a decrease in both the number of cases dictated the day following their completion and the number of outliers (markedly delayed dictations). The decrease in outliers is probably due to a decrease in the number of "lost" film-based studies. Copyright (C) 1999 by W.B. Saunders Company.

关键词：计算机系统数据收集评价研究(主题) 随访研究放射学放射学信息系统/仪器和设备放射学信息系统/组织和管理时间因素体层摄影术 X线计算机 X线胶片人类

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Bridging the gap: Linking a legacy hospital information system with a filmless radiology picture archiving and communications system within a nonhomogeneous environment

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 96-98页

作者： Rubin, RK Henri, CJ Cox, RD McGill Univ Ctr Hlth Dept Diagnost Radiol Montreal PQ Canada

A health level 7 (HL7)-conformant data link to exchange information between the mainframe hospital information system (HIS) of our hospital and our home-grown picture archiving and communications system (PACS) is a result of a collaborative effort between the HIS department and the PACS development team. Based of the ability to link examination requisitions and image studies, applications have been generated to optimise workflow and to improve the reliability and distribution of radiology information. Now, images can be routed to individual radiologists and clinicians;worklists facilitate radiology reporting;applications exist to create, edit, and view reports and images via the internet;and automated quality control now limits the incidence of "lost" cases and errors in image routing. By following the HL7 standard to develop the gateway to the legacy system, the development of a radiology information system for booking, reading, reporting, and billing remains universal and does not preclude the option to integrate off-the-shelf commercial products. Copyright (C) 1999 by W.B. Saunders Company.

关键词：计算机通信网络数据库管理系统诊断显像医院信息系统/组织和管理信息存储和检索因特网质量控制放射学信息系统/仪器和设备放射学信息系统/组织和管理系统综合远程放射学工作负荷量人类

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Transparent image access in a distributed picture archiving and communications system: The master database broker

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 175-177页

作者： Cox, RD Henri, CJ Rubin, RK McGill Univ Ctr Hlth Dept Diagnost Radiol Montreal PQ Canada

A distributed design is the most cost-effective system for small- to medium-scale picture archiving and communications systems (PACS) implementations. However, the design presents an interesting challenge to developers and implementers: to make stored image data, distributed throughout the PACS network, appear to be centralized with a single access point for users. A key component for the distributed system is a central or master database, containing all the studies that have been scanned into the PACS. Each study includes a list of one or more locations for that particular dataset so that applications can easily find it. Non-Digital Imaging and Communications in Medicine (DICOM) clients, such as our worldwide web (WWW)-based PACS browser, query the master database directly to find the images, then jump to the most appropriate location via a distributed web-based viewing system. The Master Database Broker provides DICOM clients with the same functionality by translating DICOM queries to master database searches and distributing retrieval requests transparently to the appropriate source. The Broker also acts as a storage service class provider, allowing users to store selected image subsets and reformatted images with the original study, without having to know on which server the original data are stored. Copyright (C) 7999 by W.B. Saunders Company.

关键词： CD-ROM 计算机通信网络/经济学费用效益分析数据库(主题)/分类数据库(主题)/经济学数据库(主题)/组织和管理诊断显像信息存储和检索因特网放射学信息系统/分类放射学信息系统/经济学放射学信息系统/组织和管理人类

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Care and feeding of a staff for filmless radiology

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JOURNAL OF DIGITAL IMAGING 1999年第2期12卷 38-40页

作者： Mensch, B Honea, R Orand, M Texas Childrens Hosp Edward B Singleton Diagnost Imaging Serv Houston TX 77030 USA

Texas Children's Hospital, a definitive care pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archival and communications system (PACS) including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Developing staffing adequate to meet the demands of filmless radiology operations has been a continuous challenge. Overall guidance for the PACS effort is provided by a hospital-level PACS Committee, a department-level PACS Steering Committee, and an Operations Committee. Operational Subcommittees have been formed to address service-specific implementations, such as the Emergency Center Operations Subcommittee. These committees include membership by those affected by the change, as well as those effecting the change. Initially, personnel resources for PACS were provided through additional duties of existing imaging service personnel. As the PACS effort became more complex, full-time positions were created, including a PACS Coordinator, a PACS Analyst, and a Digital Imaging Assistant. Each position requires a job description, qualifications, and personnel development plans that are difficult to anticipate in an evolving PACS implementation. These positions have been augmented by temporary full-time assignments, position reclassifications, and cross-training of other imaging personnel. Imaging personnel are assisted by other hospital personnel from Biomedical Engineering and Information Services. Ultimately, the PACS staff grows to include all those who must operate the PACS equipment in the normal course of their duties. The effectiveness of the PACS staff is limited by their level of their expertise. This report discusses our methods to obtain training from outside our institution and to develop, conduct, and document standardized in-house training. We describe some of the products of this work, including policies and procedures, clinical competency criteria, PACS inservice t

关键词：生物医学工程临床工作能力计算机系统诊断显像医院儿科/组织和管理在职培训职业间关系医务人员医院/分类医务人员医院/教育医务人员医院/组织和管理组织方针期刊(主题) 放射科医院/组织和管理放射学信息系统/组织和管理软件得克萨斯人类

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