PACS-Based Multimedia Imaging Informatics Basic Principles and Applications

Thoroughly revised to present the very latest in PACS-based multimedia in medical imaging informatics—from the electronic patient record to the full range of topics in digital medical imaging—this new edition by the founder of PACS and multimedia image informatics features even more clinically applicable material than ever before. It uses the framework of PACS-based image informatics, not physics or engineering principles, to explain PACS-based multimedia informatics and its application in clinical settings and labs. New topics include Data Grid and Cloud Computing, IHE XDS-I Workflow Profile (Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging), extending XDS to share images, and diagnostic reports and related information across a group of enterprise health care sites.

PACS-Based Multimedia Imaging Informatics is presented in 4 sections. Part 1 covers the beginning and history of Medical Imaging, PACS, and Imaging Informatics. The other three sections cover Medical Imaging, Industrial Guidelines, Standards, and Compliance; Informatics, Data Grid, Workstation, Radiation Therapy, Simulators, Molecular Imaging, Archive Server, and Cloud Computing; and multimedia Imaging Informatics, Computer-Aided Diagnosis (CAD), Image-Guide Decision Support, Proton Therapy, Minimally Invasive Multimedia Image-Assisted Surgery, BIG DATA.

• New chapter on Molecular Imaging Informatics
• Expanded coverage of PACS and eHR's (Electronic Health Record), with HIPPA compliance
• New coverage of PACS-based CAD (Computer-Aided Diagnosis)
• Reorganized and expanded clinical chapters discuss one distinct clinical application each
• Minimally invasive image assisted surgery in translational medicine
• Authored by the world's first and still leading authority on PACS and medical imaging

PACS-Based Multimedia Imaging Informatics: Basic Principles and Applications, 3^rd Edition is the single most comprehensive and authoritative resource that thoroughly covers the critical issues of PACS-based hardware and software design and implementation in a systematic and easily comprehensible manner. It is a must-have book for all those involved in designing, implementing, and using PACS-based Multimedia Imaging Informatics. 

H.K. "Bernie" Huang, D.Sc., FRCR (Hon.), is Professor Emeritus of Radiology and Biomedical Engineering at the University of Southern California, and Professor at the Shanghai Institute of Technical Physics, The Chinese Academy of Sciences. He was former Professor and Vice Chair of Radiology at the University of California, Los Angeles; and the University of California, San Francisco; and Chair Professor of Imaging informatics at the Hong Kong Polytechnic University.

Foreword 1 xxix

Foreword 2 xxxi

Foreword 3 xxxiii

Preface to the Third Edition xxxv

Preface to the Second Edition xxxix

Acknowledgments xliii

H.K. Huang Short Biography xlv

List of Acronyms xlvii

Part 1 The Beginning: Retrospective 1

1 Medical Imaging, PACS and Imaging Informatics: Retrospective 3

PART I TECHNOLOGY DEVELOPMENT AND PIONEERS 4

1.1 Medical Imaging 4

1.2 PACS and its Development 8

1.3 Key Technologies: Computer and Software, Storage, and Communication Networks 15

1.4 Key Technologies: Medical Imaging Related 17

PART II COLLABORATIONS AND SUPPORTS 22

1.5 Collaboration with Government Agencies, Industry and Medical Imaging Associations 22

1.6 Medical Imaging Informatics 29

1.7 Summary 32

1.8 Acknowledgments 34

References 35

Part 2 Medical Imaging, Industrial Guidelines, Standards, and Compliance 37

2 Digital Medical Imaging 39

2.1 Digital Medical Imaging Fundamentals 39

2.2 Two�-Dimensional Medical Imaging 46

2.3 Three�-Dimensional Medical Imaging 55

2.4 Four�-Dimensional, Multimodality, and Fusion Imaging 78

2.5 Image Compression 85

Further Reading 93

3 PACS Fundamentals 97

3.1 PACS Components and Network 97

3.2 PACS Infrastructure Design Concept 101

3.3 Generic PACS�-Based Multimedia Architecture and Workflow 103

3.4 PACS�-Based Architectures 105

3.5 Communication and Networks 110

Further Reading 121

4 Industrial Standards: Health Level 7 (HL7), Digital Imaging and Communications in Medicine (DICOM) and Integrating the Healthcare Enterprise (IHE) 123

4.1 Industrial Standards 124

4.2 The Health Level 7 (HL7) Standard 124

4.3 From ACR�-NEMA to DICOM 127

4.4 DICOM 3.0 Standard 129

4.5 Examples of Using DICOM 136

4.6 DICOM Organizational Structure and New Features 138

4.7 IHE (Integrating the Healthcare Enterprise) 142

4.8 Some Operating Systems and Programming Languages useful to HL7, DICOM and IHE 151

4.9 Summary of Industrial Standards: HL7, DICOM and IHE 153

References 153

Further Reading 154

5 DICOM�-Compliant Image Acquisition Gateway and Integration of HIS, RIS, PACS and ePR 155

5.1 DICOM Acquisition Gateway 156

5.2 DICOM�-Compliant Image Acquisition Gateway 157

5.3 Automatic Image Data Recovery Scheme for DICOM Conformance Device 162

5.4 Interface PACS Modalities with the Gateway Computer 164

5.5 DICOM Compliance PACS Broker 166

5.6 Image Preprocessing and Display 167

5.7 Clinical Operation and Reliability of the Gateway 168

5.8 Hospital Information System (HIS), Radiology Information System (RIS), and PACS 169

References 178

6 Web�-Based Data Management and Image Distribution 179

6.1 Distributed Image File Server: PACS�-Based Data Management 179

6.2 Distributed Image File Server 179

6.3 Web Server 181

6.4 Component�-based Web Server for Image Distribution and Display 183

6.5 Performance Evaluation 188

6.6 Summary of PACS Data Management and Web�]based Image Distribution 189

Further Reading 189

7 Medical Image Sharing for Collaborative Healthcare Based on IHE XDS�-I Profile 191

7.1 Introduction 192

7.2 Brief Description of IHE XDS/XDS�-I Profiles 193

7.3 Pilot Studies of Medical Image Sharing and Exchanging for a Variety of Healthcare Services 194

7.4 Results 206

7.5 Discussion 209

Acknowledgements 212

References 212

Part 3 Informatics, Data Grid, Workstation, Radiotherapy, Simulators, Molecular Imaging, Archive Server, and Cloud Computing 215

8 Data Grid for PACS and Medical Imaging Informatics 217

8.1 Distributed Computing 217

8.2 Grid Computing 219

8.3 Data Grid 222

8.4 Fault�-Tolerant Data Grid for PACS Archive and Backup, Query/Retrieval, and Disaster Recovery 226

References 230

Further Reading 230

9 Data Grid for Clinical Applications 233

9.1 Clinical Trials and the Data Grid 233

9.2 Dedicated Breast MRI Enterprise Data Grid 239

9.3 Administrating the Data Grid 247

9.4 Summary 250

References 251

Further Reading 251

10 Display Workstations 253

10.1 PACS�-Based Display Workstation 254

10.2 Various Types of Image Workstation 260

10.3 Image Display and Measurement Functions 263

10.4 Workstation Graphic User Interface (GUI) and Basic Display Functions 267

10.5 DICOM PC�-Based Display Workstation Software 269

10.6 Post-Processing Workflow, PACS�-Based Multidimensional Display, and Specialized Post-Processing Workstation 276

10.7 DICOM�-Based Workstations in Progress 277

References 289

11 Multimedia Electronic Patient Record (EPR) System in Radiotherapy (RT) 291

11.1 Multimodality 2�-D and 3�-D Imaging in Radiotherapy 292

11.2 Multimedia ePR System in Radiation Treatment 298

11.3 Radiotherapy Planning and Treatment 301

11.4 Radiotherapy Workflow 302

11.5 The ePR Data Model and DICOM-RT Objects 303

11.6 Infrastructure, Workflow and Components of the Multimedia ePR in RT 306

11.7 Database Schema 309

11.8 Graphical User Interface Design 311

11.9 Validation of the Concept of Multimedia ePR System in RT 312

11.10 Advantages of the Multimedia ePR system in RT for Daily Clinical Practice 319

11.11 Use of the Multimedia ePR System in RT For Image�-Assisted Knowledge Discovery and Decision Making 320

11.12 Summary 321

Acknowledgement 321

References 321

12 PACS�-Based Imaging Informatics Simulators 325

12.1 Why Imaging Informatics Simulators? 326

12.2 PACS–ePR Simulator 328

12.3 Data Grid Simulator 329

12.4 CAD–PACS Simulator 331

12.5 Radiotherapy (RT) ePR Simulator 335

12.6 Image�]assisted Surgery (IAS) ePR Simulator 338

12.7 Summary 344

Acknowledgements 344

References 344

13 Molecular Imaging Data Grid (MIDG) 347

13.1 Introduction 348

13.2 Molecular Imaging 348

13.3 Methodology 351

13.4 Results 358

13.5 Discussion 360

13.6 Summary 361

Acknowledgements 361

References 362

14 A DICOM�-Based Second-Generation Molecular Imaging Data Grid (MIDG) with the IHE XDS�-i Integration Profile 365

14.1 Introduction 366

14.2 Methodology 369

14.3 System Implementation 371

14.4 Data Collection and Normalization 375

14.5 System Performance 378

14.6 Data Transmission, MIDG Implementation, Workflow and System Potential 380

14.7 Summary 383

Acknowledgements 386

References 386

15 PACS�-Based Archive Server and Cloud Computing 389

15.1 PACS�-Based Multimedia Biomedical Imaging Informatics 390

15.2 PACS�-Based Server and Archive 390

15.3 PACS�-Based Archive Server System Operations 396

15.4 DICOM�-Compliant PACS�-Based Archive Server 397

15.5 DICOM PACS�-Based Archive Server Hardware and Software 399

15.6 Backup Archive Server and Data Grid 400

15.7 Cloud Computing and Archive Server 403

Acknowledgements 414

References 414

Part 4 Multimedia Imaging Informatics, Computer-Aided Diagnosis (CAD), Image-Guide Decision Support, Proton Therapy, Minimally Invasive Multimedia Image-Assisted Surgery, Big Data 417

Prologue – Chapters 16, 17 and 18 417

16 DICOM-Based Medical Imaging Informatics and CAD 419

16.1 Computer�]Aided Diagnosis (CAD) 420

16.2 Integration of CAD with PACS�-Based Multimedia Informatics 425

16.3 The CAD–PACS Integration Toolkit 429

16.4 Data Flow of the three CAD–PACS Editions Integration Toolkit 432

References 433

Further Reading 434

17 DICOM�-Based CAD: Acute Intracranial Hemorrhage and Multiple Sclerosis 435

17.1 Computer�]Aided Detection (CAD) of Small Acute Intracranial Hemorrhage on CT of the brain 435

17.2 Development of the CAD Algorithm for AIH on CT 436

17.3 CAD�-PACS Integration 452

17.4 Multiple Sclerosis (MS) on MRI 456

References 461

Further Reading 461

18 PACS�-Based CAD: Digital Hand Atlas and Bone Age Assessment of children 463

18.1 Average Bone Age of a Child 464

18.2 Bone Age Assessment of Children 466

18.3 Method of Analysis 473

18.4 Integration of CAD with PACS�-Based Multimedia Informatics for Bone Age Assessment of Children: The CAD System 479

18.5 Validation of the CAD and the Comparison of CAD Result with Radiologists’ Assessment 483

18.6 Clinical Evaluation of the CAD System for Bone Age Assessment (BAA) 489

18.7 Integrating CAD for Bone Age Assessment with Other Informatics Systems 493

18.8 Research and Development Trends in CAD–PACS Integration 497

Acknowledgements 499

References 499

Further Reading 500

19 Intelligent ePR System for Evidence�-Based Research in Radiotherapy 503

19.1 Introduction 503

19.2 Proton Therapy Clinical Workflow and Data 506

19.3 Proton Therapy ePR System 508

19.4 System Implementation 511

19.5 Results 512

19.6 Conclusion and Discussion 520

Acknowledgements 522

References 522

20 Multimedia Electronic Patient Record System for Minimally Invasive Image�]Assisted Spinal Surgery 525

20.1 Integration of Medical Diagnosis with Image�]Assisted Surgery Treatment 526

20.2 Minimally Invasive Spinal Surgery Workflow 535

20.3 Multimedia ePR System for Image�]Assisted MISS Workflow and Data Model 536

20.4 ePR MISS System Architecture 538

20.5 Pre�-Op Authoring Module 543

20.6 Intra�-Op Module 547

20.7 Post�-Op Module 553

20.8 System Deployment, User Training and Support 554

20.9 Summary 557

References 557

21 From Minimally Invasive Spinal Surgery to Integrated Image�-Assisted Surgery in Translational Medicine 559

21.1 Introduction 560

21.2 Integrated Image-Assisted Minimally Invasive Spinal Surgery 561

21.3 IIA�-MISS EMR System Evaluation 565

21.4 To Fulfill some Translational Medicine Aims 569

21.5 Summary 571

21.6 Contribution from Colleagues 572

Acknowledgement 572

References 572

22 Big Data in PACS�-Based Multimedia Medical Imaging Informatics 575

22.1 Big Data in PACS�-Based Multimedia Medical Imaging Informatics 575

22.2 Characters and Challenges of Medical Image Big Data 577

22.3 Possible and Potential Solutions of Big Data in DICOM PACS�-Based Medical Imaging and Informatics 581

22.4 Research Projects Related to Medical Imaging Big Data 586

22.5 Summary of Big Data 587

Acknowledgements 588

References 588

Index 591

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