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PACS and Digital Imaging — New Directions
European Journal of Radiology.
EURRAD
I I (1993) l-2
00406
Editorial
PACS and Digital Imaging - New Directions Definition of the domain The generic domain of computer assisted radiology can be defined as the application of computer and communication technology in radiological and related medical activities. Main emphasis is on the generation, processing, management, and communication of medical images. For the radiologist this tool supports the qualitative impression, the quantitative measurement and the communication of medical images. With these characteristics, CAR represents a natural progression in the medical usage of tools and techniques from the early history of medicine to the present day. It can also be seen as a logical progression from the primary digital modalities: CT, echography, SPECT, PET, MRI and from the evolution towards a digital radiology. The subject area can be divided into three interdependent topics: digital image generation (digital modalities, digital radiology), image analysis and display, and communication and archiving (PACS), the last with its logical extension: radiology teleservices. The necessary integration with the information systems of the hospital, the use of diverse application of expert systems and the standardization problematics, produce an overlapping boundary with the field of Medical Informatics ‘strict0 sensu’.
Images
The computer in relation to radiological activities Figure 1 shows an activity flow chart of the ‘diagnostic pathway’. This places the radiological activities in perspective to the patient and related medical activities. Production of medical images, interpretation, consulting and reporting, delivering images for (computeraided) therapeutic procedures represent the heart of the radiological activity. Computer assistance may be realized at various positions in the pathway of the diagnostic process. This is usually achieved with specialized medical workstations which form part of, or have access to, a computer and/or communication network. Overall support for clerical and administrative activities can be provided within the radiological department by a radiological information system (RIS). Communication to the outside of the radiological department is realized 0720-048X/93/$06.00
0
1993 Elsevier Scientific
Publishers
Ireland
Therapy
Plan
Fig. 1. Activities
in the diagnostic
pathway
via an interface from RIS to a hospital information system (HIS). Image processing can be applied to image formation, reconstruction, and manipulation. This and image handling and communication is supported by medical workstations integrated into a picture archiving and communication system (PACS). A PACS may be part of
Ltd. All rights reserved
2
a local area network (LAN) or wide area network (WAN). The latter would then allow teleradiological services. Integrated into appropriate communication networks, medical workstations provide the platform from which radiology may assume an increasingly important position for servicing other medical disciplines, such as orthopaedics, cardiology, neurology, radiotherapy, as well as general and specialized surgery. In principle, improved radiological services may also be offered to referring physicians in clinical settings outside the traditional hospital environment. Computer assistance can also be given to the planning and carrying out of therapy, thereby improving patient care. Increasingly, computer assistance will become the prerequisite for a less or minimal invasive medicine. Some of the traditional activities already assisted by computers include imaging, image interpretation, consulting and reporting, and therapy planning.
New evolutions At the beginning of the 80’s, CT was in a state of advanced clinical implementation and perspectives on MRI were appearing: this meant a real revolution for the medical world. In parallel with the evident success of the digital methods, expectations were also very high with regard to the development of PACS, expert systems, and digital radiology. Limitations of the technology available during the last decade, the lack of integration with the health care information systems, and the absence of recognized and implemented standards, led to failures and a feeling of disillusion. The ‘first generation’ PACS installations have been difficult to use in clinical practice and the concept of the ‘no film option’ failed to materialize. In addition, the systems were not cost-effective. The real medical impact of expert systems and automatic image analysis remained marginal. However, the simultaneous occurrance of several sig-
nificant developments has rapidly changed the situation in recent years. Information technology made substantial progress in terms of archiving media, workstations, networks, database, etc. Amongst other benefits there has been a dramatic increase in performance. The price of the hardware dropped significantly, which places the cost-effectiveness of the systems in a new light. Efforts of integration with concepts from Medical Informatics have been made, namely in the EEC by the R&D framework Advance Informatics in Medicine - AIM. The solution of the standardization issue is underway. A dedicated European standardization body has been formed. It addresses the problem by searching for solutions on several issues simultaneously: a short-term option in collaboration with the ACRNEMA and the DICOM activity; a more fundamental long-term approach in collaboration with OSI. The manufacturers are increasingly using ‘de facto’ industrial standards; this simplifies greatly the problem of the integration of equipment into multi-vendor environments. With this new era in progress, the publication of this first special issue of PACS - Digital Imaging of the European Journal of Radiology is considered to be very timely. This first edition has been chosen to be exclusively European. In the future, as showed also by the composition of the editorial board, EJR will broaden its scope to include the work of our American and Japanese colleagues. In our opinion, it is not only of interest to the research community, but also to the practising radiologists and industry to keep the discussion of computer assisted radiology in the context of a wide international forum. H.U. Lemke, M. Osteaux, Guest Editors
EURRAD
I I (1993) l-2
00406
Editorial
PACS and Digital Imaging - New Directions Definition of the domain The generic domain of computer assisted radiology can be defined as the application of computer and communication technology in radiological and related medical activities. Main emphasis is on the generation, processing, management, and communication of medical images. For the radiologist this tool supports the qualitative impression, the quantitative measurement and the communication of medical images. With these characteristics, CAR represents a natural progression in the medical usage of tools and techniques from the early history of medicine to the present day. It can also be seen as a logical progression from the primary digital modalities: CT, echography, SPECT, PET, MRI and from the evolution towards a digital radiology. The subject area can be divided into three interdependent topics: digital image generation (digital modalities, digital radiology), image analysis and display, and communication and archiving (PACS), the last with its logical extension: radiology teleservices. The necessary integration with the information systems of the hospital, the use of diverse application of expert systems and the standardization problematics, produce an overlapping boundary with the field of Medical Informatics ‘strict0 sensu’.
Images
The computer in relation to radiological activities Figure 1 shows an activity flow chart of the ‘diagnostic pathway’. This places the radiological activities in perspective to the patient and related medical activities. Production of medical images, interpretation, consulting and reporting, delivering images for (computeraided) therapeutic procedures represent the heart of the radiological activity. Computer assistance may be realized at various positions in the pathway of the diagnostic process. This is usually achieved with specialized medical workstations which form part of, or have access to, a computer and/or communication network. Overall support for clerical and administrative activities can be provided within the radiological department by a radiological information system (RIS). Communication to the outside of the radiological department is realized 0720-048X/93/$06.00
0
1993 Elsevier Scientific
Publishers
Ireland
Therapy
Plan
Fig. 1. Activities
in the diagnostic
pathway
via an interface from RIS to a hospital information system (HIS). Image processing can be applied to image formation, reconstruction, and manipulation. This and image handling and communication is supported by medical workstations integrated into a picture archiving and communication system (PACS). A PACS may be part of
Ltd. All rights reserved
2
a local area network (LAN) or wide area network (WAN). The latter would then allow teleradiological services. Integrated into appropriate communication networks, medical workstations provide the platform from which radiology may assume an increasingly important position for servicing other medical disciplines, such as orthopaedics, cardiology, neurology, radiotherapy, as well as general and specialized surgery. In principle, improved radiological services may also be offered to referring physicians in clinical settings outside the traditional hospital environment. Computer assistance can also be given to the planning and carrying out of therapy, thereby improving patient care. Increasingly, computer assistance will become the prerequisite for a less or minimal invasive medicine. Some of the traditional activities already assisted by computers include imaging, image interpretation, consulting and reporting, and therapy planning.
New evolutions At the beginning of the 80’s, CT was in a state of advanced clinical implementation and perspectives on MRI were appearing: this meant a real revolution for the medical world. In parallel with the evident success of the digital methods, expectations were also very high with regard to the development of PACS, expert systems, and digital radiology. Limitations of the technology available during the last decade, the lack of integration with the health care information systems, and the absence of recognized and implemented standards, led to failures and a feeling of disillusion. The ‘first generation’ PACS installations have been difficult to use in clinical practice and the concept of the ‘no film option’ failed to materialize. In addition, the systems were not cost-effective. The real medical impact of expert systems and automatic image analysis remained marginal. However, the simultaneous occurrance of several sig-
nificant developments has rapidly changed the situation in recent years. Information technology made substantial progress in terms of archiving media, workstations, networks, database, etc. Amongst other benefits there has been a dramatic increase in performance. The price of the hardware dropped significantly, which places the cost-effectiveness of the systems in a new light. Efforts of integration with concepts from Medical Informatics have been made, namely in the EEC by the R&D framework Advance Informatics in Medicine - AIM. The solution of the standardization issue is underway. A dedicated European standardization body has been formed. It addresses the problem by searching for solutions on several issues simultaneously: a short-term option in collaboration with the ACRNEMA and the DICOM activity; a more fundamental long-term approach in collaboration with OSI. The manufacturers are increasingly using ‘de facto’ industrial standards; this simplifies greatly the problem of the integration of equipment into multi-vendor environments. With this new era in progress, the publication of this first special issue of PACS - Digital Imaging of the European Journal of Radiology is considered to be very timely. This first edition has been chosen to be exclusively European. In the future, as showed also by the composition of the editorial board, EJR will broaden its scope to include the work of our American and Japanese colleagues. In our opinion, it is not only of interest to the research community, but also to the practising radiologists and industry to keep the discussion of computer assisted radiology in the context of a wide international forum. H.U. Lemke, M. Osteaux, Guest Editors