PACS for the Developing World

Digital imaging is now firmly ensconced in the developed world. Its widespread adoption has enabled instant access to images, remote viewing, remote consultation, and the end of lost or misplaced film. Unfortunately, the current paradigm of Picture Archiving and Communication System (PACS), with advanced technology inseparable from high complexity, high purchase costs, and high maintenance costs, is not suited for the low-income developing world. Like the simple, easy to repair, 1950’s American cars still running on the streets of Havana, the developing world requires a PACS (DW-PACS) that can perform basic functions and survive in a limited-resource environment. The purpose of this article is to more fully describe this concept and to present a blueprint for PACS tailored to the needs and resources of the developing world. This framework should assist both users looking for a vendor-supplied or open-source solutions and developers seeking to address the needs of this emerging market

Application of Asynchronous Transfer Mode (Atm) technology to Picture Archiving and Communication Systems (Pacs): A survey

Broadband Integrated Services Digital Network (R-ISDN) provides a range of narrowband and broad-band services for voice, video, and multimedia. Asynchronous Transfer Mode (ATM) has been selected by the standards bodies as the transfer mode for implementing B-ISDN; The ability to digitize images has lead to the prospect of reducing the physical space requirements, material costs, and manual labor of traditional film handling tasks in hospitals. The system which handles the acquisition, storage, and transmission of medical images is called a Picture Archiving and Communication System (PACS). The transmission system will directly impact the speed of image transfer. Today the most common transmission means used by acquisition and display station products is Ethernet. However, when considering network media, it is important to consider what the long term needs will be. Although ATM is a new standard, it is showing signs of becoming the next logical step to meet the needs of high speed networks; This thesis is a survey on ATM, and PACS. All the concepts involved in developing a PACS are presented in an orderly manner. It presents the recent developments in ATM, its applicability to PACS and the issues to be resolved for realising an ATM-based complete PACS. This work will be useful in providing the latest information, for any future research on ATM-based networks, and PACS

Data infrastructures and digital labour : the case of teleradiology

In this thesis, I investigate the effects of digitalisation in teleradiology, the practice of outsourcing radiology diagnosis, through an analysis of the role of infrastructures that enable the transfer, storage, and processing of digital medical data. Consisting of standards, code, protocols and hardware, these infrastructures contribute to the making of complex supply chains that intervene into existing labour processes and produce interdependent relations among radiologists, patients, data engineers, and auxiliary workers. My analysis focuses on three key infrastructures that facilitate teleradiology: Picture Archiving and Communication Systems (PACS), the Digital Imaging and Communication in Medicine (DICOM) standard, and the Health Level 7 (HL7) standard. PACS is a system of four interconnected components: imaging hardware, a secure network, viewing stations for reading images, and data storage facilities. All of these components use DICOM, which specifies data formats and network protocols for the transfer of data within PACS. HL7 is a standard that defines data structures for the purposes of transfer between medical information systems. My research draws on fieldwork in teleradiology companies in Sydney, Australia, and Bangalore, India, which specialise in international outsourcing of medical imaging diagnostics and provide services for hospitals in Europe, USA, and Singapore, among others. I argue that PACS, DICOM, and HL7 establish a technopolitical context that erodes boundaries between social institutions of labour management and material infrastructures of data control. This intertwining of bureaucratic and infrastructural modes of regulation gives rise to a variety of strategies deployed by companies for maximising productivity, as well as counter-strategies of workers in leveraging mobility and qualifications to their advantage

A Secure Grid Medical Data Manager Interfaced to the gLite Middleware

International audienceThe medical community is producing and manipulating a tremendous volume of digital data for which computerized archiving, processing and analysis is needed. Grid infrastructures are promising for dealing with challenges arising in computerized medicine but the manipulation of medical data on such infrastructures faces both the problem of interconnecting medical information systems to Grid middlewares and of preserving patients' privacy in a wide and distributed multi-user system. These constraints are often limiting the use of Grids for manipulating sensitive medical data. This paper describes our design of a medical data management system taking advantage of the advanced gLite data management services, developed in the context of the EGEE project, to fulfill the stringent needs of the medical community. It ensures medical data protection through strict data access control, anonymization and encryption. The multi-level access control provides the flexibility needed for imple! menting complex medical use-cases. Data anonymization prevents the exposure of most sensitive data to unauthorized users, and data encryption guarantees data protection even when it is stored at remote sites. Moreover, the developed prototype provides a Grid storage resource manager (SRM) interface to standard medical DICOM servers thereby enabling transparent access to medical data without interfering with medical practice

New technology in radiological diagnosis: An investigation of diagnostic image quality in digital displays of radiographs

Digital radiology is undergoing rapid evolution. Its objectives can be summarized as the creation within the modern radiology department - and indeed within the entire hospital - of a harmonious, integrated, electronic network capable of handling all diagnostic radiological images, obviating the need for conventional film-based radiology. One of the limiting factors in the introduction and exploitation of digital technology is the issue of image display quality: if electronic display systems are to be widely used for primary radiological diagnosis, it is essential that the diagnostic quality of the displayed images should not be compromised. From the perspective of the practising radiologist, this study examines the performance of the first two commercially available digital radiological display systems to be purchased and installed in a British hospital. This work incorporates an extensive observer performance investigation of image quality from existing 1024- and 1280-line display systems, and suggests that displayed images digitized at a pixel size of 210?m show a significant reduction in diagnostic performance when compared with original film. Such systems appear to be unsuitable for primary radiological diagnosis of subtle lesions. Some of the physical properties of such systems, some relevant methodological issues, and the relationship between image quality and other factors influencing the development acceptance and implementation of digital technology, have also been investigated; the results are presented. This is a controversial subject, and conflicting views have been expressed in the British literature concerning the issue of whether or not the technology is now ready for total system implementation; the view of this author is that careful testing of display systems, and of every other component of digital networks, should precede their entry into clinical use

Information Systems and Healthcare XXX: Charting a Strategic Path for Health Information Technology

Despite both the slow diffusion of information technology (IT) throughout health organizations and the high cost of implementation, organizations must focus on key strategic applications that deliver high quality care at lower costs. Identifying the strategic applications that support important healthcare processes is challenging. In this article we propose a framework for developing this high level perspective of strategic health information technology (HIT) applications. We then classify into the components of the framework numerous HIT applications and initiatives reported in the media. Based on an existing framework, we identify two critical dimensions that capture two important characteristics of a healthcare delivery process, namely, the degree of mediation and the degree of collaboration. A healthcare process with a high degree of mediation involves a large series of activities in a sequential manner. Processes with a low degree of mediation “understand” that most participants in care delivery contribute directly, often simultaneously, to the final result. The underlying principle for this dimension is the level of functionality of the application. The degree of collaboration refers to the extent to which information is exchanged among the participants in a process. Depending on the degree of exchange, one can identify processes as having higher or lower degrees of collaboration. The underlying principle for this dimension is the degree of interoperability among the applications. Strategic HIT applications lie on a continuum path from a low-high degree of mediation to a low-high degree of collaboration. Our examples show that healthcare delivery organizations evolve their HIT from ad-hoc isolated systems to interoperable, integrated digital health systems. The strategic framework provides a high level perspective of HIT while assisting in the evaluation of potential HIT candidates for implementation