An electronic database for outcome studies that includes digital radiographs

The ISIS Center at Georgetown University received a grant from the U.S. Army to act as systems integrator for a project to design, develop, and implement a commercial off-the-shelf teleradiology system to support the U.S. troops in Bosnia-Herzegovina. The goal of the project was to minimize troop movement while providing primary diagnosis to military personnel. This paper focuses on Digital Imaging Communications in Medicine (DICOM) 3.0 related issues that arose from this type of teleradiology implementation. The objective is to show that using the DICOM standard provides a good starting point for systems integration but is not a plug-and-play operation. Systems were purchased that were based on the DICOM 3.0 standard. The modalities implemented in this effort were computed radiography (CR), computed tomography (CT), film digitization (FD), and ultrasonography (US). Dry laser printing and multiple-display workstations were critical components of this network. The modalities and output devices were integrated using the DICOM 3.0 standard. All image acquisition from the modalities is directly to a workstation. The workstation distributes the images to other local and remote workstations, to the dry laser printer, and to other vendors' workstations using the DICOM 3.0 standard. All systems were integrated and tested prior to deployment or purchase. Local and wide area networking were also tested prior to implementation of the deployable radiology network. The results of the integration of the multivendor network were positive. Eventually, all vendors' systems did communicate. Software configuration and operational changes were made to many systems in order to facilitate this communication. Often, software fixes or patches were provided by a vendor to modify their DICOM 3.0 implementation to allow better communications with another vendor's system. All systems were commercially available, and any modifications or changes provided became part of the vendor's commercially available package. Seven DICOM interfaces were implemented for this project, and none was achieved without modification of configuration files, changes or patches in vendor software, or operational changes. Some of the problems encountered included missing or ignored required data elements, padding of data values, unique study identifiers (UID), and the use of application entity titles. The difficulties with multivendor connectivity lie in the understanding and interpretation of standards such as DICOM 3.0. The success of this network proves that these problems can be overcome and a clinically successful network implemented utilizing multiple vendors' systems.

Digital Imaging Communications in Medicine (DICOM)-compliant equipment is pervasive in radiology, but other domains such as ophthalmology lag behind in this regard. This is not due to a lack of need. Ophthalmologists create, interpret, store and retrieve medical images on a daily basis. These images are central to any clinician’s decision making process and are a keystone in diagnosis and treatment. The ability to accurately and effectively incorporate the image and metadata into a workflow depends largely on adherence to the DICOM standard. To determine areas of possible improvement in DICOM adherence, the workflow of various modalities throughout an ophthalmology department were examined. Potential improvements were found. These options are discussed here, and possible solutions are provided.

As the extent of the networked image environments grows, it becomes increasing likely that multiple image formats will be present within a network. This paper addresses the general evolution of this environment through a specific examination of three image formats likely to be present: Digital Image Communication in Medicine (DICOM) Image Processing and Interchange (IPI)-Image Interchange Format (IIF) and the National Image Transmission Format (NITF). For each format, its approach to image format development and data encapsulation are both presented and compared to the other formats, and distinguishing capabilities and limitations are identified. A possible integration scheme for IIF and DICOM is presented and the relationship of NITF to IPI-IIF and DICOM is identified. Since a mixed image format environment could include acquired imagery, reference imagery material, or even document imagery, generalized interoperability will be a requirement of future systems. Results are generalized to provide an indication as to how this problem may be addressed.

This paper represents the discussions at the DICOM workshop for the digital imaging communications in medicine (DICOM) standard, which was orchestrated as a 'point-counterpoint' discussion. Real life issues with DICOM compatibility were posed by a user advocate to an expert panel consisting of people who participate in the DICOM standardization effort. The issue statement is described, followed by the answer by the panel.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user’s ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption—when a user views a patient’s images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability—as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy—as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.

As radiology departments move closer to enterprise-wide electronic imaging systems, the importance of timely and accurate patient and exam information cannot be overstated. In addition, automated entry of patient and exam information into image acquisition modalities (e.g., computed radiography, CR) enhances technologist productivity, which is critical in high volume practices (e.g. a major trauma center). A difficulty arises, however, since the authoritative source of patient and exam information may be a Radiology Information System (RIS) or a Hospital Information System (HIS) packages its data differently than most imaging modalities. To bridge this gap, we have implemented an interface engine to affect the translation of Health Level Seven (HL7) messages from the RIS (or HIS) into Digital Imaging Communications In Medicine (DICOM) messages for seven CR systems (Fuji Medical Systems, Burbank, CA). Recent measurements suggest that manual technologist transcription of information into the CR unit takes 45.4 plus or minus 3.0 seconds. Since the introduction of the HL7/DICOM broker, the time has dropped to 5.4 plus or minus 0.1 seconds to produce the same information.

PACS and Web-based image distribution and display

Integrating the Healthcare Enterprise-Japan (IHE-J) was established in Japan in 2001 and has been working to standardize health information and make it accessible on the basis of the fundamental Integrating Healthcare Enterprise (IHE) specifications. However, because specialized operations are used in nuclear medicine tests, online sharing of patient information and test order information from the order entry system as shown by the scheduled workflow (SWF) is difficult, making information inconsistent throughout the facility and uniform management of patient information impossible. Therefore, we examined the basic design (subsystem design) for order entry systems, which are considered an important aspect of information management for nuclear medicine tests and needs to be consistent with the system used throughout the rest of the facility. There are many items that are required by the subsystem when setting up an order entry system for nuclear medicine tests. Among these items, those that are the most important in the order entry system are constructed using exclusion settings, because of differences in the conditions for using radiopharmaceuticals and contrast agents and appointment frame settings for differences in the imaging method and test items. To establish uniform management of patient information for nuclear medicine tests throughout the facility, it is necessary to develop an order entry system with exclusion settings and appointment frames as standard features. Thereby, integration of health information with the Radiology Information System (RIS) or Picture Archiving Communication System (PACS) based on Digital Imaging Communications in Medicine (DICOM) standards and real-time health care assistance can be attained, achieving the IHE agenda of improving health care service and efficiently sharing information.

An Enumeration of Radiotherapy Terminologies, Planning and its Optimization

BACKGROUND: Total hip arthroplasty (THA) is one of the most performed and most researched procedures worldwide, and there is an ever-growing demand for THA in an already resource-constrained system in South Africa. Early dislocation after THA remains a serious and costly problem; however, few THA outcome studies have been performed locally. This study therefore aimed to calculate the incidence of dislocation after THA and to identify risk factors for dislocation after THA in a South African academic hospital METHODS: In this retrospective cohort review, files and radiographs of 543 patients were reviewed for dislocation during the first year after primary THA. The reason for the THA, the surgical data, the implant data, and whether and when dislocation occurred were recorded for each patient. Fisher's exact tests and independent t-tests were done to analyse the association between variables and a patient's odds of experiencing a dislocation after THA RESULTS: Twenty (3.7%) out of 543 THAs dislocated during the first year, 17 of these within the first three months. The surgical approach used was not shown to be a significant risk factor (p = 0.650) for dislocation, although the Hardinge approach had been used for all 20 cases of dislocation. Similar dislocation rates (p = 0.967) were found for THAs done for displaced neck of femur (NOF) fractures (3.6%) and for elective THAs (3.7%). Trauma THAs made up more than half (55%) of our study population. Femoral head sizes < 32 mm (p = 0.390 for neck of femur THA and p = 0.451 for elective THA) and a single mobility design (p = 0.494) both produced a higher dislocation rate, although this was not statistically significant. Surgeon experience did not prove to be significant for our study population (p = 0.570 CONCLUSION: The dislocation rate after THA at our institution is lower than rates reported in the literature for NOF THA and similar to rates reported for elective THA. This was found despite the dislocation rate for the Hardinge approach being nearly eight times higher than expected. Minimal surgeon experience, implant coupling and smaller femoral head size did not prove to be significant risk factors for dislocation after THA Level of evidence: Level 4

Multicenter Randomized Controlled Trial Comparing Early Versus Late Aquatic Therapy After Total Hip or Knee Arthroplasty

Diagnostic tools supported by digital medical images have increasingly become an essential aid to medical decisions. However, despite its growing importance, Picture Archiving and Communication Systems (PACS) are typically oriented to support a single healthcare institution, and the sharing of medical data across institutions is still a difficult process. This paper describes a proposal to publish and control Digital Imaging Communications in Medicine (DICOM) services in a wide domain composed of several healthcare institutions. The system creates virtual bridges between intranets enabling the exchange, search and store of the medical data within the wide domain. The service provider publishes the DICOM services following a token-based strategy. The token advertisements are public and known by all system users. However, access to the DICOM service is controlled through a role association between an access key and the service. Furthermore, in medical diagnoses, time is a crucial factor. Therefore, our system is a turnkey solution, capable of exchanging medical data across firewalls and Network Address Translation (NAT), avoiding bureaucratic issues with local network security. Security is also an important concern - in any transmission across different domains, data is encrypted by Transport Layer Security (TLS).

Fibroa Adenoma Mammae (FAM) or called a benign tumor is the most common tumor found in the breast, often this disease is considered as breast cancer by some laymen, but this disease is different from cancer because Fibroadenoma (FAM) can grow in all parts of the breast, In identifying FAM, doctors or radiologists usually have to analyze carefully the images of Magnetic Resonance stored in the format of Digital Imaging Communication In Medicine (DICOM). This process is certainly quite time consuming. Thus the author feels the need to create a digital image processing application to help doctors or radiologists identify FAM in the breast by utilizing the segmentation process in medical images of USG results using the Sobel method. This method performs the original image segmentation process by detecting the edges of the image then the segmentation results are converted into binary images so the system can determine the FAM area. Medical image segmentation using the Sobel method is good for determining the edges of FAM objects because the edges can be clearly seen but for some image images with less resolution as previously tested, edge detection will be difficult to determine the edges of smooth objects and only form lines rough edges.

Background: Bone fractures represent a substantial proportion of cases presenting to emergency and orthopedic departments worldwide, including in resource-limited settings like Nishtar medical university/Hospital, Multan. Timely and precise diagnosis is vital for the initiation of appropriate treatment, minimizing complications, and improving long-term functional outcomes. Conventional radiography (X-ray) has historically been the cornerstone of fracture detection. However, recent advancements in digital imaging technology have introduced digital radiography as a potentially superior alternative, offering improved image resolution, faster processing times, ease of storage and retrieval, and reduced radiation exposure. Despite these advantages, its diagnostic performance in comparison to conventional methods remains a subject of investigation, particularly in developing healthcare settings. Objective: This study aimed to compare the diagnostic accuracy of digital and conventional radiography in the detection of bone fractures among patients presenting to the emergency and orthopedic departments at Nishtar medical university/Hospital, Multan. Methodology: A descriptive cross-sectional study was carried out over an eight-month period from 1st October 2022 to 31st March 2023. A total of 200 patients of various age groups and both genders, presenting with clinical suspicion of bone fractures, were enrolled through consecutive sampling. Each patient underwent both conventional and digital radiographic imaging of the affected area. The radiographs were independently interpreted by two qualified radiologists who were blinded to each other’s findings and to the clinical details. The findings were then validated against a reference standard, which included either computed tomography (CT) findings or intraoperative surgical confirmation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic concordance rates were calculated and compared for both modalities. Results: The study revealed that digital radiography outperformed conventional radiography in terms of both sensitivity and specificity. Digital radiography demonstrated a sensitivity of 94.5% and a specificity of 91.2%, whereas conventional radiography showed a sensitivity of 83.0% and a specificity of 85.0%. The difference in diagnostic performance was particularly evident in the detection of fractures involving smaller or more complex anatomical regions, such as the wrist, hand, ankle, and foot. Inter-observer agreement was also higher for digital images, suggesting better clarity and interpretability. Moreover, the turnaround time for digital imaging was shorter, facilitating faster decision-making in emergency settings. Conclusion: The findings of this study indicate that digital radiography provides significantly higher diagnostic accuracy compared to conventional X-ray, particularly in identifying subtle or small bone fractures. Given its superior image quality, reduced radiation dose, and operational efficiency, digital radiography should be considered the preferred imaging modality in emergency and orthopedic practice, especially in facilities where resources permit. The integration of digital systems may lead to improved diagnostic confidence, faster clinical decision-making, and ultimately, better patient outcomes. Keywords: Digital radiography, conventional X-ray, bone fractures, diagnostic accuracy, emergency imaging, orthopedic trauma, sensitivity, specificity

Enterprise-wide PACS: Beyond Radiology, an Architecture to Manage All Medical Images 1