Integration of implant planning workflows into the PACS infrastructure

Abstract

ABSTRACTThe integration of imaging devices, diagnostic workstations, and image servers into Picture Archiving and Com-munication Systems (PACS) has had an enormous eect on the eciency of radiology work”ows. The stan-dardization of the information exchange between the devices with the DICOM standard has been an essentialprecondition for that development.For surgical procedures, no such infrastructure exists. With the increasingly important role computerized plan-ning and assistance systems play in the surgical domain, an infrastructure that uni“es the communication betweendevices becomes necessary. In recent publications, the need for a modularized system design has been established.A reference architecture for a Therapy Imaging and Model Management System (TIMMS) has been proposed.It was accepted by the DICOM Working Group 6 as the reference architecture for DICOM developments forsurgery.In this paper we propose the inclusion of implant planning systems into the PACS infrastructure. We proposea generic information model for the patient speci“c selection and positioning of implants from a repository ac-cording to patient image data. The information models are based on clinical work”ows from ENT, cardiac, andorthopedic surgery as well as technical requirements derived from dierent use cases and systems.We show an exemplary implementation of the model for application in ENT surgery: the selection and position-ing of an ossicular implant in the middle ear. An implant repository is stored in the PACS. It makes use of anexperimental implementation of the Surface Mesh Module that is currently being developed as extension to theDICOM standard.Keywords: Surgical Planning, Implant, Image Guided Therapy, PACS, DICOM1. PURPOSEThe integration of imaging devices, diagnostic workstations, and image servers into Picture Archiving and Com-munication Systems (PACS) has had an enormous eect on the eciency of radiology work”ows. Most PACSare based on international standards such as DICOM