PACS and Imaging Informatics

Abstract

The picture archiving and communication system (PACS) originated as an image management system for improving the efficiency of radiologic practices. It has evolved into a hospital-integrated system that stores information media in many forms, including voice, text, medical records, waveform images, and video recordings. The integration of these various types of information requires the technology of multimedia, including hardware platforms, information systems and databases, communication protocols, display technology, and system interfacing and integration. The purpose of this book is to discuss the conceptual and technologic advances in PACS development for all of these previously mentioned technologies. The book also emphasizes the growing field of PACS-based imaging informatics, where existing PACS resources are used for largescale horizontal and longitudinal clinical service, research, and education applications. The book is intended for those who are involved in a health care environment that manages the everyday practical realities of PACS planning, operation, and maintenance. The book will also serve as excellent curriculum material for the training of PACS information technology personnel because the author provides comprehensive concepts that tie medical imaging, medical physics, information technology, and clinical workflow with enterprise PACS (multiple, hospital-wide PACS). The author, H. K. Huang, has been involved in PACS development since the 1980s and is a leading scientist in the field. The book is divided into five parts and 23 chapters. Part 1, titled “Medical Imaging Principles,” summarizes the history of PACS, the fundamental concepts of digital medical imaging, and the different types of modalities integrated into PACS. Part 2, titled “PACS Fundamentals,” describes in detail the PACS subsystems and industry standards (Digital Imaging and Communications in Medicine and Health Level 7) that are used to integrate PACS with the hospital information system and radiology information system. Part 3, titled “PACS Operation,” describes the practical problems encountered by PACS administrators and users and discusses different techniques to solve these problems, with many examples from installed PACS sites around the world. Because the author developed PACS at the University of California, Los Angeles, in 1991 and the University of California, San Francisco, in 1995, he is able to draw from his expertise on the subject. The author also uses his experience from developing many state-of-theart prototypes (eg, fault tolerant storage system) funded by research grants. Part 4, titled “PACS-based Imaging Informatics,” presents image-processing techniques that can be used to mine the huge image and clinical data resources stored in the PACS archive. The analysis of lung nodules by using temporal computed tomographic and contentbased image indexing are some of the examples of advanced processing applications applied to PACS data mining. Part 5, titled “Enterprise PACS,” describes different models for implementing an enterprise PACS in terms of the architectural design of the system and financial and business models. This new book builds on two previous volumes on PACS that were written by the author. The text, image collections, and schematic diagrams in this current work achieve the author’s goal of providing up-to-date material concerning the technologic advances in PACS and imaging informatics. The text serves as a guide for those who are planning an enterprise PACS and provides teaching material for training PACS developers in industry and health care. The author has used portions of this book as lecture material for graduate courses at leading universities in the United States and abroad. The author also uses many examples to emphasize that the integration of heterogeneous health care information systems is becoming more complex and that, as more radiologists and clinicians expect higher standards in the reliability of the data, a systemic understanding of Digital Imaging and Communications in Medicine, Health Level 7, and Integrating the Healthcare Enterprise becomes ever more important to optimize enterprise workflow. The strength of the book lies in the vast experience that the author, who has implemented PACS at numerous institutions in the United States and abroad, has transmitted into this new book. Huang has conducted first-hand analysis of the various systems from PACS manufacturers that are used in clinical operation at large medical institutions and has performed up-to-date research in data mining of the huge image and data resources stored in the PACS repository.