Digital Imaging Communications In Medicine Research Articles

Reversible data hiding scheme using deep learning and visual cryptography for medical image communication

Due to a growth in information sharing and the use of multiple digital technologies, human lifestyles have been delivered into the virtual world. This digital world has seen the use of images in special fields increase dramatically, especially in healthcare. Healthcare services can be delivered remotely through telemedicine, a well-known method of providing quality healthcare for people worldwide. There is the risk of illegal exploitation of medical data when telemedicine applications involve exposing data over open networks. In particular, medical experts should exercise more caution when sharing a patient’s private information. In the proposed model, reversible data concealment is combined with visual cryptography to provide a secure method of exchanging medical images. A cover image is divided into nonoverlapping secret shares using Hadamard matrix. Secret digital imaging communication in medicine (DICOM) image is encoded by a deep learning model and embedded into secret shares for secure medical image sharing. Finally, the DICOM image is fully reversibly extracted with the cover image. In this case, a visual cryptographic design is used to secure the embedded secret shares. Furthermore, the metrics, such as mean squared error, peak-signal–to-noise ratio, and normalized correlations, are evaluated in the suggested scheme and are compared with various research outcomes to determine the performance of the nominated model.

P-67892863-249 - Upper airway 3D assessment in CBCT-based orthognathic surgery

<h3>Objectives</h3> To stratify the maxilla-mandibular movements in the orthognathic surgery treatments of class III patients, assess the volumetric and bidimensional repercussions of these movements in the Upper Airway (UA). <h3>Methods</h3> The CBCT data of 44 patients class III, who had undergone orthognathic surgery were collected. After acquisition, the images were recorded and stored in Digital Imaging Communication in Medicine (DICOM) format. Preoperative files (T0) and the 1 to 4 months post-operative files (T1) were obtained. The 3D craniometric evaluation was carried out in the software. In the sinus/airway tool, the total airway pharyngeal nasopharynx, oropharynx, and hypopharynx were delineated, as following the boundaries. In each region, the volume, Minimum Axial Area (MAA) and the area of the respective delineated regions were calculated. The patients were divided into Group I (maxilla 0 to 4.9mm forward) and Group II (the maxilla 5.0 to 10.0mm forward). <h3>Results</h3> In Group I the correlation between the counterclockwise and the hipopharynx's MAA was moderate (0.439), and for every 1mm of maxillary advancement obtained a gain of 214.74mm³ in nasopharynx and 653.90mm³ in the oropharynx. <h3>Conclusion</h3> Maxillary advancement promotes an increase in the upper airway, compensating for a possible constriction that the mandibular setback may promote in the hypopharynx. Small maxillary advancements associated with different mandibular movements promoted greater airway gain.

Multi-Range Fusion for X-ray Image Enhancement

Digital medical images are stored in the Digital Imaging Communications in Medicine (DICOM) standard where a 12-bit integer represents each pixel. However, commercial display devices are only designed to work with an 8-bit standard such as JPEG or PNG. Traditional methods compress the high dynamic range (HDR) to a low dynamic range (LDR) to visualize a DICOM image. The compression process is a linear transformation and the LDR is represented in an 8-bits format. Due to a quantization error the contrast is limited. Therefore, in this article, we propose a method to enhance X-ray images in term of contrast. Firstly, we estimate an information range that captures valuable information of an x-ray image. The range is represented by an upper and lower threshold. Within these thresholds, LDR images will be extracted to capture information from a specific sub-range. These images are then fused to create an enhanced LDR image that has a higher contrast but retains information from each sub-range. Experimental results demonstrate that the proposed method helps achieve a better contrast.

The Role of Standards in Accelerating the Uptake of Artificial Intelligence in Dermatology

Background The use of artificial intelligence (AI) for dermatology is showing great promise in research contexts. However, the clinical use of AI in dermatology is still limited. The uptake of medical imaging standards for dermatology imaging is also limited. Standards adoption is more widespread in other imaging specialties (eg, radiology) as is the clinical use of AI. Digital Image Communication in Medicine (DICOM) is the standard for medical imaging. DICOM standardizes image formats and associated metadata. Further, DICOM facilitates interoperability between actors in the digital health ecosystem. Objective This study aimed to identify how medical imaging standards, in particular DICOM, can support the clinical use of AI. Methods Design Science Research Methodology was used to determine the role of DICOM in AI-based medical imaging workflows. Scenarios were identified and synthesized using expert consensus. Results The key benefits of using DICOM to improve the clinical use of AI were the potential to encode artefacts derived from the AI process as DICOM objects and store them alongside the original images. Such objects include downsized or down-sampled images, segmentation objects, or visual explainability maps (eg, class activation maps). DICOM can facilitate interoperability between actors in the medical imaging workflow pipeline and permits the inclusion of AI evidence creators in this pipeline. Owing to standardized image formats and metadata, DICOM can be beneficial for the curation of multi-institutional data sets. The key challenge of using DICOM is limited uptake in some specialties including dermatology. Conclusions DICOM offers potential to accelerate the clinical adoption of AI in dermatology by addressing several technological issues. More widespread uptake of DICOM in dermatology imaging is required to achieve this potential. Conflicts of Interest None declared.

The Importance of Body Part Labeling to Enable Enterprise Imaging: A HIMSS-SIIM Enterprise Imaging Community Collaborative White Paper

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.

Segmentasi Citra Medis untuk Deteksi Objek FAM pada Payudara Menggunakan Metode Sobel

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.

Dosimetric comparison of conventional and field-in-field techniques in early stage breast cancer radiotherapy

Introduction: Breast conserving surgery followed by adjuvant radiotherapy (RT) of the whole breast is accepted as the treatment of choice in early stage breast cancer. Due to breast irregularities, it is difficult to access homogenous dose distribution with conventional techniques. Currently, it is possible to use varied breast irradiation techniques, such as field- in-field (FIF), to apply a more homogenous distribution of doses within target volumes, and organs at risk (OAR) sparing which lead to achieve better treatment outcome. This study aimed to compare conventional and FIF techniques dosimetrically Materials and Methods: Twenty patients with early-stage breast cancer underwent computed tomography (CT) with a 16 Slice CT simulator; datasets were transferred to the treatment planning system (TPS) via a digital imaging communications in medicine (DICOM). Two different treatment plans were created for each patient by the same medical physicist: a wedge base (conventional) plan and a FIF plan. Then, dosimetric and monitor unit (MU) results were compared. Results: Dosimetric indices in the planning target volume (PTV) were more satisfying with the FIF technique than with three dimensional-conformal RT (3D-CRT). FIF reduced the maximum doses of PTV and MU. In addition, the FIF technique reduced doses to the heart (in left-side irradiation cases) and ipsilateral lung by 7% and 8%, respectively. FIF also significantly reduced V40 (volume receiving 40 Gy) of heart in left side breast irradiation. V20 of lung (volume receiving 20 Gy), and also doses to the contralateral lung did not differ significantly. Conclusion: FIF can produce more homogenous doses within the PTV, and reduce doses to the OAR. Moreover, by using the FIF technique in breast irradiation, MUs required for therapy are significantly decreased compared with that required by 3D-CRT.

An Enumeration of Radiotherapy Terminologies, Planning and its Optimization

The process of radiotherapy involves irradiating radiation in the tumours to destroy cancer cells shielding healthy tissues and vital organs from the effect of radiation. Therefore the objective of this paper is an effort for understanding the Intensity Modulation Radiation Therapy (IMRT) machine along with its treatment planning. The radiotherapy terminologies that enumerates details about Dose Volume Histogram (DVH), bixels, voxels and the standard for sharing medical images compatible with various devices known as Digital Imaging Communications in Medicine (DICOM).Finally the optimization techniques involved in cancer treatment using Intensity Modulation Radiation Therapy (IMRT) is formulated. The linprog tool in MATLAB is used to solve the formulated Linear Programming Problem (LLP) to illustrate the application of operation research in radiotherapy.

Segmentasi Citra Mri Menggunakan Deteksi Tepi Untuk Identifikasi Kanker Payudara

One type of cancer that is capable identified using MRI technology is breast cancer. Breast cancer is still the leading cause of death world. therefore early detection of this disease is needed. In identifying breast cancer, a doctor or radiologist analyzing the results of magnetic resonance image that is stored in the format of the Digital Imaging Communication In Medicine (DICOM). It takes skill and experience sufficient for diagnosis is appropriate, andaccurate, so it is necessary to create a digital image processing applications by utilizing the process of object segmentation and edge detection to assist the physician or radiologist in identifying breast cancer. MRI image segmentation using edge detection to identification of breast cancer using a method stages gryascale change the image format, then the binary image thresholding and edge detection process using the latest Robert operator. Of the20 tested the input image to produce images with the appearance of the boundary line of each region or object that is visible and there are no edges are cut off, with the average computation time less than one minute.

Application of Unibody Single-Branch Endografts in Stanford Type B Dissections with Primary Entry Tear Adjacent to the Left Subclavian Artery: A Computed Tomography–Based Planning Study

A custom-made unibody single-branch endograft (USBE) could provide great gains in the landing zone, while maintaining a left subclavian artery (LSA) perfusion in some patients with Stanford type B dissections (TBADs). We performed a computed tomography (CT)-based planning study to determine the proportion of TBAD patients who could benefit from this custom-made USBE and ascertained the possibility of an off-the-shelf USBE in an emergency setting. We carried out a retrospective study of TBAD patients with optimal CT scans at our center from 2007 to 2013. Patients' CT scans were analyzed using 3-dimensional reconstruction software. After generating a centerline of flow, measurements (including numerous morphologic characteristics of anatomy) were evaluated. A selected subset of patients suitable for USBE was determined. Finally, the most frequently used configurations of endografts were figured out by subgroup analysis. A total of 314 patients with optimal digital imaging communications in medicine (DICOM) data were included in our study. The main primary entry tears (MPETs) were located at 22.8 ± 17.3 and 36.3 ± 18.6 mm distal to the LSA and the left common carotid artery, respectively. Overall, 169 (54.2%) patients with MPET distal to LSA (＞20 mm) could be treated by tubular stent grafts. Of the 143 patients who had intimal tears adjacent to the LSA (≤20 mm), there were 111 (35.4%) patients who could benefit from treatment using USBE based on our selection criteria. Subgroup analysis estimated the number of graft configurations needed to treat a proportion of patients: 1 design would treat 6.7% of the population, 5 designs would treat 23.1%, 10 designs would treat 37.6%, and 20 configurations would treat 54.8% . In all, 35.4% patients with TBAD could potentially benefit from USBE. The use of off-the-shelf endografts might be possible in cases of emergency, given the evidence of recurrent configurations.

Stress Distribution with Different Implant Dimensions in Implant-Supported Partial Overdentures

Objective: This study was conducted to evaluate the effect of changing implant dimensions on the stress distribution in the supporting structures in implant-supported partial over-dentures. Methods: The finished partial over-denture was checked in the patient's mouth. Construction of the physical model took place as the CT image acquisition was performed in a DICOM (Digital Imaging Communications in Medicine) format using Asteion 4 multi-slice CT scanner. After entering the data and initiating the segmentation procedure, a mask was constructed containing all the elements in the study. Then, construction of the Finite Element Model was carried out. A 100 Newton masticatory load was applied to the prosthesis in vertical and oblique directions. The percentage increase or decrease in the resultant stresses induced in the different model elements by utilizing different lengths and diameters of the dental implant was evaluated under unilateral vertical and oblique loading. Results: With the increase in the implant diameter, a statistically significant decrease (P≤0.05) in all forms of stresses was observed in the compact bone, cancellous bone and implant, as compared to the increase in the implant length. The decrease was in the Von Mises stresses, tensile, compressive and shear stresses under vertical or oblique loading. Conclusions: From the results of this study, it could be achieved that the increase in the implant diameter significantly reduced the stresses transmitted to the supporting bone compared to increasing the implant length and that the wider the implant diameter, the better the dissipation of the masticatory forces.

Research on Applied Technology in Storing and Transmitting Medical Image Based on DICOM

DICOM is the international standard for the digital imaging communication in medicine. This paper introduces the development of DICOM and analyzes the communication process based on DICOM protocol. Besides, the communication between store SCP and store SCU was designed and implemented.

Comparison of the Accuracy of Voxel Based Registration and Surface Based Registration for 3D Assessment of Surgical Change following Orthognathic Surgery

PurposeSuperimposition of two dimensional preoperative and postoperative facial images, including radiographs and photographs, are used to evaluate the surgical changes after orthognathic surgery. Recently, three dimensional (3D) imaging has been introduced allowing more accurate analysis of surgical changes. Surface based registration and voxel based registration are commonly used methods for 3D superimposition. The aim of this study was to evaluate and compare the accuracy of the two methods.Materials and methodsPre-operative and 6 months post-operative cone beam CT scan (CBCT) images of 31 patients were randomly selected from the orthognathic patient database at the Dental Hospital and School, University of Glasgow, UK. Voxel based registration was performed on the DICOM images (Digital Imaging Communication in Medicine) using Maxilim software (Medicim-Medical Image Computing, Belgium). Surface based registration was performed on the soft and hard tissue 3D models using VRMesh (VirtualGrid, Bellevue City, WA). The accuracy of the superimposition was evaluated by measuring the mean value of the absolute distance between the two 3D image surfaces. The results were statistically analysed using a paired Student t-test, ANOVA with post-hoc Duncan test, a one sample t-test and Pearson correlation coefficient test.ResultsThe results showed no significant statistical difference between the two superimposition methods (p<0.05). However surface based registration showed a high variability in the mean distances between the corresponding surfaces compared to voxel based registration, especially for soft tissue. Within each method there was a significant difference between superimposition of the soft and hard tissue models.ConclusionsThere were no significant statistical differences between the two registration methods and it was unlikely to have any clinical significance. Voxel based registration was associated with less variability. Registering on the soft tissue in isolation from the hard tissue may not be a true reflection of the surgical change.

Design of a Digital Imaging and Machining System Programme for Human Bone Implants

Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) is now used in the medical field as well. This paper outlines the design process and the final software package for a human bone implants. A Computer Tomography (CT) scan was used to scan the knee bone and the scanned pictures were sent to Digital Imaging Communication in Medicine (DICOM) viewer. The DICOM images with Digital Communication in Medicine ( DCM) format were converted to Joint Photographic Expert Group (JPEG) format JPEG format images were converted to to PDF format. Subsequently a PDF to Drawing (DWG) converter was used to convert the PDF file to DWG file format compatible with Mastercam. The final stage of the system involved generation of the NC (Numerical Control) code for the knee bone drawing and machining of the bone implant by the CNC machine. Oracle database express system has been used to design platform. Keywords—Computer Aided Design (CAD), Digital Imaging Communication in Medicine (DICOM), Computer Tomography (CT), Computer Numerical Control (CNC) machines, Human bone Implant, Imaging,.

Comparison of femoral tunnel widening between outside-in and trans-tibial double-bundle ACL reconstruction

The objectives of this study were to compare (1) the degree of widening by comparing the diameter at the most widened area and the site of widening by measuring the distance from the tunnel entrance to the most widened area in two femoral tunnels (anteromedial and posterolateral), and (2) the morphologic change at the tunnel entrance between outside-in and trans-tibial double-bundle anterior cruciate ligament (ACL) reconstruction. A retrospective study that included 17 trans-tibial and 19 outside-in double-bundle ACL reconstructed patients was conducted for evaluation of serial computed tomography (CT) scan (immediate post-operation and post-operative 1 year). Digital image communication in medicine (DICOM) data was extracted from the PiViewSTAR and imported into OsiriX, which was installed on a Macbook Pro laptop computer. Diameter of the most widened area and distance from the entrance to this point were measured from each of two perpendicular (sagittal and coronal) planes that were accurately realigned parallel to the tunnel direction. Change in the morphology of the tunnel entrance between immediate post-operation and 1-year post-operation was evaluated. Widening was observed in both planes of both tunnels in the two techniques. However, no statistical significances in the diameter of most widened area and distance from the tunnel entrance to the most widened point were observed between the both techniques (n.s.). Distances from the centre point to each four sections showed an increase in all four sections of all both tunnels in both techniques. However, no statistical significance was observed between the two techniques (n.s.). Widening was observed in all tunnels using both techniques and degrees, and sites of the widening did not differ between groups. Morphologic change at the tunnel entrance was not limited to the specific direction and occurred in all directions without significant difference between groups. Retrospective comparative study, Level III.

DICOM relay over the cloud

Healthcare institutions worldwide have adopted picture archiving and communication system (PACS) for enterprise access to images, relying on Digital Imaging Communication in Medicine (DICOM) standards for data exchange. However, communication over a wider domain of independent medical institutions is not well standardized. A DICOM-compliant bridge was developed for extending and sharing DICOM services across healthcare institutions without requiring complex network setups or dedicated communication channels. A set of DICOM routers interconnected through a public cloud infrastructure was implemented to support medical image exchange among institutions. Despite the advantages of cloud computing, new challenges were encountered regarding data privacy, particularly when medical data are transmitted over different domains. To address this issue, a solution was introduced by creating a ciphered data channel between the entities sharing DICOM services. Two main DICOM services were implemented in the bridge: Storage and Query/Retrieve. The performance measures demonstrated it is quite simple to exchange information and processes between several institutions. The solution can be integrated with any currently installed PACS-DICOM infrastructure. This method works transparently with well-known cloud service providers. Cloud computing was introduced to augment enterprise PACS by providing standard medical imaging services across different institutions, offering communication privacy and enabling creation of wider PACS scenarios with suitable technical solutions.

SU-E-T-570: Improvement to the Histogram Analysis in Radiation Therapy (HART): An Open Source Software System for the Multi-Dimensional Dose- Volume Histogram Analysis in Digital Image Communication in Medicine - Radiation Therapy (DICOM-RT) Treatment Plans.

Histogram Analysis in Radiation Therapy (HART) is an efficient and accurate dose-volume histogram (DVH) computational tool in radiotherapy research. Several applications of the program have been presented previously (J Appl Clin Med Phys 11(1): 3013, 2010; Med Phys 38(6), p.3678, 2011) for the Radiation Therapy Oncology Group (RTOG) users. The program has been further developed to incorporate various types of DVH analysis features to support the research using DICOM-RT plans. The main objective of this work was to present the improvement and compatibility of the program for the DICOM-RT plans. MATLAB based codes were primarily designed to read and write a simpler HART format from the standard DICOM-RT data objects exported from the Xio treatment planning system (CMS Inc., St. Louis, MO). This format employed an optimal polynomial fitting technique to interpolate the co-ordinates of the contours in the regions-of-interest. The format was efficient for the (a) precise extraction of the cumulative DVH (cDVH) and spatial DVH (sDVH; x-,y-, and z-DVHs respectively) data- statistics, (b) universal-plan indices evaluation, (c) biological modeling based outcome analyses (BMOA), (d) radiobiological dose-response modeling, and (e) physical parameterization modules. The fundamental DVH statistics were validated using the DVH statistics extracted from the Computational Environment for Radiotherapy Research program. HART offers various types of DVH computational functionalities, several plan evaluation and radiobiological outcome analysis modules in a user- friendly software package for the RTOG and DICOM-RT planners. The cDVH and BMOA modules were found to be the most applicable features for the global researchers. HART is a novel and universal multi-dimensional DVH analysis tool for the radiation therapy research. We further expect to develop HART for the space-time DVH analysis and proton therapy applications. The software is available online (http://www2.uic.edu/∼apyaku1) for the radiotherapy research. This work was partially supported by NIH-NIDCD grant.

The Study Based on SOA in Digital Hospital Systems Integration

In the medical information process, many systems need to be integrated, such as, within hospitals, between hospitals, hospitals and health departments and between hospitals and related outside sectors. But most of hospital information applications is narrow, lacks industry application standards, lacks hospital information technology planning, poor integration leads to hospital information island and can not effectively share information. In order to share information within the hospital ,such as, between HIS(Hospital Information System) and PACS(Picture Archiving and Communication Systems), between hospitals, such as, between HIS and HIS, between PACS and PACS, to realize automate business processes, according to the current technology, should use SOA(Service Oriented Architecture), Because SOA uses service as its core to encapsulate business processes and applications systems, the service with a higher level of abstraction, can achieve a higher level of reuse, and solve the relevance of between IT systems and business processes. This paper designs regional health information integrated services platform with SOA, realizes PACS service platform with web services technology ,at last, uses IE(Internet Explorer) view a patient’s DICOM(Digital Imaging Communications in Medicine) images. The results show that using SOA to integrate digital hospital systems is effective.

A hybrid robot system for CT-guided surgery

SUMMARYThe common serial robot or parallel robot is difficult to implement for CT-guided surgery in a limited workspace. A novel hybrid robot with 9 degrees of freedom is presented in this paper, whose detailed structure is analysed based on screw theory and displacement manifold (DM). The dexterity of the hybrid robot is provided in terms of Riemann manifold (RM). Besides, DICOM (digital imaging communications in medicine) image processing, spatial registration and 3D dynamic reconstruction in the operation planning subsystem are analysed, in which some innovative methods are introduced. Meanwhile, the architecture of the CT-guided hybrid robot system and its subsystems are proposed. Simulative clinical experiment showed that the locating precision of the hybrid robot reaches 1.08 mm, which can meet the requirement of CT-guided surgery.

Considerations for Setting Up an Order Entry System for Nuclear Medicine Tests

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.