Picture Archiving And Communication System Workstation Research Articles

COVID-19 and Virtual Medical Student Education.

COVID-19 and Virtual Medical Student Education.

A low-resource digital infrastructure to streamline viewing and interpretation of radiographic images: A case study of Uganda's hospital-wide environment.

Picture Archiving and Communication Systems (PACS) are said to improve patient quality of care through timely access to radiological images by clinicians. However, they are costly to be considered for hospital wide environment in low income countries. Ordinary core i3 computer systems (PCs) can provide an affordable and faster alternative solution for PACS workstations. This comparative study assessed the diagnostic accuracy, image quality of ordinary PC systems versus PACS workstations and patient turnaround time (PTAT). Forty images were randomly obtained and viewed by four raters from both PACS and PC. The findings showed modest agreement among raters (kappa 0.644 for PACS and 0.5164 PC) with acceptable diagnostic accuracy for PC (AUC = 0.7990), 97.5% reproduction of images on PC and significant reduction in PTAT after a switch to PC (4.8 min), p < 0.001, suggesting that PC display can improve quality of health care services through timely access to radiographic images.

Radiologist Mouse Movements at a PACS Workstation.

HomeRadiologyVol. 299, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyRadiologist Mouse Movements at a PACS WorkstationJan Vosshenrich , Hanns-Christian BreitJan Vosshenrich , Hanns-Christian BreitAuthor AffiliationsFrom the Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.Address correspondence to J.V. (e-mail: [email protected]).Jan Vosshenrich Hanns-Christian BreitPublished Online:Feb 16 2021https://doi.org/10.1148/radiol.2021203469MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPointBecause of the rising volumes and complexity of diagnostic imaging studies and the demand for advanced postprocessing, radiologists’ workloads continue to increase substantially. To reveal the extent of computer mouse movements, we tracked the activity of a radiology resident during an 8-hour shift. The figure shows the mouse movements (line coloration indicates movement orientation: vertical [pink], horizontal [green], and oblique [orange and purple]) and mouse stops (colored circles) at a typical radiology information system (RIS) and picture archiving and communication system (PACS) workstation set-up (one RIS monitor [Figure, part a] and two PACS monitors [Figure, part b]), tracked with software (version 1.0.1; IOGraph). The mouse activity added up to a distance of 2.2 km (1.37 miles) and 10 778 keystrokes (23 keystrokes per minute).(a) Mouse movements and mouse stops on radiology information system screen tracked over course of 8-hour shift. (b) Mouse movements and mouse stops on picture archiving and communication system screens tracked over course of 8-hour shift.Download as PowerPointOpen in Image Viewer (a) Mouse movements and mouse stops on radiology information system screen tracked over course of 8-hour shift. (b) Mouse movements and mouse stops on picture archiving and communication system screens tracked over course of 8-hour shift.Download as PowerPointOpen in Image Viewer The complex and extensive mouse patterns suggest the need for advanced user interface devices with greater functionality. Artificial intelligence solutions may also help automate time-consuming repetitive tasks (eg, creating hanging protocols or synchronizing image stacks). Optimization and streamlining these processes would be important for radiologists to keep pace with their increasing workloads.Disclosures of Conflicts of Interest: J.V. disclosed no relevant relationships. H.C.B. disclosed no relevant relationships.Article HistoryReceived: Aug 18 2020Revision requested: Aug 20 2020Revision received: Aug 21 2020Accepted: Aug 26 2020Published online: Feb 16 2021Published in print: Apr 2021 FiguresReferencesRelatedDetailsCited By2021 Top Images in Radiology: Radiology In Training Editors’ ChoicesFrancis Deng, Eric Kim, Anna V. Trofimova, Susanna I. Lee, 30 November 2021 | Radiology, Vol. 302, No. 3European Journal of Radiology, Vol. 155Recommended Articles 2021 Top Images in Radiology: Radiology In Training Editors’ ChoicesRadiology2021Volume: 302Issue: 3pp. 507-510Reducing Functional MR Imaging Acquisition Times by Optimizing WorkflowRadioGraphics2017Volume: 37Issue: 1pp. 316-322Translabial US and Dynamic MR Imaging of the Pelvic Floor: Normal Anatomy and DysfunctionRadioGraphics2018Volume: 38Issue: 1pp. 287-308Extraprostatic Tumor Extension: Comparison of Preoperative Multiparametric MRI Criteria and Histopathologic Correlation after Radical ProstatectomyRadiology2020Volume: 296Issue: 1pp. 87-95Increasing Median Time between Interruptions in a Busy Reading RoomRadioGraphics2021Volume: 41Issue: 2pp. E47-E56See More RSNA Education Exhibits Robotic Process Automation: Go Beyond Artificial Intelligence in the Radiology DepartmentDigital Posters2018Learning from Gamers: Multi-Button Mouse, Keypad and AHK Scripts as Tools to Simplify Complex Repetitive Tasks to Improve and Personalize WorkflowDigital Posters2018The On-Call Radiology Residents Guide to Managing the Reading Room: Distractions, Downtimes, and DiscussionsDigital Posters2019 RSNA Case Collection Primary gastric torsionRSNA Case Collection2021Hypertrophic Olivary DegenerationRSNA Case Collection2021Bucket handle tearRSNA Case Collection2020 Tweetorial » Vol. 299, No. 1 Metrics Altmetric Score PDF download

Ankle fracture management using smartphone multimedia messaging service (MMS) imaging — How reliable and to what point?

BackgroundThe use of smartphones and multimedia messaging service (MMS) continues to increase in day to day orthopaedic clinical practice. However, there is limited evidence to support the safe utilisation of MMS. ObjectivesThe aim of this study was to correlate the performance of MMS imaging to picture archiving and communication systems (PACS) imaging within the setting of diagnosis and management of ankle fractures. MethodsThe ankle fracture radiograph series of 82 consecutive patients were evaluated by five orthopaedic consultant specialists. A questionnaire regarding diagnosis and preferred management was completed separately for each patient using smartphone and PACS images. Statistical analysis was performed using Intraclass Correlation Coefficient (ICC). ResultsAnkle fracture diagnosis showed strong to excellent correlation both inter- and intraobserver MMS vs PACS when using the Weber (0.815, 0.988), Anatomical (0.858, 0.988), and AO classification systems (0.855, 0.985). MMS was less reliable than PACS in determining many management options. ConclusionThe reliability of ankle fracture classification using MMS image viewing was not significantly different to interpretation on PACS workstations. Smartphone use in ankle fracture classification is supported by this study. Smartphone use was less accurate than PACS in devising management plans and future use should be limited to making only initial plans that must be corroberated with PACS and intraoperative findings prior to definitive fixation.

Accuracy and reliability of tablet computer as an imaging console for detection of radiological signs of acute appendicitis using PACS workstation as reference standard.

To ascertain the accuracy and reliability of tablet as an imaging console for detection of radiological signs of acute appendicitis [on focused appendiceal computed tomography (FACT)] using Picture Archiving and Communication System (PACS) workstation as reference standard. From January, 2014 to June, 2015, 225 patients underwent FACT at our institution. These scans were blindly re-interpreted by an independent consultant radiologist, first on PACS workstation and, two weeks later, on tablet. Scans were interpreted for the presence of radiological signs of acute appendicitis. Accuracy of tablet was calculated using PACS as reference standard. Kappa (κ) statistics were calculated as a measure of reliability. Of 225 patients, 99 had radiological evidence of acute appendicitis on PACS workstation. Tablet was 100% accurate in detecting radiological signs of acute appendicitis. Appendicoliths, free fluid, lymphadenopathy, phlegmon/abscess, and perforation were identified on PACS in 90, 43, 39, 10, and 12 scans, respectively. There was excellent agreement between tablet and PACS for detection of appendicolith (к=0.924), phlegmon/abscess (к=0.904), free fluid (к=0.863), lymphadenopathy (к=0.879), and perforation (к=0.904). Tablet computer, as an imaging console, was highly reliable and was as accurate as PACS workstation for the radiological diagnosis of acute appendicitis.

The diagnostic accuracy of smartphones in the radiographic analysis of ankle fractures

Background: Orthopaedic surgeons rely on radiographs to assist in the evaluation and treatment of patients. The technological advances of smartphones have allowed data to be transferred quickly and viewed from remote locations. The diagnostic accuracy of viewing radiographs on smartphones remains unproven. As such, this study aimed to evaluate the ability of smartphones to allow surgeons to correctly diagnose and interpret radiographs of ankle fractures on one of the most popular smartphones, an Apple iPhone 4S (Apple Inc, Cupertino, CA, USA). Methods: Using the smartphone, individual pictures were taken of anteroposterior, mortise, and lateral radiographs of 20 ankle fractures. These images were then evaluated through 10 questions that included acceptable quality, presence and displacement of fibula, medial malleolus, and posterior malleolar fractures, ankle subluxation, syndesmotic disruption, Lauge-Hansen classification, and the need for open reduction and internal fixation. Results were compared to the same radiographs viewed on a picture archiving and communication system (PACS) workstation. Results: Ten orthopaedic surgery residents and five orthopaedic surgery attendings evaluated the radiographs and answered a total of 6000 questions. When comparing the responses between those images viewed on the smartphone versus those viewed on the PACS workstation, 826 differences were found. After analysis of both interobserver and intraobserver reliability, a significant difference was found between viewing modalities, with the smartphone found to be not as reliable as the PACS workstation. However, when looking at the single question of whether or not the fracture would require operative fixation, no significant difference was found between the use of a smartphone or PACS workstation. Conclusions: The smartphone images demonstrated a reliable prediction of the proper treatment for the 20 ankle fractures despite noted differences between the two viewing modalities.

A IHE-Like Approach Method for Quantitative Analysis of PACS Usage.

Today, many hospitals have a running enterprise picture archiving and communication system (PACS) and their administrators should have the tools to measure the system activity and, in particular, how much it is used. The information would be valuable for decision-makers to address asset management and the development of policies for its correct utilization and eventually start training initiatives to get the best in resource utilization and operators' satisfaction. On the economic side, a quantitative method to measure the usage of the workstations would be desirable to better redistribute existing resources and plan the purchase of new ones. The paper exploits in an unconventional way the potential of the IHE Audit Trail and Node Authentication (ATNA) profile: it uses the data generated in order to safeguard the security of patient data and to retrieve information about the workload of each PACS workstation. The method uses the traces recorded, according to the profile, for each access to image data and to calculate how much each station is used. The results, constituted by measures of the frequency of PACS station usage suitably classified and presented according to a convenient format for decision-makers, are encouraging. In the time of the spending review, the careful management of available resources is the top priority for a healthcare organization. Thanks to our work, a common medium such as the ATNA profile appears a very useful resource for purposes other than those for which it was born. This avoids additional investments in management tools and allows optimization of resources at no cost.

A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone

We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.

Simple and Efficient Method for Region of Interest Value Extraction from Picture Archiving and Communication System Viewer with Optical Character Recognition Software and Macro Program

The objectives are: 1) to introduce a simple and efficient method for extracting region of interest (ROI) values from a Picture Archiving and Communication System (PACS) viewer using optical character recognition (OCR) software and a macro program, and 2) to evaluate the accuracy of this method with a PACS workstation. This module was designed to extract the ROI values on the images of the PACS, and created as a development tool by using open-source OCR software and an open-source macro program. The principal processes are as follows: (1) capture a region of the ROI values as a graphic file for OCR, (2) recognize the text from the captured image by OCR software, (3) perform error-correction, (4) extract the values including area, average, standard deviation, max, and min values from the text, (5) reformat the values into temporary strings with tabs, and (6) paste the temporary strings into the spreadsheet. This principal process was repeated for the number of ROIs. The accuracy of this module was evaluated on 1040 recognitions from 280 randomly selected ROIs of the magnetic resonance images. The input times of ROIs were compared between conventional manual method and this extraction module-assisted input method. The module for extracting ROI values operated successfully using the OCR and macro programs. The values of the area, average, standard deviation, maximum, and minimum could be recognized and error-corrected with AutoHotkey-coded module. The average inputtimes using the conventional method and the proposed module-assisted method were 34.97 seconds and 7.87 seconds, respectively. A simple and efficient method for ROI value extraction was developed with open-source OCR and a macro program. Accurate inputs of various numbers from ROIs can be extracted with this module. The proposed module could be applied to the next generation of PACS or existing PACS that have not yet been upgraded.

Merits of usability testing for PACS selection

ObjectivesTo compare the usability of different Picture Archiving and Communication System (PACS) workstations, determine whether a usability test has added value with respect to the traditional way of comparing PACSs based on functional requirements, and to evaluate the appropriateness of a task-based methodology for a PACS usability test. MethodsA task-based usability test of four PACS workstations was performed. Radiologists’ subjective responses to the PACSs and their performance on the tasks were measured. To mimic the traditional PACS selection process, two functional requirements were defined which the PACSs met in varying degrees. The focus of the usability test was on the aspects of the PACS related to these requirements. The usability results were compared to the PACSs’ ability to meet the functional requirements. ResultsOne PACS outperformed the other PACSs both in terms of subjective preference and task performance, indicating its superior usability. There were differences in usability between PACSs with identical functionality. Also, a PACS with theoretically advantageous functionality for a given task did not necessarily have better usability for this task than a PACS without this functionality. There was a discrepancy between participants’ subjective preferences and their task performance, which indicates that it is vital to include performance measures in the usability assessment so that it accurately reflects the efficiency of interaction. ConclusionsThe differences in usability between PACSs with identical functionality indicate that functional requirements alone are insufficient to determine a PACS's overall quality. A usability test should therefore be used in addition to a functional requirement list in a PACS selection process to ensure that a hospital buys the PACS with the highest quality. A task-based usability evaluation methodology, which yields both subjective preference data and objective performance data of radiologists interacting with the PACS, is very suitable for such a usability test.

Visual Interpretation with Three-Dimensional Annotations (VITA): three-dimensional image interpretation tool for radiological reporting.

This paper introduces a software framework called Visual Interpretation with Three-Dimensional Annotations (VITA) that is able to automatically generate three-dimensional (3D) visual summaries based on radiological annotations made during routine exam reporting. VITA summaries are in the form of rotating 3D volumes where radiological annotations are highlighted to place important clinical observations into a 3D context. The rendered volume is produced as a Digital Imaging and Communications in Medicine (DICOM) object and is automatically added to the study for archival in Picture Archiving and Communication System (PACS). In addition, a video summary (e.g., MPEG4) can be generated for sharing with patients and for situations where DICOM viewers are not readily available to referring physicians. The current version of VITA is compatible with ClearCanvas; however, VITA can work with any PACS workstation that has a structured annotation implementation (e.g., Extendible Markup Language, Health Level 7, Annotation and Image Markup) and is able to seamlessly integrate into the existing reporting workflow. In a survey with referring physicians, the vast majority strongly agreed that 3D visual summaries improve the communication of the radiologists' reports and aid communication with patients.

Can Paper Replace Laser Film to Communicate the Results of Wrist Radiographs in Trauma Cases? A Reproducibility Study of the Reading of Wrist Trauma Case Radiographs on a PACS Workstation, Laser Film, and Paper

The main goal of this study was to determine the reproducibility of the reading of wrist trauma case radiographs using three different media: laser film, a picture archiving and communication systems (PACS) workstation, and paper with an optimized layout. The study was conducted retrospectively in 200 consecutive patients consulting at the emergency department for wrist trauma and who underwent wrist X-ray investigation using a computed radiography system. There were 82 men and 118 women. The mean age was 48.3years (16-95years). Our institutional review board does not require patient approval or informed consent for retrospective review of case records. The readings were made by two independent readers who analyzed the 200 patient radiographs consecutively in one session for each type of media: paper, laser film, and on a PACS dual-screen workstation. The inter-reader agreements were substantial or almost perfect, with kappa values of 0.83 (0.76-0.90) for the PACS, 0.83 (0.76-0.90) for film, and 0.80 (0.72-0.87) for paper. The inter-technique agreement was almost perfect in all cases. There is a high interobserver agreement between PACS, laser film, and paper readings for wrist trauma cases. With a layout of one radiograph on each sheet, paper could replace laser films to communicate the results of wrist radiographs in trauma cases for outpatients.

Numbering of vertebrae on MRI using a PACS cross-referencing tool

For the detection and documentation of numeric variations on spine magnetic resonance imaging (MRI), different techniques have previously been introduced. However, these methods require additional special imaging algorithms, software, or devices. We intend to introduce a vertebral numbering method using the existing picture archiving and communication system (PACS) and MRI system. To assess the accuracy of a method for numbering presacral vertebrae based on the cross-referencing of two sagittal MRI series. This study was a retrospective review of 224 consecutive patients who underwent both lumbar MRI with cervicothoracic scan and whole spine radiographic examinations. A radiologist and a neurosurgeon independently counted the number of presacral vertebrae in a cranial-to-caudal approach with cross-referencing of cervicothoracic and lumbar MRI sagittal series on the PACS workstation. Radiographic numbering from the cervical through the thoracic to the lumbar vertebrae, as a reference standard, was completed independently by the two reviewers. An analysis of the inter-observer and intermodality agreements of radiography and MRI was done. In all cases except one, concordant numbering existed between the two modalities of MRI cross-referencing and radiographs combination. Both observers agreed completely, with no inter-observer discordance. The number of vertebrae could be identified consistently by counting caudally from C2 with cross-referencing cervicothoracic and lumbosacral sagittal MRI scans on the PACS workstation.

Wish list for future features of breast MRI computer aided evaluation

During the 2011 Radiological Society of North America meeting, this author approached one PACS (picture archiving and communication system) workstation manufacturer and asked if analysis of multiphasic examination was offered. It is perhaps shocking that this question was met with a puzzlement and immediate consultation between booth personnel, until finally; someone replied that this option was not yet available. Keep in mind that this is almost 20 years since Kaiser and colleagues first published on the importance of multiphasic breast MR examination [1]. The breast radiologist presented with interpretation of a breast MRI faces the daunting task of examining 1000–2000 images. Although current PACS workstations can easily display large imaging sets (e.g. during MR angiography), the current PACS workstation is not equipped to perform some basic tasks that are easily handled on a dedicated breast MRI workstation. Unfortunately, this requires that the radiologist switch to a dedicated workstation for examination of that breast MRI, then switch back to PACS afterwards to resume examination of the other imaging modalities associated with that patient. Further complicating this is the fact that digital mammography requires use of a high resolution workstation, not usually used for CT and MRI interpretation. The motivation for this presentation is to spur discussion between radiologists, physicists and equipment manufacturers in optimizing the workstation so as to improve radiologist efficiency and improve the quality of breast MRI interpretation.

Tracking PACS Usage with Open Source Tools

A typical choice faced by Picture Archiving and Communication System (PACS) administrators is deciding how many PACS workstations are needed and where they should be sited. Oftentimes, the social consequences of having too few are severe enough to encourage oversupply and underutilization. This is costly, at best in terms of hardware and electricity, and at worst (depending on the PACS licensing and support model) in capital costs and maintenance fees. The PACS administrator needs tools to asses accurately the use to which her fleet is being subjected, and thus make informed choices before buying more workstations. Lacking a vended solution for this challenge, we developed our own.

Tools for Multi-Media Presentations and Publications

Tools for Multi-Media Presentations and Publications

Making the PACS workstation a browser of image processing software: a feasibility study using inter-process communication techniques

To enhance the functional expandability of a picture archiving and communication systems (PACS) workstation and to facilitate the integration of third-part image-processing modules, we propose a browser-server style method. In the proposed solution, the PACS workstation shows the front-end user interface defined in an XML file while the image processing software is running in the background as a server. Inter-process communication (IPC) techniques allow an efficient exchange of image data, parameters, and user input between the PACS workstation and stand-alone image-processing software. Using a predefined communication protocol, the PACS workstation developer or image processing software developer does not need detailed information about the other system, but will still be able to achieve seamless integration between the two systems and the IPC procedure is totally transparent to the final user. A browser-server style solution was built between OsiriX (PACS workstation software) and MeVisLab (Image-Processing Software). Ten example image-processing modules were easily added to OsiriX by converting existing MeVisLab image processing networks. Image data transfer using shared memory added <10ms of processing time while the other IPC methods cost 1-5 s in our experiments. The browser-server style communication based on IPC techniques is an appealing method that allows PACS workstation developers and image processing software developers to cooperate while focusing on different interests.

Data Management Solution for Large-Volume Computed Tomography in an Existing Picture Archiving and Communication System (PACS)

Multidetector row computed tomography (MDCT) creates massive amounts of data, which can overload a picture archiving and communication system (PACS). To solve this problem, we designed a new data storage and image interpretation system in an existing PACS. Two MDCT image datasets, a thick- and a thin-section dataset, and a single-detector CT thick-section dataset were reconstructed. The thin-section dataset was archived in existing PACS disk space reserved for temporary storage, and the system overwrote the source data to preserve available disk space. The thick-section datasets were archived permanently. Multiplanar reformation (MPR) images were reconstructed from the stored thin-section datasets on the PACS workstation. In regular interpretations by eight radiologists during the same week, the volume of images and the times taken for interpretation of thick-section images with (246 CT examinations) or without (170 CT examinations) thin-section images were recorded, and the diagnostic usefulness of the thin-section images was evaluated. Thin-section datasets and MPR images were used in 79% and 18% of cases, respectively. The radiologists' assessments of this system were useful, though the volume of images and times taken to archive, retrieve, and interpret thick-section images together with thin-section images were significantly greater than the times taken without thin-section images. The limitations were compensated for by the usefulness of thin-section images. This data storage and image interpretation system improves the storage and availability of the thin-section datasets of MDCT and can prevent overloading problems in an existing PACS for the moment.

Accuracy and precision of linear measurements in cone beam computed tomography Accuitomo® tomograms obtained with different reconstruction techniques

To assess the accuracy and precision of linear measurements, the influence of different object positions in cone beam CT (CBCT) images and the effect of different systems for reformatting and viewing the tomograms on measurement values. An object consisting of Plexiglas plates with metal spheres was radiographically examined in three positions using the CBCT unit Accuitomo. Tomograms were reformatted using the i-Dixel software and Sectra picture archiving and communication system (PACS) multiplanar reformatting (MPR). Two observers measured 20 linear distances in axial, frontal and sagittal planes. Physical measurements of actual distances by means of a digital caliper served as the gold standard. For measurements performed on the Accuitomo and Sectra PACS workstations, the mean differences between repeated measurements were below 0.13 mm (standard deviation (SD) 0.13 mm) and 0.21 mm (SD 0.18 mm), respectively. Mean differences between the two observers were below 0.11 mm (SD 0.07 mm) and 0.15 mm (SD 0.09 mm). The mean difference between the gold standard and the basic position when using the Accuitomo workstation, was -0.08 mm (SD 0.21 mm) and for a deviated/rotated position -0.08 mm (SD 0.23 mm) and -0.09 mm (SD 0.20 mm). None was statistically significant (P > 0.05). For measurement performed on MPR tomograms using the Sectra PACS workstation, mean differences were -0.09 mm (SD 0.17 mm) for basic position, and -0.08 mm (SD 0.19 mm) and -0.13 mm (SD 0.15 mm) for deviated and rotated positions, respectively. The mean difference between gold standard and basic/rotated positions was statistically significant, with P = 0.032 and P = 0.002. Our study confirms previous findings indicating that measurements in 3DX Accuitomo FPD (flat panel detector) tomograms show a high level of agreement with actual distances. Our findings suggest the possibility of minor distortion in tomograms reformatted by means of Sectra PACS MPR.

Integration of computer-aided diagnosis/detection (CAD) results in a PACS environment using CAD–PACS toolkit and DICOM SR

Picture Archiving and Communication System (PACS) is a mature technology in health care delivery for daily clinical imaging service and data management. Computer-aided detection and diagnosis (CAD) utilizes computer methods to obtain quantitative measurements from medical images and clinical information to assist clinicians to assess a patient's clinical state more objectively. CAD needs image input and related information from PACS to improve its accuracy; and PACS benefits from CAD results online and available at the PACS workstation as a second reader to assist physicians in the decision making process. Currently, these two technologies remain as two separate independent systems with only minimal system integration. This paper describes a universal method to integrate CAD results with PACS in its daily clinical environment. The method is based on Health Level 7 (HL7) and Digital imaging and communications in medicine (DICOM) standards, and Integrating the Healthcare Enterprise (IHE) workflow profiles. In addition, the integration method is Health Insurance Portability and Accountability Act (HIPAA) compliant. The paper presents (1) the clinical value and advantages of integrating CAD results in a PACS environment, (2) DICOM Structured Reporting formats and some important IHE workflow profiles utilized in the system integration, (3) the methodology using the CAD-PACS integration toolkit, and (4) clinical examples with step-by-step workflows of this integration.