Picture Archiving And Communication Research Articles

The burden of road traffic accident-related trauma to orthopaedic healthcare and resource utilisation at a South African tertiary hospital: a cost analysis study

BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3

Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

Progressive quality coding for compression of medical images in telemedicine

Telemedicine network is used to transmit medical images from hospital to remote medical centres for diagnosis. In this connection, progressive quality coding algorithm has been developed to save storage space and better utilisation of bandwidth and to improve speed of data transmission. Generally, lossless compression should be used for region of interest (ROI) and lossy compression should be used for region of background (ROB) with a lower quality. In existing system, ROI is selected manually, but ROI is selected automatically in the proposed method, pre-processing is done to improve the visual quality of the image. Segmentation is carried out accurately and efficiently using canny edge operator and morphological processing method. The classification is done in medical image using particle swarm optimisation. ROB part of an image is compressed using set partition in hierarchical tree (SPIHT) algorithm in near lossless manner. Finally, the ROI is superimposed in compressed non-ROI (ROB) image. This method improves the compression ratio and increases the PSNR value compared to existing method. The proposed method is used for implementations of teleradiology and digital picture archiving and communications (PACS) systems practically.

English

Generally lossless compression should be used for ROI (Region of Interest) and lossy compression should be used for ROB (Region of Background) with a lower quality. In existing system, Region of Interest (ROI) is selected manually, but ROI is selected automatically in the proposed method, pre-processing is done to improve the visual quality of the image. Segmentation is carried out accurately and efficiently using region growing followed by morphological processing method. The features are extracted and classification is done in medical image using Fuzzy logic. ROB part of an image is compressed using SPIHT (Set Partition In Hierarchical Tree) algorithm in near lossless manner. Finally the ROI is superimposed in compressed Non ROI (ROB) image. This method improves the compression ratio and increase the PSNR value compared to existing method. The proposed method is used for implementations of teleradiology and digital picture archiving and communications (PACS) systems practically. Key words: Image compression, segmentation, wavelet decomposition, fuzzy logic , decompression, compression ratio.

Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound.

The aim of this study was to evaluate the accuracy of multislice computed tomography (MSCT) with double-contrast technique and transrectal ultrasound (TRUS) in staging of rectal carcinoma compared with histopathological confirmation. In a prospective study of 92 patients with rectal carcinoma, preoperative MSCT with negative rectal contrast (methylcellulose) and intravenous contrast was performed. Reconstructions in 3 planes were analyzed in a cine mode in picture archiving and communication (PAC) system. Analysis of rectal wall infiltration was performed preoperatively according to a modified tumor, nodes, metastases (TNM)-classification system (< or =T2/T3/T4, N0/N+, UICC/UICC I > I). MSCT imaging findings were compared with the results of TRUS and histopathology in all patients. With interactive multiplanar image viewing, the results of MSCT of depth of rectal wall invasion (T-staging) were as follows: sensitivity, specificity, positive and negative predictive values, and accuracy rate were 85%, 87%, 88%, 84%, and 86% (54/63 patients) compared with 59%, 63%, 72%, 48%, and 60% (38/63 patients), respectively, for TRUS staging in the same patients. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of MSCT for perirectal nodes evaluation was 75%, 85%, 75%, 85%, and 81% (51/63 patients) compared with 55%, 71%, 50%, 74%, and 65% (41/63 patients), respectively, for TRUS in detecting metastatic lymph nodes. Preoperative double-contrast MSCT accurately indicates the exact depth of tumor infiltration and improves lymph node staging. The new technical innovations of MSCT provide superior information for preoperative staging of rectal cancer and may compete with TRUS as the standard preoperative diagnostic method.

Application service providers: an alternative approach to PACS implementation.

Several impediments have delayed the adoption of filmless imaging by the majority of radiology practitioners. These factors include concerns for technology obsolescence, limited available capital, and lack of existing information technology (IT) infrastructure and experienced personnel. Application service providers (ASPs) have begun to emerge as an alternative approach to the more traditional acquisition of picture archiving and communication (PAC) systems. This approach offers the prospective PACS customer the opportunity to outsource hardware, software, and IT services to a vendor on a fee-per-use basis. The ideal candidates for such an approach would be small to medium-sized hospitals with limited existing IT infrastructure. Using the ASP model, prospective PACS customers can purchase services unique to their needs and upgrade or expand these as needed. As ASP vendors increase their customer base, there is the potential for customers to achieve unique economies of scale not available through traditional financing means. This report discusses the economic and operational issues associated with ASPs, as well as potential limitations and future implications of this phenomenon.

The rural and global medical informatics consortium and network for radiology services

Telemedicine systems that provide health delivery services to rural clinics and hospitals are being demonstrated in clinical settings. This paper summarizes the research and consortia projects at the University of Arizona Medical Center. The paper describes the Rural and Global Picture Archiving and Communications (PACS) environment developed under a National Science Foundation grant. The Rural and Global PACS environment includes many workstations, database, and networking components and is treated as a large distributed system. These components are described in this paper. The multimedia services for radiology provided by the Rural and Global PACS are described and their performance is measured. Finally, the current research work using the Open Software Foundation's distributed computing environment (OSF DCE) services is described. An OSF DCE testbed for the Rural and Global PACS is described and the rationale of using OSF DCE in the project is presented.

Trieste PACS project: a functional assessment

A picture archiving and communication (PAC) system (CommView by AT&T and Philips) has recently been installed in the Radiology Department of the University of Trieste, Italy, and is currently under experimental evaluation. The current status of the system and the planned developments are reported. A major project at present is the evaluation of the impact of the PAC system on the radiology system on a functional basis, by applying in the medical field a modelling methodology developed to analyse manufacturing systems. Other research in progress is devoted to technical, clinical and ergonomic aspects, on the basis of a comprehensive assessment project.

MIPS Standard activities in Japan

The Medical Image Processing System (MIPS) plan is a standard plan for the online communication of imaging data in Japan. The ACR-NEMA Standard is not always easy for manufacturers in Japan to comply with. This situation led to the formulation of MIPS Plan Minimum Set-87 (MIPS Standard-87), which uses reciprocal corresponding patterns to ACR-NEMA Standards. The working groups on current and future trends study data collected with a questionnaire in 1985 regarding (1) current technology and (2) its future direction as well as (3) the status of utilization of medical imaging and its data management. In 1986, they engaged in further investigations on the above subjects and presented their views on standardization. Conformance tests have been discussed and the conclusions were published in 1987 and 1988. Protocol conversion between MIPS Standard-87 and ACR-NEMA Standard was also discussed and the conclusions were reported. At the beginning of 1988, validation from medical viewpoints, e.g. the setting of anatomical position codes, was requested by medical members. Each layer of MIPS is compared briefly with the ACR-NEMA Standard. A small picture archiving and communication (PAC) system for three X-ray computer tomography units (X-CTs) has been constructed at the University of Tokyo Hospital. In this implementation, X-CTs and an imaging filing system are successfully connected by MIPS Standard-87. Some problems of MIPS Standard-87 are mentioned.

Imaging Workstations for Computer-Aided Primatology: Promises and Pitfalls

In this paper, the application of biomedical imaging workstations to primatology will be explained and evaluated. The technological basis, computer hardware and software aspects, and the various uses of several types of workstations will all be discussed. The types of workstations include: (1) Simple - these display-only workstations, which function as electronic light boxes, have applications as terminals to picture archiving and communication (PAC) systems. (2) Diagnostic reporting - image-processing workstations that include the ability to perform straightforward manipulations of gray scale and raw data values will be considered for operations such as histogram equalization (whether adaptive or global), gradient edge finders, contour generation, and region of interest, as well as other related functions. (3) Manipulation systems - three-dimensional modeling and computer graphics with application to radiation therapy treatment planning, and surgical planning and evaluation will be considered. A technology of prime importance in the function of these workstations lies in communications and networking. The hierarchical organization of an electronic computer network and workstation environment with the interrelationship of simple, diagnostic reporting, and manipulation workstations to a coaxial or fiber optic network will be analyzed.

Cost-effectiveness prospects of picture archiving and communication systems

PAC (picture archiving and communication) systems are widely discussed and promoted as the organizational solution to digital image management in a radiology department. For approximately two decades digital imaging has increasingly been used for such diagnostic modalities as CT, DSA, MRI, DR (Digital Radiography) and others. PACS are seen as a step toward high technology integration and more efficient management. Although the acquisition of such technology is investment intensive, there are well-founded projections that prolonged operation will prove cost justified. Such justification can only partly be derived from cost reduction through PAC with respect to present department management - the major justification is preparation for future economic pressures which could make survival of a department without modern technology difficult. Especially in the United States the political climate favors ‘competitive medicine’ and reduced government support. Seen in this context PACS promises to speed the transition of Health Care Services into a business with tight resource management, cost accounting and marketing. The following paper analyzes cost and revenue in a typical larger Radiology Department, projects various scenarios of cost reduction by means of digital technology and concludes with cautious optimism that the investment expenses for a PACS will be justified in the near future by prudent utilization of high technology.