Pictorial Information Systems in Medicine PDF
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Pictorial Information Systems in Medicine NATO ASI Series Advanced Science Institutes Series A series presenting the results of activities sponsored by the NA TO Science Committee, which aims at the dissemination of advanced scientific and technological knowledge, with a view to strengthening links between scientific communities. The Series is published by an international board of publishers in conjunction with the NATO Scientific Affairs Division A Life Sciences Plenum Publishing Corporation B Physics London and New York C Mathematical and D. Reidel Publishing Company Physical Sciences Dordrecht, Boston and Lancaster D Behavioural and Martinus Nijhoff Publishers Social Sciences Boston, The Hague, Dordrecht and Lancaster E Applied Sciences F Computer and Springer-Verlag Systems Sciences Berlin Heidelberg New York Tokyo G Ecological Sciences Series F: Computer and Systems Sciences Vol. 19 Pictorial Information Systems in Medicine Edited by Karl Heinz Hahne Institute of Mathematics and Computer SCience In Medicine University of Hamburg, MartlnlstraBe 52 2000 Hamburg 20, Federa Republic of Germany Springer-Verlag Berlin Heidelberg New York Tokyo Published Ir' cooperatlO1 with NATO SCientific Affairs DIvIsion Proceedings of the NATO Advanced Study Institute on Pictorial Information Systems in Medicine held in Braunlage/FRG, August 27-September 7,1984 ISBN-13 978-3-642-<'l2386-2 e-ISBN-13 978-3-642-<'l2384-8 OOI10.10071978-3-642-<'l2384-8 Library of Congress Cataloging in Publication Data. NATO Advanced Study Institute on Pictorial Information Systems In Medicine (t 984 Braunlage, Germany) Pictorial information systems in medicine. (NATO ASI series. Series F, Computer and systems sciences, vo!. 19) "Proceedings of the NATO Advanced Study Institute on Pictorial Information Systems in Medicine, held in Braunlage/FRG, August 27 -September 7,1984"-Tp. verso. "Published in cooperation with NATO Scientific Affairs Division." Includes bibliographies. 1.lmaging systems in medicine-Data processing-Congresses. 2. Computer graphics-Congresses.!. Hahne, K. H. (Karl-Heinz), 1937-.11. North Atlantic Treaty Organization. SCientific Affairs Division. III. Title. IV. Series NATO ASI series. Series F, Computer and system sciences, no. 19. [DNLM 1 Computers-congresses. 2. Information Systems-congresses. 3. Medicine-con gresses. 4. Technology, Radlologlc-Instrumentation-congresses. W 26.5 N279p 1984J R85706N38 1984 610'28'5 85-32111 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translating, reprinting, re-use of illustrations, broadcastings, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to "Verwertungsgesellschaft Wort", Munich. © Springer-Verlag Berlin Heidelberg 1986 Softcover reprint of the hardcover 1s t edition 1986 Bookbinding J. Schaffer OHG, Grunstadt 2145/3140-543210 1m ge data b se psychovisu I is ues I expert y t m I computer graphic / man-m chine data compre sion interaction Preface This volume contains the proceedings of the NATO Advanced Study Institute on "Pictorial Information Systems in Medicine" held August 27-September 7, 1984 in Hotel Maritim, Braunlage/Harz, Federal Republic of Germany. The program committee of the institute consisted of KH Hohne (Director), G.T Herman, G. S. Lodwick, and D. Meyer-Ebrecht. The organization was in the hands of Klaus Assmann and Fritz Bocker In the last decade medical imaging has undergone a rapid development New imaging modalities such as Computer Tomography (CT), Digital Angiography (DSA) and Magnetic Resonance Imaging (MRI) were developed using the capabilities of modern computers. In a modern hospital these technologies produce already more then 25% of image data in digital form. This format lends itself to the design of computer assisted Information systems Integrating data acquisition, presentation, communi cation and archiving for all modalities and users within a department or even a hospital. Advantages such as rapid access to any archived Image, synoptic presentation, computer assisted image analysis to name only a few, are expected. The design of such pictorial information systems, however, often called PACS (Picture Archiving and Communication Systems) In the medical community is a non-trivial task involving know-how from many disciplines such as - Medicine (especially Radiology), - Data Base Technology, - Computer Graphics, - Man Machine Interaction, - Hardware Technology and others. Most of these disCiplines are represented by disjunct scientific communities. It was the aim of the meeting to get experts In the different fields together to review the fundamentals, to identify the problems and to discuss the possible solutions. It was an experiment without any guarantee of success. Would the participants talk to each other? Would they understand their different terminologies? The organizers felt a lot of relief when they recognized a few days after the beginning of the meeting that the communication really succeeded. The lectures and discussions of the institute fell Into quite heterogenous categories. Starting from the fact that the design of pictorial Information systems certainly requires a careful analysis of the users needs on one hand and the special properties of the Imaging modalities on the other, G. S. Lodwick looked at the task from the radiologists view, while S. Nudelman gave a detailed review of the specific properties of the different Image aqulsition devices. The following paper of A R. Bakker on hospital informatIOn systems was important for the following reason When bUilding PACS it IS not only necessary to include know-how from hospital Information system methodology, in fact PACS will not be of any value without a link to a patient information system. D. Meyer-Ebrecht followed In presenting his ideas on developing architectures for pictorial information systems in medicine. Some of the most striking new possibilities opened up by digital imaging techniques are new kinds of image presentation such as 3D-displays. G. T Herman reviewed this topic based on his long experience in this field, S. M. Pizer complemented his talk with an overview of 3D-imaging hardware. The large variety of available display techniques offered by Image processing and computer graphics raises the new VIII question of which is the optimal presentation. S. M. Pizer therefore also discussed the psychovisual issues in the display of medical images. There is no doubt that a pictorial information system will not be successful unless it is as easy to use as a conventional film reading environment. The design of a suitable man machine interface is already non trivial in general purpose computing. Man machine communication problems become even more severe when pictorial data are included. J. Nievergelt covered therefore the various issues in the design of man machine interfaces. In addition complex systems such as pictorial information systems cannot be designed without appropriate software tools. J. W. Schmidt reported on novel concepts for supporting data intensive data base applications. K. Assmann and K. H. Hahne presented an implemented experimental programming environment for pictorial data management as a possible software solution. Although the problem of designing systems, that can compete with the conventional image handling, is not yet solved, it is tempting to take a look into the future. While present PACS attempts deal with patient and pictorial data, future systems will also make use of knowledge about image interpretation, thus assisting the physician in the diagnostic process. I. Hoffmann gave a review of the state-of-art in the field of knowledge-based and expert systems. The lecturer's papers were complemented by papers contributed by participants. Yet not all aspects could be discussed in depth. So the institute did not discuss very much the more technological aspects of storage and communication technology. Suitable hardware will certainly be developed by the engineers because it is also required urgently for other data intensive applications aside from medical imaging. The problem of image standardization was not covered. Although its solution is not trivial, it was not considered a scientific topic for this meeting. One remarkable effect of the institute was the formation of a new interdisciplinary scientific community. As a visible result, EUROPACS, an association of European PACS researchers was founded during the meeting. Many people contributed to the success of this institute. I am very grateful to the members of my department for their continuous help in the preparation of the meeting. The organizers would also like to express their gratitude to Dr. C. Sinclair, NATO Scientific Affairs Division, for his support and Dr. Tilo Kester, Intemational Transfer of Science and Technology, for the help in the logistics. Last, but not least, the organizing committee would like to thank all the lecturers and participants, upon whose enthusiasm and technical expertise the institute was based. Hamburg, September 1985 Karl Heinz Hahne Table of Contents Long Papers Radiological Background G.S. LODWICK, Pictorial Information Systems and Radiology Improving the Quality of Com munications 1 Introduction 1 2. Radiology Information management and costs 5 3. File management 7 4. Communications problems with refernng physIcians 10 5. How can we Improve communications in Radiology? 11 6. Advantages of PACS 19 7 Conclusions 24 References 25 S. NUDELMAN, Image Acquisition Devices and Their Application to Diagnostic Medicine 29 Introduction 29 Devices and applications 31 1. light and photoelectronlc imaging devices 31 a. Types 31 b. Applications 39 2. X-ray Imaging devices and systems for radiology 46 a. Shadowgraphs 46 b. Device structures 48 c. Subtraction Imaging 56 References 98 Information System Aspects A R. BAKKER, Integrated Hospital Information Systems . 105 1. On data In a hospital and their use 106 2. The concept HIS and ItS position ir the hospital 108 3. Integratior, 113 4. Application of a HIS 114 5. Performance aspects 117 6. Data protection aspects 123 7. An example of a HIS 126 8 Costs of a hospital Information system 131 9. Benefits and evaluation 136 10. Lessons to be learned 137 x 11. On the relations between a HIS and a PACS 140 12. Further HIS developments and problems involved 141 References 148 D. MEYER-EBRECHT, On the Architecture for Pictorial Information Systems 151 BasIc ideas on Architecture 151 The particular role of architecture in the medical Image domain 153 A modelling concept 157 An overall PACS philosophy 161 A hierarchical image mass storage concept 164 A unifying image coding concept 167 A modular image processor architecture for high power work stations 169 References 179 Aspects of Image Presentation GT HERMAN, Three-Dimensional Computer Graphic Display In Medicine: The MIPG Perspec- tive 181 Introduction 181 Discrete 3D scenes 185 Objects and their surfaces 187 Surface detection of 1-objects in binary scenes 192 Display of object surfaces 193 Recent advances in the cuberille approach 196 The computer program 3083 . 198 Summary 206 References 208 S. M. PIZER, Psychovisual Issues in the Display of Medical Images 211 1. Introduction 211 2. Spatial issues of display 212 3. Intensity issues of display 217 4. Other visual dimensions: Motion and 3D 230 5. Summary . 232 References 232 S. M. PIZER, Systems for 3D Display in Medical Imaging 235 1. Introduction 235 2. Reflective display systems 237 3. Self-luminous display systems 242 4. Conclusion 247 References 248 Computer Science Tools J. NIEVERGEL T, Issues in the Design of Human-Computer Interfaces 251 1. The computer-driven screen as a communications medium 253 2. Survey and classification of errors 253 3. An interactive system as seen by the user 255 4. Is a standard man-machine interface possible? 259 XI 5. Programming the man-machine interface 261 References 262 JW SCHMIDT, W LAMERSDORF, Programming Support for Data-Intensive Applications 263 1 Introduction database programming 263 2. A programmer's approach to the relational model of data 264 3. Some high level language constructs for relations 268 4. Support for database Integrity, recovery and concurrency 274 5. Requirements for compound object modelling 278 6. Extended constructs for compound object definition 282 7. Extended constructs for compound object operation 286 8. Concluding remarks 288 References 289 I. HOFMANN, H. NIEMANN, G. SAGERER, Knowledge-Based and Expert Systems: Represen tation and Use of Knowledge . 293 1 Introduction 294 2. An overview of knowledge-based and expert systems 297 3. Representation and use of knowledge 306 4. A speCial application: a pictorial knowledge-based system 315 5. Results and future aspects 326 References 329 K. ASSMANN, R. VENEMA, K. H. HOHNE, Software Tools for the Development of Pictorial Information Systems in Medicine - The ISOL Experience - 1. Objectives and Problems 333 2. The ISOL Approach 336 3. PACS - Functions, Concepts and Realization with the tooilSOL . 340 1. Integration into the departmental or hospital organization 340 2. Management of images 344 3. Human computer communication 345 4. User environments 348 5. Further developments 350 6. Software properties of the tool ISOL 352 4. Conclusion 352 References 353 First Experiences D.F. PRESTON, S.J. DWYER, WH. ANDERSON et ai, Experience with a Prototype PACS System in a Clinical EnVIronment 357 On-line radiology networking 357 Daily generation of digital data 358 Daily requirements of digital transmission 359 Interactive diagnOSIs display station 360 Hard copy recording. 361 Long-term archiving 361 PACS standards 362 Summary 363 References 364
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