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Imaging Informatics: from Image Management to Image Navigation 167 © 2009 IMIA and Schattauer GmbH Imaging Informatics: from Image Management to Image Navigation O. Ratib Department of Medical Imaging and Information Sciences, University Hospital of Geneva, Switzerland Summary vide the necessary tools for radiologists to Introduction review them and make adequate diagnosis. Objective: To review the rapid evolution of imaging informatics In the early eighties, emergence of These early home-grown systems were dealing with issues of management and communication of digital digital imaging in medicine brought a clumsy and expensive, but they lead the way images starting from the era of simple storage and transfer of im- new challenge to computer scientists to to the concept of a filmless radiology. ages to today’s world of interactive navigation in large sets of multi- find ways of managing increasingly large dimensional data. volumes of image data in digital format. Methods: This paper will review the initial concepts of Picture The conversion of conventional Xrays The Pioneers Archiving and Communication Systems (PACS) and the early devel- from traditional films to digital detec- opments and standardization efforts that lead to the deployment of tors generated very large size images that Early adopters of this new concept de- large intra-institutional networks of image distribution allowing required adequate display technology that veloped several innovative and unprec- radiologists and physicians to access and review images digitally. was beyond the capabilities of standards edented systems that were tested in the With the deployment of PACS came along the need for advanced CRT at that time. Conversely, a rapid field and in real clinical practice. Samuel tools for image visualization and image analysis. evolution of scanners technology raised J. Dwyer lll, an electrical engineer work- Results: Review of the history of PACS and Imaging Informatics the number of images and the resolution ing on digital imaging, who was one of clearly shows that the early developments were focused on the that can be acquired resulting in a huge the co-organizer of the landmark PACS radiologist’s requirements for diagnosis and image interpretation. growth in data volumes. This rapidly conference in Los Angeles, oversaw the These early developments lagged behind the rapid adoption of digi- growing field led to tremendous interest building of what is probably one of the tal imaging in areas outside radiology. Only recently, imaging among the scientific and research com- first PACSat the University of Kansas. informatics shifted toward the development of new tools geared munity. The earliest reference to PACS Based on connecting ultrasound machines toward the needs of other users such as surgeons, referring physi- that we know of came in 1979 when pro- and film digitizer in an Ethernet network cians and care-providers, and even for the patients themselves. Also fessor Heinz Lemke, PhD, at the Tech- connected to a handful of workstations in the recent years, the development of multimedia and communica- nical University of Berlin published a served as a demonstration system and a tion tools in the consumer market has influenced the design and paper on applied image processing and proof of concept. At the same time, Dr. strategic development of image management platforms inside and computer graphics methods in a study Steven Horii who also attended the 1982 outside healthcare institutions. of head CT scans [1]. In his paper he PACS conferenceand who was then at Conclusions: The focus of imaging informatics has clearly shifted in described all the basic components in- New York University, had been working the last decade from basic infrastructure design to complete data cluding interfaces to hospital informa- on a project to create side-by-side digi- and image navigation systems. While the challenge of storing and tion systems. Soon after, a first pivotal tal displays of nuclear medicine head managing large volumes of imaging data have slowly vanished event was a SPIE/PACS conference held scans and head CTs. Due to the difficul- with the rapid development if information technology, the new chal- in 1982 in Los Angeles under the initia- ties he encountered in reading encrypted lenge emerged from the new requirements of image manipulation tive of Dr. André Duerinckx and Samuel proprietary image formats of the CT and analysis in clinical practice. J. Dwyer III, PhD, internationally rec- studies he soon realized that a more open ognized pioneers and leaders in this standard for images would be necessary. Keywords emerging field [2]. It was at this confer- He later became instrumental in standard- Medical imaging, imaging informatics, PACS, image analysis work- ence that the acronym PACS for Picture ization efforts and one of the promoters stations Archiving and Communication Systems of the DICOM initiative (see below). At was first cited and used ever since. A UCLA another pioneering effort was Yearb Med Inform 2009:167-72 recent article published in 2003 [3] re- under way that came to fruition between ports a transcript of the original work- 1989 and 1991 under the leadership of shop of 1982. In the following years this H.K. “Bernie” Huang, DSc, FRCR, that new discipline has slowly matured had come to UCLA in the early 1980s through different early projects in the US and started a new medical imaging divi- and in Europe aimed toward the devel- sion and a graduate program in medical opment of systems capable of handling physics [4]. Prof. Huang put his gradu- large volumes of imaging data and pro- ate students, who included myself, to IMIA Yearbook of Medical Informatics 2009 168 Ratib work on building a homegrown PACS. J.R. Scherrer the creator of the Diogene tween academic centers and industry. It was initially deployed in pediatric ra- hospital information system [8], Dr. O. With this trend came the urge for stan- diology and used early low-resolution Ratib and his team developed their own dardization efforts allowing multi-ven- monochrome monitors. It was built image management system based on a dor systems to interconnect. around the first two CR units in the distributed architecture [9] with an inno- United States allowing direct capture of vative imaging workstation called Osiris digital Xray images. More significantly, based on interactive graphic user interface from a manufacturing source he obtained (GUI) that was developed to be portable on Emergence of Standards two computer boards that enabled him different operating systems such as Unix, The need for a standard allowing inter- to decode the digital information on the Microsoft Windows and Apple computers connectivity and exchange of images CR plates. This made it possible to dis- [10]. Other projects were also attempted in between devices from different manu- play the x-rays on the PACS monitors. other countries such as Austria, France, Italy facturers led the American College of Later, UCLA became one of the first sites and United Kingdom [11]. In the latter, some Radiology (ACR) and the National Elec- to show the use of high-resolution moni- ambitious projects were envisioned as early trical Manufacturers Association tors for PACS workstations capable of as 1982 were plans to create the first filmless (NEMA) to form a joint committee in displaying images at full resolution of hospital in the United Kingdom at St Mary’s order to create a standard method for the 2000x2500 pixels and a dynamic depth Hospital in London were submitted by Dr transmission of medical images and their of 10 bits. At the University of Florida, J.O.M.C. Craig of St Mary’s with the Re- associated information. This committee, Gainesville, Janice Honeyman-Buck was gional Scientific Officer, Harold Glass.In formed in 1983, published in 1985 the also struggling in the early 1990s to com- same time in France a very early PACS ACR-NEMA Standards Publication No. plete a limited PACS. With her group project (called SIRENE) was initiated by 300-1985s. While the initial versions of she attempted to break the code and ex- Dr J.M. Scarabin, a neurosurgeon in the ACR-NEMA effort (version 2.0 was tract CT and MR image data from the Renne’s University Hospital and Dr R. published in 1988) created standardized scanners way before DICOM standard Renoulin, an engineer working in the field terminology, an information structure, came along, to store these images in a of enterprise networks in a Telecommuni- and unsanctioned file encoding, most of central archive built on common juke- cations Research Center in Rennes. The the promise of a standard method of com- box of large optical disks. EuroPACS association (http://www. municating digital image information At the same time a small group of early europacs.org/) supported by all the early was not realized until the release of ver- adopters in Europe have initiated sev- leaders of these projects has continued to sion 3.0 of the Standard in 1993. The eral exploratory projects [5]. Professor pursue its original mission of promotion and release of version 3.0 saw a name change, A.R. Bakker at the university of Leiden education of new concepts in PACS and to Digital Imaging and Communications was one of them. Together with Profes- medical imaging and continues today to be in Medicine (DICOM), and numerous sor Heinz Lemke from Berlin and a hand- one of the leading international organiza- enhancements that delivered on the ful of others they created the first PACS tion in the field holding annual meetings promise of standardized communications society “EuroPACS” in 1984. Bakker and and educational seminars and workshops. [13]. The DICOM Standard now speci- his co-workers at BAZIS in Leiden car- The early projects suffered from sig- fied a network protocol utilizing TCP/ ried out PACS research and development nificant limitations in performance and IP, defined the operation of Service as part of hospital information systems were only able to handle a limited num- Classes beyond the simple transfer of (HIS) activities.
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