System Features

As previously mentioned, this in-house software was primarily developed by the attending physicians of the PCH. The graphics user interface is very friendly and follows the conventional window software architecture.

As Figure 1 shows, the GUI is displayed with Chinese characters, making it easy to manipulate even for the non-technical users. When a physician desires to access the system to obtain information on a patient, all the examination results completed the same day will be displayed, even if the patient had visited more than one

doctor in different departments. Data deserving of urgent or immediate attention will automatically be displayed in red. If any image-related tests were performed, those images can also be shown on a high resolution computer monitor. A complicated examination might be composed of more than one image.

This system allows the physician to view pictures in either single image or multiple (4 or 16) image mode. If the same examination was performed previously, this system can also display these two sets of images together, allowing the doctor to track the patient’s prognosis and to follow the progress of the disease to determine if the patient is getting better or worse.

Figure 3 demonstrates this functionality.

Figure 3 Multi-image display mode of the in-house PACS system.

Preparing the diagnostic reports with medical images is very tedious work. This new system allows the physicians to embed the medical images in the report by selecting the image and then clicking the “Report”

option. The selected image(s) can be placed either vertically or horizontally. Text can easily be made to flow around the images. Since most patients’ symptoms can be classified, and some of them are either similar or the same, the physicians can use the system to pre-define these symptoms, along with their suggested method of treatment and/or comments. In specifying the parameters of the reports, these pre-defined items can be included to reduce the amount of typing. Furthermore, in order to take advantage of the electronic referral procedure, the physician (after inputting administrative permission and security clearance) can use this system to easily attach the medical images along with the diagnostic reports, and then utilize Microsoft email system (such as Outlook Express or Outlook) to disseminate the information to designated personal in other hospitals. Even though sending the information through the email system could cause the security concern, yet the encryption approach, request return receipt and the digital signature can be used to meet the authentication, integrity and nonrepudiation security purpose. These features are demonstrated in Figure 4 and Figure 5 respectively.

Figure 4. Easy report generation feature.

Figure 5. The software integrates email system for e-referral procedure.

When the PACS was first announced, one of its goals was to create a paperless working environment.

However, after several years of development, realistic expectations have been re-focused towards increasing the rate of correct diagnosis in order to diagnose and treat the patients as quickly as possible. The way this system is developing is in this direction. It possesses very useful and efficient manipulative functions when examining the desired images. For example, the physician can use the mouse to select the interested area, and then enlarge this region to view more detailed information. By using the scrolling function of the mouse wheel, various properties of the image, such as the brightness, contrast or quality, can be easily adjusted.

In many cases, the distance or the size of particular image, such as the tumor size, means a lot to the medical treatment. This system also provides the flexibility to allow the doctor to measure the distance and area multiple times over the image directly. This distance information is also preserved when exported to the diagnostic report. In addition, if further image manipulation function is needed, this system can evoke other image manipulation software such as PhotoShop to perform the editing. The images can also be copied and

pasted into other software packages to make illustration material for training purposes. These functions are shown in Figure 6.

Even though this system was originally designed for the attending physician, resident physicians or any clinicians who are outside of their area of specialty can easily use this system. However, there is always the desire to increase the practicability and convenience for the PACS. As medical science becomes more diversified and specialized, even an experienced physician might have difficulty in making correct judgments when examining results from other specialties.

To overcome this obstacle for physicians or other technicians using this software, when the user selects an image, the appropriate image database with related documentation will be displayed. The user can then compare the images in order to obtain necessary information relating to the image and/or to confirm the symptoms of a particular disease. This practical function is demonstrated in Figure 7 and Figure 8.

Figure 6. The system has strong image manipulation capability.

Figure 7. The system displays the examined images which are then compared with the appropriate medical images.

Figure 8. The system can bring in standard images with detail documentation for comparison so that the physicians can have better confirmation and understanding of patients’ conditions.

After several years of evolution, the internet activities have become an important part of people’s regular daily life. According to the recent statistical report, the time spent engaged in internet browsing activities for people in Taiwan ranks among the top five worldwide. The fact that the internet has been deeply embraced indicates that the web browser can be a very convenient tool for collecting the information needed. With this in mind, this PACS system allows the world wide web-based viewer to access the database server through the Local Area Network (LAN). This web-based viewing system allows physicians to check examination results and retrieve image archived through the hospital internet into the PACS servers. It is a design based on the DICOM 3.0 standard format over TCP/IP communications protocol. With tight security control (such as firewall and password protection and access privilege settings), the system provides a convenient way for the attending physician or any clinician to verify a patient’s condition at any time. The system also automatically tracks all activities when a physician uses this web-based viewing software, and saves the histories into the system log.

The system administrator can monitor all accesses through this history log to prevent any illegal web actions. These functions are demonstrated in Figure 9 and Figure .

One of the on going projects is to integrate 3D medical database browsing into this system. Two major graphics libraries are used to develop this 3D browsing feature –the vtk [14, 15] and itk [16]. The vtk (Visualization ToolKit) and itk (National Library of Medicine Insight Segmentation and Registration Toolkit) are open-source, freely available software systems for computer graphics, image processing, and visualization.

It supports hundreds of algorithms in visualization and image processing fields. These two libraries were designed primarily for medical research. They also support different computer language bindings, and are

available on different computer platforms such as Linux or Windows. The user can operate the arrow keys to move the sliding plane for the desired cutting plane or to rotate the mouse to visualize the entire medical object in three dimensions freely.

Figure 9. The login interface for the web-based viewing system.

Figure 10. Web-based viewing interface allows online browsing of patient examination results.

Figure 11. The interactive three dimensional browsing feature for medical data set.