交互式远程医疗系统及其关键技术的研究
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摘要
远程医疗是网络科技与医疗技术结合的产物，它实现了医疗资源共享，减少甚至消除了因地域限制造成的疑难病症诊断和治疗的难题。远程医疗技术的发展使得经济的、迅速的医疗检查、监护、诊断和病历管理成为可能，具有广阔的发展前景。它结合了远程通讯技术、信息学技术和医疗保健技术，延伸了传统的单纯的医院信息系统(Hospital Information System,HIS)、放射信息系统(Radiological Information System,RIS)等事务管理的模式，创造出面向医疗服务和医学教育、医学影像信息和医疗管理信息的综合化医院信息系统。
近十年来，随着硬件基础设施的不断完善，软件系统结构概念的逐步成熟及计算机应用水平的不断提高，远程医疗由原来的实验室中的概念模型，转变为实实在在的与人民生活相联系的事物。与此同时，远程医疗的概念也随着各种新需求、新应用的出现不断拓展，如基于无线应用的医疗服务及虚拟医院等。可以预计，远程医疗必将以其广泛的应用背景和鲜明的特色成为今后医院信息化发展的一个必然趋势。虽然远程医疗技术已经获得了较大发展，但其中的很多关键技术还有待解决，如医学影像的无损压缩、传输、高清晰度显示处理及针对该类系统所应采用的软件结构和开发方式等。这些技术已经有了一些不同的实现且各具特色，但并没有给出统一的标准，也没有最佳实现，这就给本文的工作提供了资料和创新的空间。同时，本文从软件工程的角度对于远程医疗系统的体系结构进行了重新设计，采用了与以往系统不同的开发模型。
本论文详细叙述了一种基于多层客户/服务器结构的远程医疗系统—MedJ，并给出了完全基于Java的系统实现方案，它具有较强的灵活性及异构平台兼容性。在此系统构架下，论文对系统中涉及的医学图像压缩技术进行讨论并给出了实现，主要是JPEG2000图像压缩算法的实现；介绍了医学影像处理技术，给出了若干实用的基于Java的影像处理技术实现方法及实验结果；设计了医学图像自动归档技术；讨论并实现了一种数据中间件；对于新型的无线WAP应
北京工业人学工学硕士学位论文
一
用，论文给出了相关技术并完成了与MedJ结合的演示模块。实验系统的运行
结果证明了方案的可行性。
Telemedicine is an achievement which combines the network and medical techniques. It realizes sharing of medical information and solves the problems residing in diagnosis and treatment caused by the restriction of regions. The development of telemedicine makes the fast, economic examination, control, diagnosis and medical record management possible. The broad application cases are promising. Telemedicine contains telecommunication technology, information technology and health care technology, extends transaction pattern in classical Hospital Information System HIS and Radiological Information System, RIS , and creates a synthetic hospital information system faced on medical service, imaging and information management.
With the improvement on hardware facilities, computer application level and principal of software architecture, telemedicine has become a real thing which is related closely with people's life rather than original principal model in lab paper. At the same time, the principals in telemedicine are changing as new requirement and new application comes out, such as wireless medical service, virtual hospital et al. It is sure that telemedicine will be one of the developing trends of hospital information, but some critical techniques in telemedicine, such as the medical image lossless compression, image transmission, high-resolution display and system developing mode are still need to be improved. As we can see, although there are some implements of those techniques and each has its own characteristics, an unified standards and the state of art are not given. The situation gives us chance to bring new ideas creatively. In this paper, we will redesign telemedicine system with consideration of software engineering a
nd use a different development mode from typical system.
The paper discusses a multi-tier telemedicine system-MedJ, and gives a pure Java implement. The architecture is flexible and compatible with different platforms. Within this framework, the paper also discusses image compression techniques mainly focus on JPEG2000, its principle and implement, introduces medical image processing technique with Java based implement and gives some demo results, designs auto-archiving of medical image and data middleware. For
the new WAP application, the paper lists related techniques and implements a demo model using our architecture. The experimental result has testified the feasibility of our scheme.
近十年来，随着硬件基础设施的不断完善，软件系统结构概念的逐步成熟及计算机应用水平的不断提高，远程医疗由原来的实验室中的概念模型，转变为实实在在的与人民生活相联系的事物。与此同时，远程医疗的概念也随着各种新需求、新应用的出现不断拓展，如基于无线应用的医疗服务及虚拟医院等。可以预计，远程医疗必将以其广泛的应用背景和鲜明的特色成为今后医院信息化发展的一个必然趋势。虽然远程医疗技术已经获得了较大发展，但其中的很多关键技术还有待解决，如医学影像的无损压缩、传输、高清晰度显示处理及针对该类系统所应采用的软件结构和开发方式等。这些技术已经有了一些不同的实现且各具特色，但并没有给出统一的标准，也没有最佳实现，这就给本文的工作提供了资料和创新的空间。同时，本文从软件工程的角度对于远程医疗系统的体系结构进行了重新设计，采用了与以往系统不同的开发模型。
本论文详细叙述了一种基于多层客户/服务器结构的远程医疗系统—MedJ，并给出了完全基于Java的系统实现方案，它具有较强的灵活性及异构平台兼容性。在此系统构架下，论文对系统中涉及的医学图像压缩技术进行讨论并给出了实现，主要是JPEG2000图像压缩算法的实现；介绍了医学影像处理技术，给出了若干实用的基于Java的影像处理技术实现方法及实验结果；设计了医学图像自动归档技术；讨论并实现了一种数据中间件；对于新型的无线WAP应
北京工业人学工学硕士学位论文
一
用，论文给出了相关技术并完成了与MedJ结合的演示模块。实验系统的运行
结果证明了方案的可行性。
Telemedicine is an achievement which combines the network and medical techniques. It realizes sharing of medical information and solves the problems residing in diagnosis and treatment caused by the restriction of regions. The development of telemedicine makes the fast, economic examination, control, diagnosis and medical record management possible. The broad application cases are promising. Telemedicine contains telecommunication technology, information technology and health care technology, extends transaction pattern in classical Hospital Information System HIS and Radiological Information System, RIS , and creates a synthetic hospital information system faced on medical service, imaging and information management.
With the improvement on hardware facilities, computer application level and principal of software architecture, telemedicine has become a real thing which is related closely with people's life rather than original principal model in lab paper. At the same time, the principals in telemedicine are changing as new requirement and new application comes out, such as wireless medical service, virtual hospital et al. It is sure that telemedicine will be one of the developing trends of hospital information, but some critical techniques in telemedicine, such as the medical image lossless compression, image transmission, high-resolution display and system developing mode are still need to be improved. As we can see, although there are some implements of those techniques and each has its own characteristics, an unified standards and the state of art are not given. The situation gives us chance to bring new ideas creatively. In this paper, we will redesign telemedicine system with consideration of software engineering a
nd use a different development mode from typical system.
The paper discusses a multi-tier telemedicine system-MedJ, and gives a pure Java implement. The architecture is flexible and compatible with different platforms. Within this framework, the paper also discusses image compression techniques mainly focus on JPEG2000, its principle and implement, introduces medical image processing technique with Java based implement and gives some demo results, designs auto-archiving of medical image and data middleware. For
the new WAP application, the paper lists related techniques and implements a demo model using our architecture. The experimental result has testified the feasibility of our scheme.
引文
1 李思彪．欧洲远程医疗的发展及现状．http://www.cmia.org.cn/xsyj5/5qi/ozycl.htm.
2 秦笃烈．美国远程医疗的现状和发展策略．http://www.cmia.org.cn/xsyj5/5qi/wuqi.html.
3 张鸿源．PACS核心软件的研究与实现[硕士论文]．北京工业大学，2001．
4 童明杰，胡大可．认知医学数字图像通讯标准—DICOM．国外医学生物医学工程分册，1999，22(5)
5 Subrahmanyam Allamaraju, Cedric Buest, John Davies, et al.J2EE编程指南．1.3版．北京：电子工业出版社，2002
6 Sun corp.http://java.sun.com/j2ee
7 Steven Gould. http://go4.163.com/～blueski/j2ee/java13.htm.2001
8 Steven Gould. Develop n-tier application using J2EE.
9 刘湛．J2EE全面简介．http://61.132.115.3/java/j2ee/J2EE全面简介．htm
10 Bruce Eckel.Java编程思想．第二版．北京：机械工业出版社，2002
11 Brett Spell,et al.Java专业编程指南．北京：电子工业出版社，2001
12 巨安丽，徐建荣．远程医疗技术的发展方向—会议电视系统．中国医学教育技术，1999，13(3)
13 胡秉谊，白净，叶大田．远程医疗系统的客户／服务器模型．清华大学学报(自然科学版)，1999，39(1)
14 龚志梅，陈少媒，田燕，李小华，基于Internet技术的远程医疗系统．中华医院管理杂志，1999，15(3)
15 李树均，纪震，牟轩沁，蒋一峰．利用Internet和RAS实现远程医疗．中国医疗器械杂志，1999，23(1)
16 吴雪阳，王洪强，陈英武，信息系统三层结构及其实现技术．电脑与信息技术，1999(4)
17 陈华辉，林雪明，钱旭明，王让定．基于三层结构客户／服务器模式的信息系统开发．微机发展，1999(2)
18 Khawar Zaman Ahmed et al．用J2EE和UML开发Java企业级应用程序．北京：清华大学出版社，2002
19 Arps R B, Truong T K. Comparison of international standards for lossless still image compression. Proc. of the IEEE, June 1994, 82:889-899.
20 Weinberger M J, Seroussi G, and Sapiro G. LOCO-I: A low complexity, context-based, lossless image compression algorithm. In Proc. Data Compression Conference, Snowbird, Utah, USA, Mar. 1996, pp. 140-149.
21 Weinberger M J, Rissanen J, and Arps R B. Applications of universal context modeling to lossless compression of gray-scale images. IEEE Trans. Image Processing, 1996, 5(4):575-586.
22 Wu X, Memon N D. Context-based, adaptive, lossless image coding. IEEE Trans. Commun., 1997, 45(4):437-444.
23 Howard P G, Vitter J S. Fast and efficient lossless image compression. In Proc. Data Compression Conference, Snowbird, Utah, USA, Mar. 1993, pp.351-360.
24 ISO/IEC, JBIG2 Working Draft, http://www.jpeg.org/public/jbigpt2.htm.
25 Weinberger M J, Seroussi G, and Sapiro G. The Loco-I lossless image compression algorithm: principle and standardization into JPEG-LS. Technical Report of Hewlett-Packard Laboratories, Palo Alto, CA 94304, USA, 1999.
26 Merhav N, Seroussi G, and Weinberger M J. Modeling and low-complexity adaptive coding for image prediction residuals. In Proc. of the 1996 Int'l Conference on Image Processing, Lausanne, Switzerland, Sep. 1996, vol. Ⅱ, pp.353-356.
27 Barequet R, Feder M. SICLIC: A simple inter-color lossless image coder. In Proc. of data compression conference, Edited by J. A. Storer, Snowbird Utah, USA, March, 1999, pp.500-510.
28 姚志洪，索仲良．医学图像信息系统三要素——质量速度投资评估．上海
第二医科大学附属瑞金医院计算机中心．
29 马小虎．多媒体数据压缩标准及实现．北京：清华大学出版社
30 吴乐南．数据压缩的原理与应用．北京：电子工业出版社
31 沈兰荪，魏海．图像的无损压缩研究．数据采集与处理，1999，14(4)：485-491
32 Gallager R, Voorhis D V. Optimal source codes for geometrically distributed integer alphabets. IEEE Trans. Information Theory, 1975, IT-21:228-230.
33 Nelson M. LZW Data Compression. http://dogma.net/markn/articles/lzw/lzw.htm.
34 Rao K R, Hub Y. JPEG2000. In Proc. International Symposium on Intelligent Multimedia, Video and Speech Processing, Hong Kong, China, May, 2001, pp.20-23.
35 Cruz D S, Ebrahimi T, Askelof J, Larsson M, and Christopoulos C. An analytical study of JPEG2000 functionalities. ISO/IEO JTC1/SC29/WG1 N1816, July 2000
36 李晓华，沈兰荪．一种新的静止图像压缩标准—JPEG2000．测控技术，2002，21(5)：12-15
37 Charilaos Christopoulos, Athanassios Skodras, Touradj Ebrahimi. The JPEG2000 still image coding system:an overview. IEEE Transactions on Consumer Electronics, 2000, 46(4): 1103-1127
38 Diego Santa-Cruz, Touradj Ebrahimi. An analytical study of JPEG2000 functionalities. In: Proc. of the International Conference on Image Processing (ICIP). Vancouver, Canada, September 10-13, 2000.
39 David Taubman. High Performance Scalable Image Compression with EBCOT. IEEE Transactions on image processing, 2000, 9(7): 1158-1170
40 David Taubman, Erik Ordentlich, et al. Embedded Block Coding in JPEG2000. In: 2000 IEEE International Conference on Image Processing, 2000, 2:33-36
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43 毋立芳，沈兰荪，张晓玲．基于感兴趣区的图像近无损压缩．中国图像图形学报，2001，6(6)：528-532
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67 王志远，余厚军，石明国．医学图像通讯标准DICOM原理与应用(一)[J]．现代医用影像学，2000，9(2)：84-87
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72 吴永辉，俞建新，JPEG2000图像压缩算法概述及网络应用前景．计算机工程，2003，29(3)：7-11
2 秦笃烈．美国远程医疗的现状和发展策略．http://www.cmia.org.cn/xsyj5/5qi/wuqi.html.
3 张鸿源．PACS核心软件的研究与实现[硕士论文]．北京工业大学，2001．
4 童明杰，胡大可．认知医学数字图像通讯标准—DICOM．国外医学生物医学工程分册，1999，22(5)
5 Subrahmanyam Allamaraju, Cedric Buest, John Davies, et al.J2EE编程指南．1.3版．北京：电子工业出版社，2002
6 Sun corp.http://java.sun.com/j2ee
7 Steven Gould. http://go4.163.com/～blueski/j2ee/java13.htm.2001
8 Steven Gould. Develop n-tier application using J2EE.
9 刘湛．J2EE全面简介．http://61.132.115.3/java/j2ee/J2EE全面简介．htm
10 Bruce Eckel.Java编程思想．第二版．北京：机械工业出版社，2002
11 Brett Spell,et al.Java专业编程指南．北京：电子工业出版社，2001
12 巨安丽，徐建荣．远程医疗技术的发展方向—会议电视系统．中国医学教育技术，1999，13(3)
13 胡秉谊，白净，叶大田．远程医疗系统的客户／服务器模型．清华大学学报(自然科学版)，1999，39(1)
14 龚志梅，陈少媒，田燕，李小华，基于Internet技术的远程医疗系统．中华医院管理杂志，1999，15(3)
15 李树均，纪震，牟轩沁，蒋一峰．利用Internet和RAS实现远程医疗．中国医疗器械杂志，1999，23(1)
16 吴雪阳，王洪强，陈英武，信息系统三层结构及其实现技术．电脑与信息技术，1999(4)
17 陈华辉，林雪明，钱旭明，王让定．基于三层结构客户／服务器模式的信息系统开发．微机发展，1999(2)
18 Khawar Zaman Ahmed et al．用J2EE和UML开发Java企业级应用程序．北京：清华大学出版社，2002
19 Arps R B, Truong T K. Comparison of international standards for lossless still image compression. Proc. of the IEEE, June 1994, 82:889-899.
20 Weinberger M J, Seroussi G, and Sapiro G. LOCO-I: A low complexity, context-based, lossless image compression algorithm. In Proc. Data Compression Conference, Snowbird, Utah, USA, Mar. 1996, pp. 140-149.
21 Weinberger M J, Rissanen J, and Arps R B. Applications of universal context modeling to lossless compression of gray-scale images. IEEE Trans. Image Processing, 1996, 5(4):575-586.
22 Wu X, Memon N D. Context-based, adaptive, lossless image coding. IEEE Trans. Commun., 1997, 45(4):437-444.
23 Howard P G, Vitter J S. Fast and efficient lossless image compression. In Proc. Data Compression Conference, Snowbird, Utah, USA, Mar. 1993, pp.351-360.
24 ISO/IEC, JBIG2 Working Draft, http://www.jpeg.org/public/jbigpt2.htm.
25 Weinberger M J, Seroussi G, and Sapiro G. The Loco-I lossless image compression algorithm: principle and standardization into JPEG-LS. Technical Report of Hewlett-Packard Laboratories, Palo Alto, CA 94304, USA, 1999.
26 Merhav N, Seroussi G, and Weinberger M J. Modeling and low-complexity adaptive coding for image prediction residuals. In Proc. of the 1996 Int'l Conference on Image Processing, Lausanne, Switzerland, Sep. 1996, vol. Ⅱ, pp.353-356.
27 Barequet R, Feder M. SICLIC: A simple inter-color lossless image coder. In Proc. of data compression conference, Edited by J. A. Storer, Snowbird Utah, USA, March, 1999, pp.500-510.
28 姚志洪，索仲良．医学图像信息系统三要素——质量速度投资评估．上海
第二医科大学附属瑞金医院计算机中心．
29 马小虎．多媒体数据压缩标准及实现．北京：清华大学出版社
30 吴乐南．数据压缩的原理与应用．北京：电子工业出版社
31 沈兰荪，魏海．图像的无损压缩研究．数据采集与处理，1999，14(4)：485-491
32 Gallager R, Voorhis D V. Optimal source codes for geometrically distributed integer alphabets. IEEE Trans. Information Theory, 1975, IT-21:228-230.
33 Nelson M. LZW Data Compression. http://dogma.net/markn/articles/lzw/lzw.htm.
34 Rao K R, Hub Y. JPEG2000. In Proc. International Symposium on Intelligent Multimedia, Video and Speech Processing, Hong Kong, China, May, 2001, pp.20-23.
35 Cruz D S, Ebrahimi T, Askelof J, Larsson M, and Christopoulos C. An analytical study of JPEG2000 functionalities. ISO/IEO JTC1/SC29/WG1 N1816, July 2000
36 李晓华，沈兰荪．一种新的静止图像压缩标准—JPEG2000．测控技术，2002，21(5)：12-15
37 Charilaos Christopoulos, Athanassios Skodras, Touradj Ebrahimi. The JPEG2000 still image coding system:an overview. IEEE Transactions on Consumer Electronics, 2000, 46(4): 1103-1127
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