基于CSCW的远程放射系统的关键技术研究与实现
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摘要
远程医疗是利用现代化网络技术、通信技术、多媒体技术以及现代医疗技术，建立不同区域的医疗单位之间、医师和患者之间的联系，完成远程咨询、诊治、教学、学术研究和信息交流，形成医学专家之间及其与患者之间的一种全新的诊疗模式。随着医疗信息化及相关科学技术、学科的发展，远程医疗也成为目前研究的热点之一。但已有远程医疗系统或多或少都由于自身的设计或实现而无法满足实际远程医疗的需要，众多患者、医生甚至医院都呼唤一个新型、符合医疗标准、能实现实时通讯和医疗信息共享并且安全可靠的多方远程会诊系统。此外用于医生诊断的各类医学信息中，医学影像所能提供的信息是比较直观并且信息量很大，同时临床医生也往往需要就图像与诊断医生会诊。因此本文将研究的重点放在远程放射系统上。
当今社会，越来越多的工作要依靠计算机来完成。社会的发展使人们之间的合作更加紧密，人们不满足计算机仅支持单人的工作，而希望计算机能支持多人的协同工作。由此，提出了计算机支持的协同工作(Computer Supported Cooperative Work，简称CSCW)概念，意指在计算机网络中，一群成员合作完成一项任务。
本文在系统分析及研究协同理论与技术的基础上，针对远程医疗系统的特点，研究分析了远程医疗中的协同工作，提出了基于CSCW技术的远程放射系统(JW-Telradiology)，以及该系统的实现目标，并且对医学信息资料共享、会诊各方间的协同运行、协作多用户接口以及系统的安全性等相关关键技术进行了分析与设计，最后具体描述了该系统的实现。
Telemedicine, a novel model regarding inter-hospital medical treatment between doctors and patients in different regions, is realized in technology covering modern network, telecommunication, multi-media and medicine. Such a model offers teleconsultation, medical treatment, teaching instructions, academic research and information exchanges among doctors and patients themselves. With the development of medical information as well as other relevant disciplines and technology, telemedicine has become one of the hotspots for research. It should be pointed out that due to its imperfect design, the existing practice of medical treatment for long distance purpose is observed, more or less, unable to fulfil the task to be performed by telemedicine in reality. Thus voices from patients, doctors and even hospitals are heard for a completely new, standard and safer system for long distance consultation among multiple parties capable of performing online communication and of sharing information. Apart from this, among i
nformation of various kinds used by doctors for diagnoses, those provided by medical images are the most informative and objective. Meanwhile, it is the images that clinic doctors need for consultation with doctors in charge of diagnosis. Therefore, the present paper focuses on the system of teleradiology.
Nowadays, more and more work is to be implemented via computer. The social development makes interpersonal cooperation much closer. It is now far from enough for computer to support one individual's job only but the coordination among more than one! It is in this spirit that the idea of CSCW (Computer Supported Cooperative Work) is put forward. The interpretation here goes that a job is done with the cooperation of a group of people in the computer network.
Based on the systematic analysis as well as on the theory and practice of technology, the present paper, while aiming at the characteristics inherent in telemedicine, had a thorough analysis of the coordinating work in
telemedicine and put forward the JW-Teleradiology based on CSCW and the goal that the former is to achieve. Besides, the author has also analyzed and ad hoc designed the key to the relevant technology such as medical information sharing, coordination among consultant parties, the ways of hooking in for multiple-users and the system safety. Finally, the author presented the detailed description germane to the how of the system's realization.
当今社会，越来越多的工作要依靠计算机来完成。社会的发展使人们之间的合作更加紧密，人们不满足计算机仅支持单人的工作，而希望计算机能支持多人的协同工作。由此，提出了计算机支持的协同工作(Computer Supported Cooperative Work，简称CSCW)概念，意指在计算机网络中，一群成员合作完成一项任务。
本文在系统分析及研究协同理论与技术的基础上，针对远程医疗系统的特点，研究分析了远程医疗中的协同工作，提出了基于CSCW技术的远程放射系统(JW-Telradiology)，以及该系统的实现目标，并且对医学信息资料共享、会诊各方间的协同运行、协作多用户接口以及系统的安全性等相关关键技术进行了分析与设计，最后具体描述了该系统的实现。
Telemedicine, a novel model regarding inter-hospital medical treatment between doctors and patients in different regions, is realized in technology covering modern network, telecommunication, multi-media and medicine. Such a model offers teleconsultation, medical treatment, teaching instructions, academic research and information exchanges among doctors and patients themselves. With the development of medical information as well as other relevant disciplines and technology, telemedicine has become one of the hotspots for research. It should be pointed out that due to its imperfect design, the existing practice of medical treatment for long distance purpose is observed, more or less, unable to fulfil the task to be performed by telemedicine in reality. Thus voices from patients, doctors and even hospitals are heard for a completely new, standard and safer system for long distance consultation among multiple parties capable of performing online communication and of sharing information. Apart from this, among i
nformation of various kinds used by doctors for diagnoses, those provided by medical images are the most informative and objective. Meanwhile, it is the images that clinic doctors need for consultation with doctors in charge of diagnosis. Therefore, the present paper focuses on the system of teleradiology.
Nowadays, more and more work is to be implemented via computer. The social development makes interpersonal cooperation much closer. It is now far from enough for computer to support one individual's job only but the coordination among more than one! It is in this spirit that the idea of CSCW (Computer Supported Cooperative Work) is put forward. The interpretation here goes that a job is done with the cooperation of a group of people in the computer network.
Based on the systematic analysis as well as on the theory and practice of technology, the present paper, while aiming at the characteristics inherent in telemedicine, had a thorough analysis of the coordinating work in
telemedicine and put forward the JW-Teleradiology based on CSCW and the goal that the former is to achieve. Besides, the author has also analyzed and ad hoc designed the key to the relevant technology such as medical information sharing, coordination among consultant parties, the ways of hooking in for multiple-users and the system safety. Finally, the author presented the detailed description germane to the how of the system's realization.
引文
1. Akselsoons, Edidsvik AK, Folkow T. Telemedicine and ISDN. IEEE Communication Magazine, 1993; 31(1): 46-51
2. Murakami H, Shimizu K, Yamamoto K, etal. Telemedicine using mobile satellite communication. IEEE Transactions on Biomedical Engineering, 1994; 41(5): 488-497
3. RichardsonIain EG, Riley Martr J, Haston Wendy, etal. Telemedicine and teleconferencing: The SAVIOUR project. Computer & Control Engineering Journal, 1996; 7(1): 21-26
4. Dimitris Lymberopoulos. An homogeneous medicaltele-working domain supported by a new remote expert consultation conferencing service. European Transact ion Telecommunications and Related Technology, 1994; 5(4): 495-507
5. Gomez EJ, del Pozo F, Quiles JA, etal. A telemedicine system for remote cooperative medical imaging diagnosis. Computer Method and Programs in Biomedicine, 1996; 49: 37-48
6. James E. Cabral Jr and Yongming Kim Multimedia Systems for Telemedicine and Their Communications Requirements IEEE Communications Magazine July 1996.
7. American College of Radiology, National Electrical Manufac-tures Association. Digital Imaging and Communications in Medicine(DICOM): Version 3.0. Draft Stand-Ard, ACR-NEMA Commi-tree, Working Group Ⅵ, Washington DC, 1993.
8. D. Li and R. R. Muntz. Runtime Dynamics In Collaborative Systems. In Proceedings of ACM GROUP'99 International Conference on Supporting Group Work, Phoenix, Arizona, Nov 1999.
9. D.Li And R.R.Muntz. COCA: Collaborative Objects Coordinaton Architecture. In Proceedings Of ACM CSCW'98, Seattle, WA, Nov. 1998.
10. P. Dourish And V. Bellotti. Awareness And Coordination In Shared Workspaces, Proc. Int. Conf. On CSCW (Toronto, Canada). Oct. 1992, P 107-114, J. Turner And R.E.Kraut(Eds), ACM Press, 1992.
11. T.Rodden. Populating The Application: A Model Of Awareness For Coorperative Applicatons. Proc. Of The ACM 1996 Conf. On CSCW, Boston, Mass. Pp.87-96, 1996
12. L.M.Haas, R.J.Miller, B.Niswonger Etc. Transforming Heterogeneous Data With Database Middleware, IEEE Transaction On Data Engineering, 1999; 22(1): 31-37
13. C.B.Et Al. Electronic Medical Consultation: A New Zealand Perspective. URL: http://www.jmir.org/2001/1/E13/, 2001.Journal Of Medical Internet Research 2001: 3(1)
14．胡秉谊，白净，叶大田．远程医疗系统的客户／服务器结构模型．清华大学学报(自然科学版)1999；39(1)：19-21
15．艾育华，方少元，孙季丰．远程医疗浅析．北京生物医学工程．2000；19(4)：249-252
16．余正华，陈克琴，黄玫．论发展远程医疗服务．医学信息．2000；13(12)：651-652
17．李科，尧德中，蒲立新．基于组播技术的远程医疗会诊系统．生物医学工程杂志．2003；20(2)：237-240
18．黄锡伟，毕厚杰．计算机支持的协同工作(CSCW)研究和设计．计算机工程与应用．1998．6：31-34
19．李人厚，郑庆华．CSCW的概念、结构、理论与应用[J]．计算机工程与应用．1997：33(2)：8-33
20．张冰，张文英．基于CSCW的协同编著系统[J]．计算机工程与应用．2001；35(5)：80-82
21．孙艳春，刘积仁．CSCW系统体系结构模型的研究[J]．小型微型计算机系统．2001；22(2)：210-213
22．王魁生，李人厚，李宏敏等．一个CSCW系统的设计与实现[J]．小型微型计算机系统，2001；22(2)：214-217
23．李村合．谈网络环境下的信息存储技术．情报学报，2002：21(1)：48-51
24．陈凯，白英彩．网络存储技术及发展趋势．电子学报，2002；30(12A)：1928-1932
25．池慧．远程放射学与远程医学．国外医学生物医学分册，1998；21(8)：
112-120
26．葛声，马殿富，怀进鹏．基于角色的群体感知模型．软件学报，2001；12(6)：864—871
27．郑庆华，李人厚．CSCW协作多用户接口的设计与实现，小型计算机系统，1998；19(1)：40-46
28．远程医疗及其协同理论与技术研究．西北大学博士论文
29．李军怀，周明全，耿国华．异构环境下的CSCW模型研究与实现，计算机科学，2002；10
30．王奎生．计算机支持协同设计系统的研究与实现．西安交通大学博士论文
31．吴小毅，宋庆宇．远程医疗系统的支撑技术，遵义医学院学报，2002；25(4)：359-360
32．廉世俊，胡大可．远程医疗中的通信问题，国外医学生物医学工程分册，1999；22(5)：263-269
33．高燕婕．世界卫生组织关于远程医疗的发展策略，中国医院统计，2000；7(3)：161-162
34．杨全胜，朱士俊，刘海一．远程会诊的信息安全及管理对策，解放军医院管理杂志，1999；6(5)：375-377
35．吉农．远程医疗服务的管理及质量控制，中华医院管理杂志，1998；14(9)：566-569
36．钟晓东，胡晓亮，张永红等．基于CSCW的分布式多媒体远程合作会诊系统的设计与实现，电子学报，2003；31(11)：1634-1638
37．潘耘，冷英男，李文超等．CSCW的研究内容及其关键技术，抚顺石油学院学报，2001；21(3)：65-69
2. Murakami H, Shimizu K, Yamamoto K, etal. Telemedicine using mobile satellite communication. IEEE Transactions on Biomedical Engineering, 1994; 41(5): 488-497
3. RichardsonIain EG, Riley Martr J, Haston Wendy, etal. Telemedicine and teleconferencing: The SAVIOUR project. Computer & Control Engineering Journal, 1996; 7(1): 21-26
4. Dimitris Lymberopoulos. An homogeneous medicaltele-working domain supported by a new remote expert consultation conferencing service. European Transact ion Telecommunications and Related Technology, 1994; 5(4): 495-507
5. Gomez EJ, del Pozo F, Quiles JA, etal. A telemedicine system for remote cooperative medical imaging diagnosis. Computer Method and Programs in Biomedicine, 1996; 49: 37-48
6. James E. Cabral Jr and Yongming Kim Multimedia Systems for Telemedicine and Their Communications Requirements IEEE Communications Magazine July 1996.
7. American College of Radiology, National Electrical Manufac-tures Association. Digital Imaging and Communications in Medicine(DICOM): Version 3.0. Draft Stand-Ard, ACR-NEMA Commi-tree, Working Group Ⅵ, Washington DC, 1993.
8. D. Li and R. R. Muntz. Runtime Dynamics In Collaborative Systems. In Proceedings of ACM GROUP'99 International Conference on Supporting Group Work, Phoenix, Arizona, Nov 1999.
9. D.Li And R.R.Muntz. COCA: Collaborative Objects Coordinaton Architecture. In Proceedings Of ACM CSCW'98, Seattle, WA, Nov. 1998.
10. P. Dourish And V. Bellotti. Awareness And Coordination In Shared Workspaces, Proc. Int. Conf. On CSCW (Toronto, Canada). Oct. 1992, P 107-114, J. Turner And R.E.Kraut(Eds), ACM Press, 1992.
11. T.Rodden. Populating The Application: A Model Of Awareness For Coorperative Applicatons. Proc. Of The ACM 1996 Conf. On CSCW, Boston, Mass. Pp.87-96, 1996
12. L.M.Haas, R.J.Miller, B.Niswonger Etc. Transforming Heterogeneous Data With Database Middleware, IEEE Transaction On Data Engineering, 1999; 22(1): 31-37
13. C.B.Et Al. Electronic Medical Consultation: A New Zealand Perspective. URL: http://www.jmir.org/2001/1/E13/, 2001.Journal Of Medical Internet Research 2001: 3(1)
14．胡秉谊，白净，叶大田．远程医疗系统的客户／服务器结构模型．清华大学学报(自然科学版)1999；39(1)：19-21
15．艾育华，方少元，孙季丰．远程医疗浅析．北京生物医学工程．2000；19(4)：249-252
16．余正华，陈克琴，黄玫．论发展远程医疗服务．医学信息．2000；13(12)：651-652
17．李科，尧德中，蒲立新．基于组播技术的远程医疗会诊系统．生物医学工程杂志．2003；20(2)：237-240
18．黄锡伟，毕厚杰．计算机支持的协同工作(CSCW)研究和设计．计算机工程与应用．1998．6：31-34
19．李人厚，郑庆华．CSCW的概念、结构、理论与应用[J]．计算机工程与应用．1997：33(2)：8-33
20．张冰，张文英．基于CSCW的协同编著系统[J]．计算机工程与应用．2001；35(5)：80-82
21．孙艳春，刘积仁．CSCW系统体系结构模型的研究[J]．小型微型计算机系统．2001；22(2)：210-213
22．王魁生，李人厚，李宏敏等．一个CSCW系统的设计与实现[J]．小型微型计算机系统，2001；22(2)：214-217
23．李村合．谈网络环境下的信息存储技术．情报学报，2002：21(1)：48-51
24．陈凯，白英彩．网络存储技术及发展趋势．电子学报，2002；30(12A)：1928-1932
25．池慧．远程放射学与远程医学．国外医学生物医学分册，1998；21(8)：
112-120
26．葛声，马殿富，怀进鹏．基于角色的群体感知模型．软件学报，2001；12(6)：864—871
27．郑庆华，李人厚．CSCW协作多用户接口的设计与实现，小型计算机系统，1998；19(1)：40-46
28．远程医疗及其协同理论与技术研究．西北大学博士论文
29．李军怀，周明全，耿国华．异构环境下的CSCW模型研究与实现，计算机科学，2002；10
30．王奎生．计算机支持协同设计系统的研究与实现．西安交通大学博士论文
31．吴小毅，宋庆宇．远程医疗系统的支撑技术，遵义医学院学报，2002；25(4)：359-360
32．廉世俊，胡大可．远程医疗中的通信问题，国外医学生物医学工程分册，1999；22(5)：263-269
33．高燕婕．世界卫生组织关于远程医疗的发展策略，中国医院统计，2000；7(3)：161-162
34．杨全胜，朱士俊，刘海一．远程会诊的信息安全及管理对策，解放军医院管理杂志，1999；6(5)：375-377
35．吉农．远程医疗服务的管理及质量控制，中华医院管理杂志，1998；14(9)：566-569
36．钟晓东，胡晓亮，张永红等．基于CSCW的分布式多媒体远程合作会诊系统的设计与实现，电子学报，2003；31(11)：1634-1638
37．潘耘，冷英男，李文超等．CSCW的研究内容及其关键技术，抚顺石油学院学报，2001；21(3)：65-69