FPAX的数据库系统设计与远程医学关键技术的研究
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摘要
随着网络技术的迅速发展，在医院建立高效率、高质量的医学图像归档及通信系统(Picture Archiving and Communication System，PACS)的时机已经成熟。建立PACS的目的是为了利用先进的医学图像处理技术和计算机网络技术解决目前阻碍医院网络化信息管理的海量医学影像的获取、显示、存储、查询、保密、交换等问题，实现医院各种图像信息的共享。它是现代医院综合化信息管理中的一个重要组成部分，是集最先进的计算机、通讯、医学影像、医院信息管理等技术为一体的复杂系统工程，代表着当前医疗信息系统应用的最高水平。因此，PACS系统的研究和设计吸引了许多研究人员的全力投入，但是，要真正建立一套完整和具有广泛适应性的解决方案而且适合中国当前医院管理模式的PACS系统还有一定的距离。
本研究受军队“十五”重大课题《数字医学图象通信与处理关键新技术研究》的支持，本人有幸参加并开展了比较深入的研究工作。
在对目前军队医院普遍使用的医院信息管理系统——“军惠医院信息管理系统”进行深入的调查、分析后，根据医院各类人员对医学影像数据的不同需求，结合临床用户的实际需要，在系统设计中注意遵循分布式数据库设计的原理以及当今对象—关系数据库系统发展的新理论，同时借鉴面向对象设计中最新的设计模式，增加了系统的可维护性。另外，为了实现远程的医学影像数据共享，本人采用当前在Internet网络设计中最佳的编程工具——Java语言来实现基于Web的远程PACS系统。
本文主要分为以下两个部分：
(1)FPAX系统的数据库系统设计与实现。
目前，PACS是现代医院实现信息化和网络化的一个研究热点。PACS系统旨在综合利用现代的数字化技术、图像技术、通信技术和计算机网络技术，取代医院目前对医学影像数据仍旧采用胶片的管理方式，解决目前不适应现代医院发展需要的医学影像图像的获取、显示、存储、查询、保密、交换等问题。本部分基于实验室以前关于DICOM标准和图像处理研究的技术积累，受到军队“十五”重大课题资助，主要研究和分
析了医院信息管理系统应当遵循的HL7标准与医学影像数据应当遵循的
DlcoM3.0标准之间相互关联的部分，以及当前数据库系统设计的原理和
方法，注重实现确实能够在医院发挥效能的PACS系统设计中应考虑与解
决的关键问题与特色技术。
(2)基于Java技术的远程医疗系统的方案研究。
本研究试图对应用Java技术构筑远程医疗网进行一点初浅的探讨，
希望借助Java的强大功能，应用JSP/Servlet建立一个远程医疗网站;
应用Java APPlet实现电子白板、语音传输、文字交流等功能;采用JPEG
和小波算法实现图像的压缩;实现多种传输模式结构;实现病历数据的
后台管理;最终建立一个适合不同操作系统的远程医疗会诊及教育系统。
Along with the rapid development of the network technologies, it is the real time for hospitals to build a Picture Archiving and Communication System with high efficiency and high quality. The goal of PACS (Picture Archiving and Communication System) is to utilize the advanced technology of medical imaging and computer network to solve the problems of acquisition, viewing, storage, query, transmission, secrecy and coding of the gigantic amount of medical^ image data to catch up with the rapid development of networklized information management in modem hospitals. It is the most important part of the integrated information management of modem hospitals, and it is a most complicated systems engineering and integrates with technologies of computer, communication, medical image manipulation and hospital information management. The research and development of PACS has been carried on by many researchers and companies for years, but there are still problems hampering to build a really suitable PACS, which could rea
lly benefit the hospitals especially in China.
This research is supported by PLA's key research project of 10?Five-Year Plan, the key technologies of the communication and manipulation of digital medical images. I have the honor to become a member of the group and participate in the research on the development of the FPAX system.
After investigating into the JunHui hospital information system(JunHui HIS), which is widely used in PLA's hospitals, and with the user's requirements coming from different kinds of hospitals for PACS, This thesis pays special attention to comply with the theory of Distributed Database System design and the new theory about the Object-Relation Database System. The propose is obviously that I want to make the design of the FPAX's Database system more reliable, efficient and valuable. In addition, in order to sharing the medical images with others who are in anther area, I use the Java language to program and archive the tele-PACS based on the Web technologies.
The main topics discussed in the thesis consist of two parts:
Part one: The Design and Realization of the FPAX's Database system.
Recently, research and development of PACS is a hot-point in biomedical
engineering and modernization of hospitals. The goal of PACS is to utilize
the advanced technology of digital, medical image, communication and
computer network to solve the problems of acquisition, storage, viewing, search, coding and transmission of medical images which hampered the development of modern hospitals. This part is based on accumulated research results about DICOM standard and medical image of our lab and supported by PLA's key research project of 10?Five-Year Plan. The primary research is focus on HL7 standard, DICOM standard and the relationship between each other. Of course, the theories and approaches about the design of Database management system and how to integrate our previous research results into the FPAX's system will be discussed as a main point.
Part two: In this part, we attempt to introduce the model of the Web site
so as to build a teleconsultation system based on the Browser/Server model. Via using the Java language program, we hope that our telemedicine user can achieve the goal of the teleconsultation just using a WWW browser.
本研究受军队“十五”重大课题《数字医学图象通信与处理关键新技术研究》的支持，本人有幸参加并开展了比较深入的研究工作。
在对目前军队医院普遍使用的医院信息管理系统——“军惠医院信息管理系统”进行深入的调查、分析后，根据医院各类人员对医学影像数据的不同需求，结合临床用户的实际需要，在系统设计中注意遵循分布式数据库设计的原理以及当今对象—关系数据库系统发展的新理论，同时借鉴面向对象设计中最新的设计模式，增加了系统的可维护性。另外，为了实现远程的医学影像数据共享，本人采用当前在Internet网络设计中最佳的编程工具——Java语言来实现基于Web的远程PACS系统。
本文主要分为以下两个部分：
(1)FPAX系统的数据库系统设计与实现。
目前，PACS是现代医院实现信息化和网络化的一个研究热点。PACS系统旨在综合利用现代的数字化技术、图像技术、通信技术和计算机网络技术，取代医院目前对医学影像数据仍旧采用胶片的管理方式，解决目前不适应现代医院发展需要的医学影像图像的获取、显示、存储、查询、保密、交换等问题。本部分基于实验室以前关于DICOM标准和图像处理研究的技术积累，受到军队“十五”重大课题资助，主要研究和分
析了医院信息管理系统应当遵循的HL7标准与医学影像数据应当遵循的
DlcoM3.0标准之间相互关联的部分，以及当前数据库系统设计的原理和
方法，注重实现确实能够在医院发挥效能的PACS系统设计中应考虑与解
决的关键问题与特色技术。
(2)基于Java技术的远程医疗系统的方案研究。
本研究试图对应用Java技术构筑远程医疗网进行一点初浅的探讨，
希望借助Java的强大功能，应用JSP/Servlet建立一个远程医疗网站;
应用Java APPlet实现电子白板、语音传输、文字交流等功能;采用JPEG
和小波算法实现图像的压缩;实现多种传输模式结构;实现病历数据的
后台管理;最终建立一个适合不同操作系统的远程医疗会诊及教育系统。
Along with the rapid development of the network technologies, it is the real time for hospitals to build a Picture Archiving and Communication System with high efficiency and high quality. The goal of PACS (Picture Archiving and Communication System) is to utilize the advanced technology of medical imaging and computer network to solve the problems of acquisition, viewing, storage, query, transmission, secrecy and coding of the gigantic amount of medical^ image data to catch up with the rapid development of networklized information management in modem hospitals. It is the most important part of the integrated information management of modem hospitals, and it is a most complicated systems engineering and integrates with technologies of computer, communication, medical image manipulation and hospital information management. The research and development of PACS has been carried on by many researchers and companies for years, but there are still problems hampering to build a really suitable PACS, which could rea
lly benefit the hospitals especially in China.
This research is supported by PLA's key research project of 10?Five-Year Plan, the key technologies of the communication and manipulation of digital medical images. I have the honor to become a member of the group and participate in the research on the development of the FPAX system.
After investigating into the JunHui hospital information system(JunHui HIS), which is widely used in PLA's hospitals, and with the user's requirements coming from different kinds of hospitals for PACS, This thesis pays special attention to comply with the theory of Distributed Database System design and the new theory about the Object-Relation Database System. The propose is obviously that I want to make the design of the FPAX's Database system more reliable, efficient and valuable. In addition, in order to sharing the medical images with others who are in anther area, I use the Java language to program and archive the tele-PACS based on the Web technologies.
The main topics discussed in the thesis consist of two parts:
Part one: The Design and Realization of the FPAX's Database system.
Recently, research and development of PACS is a hot-point in biomedical
engineering and modernization of hospitals. The goal of PACS is to utilize
the advanced technology of digital, medical image, communication and
computer network to solve the problems of acquisition, storage, viewing, search, coding and transmission of medical images which hampered the development of modern hospitals. This part is based on accumulated research results about DICOM standard and medical image of our lab and supported by PLA's key research project of 10?Five-Year Plan. The primary research is focus on HL7 standard, DICOM standard and the relationship between each other. Of course, the theories and approaches about the design of Database management system and how to integrate our previous research results into the FPAX's system will be discussed as a main point.
Part two: In this part, we attempt to introduce the model of the Web site
so as to build a teleconsultation system based on the Browser/Server model. Via using the Java language program, we hope that our telemedicine user can achieve the goal of the teleconsultation just using a WWW browser.
引文
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2． Knoll,-P; Holl,-K; Mirzaei,-S; Koriska,-K; Kohn,-H, et, al. Distributed nuclear medicine applications using World Wide Web and Java technology[J], Eur-Radiol. 2000; 10(9) : 1483-6．
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5． Mizushima,-H; Uchiyama,-E; Nagata,-H; et, al. Japanese experience of telemedicine in oncology[J], Int-J-Med-Inf. 2001 May; 61(2-3) : 207-15．
6． Dionisio,-J-D; Taira,-R-K; Sinha,-U; et, al. Teleradiology as a foundation for an enterprise-wide health care delivery system, Radiographics[J]. 2000 Jul-Aug; 20(4) : 1137-50．
7． Sung,-M-Y; Kim,-M-S; Kim,-E-J; et, al. CoMed: a real-time collaborative medicine system[J], Int-J-Med-Inf. 2000 Jul; 57(2-3) : 117-26．
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10． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3． 3: Information Object Definition.
11． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3． 4: Service Class Specification.
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1． 白净、张永红，等．远程医疗概论[M]，清华大学出版社，2000．
2． Knoll,-P; Holl,-K; Mirzaei,-S; Koriska,-K; Kohn,-H, et, al. Distributed nuclear medicine applications using World Wide Web and Javatechnology[J], Eur-Radiol. 2000; 10(9) : 1483-6．
3． Hwang,-S-C; Lee,-M-H, "A Web-based telePACS using an asymmetric satellite system", EEEE-Trans-Inf-Technol-Biomed. 2000 Sep; 4(3) : 212-5．
4． Pallawala,-P-M; Lun,-K-C, et, al. EMR based telegeriatric system[J], Int-J-Med-Inf. 2001 May; 61(2-3) : 229-34．
5． Mizushima,-H; Uchiyama,-E; Nagata,-H; et, al. Japanese experience of telemedicine in oncology[J], Int-J-Med-Inf. 2001 May; 61(2-3) : 207-15．
6． Dionisio,-J-D; Taira,-R-K; Sinha,-U; et, al. Teleradiology as a foundation for an enterprise-wide health care delivery system, Radiographics[J]. 2000 Jul-Aug; 20(4) : 1137-50．
7． Sung,-M-Y; Kim,-M-S; Kim,-E-J; et, al. CoMed: a real-time collaborative medicine system[J], Int-J-Med-Inf. 2000 Jul; 57(2-3) : 117-26．
8． "Networking our whiteboard with Java 1． 1". http://www.javaworld.com.
9． "Draw the world: Create networked whiteboards with Java 1． 1" .http://www.iavaworld.com
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11． ANSI(American National Standards Institute), Infromation Resource Dictionary Systems. Document ANSI X3． 138,1989
12． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine. PS3． 1: Introduction and Overview
13． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine. PS3． 2: Conformance
14． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine.PS3． 3: Information Object Definition
15． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in
Medicine, PS3.4: Service Class Specification
16. ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3.5: Data Structure and Encoding
17. ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3.6: Data Dictionary
18. ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3.7: Message Exchange
19. ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, Part8: Network Communication Support for Message Exchange
20．Java高级服务器编程[M]，北京：机械工业出版社，2001
21．JSP编程指南[M]，北京：电子工业出版社，2001．
22．郝立巍硕士论文，PACS系统的设计及基于PACS平台的可视化关键技术研究。2002．05
23．罗奇伟等，构筑基于Web技术的远程医疗网的技术方案，中国医学物理学杂志，2002．
2． Knoll,-P; Holl,-K; Mirzaei,-S; Koriska,-K; Kohn,-H, et, al. Distributed nuclear medicine applications using World Wide Web and Java technology[J], Eur-Radiol. 2000; 10(9) : 1483-6．
3． Hwang,-S-C; Lee,-M-H, "A Web-based telePACS using an asymmetric satellite system", IEEE-Trans-Inf-Technol-Biomed. 2000 Sep; 4(3) : 212-5．
4． Pallawala,-P-M; Lun,-K-C, et, al. EMR based telegeriatric system[J], Int-J-Med-Inf. 2001 May; 61(2-3) : 229-34．
5． Mizushima,-H; Uchiyama,-E; Nagata,-H; et, al. Japanese experience of telemedicine in oncology[J], Int-J-Med-Inf. 2001 May; 61(2-3) : 207-15．
6． Dionisio,-J-D; Taira,-R-K; Sinha,-U; et, al. Teleradiology as a foundation for an enterprise-wide health care delivery system, Radiographics[J]. 2000 Jul-Aug; 20(4) : 1137-50．
7． Sung,-M-Y; Kim,-M-S; Kim,-E-J; et, al. CoMed: a real-time collaborative medicine system[J], Int-J-Med-Inf. 2000 Jul; 57(2-3) : 117-26．
8． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Me,dicine, PS3． 1: Introduction and Overview.
9． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3． 2: Conformance.
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11． ACR-NEMA, 1999/8/26, Digital Imaging and Communications in Medicine, PS3． 4: Service Class Specification.
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