基于IHE的PACS工作流系统研究与实现
摘要
随着DICOM(Digital Imaging and Communications in Medical医学数字成像及通信协议)标准的不断完善和普遍推广，PACS(Picture Achieving and Communication System医学影像归档与传输系统)工程在国内外得到广泛应用实践。在系统实施方面，由于复杂的实际工作流程和应用环境，对技术提出更高的需求，要求支持更多更先进的特性。因此，从集成技术规范、工业标准到具体应用实施各个层次，对PACS的研究与设计得到不断深入和创新。
国际范围的各种相关研究机构和行业组织，针对新的发展方向和临床应用需求，对标准制定和系统集成进行了新一轮的研究讨论和修订升级，这些组织和形成的标准规范包括ACR-NEMA(American Colleague of Radiography-Nation Electrical Manufacturers Association美国放射学会和美国国家电气制造商协会)的DICOM，RSNA(Radiological Society of North America北美放射学会)和HIMSS(Healthcare Information and Management Systems Society医疗信息和管理系统协会)的IHE(Integrating the Healthcare Enterprise集成医疗机构)，以及ANSI(American National Standards Institute美国国家标准学会)指定为其工业标准的异质系统之间的通讯协议的HL7(Health Level Seven医疗第七层)。这些修订的标准和协议包含一些共同特征，即对系统工作流的定义和规划，对异质系统间信息共享等，以解决医疗领域中设计实现和集成系统时遇到的工作流问题，达到更佳的应用效果。
文章首先讨论PACS之前、早期PACS的工作流程，进行优劣对比，然后在对这些规范和标准的解析基础上，设计基于IHE技术规范的PACS的工作流框架，然后对具体标准定义的工作流相关内容进行解析，采用各种技术加以实现。框架下的详细系统分析和实现分三个部分阐述，一是以标准DICOM设备为图像来源的工作流分析与实现；二是以非标准DICOM设备为图像来源的工作流分析与实现；三是整体管理的角度对PACS管理子系统的设计与实现。通过这些方法，实现更高层次PACS的研究与集成开发，及其对医院医疗质量的全面提升和降低综合成本的目标。
With the enhancement and extending of DICOM (Digital imaging and Commumcations in Medical), PACS (Picture Achieving and Communication System) projects was widely implemented and carried out all over the world. In the area of system putting in practice, because of complexity of actual workflow and system environment, the technology had been asked for higher level requirement, and supported more advanced features. From framework of integration of system, to industry standards, to application used, design and research of PACS was deepened and innovated along with the time.
According to the situation mentioned above, many research institutes and industry organizes relating to PACS, had carried out a new circle of research and upgrade of constitution of the standards and system integration. These organizes and their standards were ACR-NEMA (American Colleague of Radiography - Nation Electrical Manufacturers Association) DICOM, RSNA (Radiological Society of North America), RSNA (Radiological Society of North America) and HIMSS (Healthcare Information and Management Systems Society)'s IHE (Integrating the Healthcare Enterprise), and HL7 (Health Level Seven) which was assigned as the industry standard of ANSI (American National Standards Institute). The same features of these standards and protocols lately added includes that they define and plan the system workflow and information sharing between heterogeneous systems. Through these methods, we could resolve the problem of actual workflow and system integration in healthcare region, and then we could get better application results
.
We discussed and compared the workflows of the periods before PACS and original of PACS at first. Then based on parsing of criterion and standards, we designed the framework of PACS workflow based on the IHE technique criterion. After that, we parsed the concrete content relating to workflow in the standards, and implement them using various technology. Under the framework, the detailed system analysis and implementations were separated into three parts. The first part analyzed and implemented the workflow sourced from standard DICOM modalities. The second part analyzed and implemented the workflow sourced from non-standard DICOM
modalities. The third part designed the subsystem of PACS management in order to manage wholly. By these means, we could upgrade the research and integration development of PACS to a higher level, and we could realize the object of advance hospital's healthcare quality on full-scale and reduce the general cost.
国际范围的各种相关研究机构和行业组织，针对新的发展方向和临床应用需求，对标准制定和系统集成进行了新一轮的研究讨论和修订升级，这些组织和形成的标准规范包括ACR-NEMA(American Colleague of Radiography-Nation Electrical Manufacturers Association美国放射学会和美国国家电气制造商协会)的DICOM，RSNA(Radiological Society of North America北美放射学会)和HIMSS(Healthcare Information and Management Systems Society医疗信息和管理系统协会)的IHE(Integrating the Healthcare Enterprise集成医疗机构)，以及ANSI(American National Standards Institute美国国家标准学会)指定为其工业标准的异质系统之间的通讯协议的HL7(Health Level Seven医疗第七层)。这些修订的标准和协议包含一些共同特征，即对系统工作流的定义和规划，对异质系统间信息共享等，以解决医疗领域中设计实现和集成系统时遇到的工作流问题，达到更佳的应用效果。
文章首先讨论PACS之前、早期PACS的工作流程，进行优劣对比，然后在对这些规范和标准的解析基础上，设计基于IHE技术规范的PACS的工作流框架，然后对具体标准定义的工作流相关内容进行解析，采用各种技术加以实现。框架下的详细系统分析和实现分三个部分阐述，一是以标准DICOM设备为图像来源的工作流分析与实现；二是以非标准DICOM设备为图像来源的工作流分析与实现；三是整体管理的角度对PACS管理子系统的设计与实现。通过这些方法，实现更高层次PACS的研究与集成开发，及其对医院医疗质量的全面提升和降低综合成本的目标。
With the enhancement and extending of DICOM (Digital imaging and Commumcations in Medical), PACS (Picture Achieving and Communication System) projects was widely implemented and carried out all over the world. In the area of system putting in practice, because of complexity of actual workflow and system environment, the technology had been asked for higher level requirement, and supported more advanced features. From framework of integration of system, to industry standards, to application used, design and research of PACS was deepened and innovated along with the time.
According to the situation mentioned above, many research institutes and industry organizes relating to PACS, had carried out a new circle of research and upgrade of constitution of the standards and system integration. These organizes and their standards were ACR-NEMA (American Colleague of Radiography - Nation Electrical Manufacturers Association) DICOM, RSNA (Radiological Society of North America), RSNA (Radiological Society of North America) and HIMSS (Healthcare Information and Management Systems Society)'s IHE (Integrating the Healthcare Enterprise), and HL7 (Health Level Seven) which was assigned as the industry standard of ANSI (American National Standards Institute). The same features of these standards and protocols lately added includes that they define and plan the system workflow and information sharing between heterogeneous systems. Through these methods, we could resolve the problem of actual workflow and system integration in healthcare region, and then we could get better application results
.
We discussed and compared the workflows of the periods before PACS and original of PACS at first. Then based on parsing of criterion and standards, we designed the framework of PACS workflow based on the IHE technique criterion. After that, we parsed the concrete content relating to workflow in the standards, and implement them using various technology. Under the framework, the detailed system analysis and implementations were separated into three parts. The first part analyzed and implemented the workflow sourced from standard DICOM modalities. The second part analyzed and implemented the workflow sourced from non-standard DICOM
modalities. The third part designed the subsystem of PACS management in order to manage wholly. By these means, we could upgrade the research and integration development of PACS to a higher level, and we could realize the object of advance hospital's healthcare quality on full-scale and reduce the general cost.
引文
[1] ACR-NEMA Digital Imaging and Communication in Medicine. PS3. 1 2003.
[2] ACR-NEMA Digital Imaging and Communication in Medicine. PS3. 3 2003.
[3] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 4 2003.
[4] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 5 2003.
[5] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 8 2003.
[6] 胡光荣．基于DICOM3. 0的PACS医生工作站及相关技术的研究和设计·中国优秀博硕论文数据库 2002．
[7] 王志远，余厚军，石明国·医学图像通讯标准DICOM原理与应用．现代医用影像学 2000．9．
[8] HIMSS/RSNA. IHE Technical Framework Volume Ⅰ June 12, 2003.
[9] HIMSS/RSNA. IHE Technical Framework Volume Ⅱ June 12, 2003.
[10] HL7 Version 2. 3. 1, http://www. hl7. org.
[11] HL7 Working Group, HL7 v2. 3 Reference Model. 1996. 1-6.
[12] HL7 Engine 技术说明，http://www. drpacific. com 2002-03.
[13] 谢新鹏，李绥胜·联通信息孤岛——军队医院HIS的现状及其采用HL7标准的必要．计算机世界，2002-07-11：25-18．
[14] 论PACS系统建设·医疗设备信息，医疗设备信息，2001-09：1-4．
[15] 王卫东，祝军，王剑，陈广飞·图像存档和通讯系统(PACS)及相关技术，医疗设备信息，2001(1)：1-3．
[16] 蒲卫，李军，张涛·医院信息系统与PACS的融合，医疗设备信息，2001(6)：1-3．
[17] 陈金雄，刘雄飞，吴学贵·军队医院PACS的设计与实现，医疗设备信息，2001(7)：1-2．
[18] 王岩，田捷，韩博文·基于DICOM标准的医疗数据通信设计，微
型机与应用，2001(2)：38-42．
[19] 王卫东，祝军，王剑，陈广飞·图像存档和通信系统(PACS)及其相关技术，医疗设备信息，2001(1)：1-3．
[20] 陶勇浩，缪兢陶，刘荣波·医学数字影像传输系统间互联及互操作性的初步实践，中华放射学杂志，1999年12月第33卷第12期：807-890．
[2] ACR-NEMA Digital Imaging and Communication in Medicine. PS3. 3 2003.
[3] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 4 2003.
[4] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 5 2003.
[5] ACR-NEMA. Digital Imaging and Communication in Medicine. PS3. 8 2003.
[6] 胡光荣．基于DICOM3. 0的PACS医生工作站及相关技术的研究和设计·中国优秀博硕论文数据库 2002．
[7] 王志远，余厚军，石明国·医学图像通讯标准DICOM原理与应用．现代医用影像学 2000．9．
[8] HIMSS/RSNA. IHE Technical Framework Volume Ⅰ June 12, 2003.
[9] HIMSS/RSNA. IHE Technical Framework Volume Ⅱ June 12, 2003.
[10] HL7 Version 2. 3. 1, http://www. hl7. org.
[11] HL7 Working Group, HL7 v2. 3 Reference Model. 1996. 1-6.
[12] HL7 Engine 技术说明，http://www. drpacific. com 2002-03.
[13] 谢新鹏，李绥胜·联通信息孤岛——军队医院HIS的现状及其采用HL7标准的必要．计算机世界，2002-07-11：25-18．
[14] 论PACS系统建设·医疗设备信息，医疗设备信息，2001-09：1-4．
[15] 王卫东，祝军，王剑，陈广飞·图像存档和通讯系统(PACS)及相关技术，医疗设备信息，2001(1)：1-3．
[16] 蒲卫，李军，张涛·医院信息系统与PACS的融合，医疗设备信息，2001(6)：1-3．
[17] 陈金雄，刘雄飞，吴学贵·军队医院PACS的设计与实现，医疗设备信息，2001(7)：1-2．
[18] 王岩，田捷，韩博文·基于DICOM标准的医疗数据通信设计，微
型机与应用，2001(2)：38-42．
[19] 王卫东，祝军，王剑，陈广飞·图像存档和通信系统(PACS)及其相关技术，医疗设备信息，2001(1)：1-3．
[20] 陶勇浩，缪兢陶，刘荣波·医学数字影像传输系统间互联及互操作性的初步实践，中华放射学杂志，1999年12月第33卷第12期：807-890．