PACS experiences in Trieste

The installation of a commercial PACS in the Hospitals of Trieste has been the start-point for a project of technology assessment, aimed at the evaluation of technical, clinical and economic aspects related to the introduction of this new and expensive technology in the health care system. During more than two years of use of this system in the clinical environment, several research activities have been carried out concerning the analysis of the organization of radiology departments in Italy, the analysis of work and data volumes, the evaluation of technical and clinical performances of PACS versus conventional film-based radiology, the integration between PACS and RIS, the experimentation of teleradiology applications. An overview of the most important activities and related results is given in this paper as well as some indications about future developments of the Trieste Project.     

Overview of some methodological problems in assessment of PACS

The purpose of technology assessment of picture archiving and communications systems (PACS) is to establish the need for the technology, provide a measure of functionality and to establish the costs and benefits associated with the introduction of the system. Given concerns about the clinical acceptability of PACS, it is unlikely that radiologists will change from existing film based systems until a clear demonstration of costs and benefits has been performed. The major need at present is to quantify the benefits which may flow from the introduction of PACS system in a standard manner which can be accepted by all parties involved.     

Workshop aims,outline of the program

This workshop on the Technology Assessment of PACS has been organized as a rounding off of the Technology Assessment Activities which were initiated within the Dutch PACS Project (1986–1989). It is made possible by a funding from the Dutch Ministry of Health Care (WVC). We hope it will be not only a rounding off, but will contribute to more intensive cooperations in this area. In the scope of the Dutch PACS project, the software package CAPACITY for cost analyses of PACS has been developed, to stimulate the dialogue and exchange of data. During the workshop, the data which were collected with CAPACITY are used as a framework for discussions. This paper presents the outline of the workshop, its background, its aims and the program.     

PACS辅助教学在医学影像学实习教学中的应用探讨

尝试应用影像存储及传输系统(Picture Archiving and Communication System,PACS),对我院临床本科生进行影像学实习教学。首先应用PACS建立电子影像学图片库,学生在PACS联网的计算机上学习教学内容,通过定期随堂测验、期末考试和课后问卷调查评估PACS辅助教学的教学效果,对PACS辅助教学在医学影像学实习教学中的应用价值进行探讨。与以往传统医学影像学实习教学方法相比,PACS辅助教学在医学影像学实习教学中具有激发学生学习主动性、提高学习效率和学生读片能力的优越性,显著提高教学效果和教学质量,对促进医学影像学教学改革具有重要意义。     

Benefits of coordinated action in PACS evaluation

PACS, a health care technology still in its developmental stage, aims to improve the management of diagnostic imaging investigations. As the technology has not been comprehensively assessed, data and facts to justify its clinical, economic and other benefits are to date insufficient. Through internationally coordinated action, it is expected to obtain a faster and more comprehensive technology assessment of PACS as well as recommendations for optimization of the system and guidelines for its rational use in various health care environments.     

Influence of health care systems on the market for picture archiving and communication systems

An analysis is given of the relation between health care systems and the PACS market. Two driving forces exist in the market: quality and price. It is argued that the quality driven market is mainly independent of the health care system and will be the force that drives the introduction of the health care system and will be the force that drives the introduction of PACS in the forthcoming years. Finally a change of focus is suggested from only archiving and communication to a more general concept of image networking, serving more goals than only the goal of working filmlessly.     

Experience with an operational nuclear medicine PACS in the Utrecht University Hospital

At the department of nuclear medicine of the University Hospital Utrecht a single modality PACS has been operational since mid 1990. After 1 year of operation the functionality, the organizational and economical consequences and the acceptability of the PACS are evaluated. The functional aspects reviewed are: viewing facilities, patient data management, connectivity, reporting facilities, archiving, privacy and security. It is concluded that the improved quality of diagnostic viewing and the potential integration with diagnosis, reporting and archiving are highly appreciated. The many problems that have occurred during the transition period, however, greatly influence the appreciation and acceptability of the PACS. Overall, we feel that on the long term there will be a positive effect on the quality and efficiency of the work done in our department.     

IMPAX PACS在黑龙江省区域化医疗远程会诊中的初步应用

目的:研究黑龙江省不同医疗机构之间新型协同服务模式,加强垦区各级医疗机构的信息化基础建设,建立基于医学影像存档与通信传输系统(Picture Archiving and Communications System,PACS)的数字化医疗区域。方法:将哈尔滨医科大学附属第四医院现有的影像数据归档,集成到IMPAX PACS数据中心(Internet Data Center,IDC),作为整个区域医疗的影像中心。通过IDC交换平台的延伸覆盖,以及医院信息系统(Hospital Information System,HIS)与XERO集成,可经网络调阅IDC中的影像,实现远程影像会诊。结果:建立基于IMPAX PACS的区域医疗;工程覆盖1家省会大医院和垦区2家综合性医院、5家二级医院、11家农场医院,实现联网医院间的影像学远程会诊。结论:PACS区域远程医疗系统的建立为基层百姓就医提供方便,影像学远程会诊可有效避免影像学重复检查,双向转诊、信息共享给患者带来更多的便利和实惠,具有巨大的社会效益。     

BAFF and innate immunity: new therapeutic targets for systemic lupus erythematosus

Recently, the B cell has emerged as a cornerstone of systemic lupus erythematosus (SLE) pathogenesis. This has been highlighted by studies of the cytokine B-cell-activating factor of the tumour necrosis factor (TNF) family (BAFF), a crucial factor regulating B-cell maturation, survival and function. Overexpression of BAFF in mice leads to the development of an SLE-like disease, independent of T cells but instead relying on innate immunity mechanisms. Moreover, BAFF has been shown to be elevated in the serum of patients suffering from autoimmune conditions, especially SLE, and may correlate with disease activity. These findings challenge the previous notion that T:B-cell collaboration is the sole driver of SLE. In recent years, controlled trials have for the first time tested targeted therapeutics for SLE. However, agents designed to target B cells failed to meet primary endpoints in clinical trials in SLE, suggesting that a more complex role for B cells in SLE awaited elucidation. By contrast, on 9 March 2011, the US Food and Drug Administration approved belimumab, a fully human anti-BAFF monoclonal antibody, as a new B-cell-specific treatment for SLE. This article will review over 10 years of research on the BAFF system, key findings that led to this recent positive clinical outcome and propose a model potentially explaining why this B-cell-specific therapy has yielded positive results in clinical trials. We will also review promising therapies presently in clinical trials targeting innate immunity, which are likely to revolutionize SLE management towards a personalized and targeted therapy approach.     

郑州市第五人民医院PACS医学影像系统设计

本文介绍了郑州市第五人民医院PACS医学影像系统,描述了系统的目标,构架,功能和特点,采用了功能化的模块设计。可满足后续设备联入系统,已应用于医院的医疗过程中,解决了医学图像的获取,显示,存储,传输和管理等问题。符合DICOM3.0国际信息交换标准,实现了数字化,网络化和无胶片化的现代化医学影像诊断与管理,显著提高了诊疗质量和工作效率,降低了医疗成本,增加了经济收入和社会效益,对其它医院实现数字化进程也具有一定的借鉴意义。     

医用PACS系统及其主要技术问题

医用图像归档与通信系统(简称PACS)是近年来医学图像处理的一个研究热点。本文介绍了这一系统的基本功能、系统构成及其几个主要技术问题。     

Focus: 50 Years of DNA Repair: The Yale Symposium Reports: Fanconi Anemia: A Signal Transduction and DNA Repair Pathway

Fanconi anemia (FA) is a fascinating, rare genetic disorder marked by congenital defects, bone marrow failure, and cancer susceptibility. Research in recent years has led to the elucidation of FA as a DNA repair disorder and involved multiple pathways as well as having wide applicability to common cancers, including breast, ovarian, and head and neck. This review will describe the clinical aspects of FA as well as the current state of its molecular pathophysiology. In particular, work from the Kupfer laboratory will be described that demonstrates how the FA pathway interacts with multiple DNA repair pathways, including the mismatch repair system and signal transduction pathway of the DNA damage response.     

Innovation meets quality: moving cellular therapies at the National Institutes for Health from bench to bedside

The National Institutes of Health (NIH) Department of Transfusion Medicine has supported clinical investigation in cellular therapies over the past 20 years. This experience, which encompasses product development research, quality system design and product manufacturing for a wide range of early phase clinical trials, provides a firm basis for future work with novel stem cell therapies.     

CBL教学模式在脑血管病教学中的应用分析

在我国案例教学法（CBL）已逐步运用到了脑血管病的教学中。CBL通过互动性的教学训练,在案例实战过程中增强了学生 对学习的主动性,令其能迅速地把握脑血管病的诊断方法,建立疾病相关的知识轮廓,同时培养其科学的分析思路以及熟悉正确 的处理与治疗疾病方法,使得其临床实践能力及整体综合能力得到了提高,从而为日后的正式临床工作打下良好的基础。     

PACS的高级预防维护技术

目的 通过讨论PACS高级预防维护技术,供同他人在日常维护过程中有一定地借鉴作用.方法 从PACS数据库性能检测与优化,存储设备检测及PACS各应用软件模块三方面进行阐述.结果 经过医院一线安装维护人员和PACS厂家多年实践的总结,拥有一定的可参考依据.结论 PACS的高级预防维护是一个复杂的系统工程,包括一般维护和高级维护在内的实践理论才刚刚起步,科学的、规范化的预防维护需要不断地完善和发展.     

Cellular distribution, metabolism and regulation of the xanthine oxidoreductase enzyme system

Xanthine oxidase (EC 1.1.3.22) and xanthine dehydrogenase (EC 1.1.1. 204) are both members of the molybdenum hydroxylase flavoprotein family and represent different forms of the same gene product. The two enzyme forms and their reactions are often referred to as xanthine oxidoreductase (XOR) activity. Physiologically, XOR is known as the rate-limiting enzyme in purine catabolism but has also been shown to be able to metabolize a number of other physiological compounds. Recent studies have also demonstrated its ability to metabolize xenobiotics, including a number of anticancer compounds, to their active metabolites. During the past 10 years, evidence has mounted to support a role for XOR in the pathophysiology of inflammatory diseases and atherosclerosis as well as its previously determined role in ischemia-reperfusion injury. While significant progress has recently been made in our understanding of the physiological and biochemical nature of this enzyme system, considerable work still needs to be done. This paper will review some of the more recent work characterizing the interactions and the factors that influence the interactions of XOR with various physiological and xenobiotic compounds.     

Current views on the functionalities of PACS

The concept of PACS has evolved from a central storage of medical images to a distributed data and image management system. The trend and evolution of the definition and design of PACS systems is described in this paper. Special emphasis on the concept of distributed and open architecture is given with a discussion of the advantages and disadvantages of each approach. A hospital-wide PACS system designed based on a distributed architecture integrated with a Hospital Information System (HIS) at the University Hospital of Geneva is further described.     

Overview of capacity data

This paper presents an overview of the data from 15 cases collected with the CAPACITY software for cost analysis of PACS. The data suggest that both hospital wide and partial PACS implementations do not pay back yet. Only Nuclear Medicine PACS systems may be introduced cost-neutral in the near future. Because of the assumed price drop of hardware components of 5–25% per year, hospital wide and partial PACS may allow cost savings within the next 10–20 years. There are major differences in viewpoints concerning the required PACS configurations and their costs. The experiences with the CAPACITY software suggest the need for the establishment of key rules, for designing a PACS configuration and for estimating PACS costs.     

Required functionality of PACS from clinical point of view

Concerning the required functionality of PACS from a clinical point of view this paper describes the functionality during the several phases of the imaging process. A list of general requirements is summarized. To get more information a period of prototype development and testing is needed. During this period the required functionality has to be investigated by questionnaires and automatic registration by the work stations.     

MALDI imaging mass spectrometry for direct tissue analysis: technological advancements and recent applications

Matrix assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) is a method that allows the investigation of the molecular content of tissues within its morphological context. Since it is able to measure the distribution of hundreds of analytes at once, while being label free, this method has great potential which has been increasingly recognized in the field of tissue-based research. In the last few years, MALDI-IMS has been successfully used for the molecular assessment of tissue samples mainly in biomedical research and also in other scientific fields. The present article will give an update on the application of MALDI-IMS in clinical and preclinical research. It will also give an overview of the multitude of technical advancements of this method in recent years. This includes developments in instrumentation, sample preparation, computational data analysis and protein identification. It will also highlight a number of emerging fields for application of MALDI-IMS like drug imaging where MALDI-IMS is used for studying the spatial distribution of drugs in tissues.