Luís A. Bastião Silva

A PACS archive architecture supported on cloud services

PurposeDiagnostic imaging procedures have continuously increased over the last decade and this trend may continue in coming years, creating a great impact on storage and retrieval capabilities of current PACS. Moreover, many smaller centers do not have financial resources or requirements that justify the acquisition of a traditional infrastructure. Alternative solutions, such as cloud computing, may help address this emerging need.MethodsA tremendous amount of ubiquitous computational power, such as that provided by Google and Amazon, are used every day as a normal commodity. Taking advantage of this new paradigm, an architecture for a Cloud-based PACS archive that provides data privacy, integrity, and availability is proposed. The solution is independent from the cloud provider and the core modules were successfully instantiated in examples of two cloud computing providers. Operational metrics for several medical imaging modalities were tabulated and compared for Google Storage, Amazon S3, and LAN PACS.ResultsA PACS-as-a-Service archive that provides storage of medical studies using the Cloud was developed. The results show that the solution is robust and that it is possible to store, query, and retrieve all desired studies in a similar way as in a local PACS approach.ConclusionCloud computing is an emerging solution that promises high scalability of infrastructures, software, and applications, according to a “pay-as-you-go” business model. The presented architecture uses the cloud to setup medical data repositories and can have a significant impact on healthcare institutions by reducing IT infrastructures.

DICOM relay over the cloud

PurposeHealthcare institutions worldwide have adopted picture archiving and communication system (PACS) for enterprise access to images, relying on Digital Imaging Communication in Medicine (DICOM) standards for data exchange. However, communication over a wider domain of independent medical institutions is not well standardized. A DICOM-compliant bridge was developed for extending and sharing DICOM services across healthcare institutions without requiring complex network setups or dedicated communication channels.MethodsA set of DICOM routers interconnected through a public cloud infrastructure was implemented to support medical image exchange among institutions. Despite the advantages of cloud computing, new challenges were encountered regarding data privacy, particularly when medical data are transmitted over different domains. To address this issue, a solution was introduced by creating a ciphered data channel between the entities sharing DICOM services.ResultsTwo main DICOM services were implemented in the bridge: Storage and Query/Retrieve. The performance measures demonstrated it is quite simple to exchange information and processes between several institutions. The solution can be integrated with any currently installed PACS-DICOM infrastructure. This method works transparently with well-known cloud service providers.ConclusionsCloud computing was introduced to augment enterprise PACS by providing standard medical imaging services across different institutions, offering communication privacy and enabling creation of wider PACS scenarios with suitable technical solutions.

Anatomy of an Extensible Open Source PACS.

The conception and deployment of cost effective Picture Archiving and Communication Systems (PACS) is a concern for small to medium medical imaging facilities, research environments, and developing countries’ healthcare institutions. Financial constraints and the specificity of these scenarios contribute to a low adoption rate of PACS in those environments. Furthermore, with the advent of ubiquitous computing and new initiatives to improve healthcare information technologies and data sharing, such as IHE and XDS-i, a PACS must adapt quickly to changes. This paper describes Dicoogle, a software framework that enables developers and researchers to quickly prototype and deploy new functionality taking advantage of the embedded Digital Imaging and Communications in Medicine (DICOM) services. This full-fledged implementation of a PACS archive is very amenable to extension due to its plugin-based architecture and out-of-the-box functionality, which enables the exploration of large DICOM datasets and associated metadata. These characteristics make the proposed solution very interesting for prototyping, experimentation, and bridging functionality with deployed applications. Besides being an advanced mechanism for data discovery and retrieval based on DICOM object indexing, it enables the detection of inconsistencies in an institution’s data and processes. Several use cases have benefited from this approach such as radiation dosage monitoring, Content-Based Image Retrieval (CBIR), and the use of the framework as support for classes targeting software engineering for clinical contexts.

Medical imaging archiving: A comparison between several NoSQL solutions

The use of digital medical imaging systems has greatly increased in healthcare institutions and they are currently valuable tools supporting medical decision and treatment procedures. The proliferation of digital modalities led to an explosion on medical images production, increasing the need to have larger repositories to afford all this amount of data with high availability and performance. NoSQL databases have been replacing relational databases in some scenarios, due to their horizontal scalability and to their flexibility to adapt to dynamic requirements. In this paper, we present an implementation of a medical imaging archive supported in both MongoDB and CouchDB. This implementation is compliant with the medical imaging standards and the storage and query/retrieve performance of our different implementations were evaluated. We also discuss the strengths and weakness of the proposed implementations and present several scenarios that take advantage of the proposed solutions.

A Routing Mechanism for Cloud Outsourcing of Medical Imaging Repositories

Web-based technologies have been increasingly used in picture archive and communication systems (PACS), in services related to storage, distribution, and visualization of medical images. Nowadays, many healthcare institutions are outsourcing their repositories to the cloud. However, managing communications between multiple geo-distributed locations is still challenging due to the complexity of dealing with huge volumes of data and bandwidth requirements. Moreover, standard methodologies still do not take full advantage of outsourced archives, namely because their integration with other in-house solutions is troublesome. In order to improve the performance of distributed medical imaging networks, a smart routing mechanism was developed. This includes an innovative cache system based on splitting and dynamic management of digital imaging and communications in medicine objects. The proposed solution was successfully deployed in a regional PACS archive. The results obtained proved that it is better than conventional approaches, as it reduces remote access latency and also the required cache storage space.

A Centralized Platform for Geo-Distributed PACS Management

Picture Archive and Communication System (PACS) is a globally adopted concept and plays a fundamental role in patient care flow within healthcare institutions. However, the deployment of medical imaging repositories over multiple sites still brings several practical challenges namely related to operation and management (O&M). This paper describes a Web-based centralized console that provides remote monitoring, testing, and management over multiple geo-distributed PACS. The system allows the PACS administrator to define any kind of service or operation, reducing the need for local technicians and providing a 24/7 monitoring solution.

An Agile Framework to Support Distributed Medical Imaging Scenarios

Healthcare institutions are increasingly taking advantage of telemedicine to create collaborative workspaces. However, the continuous production of medical data requires higher performance from infrastructures, to maintain or even enhance the quality of service. On the other hand, a tremendous amount of ubiquitous computational power and an unprecedented number of Internet resources and services are used every day as a normal commodity. This paper presents a Cloud-based telemedicine framework that allows applications to store data and communicate easily, using any Cloud provider. From this framework, two medical imaging applications were developed to provide standard services with high abstraction level: a medical imaging repository and an inter-institutional communications platform. Furthermore, a telemedicine case study is presented, namely a regional repository, where the physicians can review medical studies from anywhere and at any time.

An efficient architecture to support digital pathology in standard medical imaging repositories

In the past decade, digital pathology and whole-slide imaging (WSI) have been gaining momentum with the proliferation of digital scanners from different manufacturers. The literature reports significant advantages associated with the adoption of digital images in pathology, namely, improvements in diagnostic accuracy and better support for telepathology. Moreover, it also offers new clinical and research applications. However, numerous barriers have been slowing the adoption of WSI, among which the most important are performance issues associated with storage and distribution of huge volumes of data, and lack of interoperability with other hospital information systems, most notably Picture Archive and Communications Systems (PACS) based on the DICOM standard. This article proposes an architecture of a Web Pathology PACS fully compliant with DICOM standard communications and data formats. The solution includes a PACS Archive responsible for storing whole-slide imaging data in DICOM WSI format and offers a communication interface based on the most recent DICOM Web services. The second component is a zero-footprint viewer that runs in any web-browser. It consumes data using the PACS archive standard web services. Moreover, it features a tiling engine especially suited to deal with the WSI image pyramids. These components were designed with special focus on efficiency and usability. The performance of our system was assessed through a comparative analysis of the state-of-the-art solutions. The results demonstrate that it is possible to have a very competitive solution based on standard workflows.

General guidelines for biomedical software development

Most bioinformatics tools available today were not written by professional software developers, but by people that wanted to solve their own problems, using computational solutions and spending the minimum time and effort possible, since these were just the means to an end. Consequently, a vast number of software applications are currently available, hindering the task of identifying the utility and quality of each. At the same time, this situation has hindered regular adoption of these tools in clinical practice. Typically, they are not sufficiently developed to be used by most clinical researchers and practitioners. To address these issues, it is necessary to re-think how biomedical applications are built and adopt new strategies that ensure quality, efficiency, robustness, correctness and reusability of software components. We also need to engage end-users during the development process to ensure that applications fit their needs. In this review, we present a set of guidelines to support biomedical software development, with an explanation of how they can be implemented and what kind of open-source tools can be used for each specific topic.

Sensor-Based Architecture for Medical Imaging Workflow Analysis

The growing use of computer systems in medical institutions has been generating a tremendous quantity of data. While these data have a critical role in assisting physicians in the clinical practice, the information that can be extracted goes far beyond this utilization. This article proposes a platform capable of assembling multiple data sources within a medical imaging laboratory, through a network of intelligent sensors. The proposed integration framework follows a SOA hybrid architecture based on an information sensor network, capable of collecting information from several sources in medical imaging laboratories. Currently, the system supports three types of sensors: DICOM repository meta-data, network workflows and examination reports. Each sensor is responsible for converting unstructured information from data sources into a common format that will then be semantically indexed in the framework engine. The platform was deployed in the Cardiology department of a central hospital, allowing identification of processes’ characteristics and users’ behaviours that were unknown before the utilization of this solution.