Yves Ligier

Happy birthday DIOGENE: a hospital information system born 20 years ago

Since its birth in 1978, DIOGENE, the Hospital Information System of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. Since a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The Hospital Information System DIOGENE plays a significant role by integrating four axes of knowledge medico-economical context for better understanding and influencing resources consumption the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.) patient-dependent knowledge, in a vision integrating time and space external knowledge bases such as Medline (patient-independent knowledge) integration of these patient-dependent and -independent knowledges in a Case-Based Reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision.

Digital image management and communication in medicine

With the rapid development of digital imaging modalities in medicine, there is an increasing need for an efficient management and archival of medical images in digital form. Picture Archiving and Communication Systems (PACS) are becoming an essential component of medical imaging equipment, allowing for medical images to be accessed and stored directly in digital form. This paper describes a hospital-wide PACS currently under development at the University Hospital of Geneva, based on an open architecture, regrouping equipment from different vendors in a distributed topology. The image archival is organized in multiple locations geographically distributed in the hospital. The PACS database is fully integrated with the concurrent Radiology Information System (RIS) and Hospital Information System (HIS). A standard image storage format called the PAPYRUS format was developed for the storage of medical images from a variety of imaging modalities. To provide a more uniform user interface on a variety of different workstations, a common platform for image display and manipulation called OSIRIS was developed.

The OSIRIS User Interface for Manipulating Medical Images

This paper describes the OSIRIS project developed at the University Hospital of Geneva. Its goal is the design of a software to read medical images files stored in the PAPYRUS format and, more important, to display and analyse them in a window based user interface environment. This software is a main part of the PACS project conducted at the Geneva Hospital. OSIRIS has been designed to work on a wide variety of workstations and window systems (Unix systems with Xll and OSF/Motif and Macintoshs). It provides the traditional modes of visualisation (zoom in, zoom out, invert, etc) and allows more specific manipulations such as a movie mode, filters, measure of distances, modification of the color lookup table. OSIRIS allows to display a second window containing the image interpretation report, a window containing some study information and allows to add annotations to an image.

Object-oriented design of medical imaging software

A special software package for interactive display and manipulation of medical images was developed at the University Hospital of Geneva, as part of a hospital wide Picture Archiving and Communication System (PACS). This software package, called Osiris, was especially designed to be easily usable and adaptable to the needs of noncomputer-oriented physicians. The Osiris software has been developed to allow the visualization of medical images obtained from any imaging modality. It provides generic manipulation tools, processing tools, and analysis tools more specific to clinical applications. This software, based on an object-oriented paradigm, is portable and extensible. Osiris is available on two different operating systems: the Unix X-11/OSF-Motif based workstations, and the Macintosh family.

Portable image-manipulation software: what is the extra development cost?

A hospital-wide picture archiving and communication system (PACS) project is currently under development at the University Hospital of Geneva. The visualization and manipulation of images provided by different imaging modalities constitutes one of the most challenging component of a PACS. It was necessary to provide this visualization software on a number of types of workstations because of the varying requirements imposed by the range of clinical uses it must serve. The user interface must be the same, independent of the underlying workstation. In addition to a standard set of image-manipulation and processing tools, there is a need for more specific clinical tools that can be easily adapted to specific medical requirements. To achieve this goal, it was elected to develop a modular and portable software called OSIRIS. This software is available on two different operating systems (the UNIX standard X-11/OSF-Motif based workstations and the Macintosh family) and can be easily ported to other systems. The extra effort required to design such software in a modular and portable way was worthwhile because it resulted in a platform that can be easily expanded and adapted to a variety of specific clinical applications. Its portability allows users to benefit from the rapidly evolving workstation technology and to adapt the performance to suit their needs.

Distributed file management for remote clinical image-viewing stations

The Geneva PACS is based on a distributed architecture, with different archive servers used to store all the image files produced by digital imaging modalities. Images can then be visualized on different display stations with the Osiris software. Image visualization require to have the image file physically present on the local station. Thus, images must be transferred from archive servers to local display stations in an acceptable way, which means fast and user friendly where the notion of file must be hidden to users. The transfer of image files is done according to different schemes including prefetching and direct image selection. Prefetching allows the retrieval of previous studies of a patient in advance. A direct image selection is also provided in order to retrieve images on request. When images are transferred locally on the display station, they are stored in Papyrus files, each file containing a set of images. File names are used by the Osiris viewing software to open image sequences. But file names alone are not explicit enough to properly describe the content of the file. A specific utility has been developed to present a list of patients, and for each patient a list of exams which can be selected and automatically displayed. The system has been successfully tested in different clinical environments. It will be soon extended on a hospital wide basis.

Self-contained off-line media for exchanging medical images using DICOM-compliant standard

The goal of this project is to develop and implement off-line DICOM-compliant CD ROMs that contain the necessary software tools for displaying the images and related data on any personal computer. We implemented a hybrid recording technique allowing CD-ROMs for Macintosh and Windows platforms to be fully DICOM compliant. A public domain image viewing program (OSIRIS) is recorded on the CD for display and manipulation of sequences of images. The content of the disk is summarized in a standard HTML file that can be displayed on any web-browser. This allows the images to be easily accessible on any desktop computer, while being also readable on high-end commercial DICOM workstations. The HTML index page contains a set of thumbnails and full-size JPEG images that are directly linked to the original high-resolution DICOM images through an activation of the OSIRIS program. Reports and associated text document are also converted to HTML format to be easily displayable directly within the web browser. This portable solution provides a convenient and low cost alternative to hard copy images for exchange and transmission of images to referring physicians and external care providers without the need for any specialized software or hardware.

PAPYRUS: a portable image file format

As part of a hospital-integrated PACS at the University Hospital of Geneva, a standard file format (PAPYRUS) was developed based on the ACR-NEMA specifications on image communication (1). The purpose was to define a unique file structure that can handle images as well as the related clinical information to be used in multimodality image archiving and communication systems. The PAPYRUS format can be referred to as an “encapsulated” format for ACR-NEMA messages. The first version of the PAPYRUS format has been extensively modified after its evaluation by a technical working group of the European teleradiology project (“TELEMED” project). After several technical meetings the different partners of TELEMED came to an agreement that required a few functionalities to be added to the original proposal. Among the modifications two features supported by the SPI (Standard Product Interconnect for compatibility of Digital Imaging) were discussed: 1) the unique image identification code and 2) the image folder concept that contains references to image data sets. Related images can be distributed in separate files or directly in the folder file.

Image manipulation software portable on different hardware platforms: what is the cost?

A hospital wide PACS project is currently under development at the University Hospital of Geneva. The visualization and manipulation of images provided by different imaging modalities constitutes one of the most challenging components of a PACS. Because there are different requirements depending on the clinical usage, it was necessary for such a visualization software to be provided on different types of workstations in different sectors of the PACS. The user interface has to be the same independently of the underlying workstation. Beside, in addition to a standard set of image manipulation and processing tools there is a need for more specific clinical tools that should be easily adapted to specific medical requirements. To achieve operating and windowing systems: the standard Unix/X-11/OSF-Motif based workstations and the Macintosh family and should be easily ported on other systems. This paper describes the design of such a system and discusses the extra cost and efforts involved in the development of a portable and easily expandable software.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Interactive Software for Cooperative Medicine and Remote Consultations

A multimodality image manipulation and analysis software called OSIRIS was developed at the University Hospital of Geneva. This software package is currently used on different hardware platforms as part of a hospital-wide PACS project. An extension of this software was recently designed to allow cooperative work on remotely located workstations. This extension was developed to allow remote consultations and communications between physicians over local and wide area networks. For teleradiology and cooperative consultations, images are exchanged between the different workstations in an ACR-NEMA based format called PAPYRUS. The interactive session can then take place where the communication protocol between the two remote stations allows for simultaneous manipulation of the same images and a live conversation through a vocal link. A special communication protocol was developed to transmit the different actions performed on one station to the other. The lower level communication protocol is TCP-IP. In addition to the local usage in Geneva, this platform was also adopted as part of a European teleradiology project called TELEMED, regrouping 17 partners from 9 different countries. It is being tested on international broadband networks for remote consultations between different countries in Europe.