Performance of Web-based image distribution: client-oriented measurements

Visualization of data in radiotherapy using web services for optimization of workflow

BACKGROUND

Every day a large amount of data is produced within a radiotherapy department. Although this data is available in one form or other within the centralised systems, it is often not in the form which is of interest to the departmental staff. This work presents a flexible browser based reporting and visualization system for clinical and scientific use, not currently found in commercially available software such as MOSAIQ(TM) or ARIA(TM). Moreover, the majority of user merely wish to retrieve data and not record and/or modify data. Thus the idea was conceived, to present the user with all relevant information in a simple and effective manner in the form of web-services. Due to the widespread availability of the internet, most people can master the use of a web-browser. Ultimately the aim is to optimize clinical procedures, enhance transparency and improve revenue.

METHODS

Our working group (BAS) examined many internal procedures, to find out whether relevant information suitable for our purposes lay therein. After the results were collated, it was necessary to select an effective software platform. After a more detailed analysis of all data, it became clear that the implementation of web-services was appropriate. In our institute several such web-based information services had already been developed over the last few years, with which we gained invaluable experience. Moreover, we strived for high acceptance amongst staff members.

RESULTS

By employing web-services, we attained high effectiveness, transparency and efficient information processing for the user. Furthermore, we achieved an almost maintenance-free and low support system. The aim of the project, making web-based information available to the user from the departmental system MOSAIQ, physician letter system MEDATEC(R) and the central finding server MiraPlus (laboratory, pathology and radiology) were implemented without restrictions.

CONCLUSION

Due to widespread use of web-based technology the training effort was effectively nil, since practically every member of staff can master the use of a web-browser. Moreover, we have achieved high acceptance amongst staff members and have improved our effectiveness resulting in a considerable time saving. The many MOSAIQ-specific parts of the system can be readily used by departments which use MOSAIQ as the departmental system.

Performance enhancement of a web-based picture archiving and communication system using commercial off-the-shelf server clusters

The rapid development of picture archiving and communication systems (PACSs) thoroughly changes the way of medical informatics communication and management. However, as the scale of a hospital's operations increases, the large amount of digital images transferred in the network inevitably decreases system efficiency. In this study, a server cluster consisting of two server nodes was constructed. Network load balancing (NLB), distributed file system (DFS), and structured query language (SQL) duplication services were installed. A total of 1 to 16 workstations were used to transfer computed radiography (CR), computed tomography (CT), and magnetic resonance (MR) images simultaneously to simulate the clinical situation. The average transmission rate (ATR) was analyzed between the cluster and noncluster servers. In the download scenario, the ATRs of CR, CT, and MR images increased by 44.3%, 56.6%, and 100.9%, respectively, when using the server cluster, whereas the ATRs increased by 23.0%, 39.2%, and 24.9% in the upload scenario. In the mix scenario, the transmission performance increased by 45.2% when using eight computer units. The fault tolerance mechanisms of the server cluster maintained the system availability and image integrity. The server cluster can improve the transmission efficiency while maintaining high reliability and continuous availability in a healthcare environment.

Development and evaluation of different methods to assess download and display time of image web systems

OBJECTIVES

The aim of this study was to develop and verify different methods of measuring time-to-display (TTD) for radiological images with image web systems (IWS). The process should be automatable in order to repeatedly perform a large number of measurements without human interaction.

MATERIALS AND METHODS

Three methods were defined and compared with respect to usability, stability, and quality of results. Method 1 was based on Windows 2000 Performance Monitor, whereas method 2 employed phototransistors taped to the screen and connected to a separate PC. A software tool developed for method 3, which used Windows application programming interface (API) function, calls to read the color code assigned to specific pixels on the screen.

RESULTS

Method 3 proved to be the most reliable and easy to automate. The accuracy is practically equivalent to method 2, but it proved to be far more automatable. Method 1 produced the largest mean error, was easily disturbed, but was also easy to set up and provided additional insights into the system's architecture especially if combined with method 3.

CONCLUSIONS

To measure the performance of image distribution systems, any of these methods can be used, but method 3 proved to be superior.

Enterprise imaging and multi-departmental PACS

The aim of this review is to present the status of digital image acquisition and archiving outside of radiology and to describe the technical concepts and possibilities of how a "radiology" Picture Archiving and Communication System (PACS) can become a multi-departmental (MD-)PACS. First the principles of system integration technology are explained and illustrated by the description of a typical radiology system integration. Then four types of modality integration approaches are defined: the direct modality integration (Type-I), the integration via DICOM acquisition software (Type-II) the integration via specialised systems either with (Type-III) or without PACS connection (Type-IV). The last section is dedicated to the presentation of the PACS requirements of selected interdisciplinary modality types [Endoscopy, Ultrasound and Electrocardiography (ECG)] and clinical disciplines (Pathology, Dermatology, Ophthalmology and Cardiology), which are then compared with the technical possibilities of a MD-PACS.

Integrating images into the electronic patient record of the hospital authority of Hong Kong

Over a period of 10 years the Hospital Authority has developed an integrated clinical information system (The Clinical Management System-CMS), including a territory-wide longitudinal electronic patient record (ePR). The CMS and ePR are used by over 4000 doctors and 20,000 other clinicians to document and review care. The ePR currently has nearly 3TB of data covering 44 million episodes for 6.4 million patients. To date the CMS has largely dealt with textual data. However, PACS technology is increasingly being adopted in the HA. This paper describes our strategy for taking the hospital image archives and making them available throughout the Authority as part of the longitudinal patient record, leveraging the ePR to distribute radiological and other images in a manner which is integrated, affordable and sustainable.

Development and evaluation of a new gray-scale test pattern to adjust gradients of thoracic CT imaging

The purpose of the present study was to evaluate the usefulness of a new gray-scale test pattern (NGTP) that was developed to easily adjust the gradients of thoracic CT imaging and enable visual consistency. The Society of Motion Picture and Television Engineers (SMPTE) pattern and the NGTP were used for comparison. The luminance character of two test patterns was evaluated by a luminance meter with three different window widths and levels (for default, mediastinum and lung). We also investigated whether SMPTE or NGTP is more suitable for adjusting the gradient of thoracic CT imaging. We found that it was easier to adjust the gradient of thoracic CT imaging with NGTP than with SMPTE, because the digital range of NGTP is 12 bits (the value of 4,096 HU, from -1,024 to 3,071 HU), and adjustable in any window width. We were able to adjust the gradients of hard-copy and soft-copy thoracic CT imaging within several hours using NGTP. We propose that NGTP is the most suitable tool for adjusting the gradients of thoracic CT imaging. NGTP can cope with any medical diagnostic display system connected with CT or MRI equipment in a network because it is in DICOM format.

Upload capacity and time-to-display of an image Web system during simultaneous up- and download processes

The aim of this study was to assess the up- and download performance of an image Web system (IWS) during simultaneous up- and download procedures. Following preparatory tests, the upload capacity (UC) with and without simultaneous download and the time-to-display (TTD) with and without simultaneous upload were determined for different image, server and compression types, and with up to 16 concurrent clients. The UC varied between 1.7-5.5 Gigabyte per hour (GB/h) and was slightly influenced by a simultaneous download; however, the TTDs were substantially prolonged during an upload and only below 5 s with up to four to six concurrent clients. The choice of image and server type had a strong impact on UC and TTD. Lossy primary compression proved slightly superior. An effective UC of approximately 4.0 GB/h or 96 Gigabyte per day (GB/day) can be achieved, which appears suitable even for large institutions. Because of its substantial influence on UC and TTD during simultaneous up- and download, the server hardware should be equipped with two processors and 1 GB RAM. Lossy primary compression may be used with slight performance benefits when full-resolution images are not required. The upload is a time-demanding process, and it is possible that during peak hours the waiting times are unacceptable for clinicians.