Medical Informative Booklets
Medical Imagery
Numerical Archives
An computerized system for the distribution, the storage and the archiving of digitised radiological images : the PACS (Pictures Archiving and Communication System)
Thanks to "Les Amis de l'Institut Jules Bordet" who have financed the project, the Jules Bordet Institute has now at its disposal a system which allows the acquisition , the storage and the archiving of medical images from various sources (CT scan, Standard radiography, NMR, echography, PET Scan).
The system was created and implemented on the proposal of Doctor M. Lemort in collaboration with Telemis and Kodak.
The PACS system can process the images (compression, securement). Besides, it provides images visualisation tools as well as in intern, within the Institute, as in extern, for instance, for external prescribing physicians.
These visualisation tools are available with all the computer. The system is integrated to all information systems of the Institute with links to several servers like the one used for computerized medical file or the one used in the radiology service to produce the examination reports. Finally, the PACS insures the archiving and the back-ups of images (management of DVD and RAID disk librairies).
Heart of the general PACS : servers TELEMIS and bookshops of hard disks for storage one line and of DVD (on the right) for the backup in the long run
The system was set up in order to stop rapidly using radiological film like imaging information support. For each digital image, the film is indeed a very faithless reproduction technique (total loss of the dynamic of the image) and very costly (production, storage, manipulation). Moreover, it is injurious for the environment and it can be lost. Moreover, it is rarely at the immediate disposal of the physician that needs it !
Thanks to the PACS, radiological images, such as the consultation notes, are now part of the computerized medical file and can be seen by a physician who takes part in the therapeutic management of a patient, on whatever work station within the Institute. The access to the information is accelerated, the care quality is optimalized.
The patient comfort is also improved since he does not have to transport his negatives anymore. The visualisation tools allow the superposition of images and chronological comparisons. This is obviously very important in such a pathology as cancer which is a chronic disease. It requires a long-term rigorous following, especially for the radiological images. Moreover, we cannot forget that the technological evolution makes the digital imagery always more performing but that it also increases the image volume : the "multibar" scans can now create 800 to 900 cuts and images for each examination. Naturally, it is really easier to see them on a screen than on a traditional negatoscope. The patient can receive the images on a CD-Rom or on paper as before he received the negatives.
Even the conventional radiology can now be digitized and produce images the PACS will treat. But, for the mammography, the film still have some advantages. It has a native high resolution the digital images do not have. In other cases, and certainly for the digital images, the film only has disadvantages, including its cost since the "film budget" of the Jules Bordet Institute in 2002 was equal to 240,000 euros. However, the quality of the mammography digitization is constantly improving and the image quality issue should be solve in a very near future. Indeed, the first totally digitized mammographic system is going to be set up at the Jules Bordet Institute.
In practice :
Since March 2004, the film production in the Radiology Unit of the Institute was totally stopped concerning the digitizable examinations such as the echography, the scan or the magnetic resonance. Later, it will also be stopped for the mammography after the digitisation of this aspect.
Every physician who prescribes radiological examinations and who works outside the Jules Bordet Institute now receives a CD-ROM rather than former films.
When measures or comments are necessary for one or another image, he will get an explanative document. As the images concerning an echography are concerned, at least when it is done separately, the images are only printed on paper (without a systematic creation of a CD-ROM).
For patients who want to consult outside the Institute, a CD-ROM including all the images of the examinations will be produce on demand.
Within the Institute, physicians can have their patients images thanks to the module of visualization "Telemis" integrated to "Oribase" (name of the new system of computerized medical file at the Jules Bordet Institute). The module also gives an access to the nuclear medicine examinations, including the PET scan.
This new development represents an important evolution within the integration of the computerized medical file.
The CD-ROM is auto-executable when it is introduced in a computer with Windows or with a Windows emulation, but also with Mac. By this way, all the examination images are stored in two sizes :
- JPEG compressed images which cannot be modified and which are automatically displayable with an Internet navigator (whatever the computer platform can be),
- DICOM images which can be opened thanks to a specific program, included on the CD and which can be executed from it or which can be permanently install on a computer. For the moment, the program only functions on computer using Windows but the images can be read by all the platform having a software able to treat DICOM images, including for the post-processing.
This can seem to be very technical but it is important for the patient since his/her complete images file can be communicated to an other hospital centre where the images will be treated again and/or compared.
The CD advanced visualization program has many functions : windowing and zoom setting, printing and exportation of images in various graphic size, distance and angles measures, annotations, etc.
All the images for each patient (including echographic images) are conserved in the numerical archives, on a on line server and with a back-up, on a DVD library. This involves that if the CD ROM is lost, it will be easy to make a new copy on demand of the physician or of the patient. The senologic archives are entrusted to a Kodak archiving server. The images are stored under a native DICOM size (without compression) during two years. A link to the PACS exists for the long term archiving (compression without loss of quality) and for the images distribution.
To stop using films at the Jules Bordet institute is a little revolution in the daily practice but the new way of working is already an irreversible evolution of the medical imagery.
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