... One theoretical example of a combination of all three worlds would be a" cellular cy... more ... One theoretical example of a combination of all three worlds would be a" cellular cyborg", a MEMS chip with a stem cell ... National Aeronautics and Space Administration (NASA) has begun programs in Astrobiology and Bioastronautics, the National Cancer Institute (NCI) of the ...
... of Hull (UK) Carla M. Pugh MD PhD Center for Advanced Surgical Education, Northwestern Univer... more ... of Hull (UK) Carla M. Pugh MD PhD Center for Advanced Surgical Education, Northwestern University Richard A. Robb PhD Mayo ... Popescu, Bhautik Joshi and Sebastien Ourselin Physics-Based Models for Catheter, Guidewire and Stent Simulation 305 Julien Lenoir, Stephane ...
... Fletcher, S. Richir, G. Stevens and G. Wrohlewski 221 Training and Assessment of Psychomotor ... more ... Fletcher, S. Richir, G. Stevens and G. Wrohlewski 221 Training and Assessment of Psychomotor Skills for Performing Laparoscopic Surgery Using BEST-IRIS Virtual Reality Training Simulator, R. Makam. CS. Rajan, T. Brendon, V Shreedhar, K Saleem, S. Shrivastava, R ...
ABSTRACT Tele-medical imaging applications require low cost, and high-speed backbone wide area ne... more ABSTRACT Tele-medical imaging applications require low cost, and high-speed backbone wide area networks (WAN) to carry large amount of imaging data for rapid turn around interpretation. Current low cost commercially WAN is too slow for medical imaging applications, while high speed WAN is too costly. The next generation Internet (NGI) or Internet2 is federal initiatives for the integration of higher speed backbone communication networks (up to 2.4 Gbits/sec) as a means to replace the current inadequate Internet for many applications including medical imaging. This paper describes our preliminary experience of connecting to Internet2 for teleradiology application. A case study is given for the NGI WAN connection between Childrens Hospital Los Angeles and National Library of Medicine. NGI WAN performance for different image modalities, measured in throughput rate and application response time, were obtained and then compared to the T1 WAN connection between Childrens Hospital Los Angeles and Saint John's Health Center Santa Monica.
ABSTRACT A single point of hardware failure in PACS is at the PACS controller, or the main archiv... more ABSTRACT A single point of hardware failure in PACS is at the PACS controller, or the main archive server. When it occurs, it renders the entire PACS inoperable and crippled until the problem is diagnosed and resolved. Many current PACS do not have a fault-tolerant design or adequate back-up system for the main archive server due to several issues including cost. Several large scale PACs utilize the Tandem or cluster design but are very costly and have not been critically tested for their degree of fault tolerance. This paper describes a novel, portable, and scalable fault-tolerant PACS controller design that is affordable for most PACS implementations.
ABSTRACT Failure of PACS archive server would cripple the entire PACS operation. Last year we dem... more ABSTRACT Failure of PACS archive server would cripple the entire PACS operation. Last year we demonstrated that it was possible to design a fault-tolerant (FT) server with 99.999% uptime. The FT design was based on a triple modular redundancy with a simple majority vote to automatically detect and mask a faulty module. The purpose of this presentation is to report on its continuous developments in integrating with external mass storage devices, and applying as an Application Service Provider (ASP) back-up archive server. ASP back-up archive is to provide instantaneous automatic backup of PACS image data and instantaneous recovery of PACS image data in the event of disaster. FT server is used as an off-site backup-archive PACS server from the main PACS archive locations. Clinical data from a hospital PACS is sent to the FT server in parallel to the exams being archived in the main server. A disaster scenario is simulated and the PACS data is sent from the offsite FT server back to the hospital PACS. The reliability, functionality and performance of the FT server and external mass storage devices are evaluated during the simulation.
Medical Imaging 2003: PACS and Integrated Medical Information Systems: Design and Evaluation, 2003
Health data security, characterized in terms of data privacy, authenticity, and integrity, is a v... more Health data security, characterized in terms of data privacy, authenticity, and integrity, is a vital issue when digital images and other patient information are transmitted through public networks in telehealth applications such as teleradiology. Mandates for ensuring health data security have been extensively discussed (for example The Health Insurance Portability and Accountability Act, HIPAA) and health informatics guidelines (such as the DICOM standard) are beginning to focus on issues of data continue to be published by organizing bodies in healthcare; however, there has not been a systematic method developed to ensure data security in medical imaging Because data privacy and authenticity are often managed primarily with firewall and password protection, we have focused our research and development on data integrity. We have developed a systematic method of ensuring medical image data integrity across public networks using the concept of the digital envelope. When a medical image is generated regardless of the modality, three processes are performed: the image signature is obtained, the DICOM image header is encrypted, and a digital envelope is formed by combining the signature and the encrypted header. The envelope is encrypted and embedded in the original image. This assures the security of both the image and the patient ID. The embedded image is encrypted again and transmitted across the network. The reverse process is performed at the receiving site. The result is two digital signatures, one from the original image before transmission, and second from the image after transmission. If the signatures are identical, there has been no alteration of the image. This paper concentrates in the method and evaluation of the digital image envelope.
ABSTRACT Many educational courses have been designed for training radiologists and allied healthc... more ABSTRACT Many educational courses have been designed for training radiologists and allied healthcare providers to operate PACS workstations. There are yet tools available for educational training of PACS concepts and workflow analysis. We have designed and implemented a RIS/PACS Simulator for this purpose. The RIS/PACS Simulator consists of six key components simulating a typical clinical RIS/PACS: RIS simulator, acquisition modality Simulator (AMS), DICOM gateway, PACS controller (UNIX-based), clinical viewing workstation, and network infrastructure with a 100mbits/sec Ethernet switch connecting to all these components. A generic RIS and a generic DICOM compliant PACS software package are used to simulate normal clinical data flow. Using this simulator, trainees can: 1. Observe clinical RIS/PACS operation, component by component 2. Trace image flow through each component 3. Identify PACS data flow bottle neck 4. Induce failure in a component to observe its impact on the PACS workflow and operation RIS/PACS simulator is a valuable tool for participants to gain knowledge of the complexity of RIS/PACS data flow with hands-on experience. As a stand-alone system, it also becomes a good test bed for evaluation of medical imaging applications without interrupting clinical workflow.
PACS is widely used in hospitals and is considered a mission critical system for around-the-clock... more PACS is widely used in hospitals and is considered a mission critical system for around-the-clock daily clinical operation. Scheduled or unscheduled downtime of the main PACS archive storage or server could potentially cripple the entire PACS operation. This is especially the case in a filmless hospital environment. Therefore, in a downtime event, it is most desirable for users to have only a minimal performance impact without interruption of clinical data flow or loss of data and to have available historical PACS studies. This paper summarizes some of the developments in the design and implementation of a reliable PACS that insures maximum uptime for end users while preserving the integrity of the PACS data and making it available during downtime events. It also details strategy for developing proper clinical workflow contingency procedures when a scheduled downtime event to the main archive storage and server occurs. Specifically, the design and implementation of a fault-tolerant (FT) main archive server, the development of a FT back-up archive using an application service provider (ASP) model, and the clinical experiences while upgrading a main archive server and migrating the stored PACS data to new storage media will be discussed.
The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) ... more The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider’s first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories (“usually appropriate” [green], “may be appropriate” [yellow], “usually not appropriate” [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provid...
... One theoretical example of a combination of all three worlds would be a" cellular cy... more ... One theoretical example of a combination of all three worlds would be a" cellular cyborg", a MEMS chip with a stem cell ... National Aeronautics and Space Administration (NASA) has begun programs in Astrobiology and Bioastronautics, the National Cancer Institute (NCI) of the ...
... of Hull (UK) Carla M. Pugh MD PhD Center for Advanced Surgical Education, Northwestern Univer... more ... of Hull (UK) Carla M. Pugh MD PhD Center for Advanced Surgical Education, Northwestern University Richard A. Robb PhD Mayo ... Popescu, Bhautik Joshi and Sebastien Ourselin Physics-Based Models for Catheter, Guidewire and Stent Simulation 305 Julien Lenoir, Stephane ...
... Fletcher, S. Richir, G. Stevens and G. Wrohlewski 221 Training and Assessment of Psychomotor ... more ... Fletcher, S. Richir, G. Stevens and G. Wrohlewski 221 Training and Assessment of Psychomotor Skills for Performing Laparoscopic Surgery Using BEST-IRIS Virtual Reality Training Simulator, R. Makam. CS. Rajan, T. Brendon, V Shreedhar, K Saleem, S. Shrivastava, R ...
ABSTRACT Tele-medical imaging applications require low cost, and high-speed backbone wide area ne... more ABSTRACT Tele-medical imaging applications require low cost, and high-speed backbone wide area networks (WAN) to carry large amount of imaging data for rapid turn around interpretation. Current low cost commercially WAN is too slow for medical imaging applications, while high speed WAN is too costly. The next generation Internet (NGI) or Internet2 is federal initiatives for the integration of higher speed backbone communication networks (up to 2.4 Gbits/sec) as a means to replace the current inadequate Internet for many applications including medical imaging. This paper describes our preliminary experience of connecting to Internet2 for teleradiology application. A case study is given for the NGI WAN connection between Childrens Hospital Los Angeles and National Library of Medicine. NGI WAN performance for different image modalities, measured in throughput rate and application response time, were obtained and then compared to the T1 WAN connection between Childrens Hospital Los Angeles and Saint John's Health Center Santa Monica.
ABSTRACT A single point of hardware failure in PACS is at the PACS controller, or the main archiv... more ABSTRACT A single point of hardware failure in PACS is at the PACS controller, or the main archive server. When it occurs, it renders the entire PACS inoperable and crippled until the problem is diagnosed and resolved. Many current PACS do not have a fault-tolerant design or adequate back-up system for the main archive server due to several issues including cost. Several large scale PACs utilize the Tandem or cluster design but are very costly and have not been critically tested for their degree of fault tolerance. This paper describes a novel, portable, and scalable fault-tolerant PACS controller design that is affordable for most PACS implementations.
ABSTRACT Failure of PACS archive server would cripple the entire PACS operation. Last year we dem... more ABSTRACT Failure of PACS archive server would cripple the entire PACS operation. Last year we demonstrated that it was possible to design a fault-tolerant (FT) server with 99.999% uptime. The FT design was based on a triple modular redundancy with a simple majority vote to automatically detect and mask a faulty module. The purpose of this presentation is to report on its continuous developments in integrating with external mass storage devices, and applying as an Application Service Provider (ASP) back-up archive server. ASP back-up archive is to provide instantaneous automatic backup of PACS image data and instantaneous recovery of PACS image data in the event of disaster. FT server is used as an off-site backup-archive PACS server from the main PACS archive locations. Clinical data from a hospital PACS is sent to the FT server in parallel to the exams being archived in the main server. A disaster scenario is simulated and the PACS data is sent from the offsite FT server back to the hospital PACS. The reliability, functionality and performance of the FT server and external mass storage devices are evaluated during the simulation.
Medical Imaging 2003: PACS and Integrated Medical Information Systems: Design and Evaluation, 2003
Health data security, characterized in terms of data privacy, authenticity, and integrity, is a v... more Health data security, characterized in terms of data privacy, authenticity, and integrity, is a vital issue when digital images and other patient information are transmitted through public networks in telehealth applications such as teleradiology. Mandates for ensuring health data security have been extensively discussed (for example The Health Insurance Portability and Accountability Act, HIPAA) and health informatics guidelines (such as the DICOM standard) are beginning to focus on issues of data continue to be published by organizing bodies in healthcare; however, there has not been a systematic method developed to ensure data security in medical imaging Because data privacy and authenticity are often managed primarily with firewall and password protection, we have focused our research and development on data integrity. We have developed a systematic method of ensuring medical image data integrity across public networks using the concept of the digital envelope. When a medical image is generated regardless of the modality, three processes are performed: the image signature is obtained, the DICOM image header is encrypted, and a digital envelope is formed by combining the signature and the encrypted header. The envelope is encrypted and embedded in the original image. This assures the security of both the image and the patient ID. The embedded image is encrypted again and transmitted across the network. The reverse process is performed at the receiving site. The result is two digital signatures, one from the original image before transmission, and second from the image after transmission. If the signatures are identical, there has been no alteration of the image. This paper concentrates in the method and evaluation of the digital image envelope.
ABSTRACT Many educational courses have been designed for training radiologists and allied healthc... more ABSTRACT Many educational courses have been designed for training radiologists and allied healthcare providers to operate PACS workstations. There are yet tools available for educational training of PACS concepts and workflow analysis. We have designed and implemented a RIS/PACS Simulator for this purpose. The RIS/PACS Simulator consists of six key components simulating a typical clinical RIS/PACS: RIS simulator, acquisition modality Simulator (AMS), DICOM gateway, PACS controller (UNIX-based), clinical viewing workstation, and network infrastructure with a 100mbits/sec Ethernet switch connecting to all these components. A generic RIS and a generic DICOM compliant PACS software package are used to simulate normal clinical data flow. Using this simulator, trainees can: 1. Observe clinical RIS/PACS operation, component by component 2. Trace image flow through each component 3. Identify PACS data flow bottle neck 4. Induce failure in a component to observe its impact on the PACS workflow and operation RIS/PACS simulator is a valuable tool for participants to gain knowledge of the complexity of RIS/PACS data flow with hands-on experience. As a stand-alone system, it also becomes a good test bed for evaluation of medical imaging applications without interrupting clinical workflow.
PACS is widely used in hospitals and is considered a mission critical system for around-the-clock... more PACS is widely used in hospitals and is considered a mission critical system for around-the-clock daily clinical operation. Scheduled or unscheduled downtime of the main PACS archive storage or server could potentially cripple the entire PACS operation. This is especially the case in a filmless hospital environment. Therefore, in a downtime event, it is most desirable for users to have only a minimal performance impact without interruption of clinical data flow or loss of data and to have available historical PACS studies. This paper summarizes some of the developments in the design and implementation of a reliable PACS that insures maximum uptime for end users while preserving the integrity of the PACS data and making it available during downtime events. It also details strategy for developing proper clinical workflow contingency procedures when a scheduled downtime event to the main archive storage and server occurs. Specifically, the design and implementation of a fault-tolerant (FT) main archive server, the development of a FT back-up archive using an application service provider (ASP) model, and the clinical experiences while upgrading a main archive server and migrating the stored PACS data to new storage media will be discussed.
The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) ... more The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider’s first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories (“usually appropriate” [green], “may be appropriate” [yellow], “usually not appropriate” [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provid...
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Papers by Greg Mogel