Future Directions In Image Management: Medical And Practical Considerations

Abstract The volume of data produced by new imaging modalities has far outstripped the ability of most departments to effectively utilize the images produced. The problem is further exacerbated by the fact that the diagnostic procedures have become progressively less invasive and traumatic and are being applied to an ever larger patient population. The decrease in cost and the rise in technological capability of computer systems in recent years has provided imaging specialists with the opportunity to create network systems for the storage and recall of diagnostic images.This paper examines the philosophy of image storage from the standpoint of the medical, legal, and practical questions. A proposal is made that not all images are equal and that some deserve to be archived for longer periods than others. The practical problem of using a video display for diagnostic readout, aside from the classical questions of resolution and response time, is discussed. A proposal is also made that two data bases might be created; one which provides rapid access to the clinically relevant images (i.e., the two or three that demonstrate pathology) and one which may require much longer to access, but which contains all the archived data.IntroductionImages for medical diagnosis evolved during the first 80 years of radiology as an empirical compromise between; 1) the portrayal of the most useful portions of potentially available diagnostic information, and 2) the costs of recording, maintaining, and retrieving the pictures on the storage media (silver film). The widespread application of Computerized Tomography, Digital Radiography, Digital Ultrasound, Digital Nuclear Medicine and, most recently, Nuclear Magnetic Resonance, has created a crisis in diagnostic imaging departments. At the present time, the complexity of this crisis is typified by Nuclear Magnetic Resonance which is capable of producing not only anatomical maps, but also physiological and chemical maps, all without the use of ionizing radiation.The volume of data produced by these imaging modalities has far outstripped the ability of most departments to effectively utilize the images produced. The problems arising from the power of digital systems to produce volumes of data are further exacerbated by the fact that the diagnostic procedures have become progressively less invasive and traumatic for the patient.This change in technology has not only resulted in the virtual replacement of more invasive diagnostic procedures such as pneumoencephalogram, but also added diagnostic procedures for which there were no previous counterparts. The significantly decreased invasiveness, patient discomfort, and resultant complications have not only increased the number of diagnostic procedures that are requested by referring physicians, but also have resulted in many cases, in an increased number of images being produced in a given diagnostic procedure. Thus, the digital image storage and retrieval systems must deal not only with the image load of the classical radiology department, but also with the significantly increased image production capability that results from the continuing technology revolution.The system designers have turned to the computer as a solution for this problem of data handling. The decrease in cost and the rise in technological capability of computer systems in recent years has provided imaging specialists with the opportunity to create network systems for the storage and recall of diagnostic images. However, these attempts have been primarily along the lines of an automated version of the classical "films in the envelope" method. With the diagnostic services able to produce such large volumes of data, it is now time to critically examine the basic philosophy of image management. The question is complicated by the fact that not only medical questions, but also legal, ethical, and practical considerations are involved.In this paper, we will discuss approaches to the image management problem, using computer power that is already available, inexpensive digital storage media that are