Medical Imaging Informatics Alex A.T. Bui, Ricky K. Taira(eds ② pringer
Medical Imaging Informatics Alex A.T. Bui, Ricky K. Taira (eds.)
editors Alex A.T. Bui Ricky K. Taira Medical Imaging Informatics Medical Imaging Informatics Group Department of Radiological Department of Radiological Sciences David Geffen School of M David Geffen School of Medicine University of Califomia, Los University of California, Los Angeles 924 Westwood Blvd 24W od Blvd Los Angeles, CA 90024 Los Angeles, CA 9002 Suite 420 Suite 420 USA buia@miL. ucla.edu taira@mii. ucla. edu ISBN978-1-4419-0384-6 e-ISBN978-1-4419-0385-3 DOI10.1007/978-1-4419-0385-3 Springer New York Dordrecht Heidelberg London Control Number: 2009939431 e Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part orm of information storage and retrieval, electronic adaptation, computer software, or nethodology now known or hereafter developed is forbidden. he use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not lentified as such, is not to be taken as an expression of opinion as to whether or not they are subject to While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein SpringerispartofSpringerSciencetBusinessMedia(www.springer.com
Editors Alex A.T. Bui Ricky K. Taira Medical Imaging Informatics Group Medical Imaging Informatics Group Department of Radiological Sciences Department of Radiological Sciences David Geffen School of Medicine David Geffen School of Medicine University of California, Los Angeles University of California, Los Angeles 924 Westwood Blvd. 924 Westwood Blvd. Los Angeles, CA 90024 Los Angeles, CA 90024 Suite 420 Suite 420 USA USA buia@mii.ucla.edu rtaira@mii.ucla.edu ISBN 978-1-4419-0384-6 e-ISBN 978-1-4419-0385-3 DOI 10.1007/978-1-4419-0385-3 Springer New York Dordrecht Heidelberg London © Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Library of Congress Control Number: 2009939431
For our mentor and friend, Hoosh, who has the wisdom and leadership to realize a vision;and to our students past, present, and future, for helping to pave a path forward
For our mentor and friend, Hoosh, who has the wisdom and leadership to realize a vision; and to our students past, present, and future, for helping to pave a path forward
Foreword Imaging is considered as one of the most effective- if not the most effective- in vivo sampling techniques applicable to chronic serious illnesses like cancer. This simple yet comprehensive textbook in medical imaging informatics(Mil) promotes and facili- tates two different areas of innovation: the innovations in technology that improve the field of biomedical informatics itself, and the application of these novel technologies to medicine, thus, improving health. Aside from students in imaging disciplines such as radiological sciences(vs. radiology as a service), this book is also very pertinent to other disciplines such as cardiology and surgery. Faculty and students familiar with this book will come to have their own ideas how to innovate. whether it be in core technologies or in applications to biomedicine Organizationally, the book follows a very sensible structure related to the process of are, which can in principle be summarized in three questions: what is wrong, how serious is it; and what to do? The first question( what is wrong) focuses mostly on diagnosis (i.e, what studies should be obtained). In this way, issues such as individu- ally-tailored image protocol selection are addressed so that the most appropriate and correct study is obtained -as opposed to the traditional sequential studies. For example, a patient with knee pain and difficulty going up stairs or with minor trauma to the knee and evidence of effusion is directly sent for an MRI (magnetic resonance imaging) study rather than first going to x-ray, or in a child suspected of having abnormal(or even normal) brain development, MRI studies are recommended rather than traditional insurance-required computed tomography (CT). The role of not only in mproving diagnosis but reducing health costs is highlighted. The second question (how serious is it)relates to how we can standardize and document image findings, on the way to providing truly objective, quantitative assessment from an imaging study as opposed to today's norm of largely qualitative descriptors. Finally, the third question in regard to how we can act upon the information we obtain clinically, from imaging and other sources: how can decisions be made rationally and how can we assess the impact of either research or an intervention? The textbook has been edited by two scientists, an Associate Professor and a Professor in Mll who are both founders of this discipline at our institution. Contributions come from various specialists in medical imaging, informatics, computer science, and bio- statistics. The book is not focused on image acquisition techniques or image process- ing, which are both well-known and described elsewhere in other texts: rather, it focuses on how to extract knowledge and information from imaging studies and related data. The material in this textbook has been simplified eloquently, one of the most difficult tasks by any teacher to simplify difficult material so that it is under- In short, this textbook is highly recommended for students in any discipline dealing with imaging as well as faculty interested in disciplines of medical imaging and informatics Hooshang Kangaroo, MD Professor Emeritus of Radiological Sciences, Pediatrics, and Bioengineering University of California at Los Angeles
vii Foreword Imaging is considered as one of the most effective – if not the most effective – in vivo sampling techniques applicable to chronic serious illnesses like cancer. This simple yet comprehensive textbook in medical imaging informatics (MII) promotes and facilitates two different areas of innovation: the innovations in technology that improve the field of biomedical informatics itself; and the application of these novel technologies to medicine, thus, improving health. Aside from students in imaging disciplines such as radiological sciences (vs. radiology as a service), this book is also very pertinent to other disciplines such as cardiology and surgery. Faculty and students familiar with this book will come to have their own ideas how to innovate, whether it be in core technologies or in applications to biomedicine. Organizationally, the book follows a very sensible structure related to the process of care, which can in principle be summarized in three questions: what is wrong; how serious is it; and what to do? The first question (what is wrong) focuses mostly on diagnosis (i.e., what studies should be obtained). In this way, issues such as individually-tailored image protocol selection are addressed so that the most appropriate and correct study is obtained – as opposed to the traditional sequential studies. For example, a patient with knee pain and difficulty going up stairs or with minor trauma to the knee and evidence of effusion is directly sent for an MRI (magnetic resonance imaging) study rather than first going to x-ray; or in a child suspected of having abnormal (or even normal) brain development, MRI studies are recommended rather than traditional insurance-required computed tomography (CT). The role of imaging, not only in improving diagnosis but reducing health costs is highlighted. The second question (how serious is it) relates to how we can standardize and document image findings, on the way to providing truly objective, quantitative assessment from an imaging study as opposed to today’s norm of largely qualitative descriptors. Finally, the third question is in regard to how we can act upon the information we obtain clinically, from imaging and other sources: how can decisions be made rationally and how can we assess the impact of either research or an intervention? The textbook has been edited by two scientists, an Associate Professor and a Professor in MII who are both founders of this discipline at our institution. Contributions come from various specialists in medical imaging, informatics, computer science, and biostatistics. The book is not focused on image acquisition techniques or image processing, which are both well-known and described elsewhere in other texts; rather, it focuses on how to extract knowledge and information from imaging studies and related data. The material in this textbook has been simplified eloquently, one of the most difficult tasks by any teacher to simplify difficult material so that it is understandable at all levels. In short, this textbook is highly recommended for students in any discipline dealing with imaging as well as faculty interested in disciplines of medical imaging and informatics. Hooshang Kangarloo, MD Professor Emeritus of Radiological Sciences, Pediatrics, and Bioengineering University of California at Los Angeles
Foreword With the advancement of picture archiving and communications systems(PACs)into mainstream use in healthcare facilities. there is a natural transition from the dis- ciplines of engineering research and technology assessment to clinical operations While much research in PACS-related areas continues, commercial systems are widely available. The burgeoning use of PACs in a range of healthcare facility sizes has created entirely new employment opportunities for"PACS managers, " modality managers,""interface analysts, and others who are needed to get these systems implemented, keep them operating, and expand them as necessary. The field of medical imaging informatics is often described as the discipline encompassing the subject areas that these new specialists need to understand. As the Society of Imaging Infor matics in Medicine(SliM)defines it Imaging informatics is a relatively new multidisciplinary field that intersects with the biological sciences, health services, information sciences and com- puting, medical physics, and engineering. Imaging informatics touches every aspect of the imaging chain and forms a bridge with imaging and other medical disciplines. Because the technology of PACS continues to evolve, imaging informatics is also important for the researcher. Each of the areas comprising the field of imaging infor- matics has aspects that make for challenging research topics. Absent the research these challenges foster and PACs would stagnate For the student of medical imaging informatics, there is a wealth of literature available for study. However, much of this is written for trainees in a particular discipline Anatomy, for example, is typically aimed at medical, dental, veterinary, and physical therapy students, not at engineers. Texts on networks or storage systems are not designed for physicians. Even primers on such topics tend not to provide a cross- disciplinary perspective of the subject The authors of Medical Imaging Informatics have accepted the challenge of creating a textbook that provides the student of medical imaging informatics with the broad range of topical areas necessary for the field and doing so without being superficial Unusual for a text on informatics, the book contains a chapter, A Primer on Imaging Anatomy and Physiology, subject material this writer knows is important, but is often lacking in the knowledge-base of the information technology (IT) people he works with. Similarly, many informatics-oriented physicians this writer knows do not have the in-depth understanding of information systems and components that IT experts have. Such is the subject matter of the"middle chapters of the book -Chapter 3. Information Systems Architectures, Chapter 4: Medical Data Visualization: Toward Integrated Clinical Workstations, and Chapter 5. Characterizing Imaging Data. The succeeding chapters are directed towards integrating IT theory and infrastructure with medical practice topics-Chapter 6: Natural Language Processing of Medical Reports, Chapter 7: Organizing Observations: Data Models, Chapter 8: Disease Models, Part 1. Graphical Models, and Chapter 9: Disease Models, Part 1 Querying Applications Finally, because a practitioner of medical imaging informatics is expected to keep up with the current literature and to know the bases of decision making. the authors have included a chapter on Evaluation. With the statistical methods and technology assess- ment areas covered, the reader will gain the understanding needed to be a critical iSocietyofImagingiNformaticsinMedicinewebsitehttp://nwwsimmveb.org
viii Foreword With the advancement of picture archiving and communications systems (PACS) into “mainstream” use in healthcare facilities, there is a natural transition from the disciplines of engineering research and technology assessment to clinical operations. While much research in PACS-related areas continues, commercial systems are widely available. The burgeoning use of PACS in a range of healthcare facility sizes has created entirely new employment opportunities for “PACS managers,” “modality managers,” “interface analysts,” and others who are needed to get these systems implemented, keep them operating, and expand them as necessary. The field of medical imaging informatics is often described as the discipline encompassing the subject areas that these new specialists need to understand. As the Society of Imaging Informatics in Medicine (SIIM) defines it: Imaging informatics is a relatively new multidisciplinary field that intersects with the biological sciences, health services, information sciences and computing, medical physics, and engineering. Imaging informatics touches every aspect of the imaging chain and forms a bridge with imaging and other medical disciplines.1 Because the technology of PACS continues to evolve, imaging informatics is also important for the researcher. Each of the areas comprising the field of imaging informatics has aspects that make for challenging research topics. Absent the research these challenges foster and PACS would stagnate. For the student of medical imaging informatics, there is a wealth of literature available for study. However, much of this is written for trainees in a particular discipline. Anatomy, for example, is typically aimed at medical, dental, veterinary, and physical therapy students, not at engineers. Texts on networks or storage systems are not designed for physicians. Even primers on such topics tend not to provide a crossdisciplinary perspective of the subject. The authors of Medical Imaging Informatics have accepted the challenge of creating a textbook that provides the student of medical imaging informatics with the broad range of topical areas necessary for the field and doing so without being superficial. Unusual for a text on informatics, the book contains a chapter, A Primer on Imaging Anatomy and Physiology, subject material this writer knows is important, but is often lacking in the knowledge-base of the information technology (IT) people he works with. Similarly, many informatics-oriented physicians this writer knows do not have the in-depth understanding of information systems and components that IT experts have. Such is the subject matter of the “middle” chapters of the book – Chapter 3: Information Systems & Architectures, Chapter 4: Medical Data Visualization: Toward Integrated Clinical Workstations, and Chapter 5: Characterizing Imaging Data. The succeeding chapters are directed towards integrating IT theory and infrastructure with medical practice topics – Chapter 6: Natural Language Processing of Medical Reports, Chapter 7: Organizing Observations: Data Models, Chapter 8: Disease Models, Part I: Graphical Models, and Chapter 9: Disease Models, Part II: Querying & Applications. Finally, because a practitioner of medical imaging informatics is expected to keep up with the current literature and to know the bases of decision making, the authors have included a chapter on Evaluation. With the statistical methods and technology assessment areas covered, the reader will gain the understanding needed to be a critical 1 Society of Imaging Informatics in Medicine website: http://www.siimweb.org