Hospital facilities manage a large amount of information that, in most cases, used to be scattered and not immediately available. For this reason, systems have been developed to help manage this information in a way that is useful for decision-making, such as the HIS system. Find out what it is used for and what its main features are below.

A hospital information system, or HIS (Hospital Information System), is one designed to meet the needs of a hospital facility, such as storing, processing, and reinterpreting medical-administrative data. All of this allows for the optimization of human and material resources.

Every HIS system will generate reports depending on the hospital area for which it is required, providing feedback on the quality of healthcare service delivery. It is important to note that its use relies on security measures, generally based on standards such as HIPAA (Health Insurance Portability and Accountability Act), which ensure the authentication, authorization, and management of user profiles for those who interact with the available data.

Within a hospital, there are several types of information systems. HIS integrates them to achieve the automation of many kinds of transactions and processes. It is important to consider the existence of major system groups, such as:

• Front office. These are systems that support the delivery of healthcare services, focused on the institution's external interactions. 
• Back office. These support the functioning of the hospital's departments, focused on the institution's internal operations. 
• Clinical systems, diagnostic and treatment support. These automatically gather the patient's clinical information and data.

In addition to these, there are several specialized services within a hospital, including: clinical laboratory, pathology, pharmacy, etc. Each of these has information systems that have been optimized to function according to the specific requirements of each area.

Requirements for implementing a HIS system

To implement a HIS system, certain basic elements are required, which will vary depending on the service provider.

1. Intranet and internet communications network.
2. Hardware equipment, depending on infrastructure and financial resources.
3. Base software with which the system will be programmed and operated.
4. Staff training for using the system and its information.
5. Financial funding.

Types of HIS systems

According to their intended functions within the hospital system, HIS systems can be classified into these types:

1.  Administrative HIS. Manages all hospital resources, including human, material, and financial resources.
   
2.  Medical-administrative HIS. Manages the relationship with patients and the data they generate as users of hospital services.
   
3. Clinical HIS. Refers to the patient's state of health or illness, as reflected in the medical record. 

Functions of a HIS system

The main function of a HIS is to manage information regarding a hospital's services and make it accessible to all authorized staff.

Likewise, a HIS is responsible for providing support for activities at various operational and tactical levels within a hospital. For this reason, computers are used to gather, store, process, and communicate clinical-administrative information. 

Other functions of HIS systems include:

• Keeping control of all services provided to patients.
• Obtaining general statistics on patients.
• Obtaining epidemiological data.
• Detailing the cost of care provided to each patient.
• Maintaining a strict electronic medical record.
• Providing patients with access to information in a timely and appropriate manner.
• Giving them the ability to update that information and exercise their right to correct data.
• Improving clinical practice through decision support.
• Supporting teaching and research activities.
• Making the institution's specific plans more efficient.
• Harmonizing scientific-technical information with administrative-accounting information.

Advantages of HIS systems

Once a HIS system has been implemented, the clinic or hospital will benefit in the following ways:

• Retrieval of information on patients and hospital processes is done more effectively, since everything is automated.
• A greater volume of information can be handled while still keeping up with daily tasks.
• All information can be managed in real time.
• Reduced paper use, since recorded information is digitized.
• Better monitoring of supplies, inventory, and medications.
• Ensures the availability of information for decision-making.
•  Minimizes response time to patients, clients, and suppliers.

Traditionally, HIS systems can be integrated with other medical systems designed to increase productivity, generate savings, and improve patient care, such as PACS and RIS systems.

References 

• Conceptos generales HIS. Oficina de inteligencia sanitaria. 
• Sistema de Información Hospitalaria. Sistema Mid.
• Leonardo Yunda Perlaza y Luis Fernando Gómez. Informática Médica: Sistemas de Información y Estándares en Salud: Modelo de Aplicación.

A PACS has become an extremely useful tool for medical centers with a radiology department. These systems allow physicians to review all files related to a patient's studies digitally.

Digitization of medical documents

The main goal of these systems is to allow medical images to be moved and managed more quickly, so that medical and administrative staff, as well as patients themselves, benefit.

PACS components

Now, when it comes to choosing the PACS that can be put to the best use, there are several aspects to consider. The first is to assess the medical center's objective, as well as its specific needs. However, when it comes to PACS components, there are some that definitely cannot be missing. Below we list five of them.

DICOM viewer

It is true that there are countless different image formats; however, in order to standardize medical studies, the DICOM format, Digital Imaging and Communications in Medicine, was created. This guarantees that all physicians can correctly view this type of image and know it is the standard format to use for any study, whether CT scan, MRI, ultrasound, etc. In addition, this type of image is also accepted in other systems with RIS or HIS, in addition to PACS.

Measurements in a PACS system

There are different types of measurements that can be relevant when interpreting a study, such as distances, angles, ROI, annotations, among others. With a PACS such as Eva, the radiologist can take these measurements while they are automatically saved in the toolbar that shares the same name. Other measurements that can be important include the cardiothoracic index and the Cobb angle.

Cloud storage of medical images

Radiologists face heavy workloads, so it is not uncommon to find them working at several medical centers. But what happens if, for some reason, they cannot travel to their workplace? With a cloud-hosted PACS, the physician can receive studies and do their work from wherever they are, with the assurance that the patient will receive their diagnosis promptly.

Cine mode in medical PACS

When dealing with very long image series, it can be useful to view them in motion, as well as to choose the number of frames per second for playback. Eva's development team created this tool with precisely this need in mind. It also makes it possible to see details that cannot be observed in a static view.

Custom tools for radiology images

There are many tools that can be added to PACS systems to make physicians' work easier. At Eva Center, our team strives to create new shortcuts every day and add whatever our partners need. Along these lines, we offer voice dictation or recognition, as well as 3D reconstruction, which can be extremely useful for a better viewing perspective, multiplanar reconstruction, and many others.

‍

The relationship between medicine and technology is becoming increasingly relevant due to the simplicity with which certain procedures can now be performed compared to how they were carried out a few years ago. For this reason, there is a key concept for measuring how viable a given tool is: usability. More and more attention is being paid to how user-friendly a given program or website is.

In the case of PACS systems, where images and reports from various studies are stored electronically, it is of great importance that they include the necessary options for medical staff to perform an appropriate interpretation. In the following section, we will describe what a PACS system is and how it works.

What does a PACS system consist of?

As mentioned earlier, PACS systems store information, mainly images from radiology studies. Previously, film printing was used, so these systems have come to replace that task. The main difference is that these PACS systems feature structures that allow for greater quality and precision.

Usability of a PACS system

There are different criteria for determining the usability of PACS systems. However, some of the most important aspects to consider are the number of available tools, the way they are laid out, and the average number of clicks it takes to complete an interpretation. There are also other factors, such as automatic sequencing and the ability to customize the system. The goal of all this is to increase the productivity of medical staff.

On the other hand, the learning curve is also relevant, since the more intuitive the PACS is, the less time it will take a physician to become familiar with the tool.

Once an institution acquires a PACS system, at some point a new physician will arrive who will also need to use this tool. That same professional is likely to work at different institutions and therefore use PACS solutions from different vendors, which is why having user-friendly tools will ensure they can do their job better.

Another relevant aspect of usability is whether the physician constantly needs an IT professional to make configuration changes. If the answer is yes, this means that usability is inadequate. This applies even more if a workstation connected to a server is used, since in that case the physician must be in that same location to interpret studies, whereas with a cloud-based PACS, only a computer with internet access is needed. If we add to this the difficulty of requiring a technology expert, the PACS's usability drops.

PACS components

A PACS has various components, such as modalities for imaging equipment, communication networks, archiving systems, workstations, and software. For example, if a physician is diagnosing a mammogram, they can choose, depending on what they need, to use two quadrants, one for the right breast and one for the left. If they want to compare it with a study from six months earlier, the screen could be divided into four quadrants. The degree of usability will depend on how simple it is to bring up these options.

It can also define the image slice thickness, use cine mode to view it in motion, or display it in 3D

So, if you are looking to switch to or acquire a new PACS, you now know some of the most important elements to evaluate in terms of usability, a fundamental recipe for these tools that will undoubtedly bring great benefits to both physicians and patients.

As the renowned American philosopher Ralph Waldo Emerson once said: "The first wealth is health," a statement society identifies with to a great extent, since people daily seek out the best hospital services for any symptom, control process, or prevention effort. Hence, hospital infrastructure management must stay at the forefront of existing advances to maintain and increase patient trust.

Now, when we talk about hospital infrastructure, it includes several elements, such as:

• Internal building structure
• Interior design
• Lighting
• Parking
• Green areas
• Access zones
• Equipment
• Information systems

In other words, this infrastructure relates to the building itself, the resources for treating patients, and also the comfort experienced at every moment within the hospital. Indeed, even the colors and decoration of the rooms, though it may not seem so, are important for conveying calm and confidence in the facility's level of professionalism.

How can hospital infrastructure be improved?

Many hospitals stand out in their category due to their expertise in different specialties, a fact that makes it considerably more difficult to fully remodel their infrastructure. However, when a facility is well regarded by patients, continually improving the most critical points delivers optimal results in the medium term.

To begin with, it is necessary to conduct a study of the aspects that cause the most discomfort for patients, sometimes parking, decoration, or the turnaround time for radiology studies, to name a few examples. Based on this, hospital management can then determine where to begin investing.

To identify patients' pain points when visiting the facility, a fairly straightforward approach is a simple multiple-choice survey. It is worth noting that these studies statistically reveal dissatisfaction with turnaround times, which is why adopting technology that reduces patient wait times is key to improving hospital infrastructure.

The importance of hospital infrastructure

As mentioned in the previous sections, patient satisfaction is what maintains or increases the profitability of healthcare facilities. In that sense, having all the elements that make them up be state of the art guarantees success.

If we talk about the building and its decoration, people naturally associate them with being able to find the solution they need to stay healthy, of course, guided by experts with extensive experience in specific specialties.

Likewise, a good parking area is appropriate so that people have easy access. Sometimes hospitals lack this service, and as a result, some people rule out the facility, even knowing that the best doctors are there. 

As for technology, it is a highly valuable asset for patients, since society is increasingly immersed in it. Therefore, finding applicable digital solutions in hospitals, such as PACS systems, is appropriate for attracting more patients.

Infrastructure of a top-tier hospital

The most notable aspects of a top-tier hospital's infrastructure are:

• Building and decoration. Modern construction featuring bright, uplifting colors such as white is the leading trend in world-class hospitals. These are linked to patients' self-esteem.
• Green areas. Some regulatory considerations must be taken into account here, since certain plants and trees attract wildlife that can affect hygiene and health aspects. Therefore, the type of flora and its placement must be carefully evaluated, though nature undoubtedly appeals to patients.
• Access areas. Doors and parking spaces are essential for people with mobility limitations, making them a crucial part of hospitals.
• Technology. State-of-the-art equipment and systems that streamline hospital operations are essential today. PACS (Picture Archiving and Communication System) systems are one such example, as they enable the capture, storage, and transmission of radiology images in record time among hospitals, specialists, and patients.

Medical technology has succeeded in harnessing different methods to determine what is happening inside our bodies. Such is the case with ultrasound, or sonography, one of the most common radiology and imaging studies, which physicians across many specialties may order for the diagnosis and treatment of numerous diseases or injuries. Below we explain how it works.

What Is Ultrasound?

There are many types of waves, and one of them is mechanical waves, which are used in ultrasound. These are sound waves not perceptible to the human ear, which can be used to diagnose various conditions, as well as to assess the general health of our bodies. In gynecology, ultrasounds are commonly used to track the progress of a possible pregnancy or the health of the reproductive system.

Ultrasound also has therapeutic applications following injuries, mainly orthopedic injuries, which may involve immobilization. 

Ultrasound is nothing more than the conversion of electrical energy into mechanical waves, and this is done by the medical equipment also called an ultrasound or sonography machine. It is a noninvasive process, and therefore neither painful nor harmful to the body. This is why there is no limit to how many ultrasounds, or other studies based on this same principle, you can undergo.

These mechanical vibrations occur upon contact with an elastic medium, such as the skin. The sound waves bounce off the structures of our body by means of a transducer, which in turn displays a real-time image on a monitor.

How Does Medical Ultrasound Work?

In medical ultrasound, waves are used to diagnose many conditions or diseases associated with gynecology and the digestive system, although it is also used in cardiology, urology, orthopedics, ophthalmology, endocrinology, and other medical specialties. 

The most important part of the equipment used for diagnostic ultrasound is the transducer probe, since it is responsible for sending and receiving waves to create the echo effect that produces images of the body. A cold gel is applied to the area of the body being examined, which helps transmit the body's images.

Another use of ultrasound is in various surgical procedures, using sterile probes to assess the internal structure to be treated as the procedure progresses. Such is the case with ultrasound-guided biopsies, which give the interventional physician a clear picture of where to take the tissue sample that will be examined under a microscope.

This type of ultrasound, in turn, has two categories: the first is the anatomical, which is used to obtain images of the body's internal structure, whether tissues or organs. The second is the functional, which allows the velocity of tissues or blood to be merged with other information to produce “information maps.”

One of the most important advances in ultrasound is that results can now be obtained in 3D, 4D, and color. This latter feature is known as Doppler ultrasound. All of this has been extremely helpful for studying the heart and its proper function, as well as arteries, liver inflammation, and many other regions of the body.

Ultrasound for Therapies

When we refer to therapeutic ultrasound, there is no change in the underlying principle of generating mechanical waves from electrical energy; the only difference is that in this case, the specialist will not give you images as results. 

The goal is for these waves to interact with the tissues of your body in order to modify them according to the pre-existing condition. Some examples include breaking down blood clots and tumors, heating certain areas to relax the muscle, and directing medication to specific locations.

This makes it possible to reduce inflammation and pain; it increases skin permeability without leaving any associated scarring, boosts enzyme production, and offers many other advantages. Depending on the purpose, there is an established frequency dose and a technique that can be either continuous or pulsed.

Are There Risks Associated with Ultrasound?

Ultrasound is noninvasive and painless for your body, which is why experts in medicine and radiology consider the risk associated with these studies and therapies to be nonexistent, especially compared with the radiation exposure involved in X-rays. 

However, you should know that these are two completely different studies with specific purposes depending on the area of the body to be assessed for a subsequent diagnosis, which is why only your physician can determine which imaging study is best for you.

To ensure your body's safety, what matters most is that you visit certified healthcare centers with extensive experience, ones that stay at the forefront in terms of equipment and updated information.

References

• Ultrasound. Terapia Física.
• Ultrasound. National Institute of Biomedical Imaging and Bioengineering.

Below we will explain what computed tomography is and what its main applications are. This radiology and imaging study is one of the most frequently ordered by experts to make their diagnoses.

One of our main wishes is to have health and well-being, and for this to be possible, it is essential that whenever we experience any symptom or trauma, we see a specialist physician, who will tell us the next steps to take. While we do indeed need to wait for these instructions, it is important to know that our physician may very well request imaging studies in order to make a diagnosis.

This is because  symptoms alone, or a simple description of what happened, are not enough for the physician to determine the extent of any condition affecting our body, whether due to an illness, or after suffering an accident, blow, or fall. So do not be surprised if, when you visit the specialist, they ask you to undergo radiology and imaging studies, since this is one of the most reliable methods for examining the internal structure of the human body.

What Is Computed Tomography and What Is It Used For?

One of the most common imaging studies is computed tomography, or computed axial tomography (CT or CAT scan), which involves two techniques for obtaining detailed images of a body area of interest. The first is the use of X-rays through a tube that rotates around you, allowing captures to be taken from different directions. The second is computer technology.

Computer technology is what allows the physician to obtain more detailed and sophisticated images of the body. In addition, this technique allows for computer manipulation to more precisely view small areas of the body, such as blood vessels, the bronchi, sections of the spinal cord, and tissues, among others.

It should be noted that the advantages mentioned above give computed tomography scans added value and therefore a higher price compared with plain radiographs (X-rays). In addition, although the process is painless, it takes a bit longer (around 30 minutes).

The above is due to the fact that the technologist or radiologist must follow a set of steps to ensure a quality tomography image, such as proper calibration of the equipment. If this is not done correctly, the study may not turn out well and you would have to undergo the radiation again. That is why we suggest going to a quality laboratory, clinic, or hospital.

Contrast Media in Computed Tomography

In certain cases, and to achieve better visualization of the inside of the body, the patient may be instructed to receive a contrast medium. This can be administered orally or intravenously.

These contrast agents are widely used and are not risky. However, you should tell whoever is performing the study if you feel any symptom of excessive heat or pressure when it is administered, as this could indicate an allergy. Afterward, it is advisable to drink plenty of fluids to help flush it out.

The facility where you have the study performed will give you the appropriate instructions for preparation before and after the study if a contrast agent has been indicated.

What Can a Physician See With a CT Scan?

Since CT scans produce sophisticated images that can be professionally manipulated on a computer to get a better view of your body's internal structure, their scope is considerably broad. 

This is why a physician may order one to evaluate any of the following diseases or medical conditions:

• Investigating possible internal bleeding, for example after cardiovascular damage.
• Assessing internal injuries or fractures of both the skeletal and muscular systems.
• Locating tumors, clots, or infections. On this last point, we can mention pulmonary conditions such as pneumonia, in which contrast agents are commonly used to highlight the condition.
• Guiding surgical procedures to determine where to make incisions. A simple example is biopsies.
• Monitoring conditions such as cancer or pulmonary diseases.

Is Getting a CT Scan Dangerous?

Indeed, when you undergo a CT scan, your body receives radiation that is higher than what you are usually exposed to naturally. However, technological advances have allowed radiologists to control radiation doses in order to reduce the associated risks.

These doses depend on the area being scanned. For example, for the abdomen and pelvis, there is an exposure of 10mSv, equivalent to two and a half years of natural background radiation. For the lungs and chest, the figure is 1.5mSv, corresponding to 6 months; and for the teeth, at 0.18 mSv, it is similar to 22 days of radiation.

How Do I Prepare for a CT Scan?

In general, no prior or special preparation is required. In some cases, you may be asked to fast or stop taking fluids or medications beforehand, but this usually occurs only when contrast media are used.

It is suggested that you wear comfortable clothing. You may be asked to remove your clothes and put on a medical gown. Likewise, you will not be allowed to wear any metal accessories of any kind. 

Notify the physician if you suspect you might be pregnant, or if you are pregnant, before undergoing the study.

When it is time to begin, you will simply need to lie down on a table. The study will be finished within 10 to 30 minutes.

How Will I Get the Results of My CT Scan?

The results are generally accompanied by an interpretation from the radiologist. Keep in mind that only your physician knows what each term means, and it is up to them to decide what steps to take regarding your treatment.

You will generally receive your results between one and three days after your study is performed. Many laboratories and hospitals allow you to view them digitally. That way, you can save them and easily share them with additional physicians, for example if you need a second opinion.

References

• Computed Tomography. MedlinePlus.
• X-Rays, CT Scans, and MRIs. OrthoInfo.
• CT Scan. Mayo Clinic.
• Radiation Risks from Imaging Tests. American Cancer Society.

Learn about the benefits of having technical support for a PACS system, and why quality service also translates into long-term savings for any healthcare institution.

Today, technology is advancing by leaps and bounds, both in our everyday lives and in various fields of knowledge, among which healthcare systems clearly stand out. In this sector, technology facilitates patient care and makes work in hospital organizations more efficient.

One example of this is PACS systems, because in addition to being secure and increasing the productivity of operations, they make work easier and provide easy access to information.

However, for the entire system to function properly, there must be certainty that if something goes wrong, a well-prepared, efficient, and available technical support service will be there. A powerful infrastructure is of little use if, when technical support is needed, requests simply go unanswered.

That is why we will now discuss the advantages and benefits of quality technical support for healthcare technology solutions, such as PACS systems.

Characteristics of a Quality Technical Support System from a PACS Provider

When choosing a PACS system, it is very important to ask the provider about the responsiveness of their technical support. 

Likewise, if a PACS system is already in place, it is worth evaluating whether quality technical support is included. No one wants to wait until a crisis occurs to find out whether there will be someone available to help resolve the problem.

Some of the factors of a quality technical support system that can be taken into consideration are the following:

• The main aspect is accessibility, since information must always be available to the medical staff who require or need it. Technical support must ensure that all staff have access to and know how the systems work, even before the PACS is implemented at an institution.
  
• In this regard, a quality PACS system must provide training not only at the start of implementation, but on an ongoing basis. This training should be provided whenever there is new staff at the healthcare institution, whenever there are system updates, and so on.

• Another important factor is security. The PACS system must guarantee that security measures are in place, and in the event of a breach, technical support must ensure a prompt and efficient resolution. It should also provide data backup and the implementation of security measures and standards, such as HIPAA.
  
• Without a doubt, another essential factor is availability. Quality technical support will offer fast response times, as well as different channels of communication. Likewise, technical support must be available around the clock, especially if the healthcare service operates 24 hours a day or handles emergencies.
  
• Network management. Acquiring a PACS system facilitates communication over computer networks and enables the transmission of images to different remote locations within the hospital through the communication network. But what happens if this communication fails or is disrupted? Efficient technical support must be able to resolve any issue in this regard, since the hospital or clinic cannot afford service interruptions.

• Support for image processing. With a PACS system, images are processed using different methods in synergy with the diagnostic modalities. Quality technical support must know how to make the appropriate adjustments so that all modalities can be used seamlessly with the PACS system.
  
• Price. When we acquire any technology service, we assume that technical support is guaranteed, but this is not always the case with PACS providers. When choosing a PACS system, questions should be asked about service, maintenance, licensing, and update costs. A quality service will include personalized attention and technical support within the cost of the system itself.

Why Choose a PACS System?

Today it has been shown that PACS systems offer great capacity and speed, facilitating better diagnosis and effective management of hospital information.

In the not-too-distant future, PACS can be expected to become a fundamental piece within the framework made up of the various information systems present in a modern healthcare institution. 

Among other elements, PACS systems offer the following benefits:

• Today's healthcare organizations come to form complex networks of affiliated institutions that provide comprehensive patient care services.
  
• As for the efficient exchange of information among the various areas and sectors related to the patient, a communication system is needed that fully incorporates all clinical data, which means that diagnostic images are an important and fundamental component.
  
• Areas explicitly dedicated to the healthcare sector need to be able to compete by lowering costs without sacrificing service efficiency, and to keep innovating for the benefit of the quality of care provided to patients. All of this is possible through the implementation of PACS systems.
  
• In addition, having a PACS system is considered a highly competitive tool and a strategic investment for improving both productivity and the organization's reputation within the hospital environment.

All of these factors depend directly on the PACS system provider being able to back its services with personalized attention and technical support that is efficient, reliable, and available at all times.

References

• Hernández, Raúl. “Desarrollo de habilidades en el uso de las tecnologías de la información y la comunicación. PACS” (Developing Skills in the Use of Information and Communication Technologies. PACS). 
• Silva Alvines, Eduardo. “Introducción a sistemas RIS-PACS” (Introduction to RIS-PACS Systems).
• “Sistemas para archivo y comunicación de imágenes (PACS)” (Picture Archiving and Communication Systems). Guía tecnológica no. 41. Secretaría de Salud (Ministry of Health), México, 2009.

Many physicians feel apprehensive about not being able to interpret this terminology since they are not trained as radiologists. To help prepare you for when you encounter these terms, we will show you how to gain a better understanding of this useful tool in the medical field so you can provide better healthcare.

What Is Magnetic Resonance Imaging and How Does It Work?

Magnetic resonance imaging (MRI) is a diagnostic method used to produce detailed images of organs and tissues by means of a magnetic field and radio waves that change rapidly. The resulting images are then displayed on a computer to determine whether a lesion is present and to what extent.

Magnetic resonance imaging is an interaction between an external magnetic field, radiofrequency waves, and atomic nuclei. When a body is subjected to a magnetic field and subsequently stimulated by electromagnetic waves (radiofrequency waves), the result is resonance of its atomic nuclei. 

The basis for obtaining images is measuring the energy released and the time it takes to return to a relaxed state once stimulation ceases. Through this radiological study, high-quality images of the human body are obtained, enabling accurate diagnoses. Thanks to magnetic resonance imaging, we have been able to reveal the different cross-sections of tissues, organs, and vascular structures.

Basic Radiology Concepts in Magnetic Resonance Imaging

Setting aside purely technical aspects, what is important to understand is the sequential process:

1. The hydrogen nuclei are the key players in forming the image by MRI. When the patient is placed in the MR scanner, the hydrogen atoms, previously oriented at random, align with the static magnetic field.

2. To detect the signal, a radiofrequency pulse is briefly applied, producing a net change in the alignment of these atomic nuclei.

3. When the radiofrequency pulse ceases, the spins return to their equilibrium state, releasing energy to the surrounding molecules.

4. The rate of energy release is determined by the intrinsic relaxation properties of each tissue, characterized by the longitudinal relaxation time (T1) and the transverse relaxation time (T2).

5. T1 represents the recovery of longitudinal magnetization in the direction of the main magnetic field.

6. T2 represents the loss of magnetization in the transverse plane, perpendicular to the axis of the field.

7. Substances with a long T1 (for example, fluids) will appear dark on T1-weighted images, while those with a short T1 (fatty tissues) will show a high-intensity signal.

8. On T2-weighted images, a substance with a long T2 (fluid) will appear bright.

9. The main advantages of MRI are its excellent contrast resolution, high spatial resolution, and the absence of ionizing radiation.

10. Among the agents approved for clinical use in MRI,  the most commonly used contrast agent is a drug that shortens T1, called gadopentetate dimeglumine (or Gd-DTPA), because it contains gadolinium, a paramagnetic agent (atoms with unpaired electrons in their outer shells).

11. Tissue relaxation is altered by the interaction between gadolinium's unpaired electron and tissue hydrogen protons, which significantly shortens the T1 of blood relative to the surrounding tissues.

12.  MR images can be obtained using different “sequences.” The most commonly used are known as spin-echo (or spin echo) sequences and can be weighted in either T1 or T2.

T1-, T2-, TR-, and TE-Weighted Images

MRI allows healthcare professionals to detect abnormalities and lesions that help confirm a diagnostic hypothesis and improve treatment guidelines. This is why we must deepen our understanding of T1-, T2-, TR-, and TE-weighted imaging.

Many physicians fear they will be unable to interpret this terminology since they are not trained as radiologists. Below we show you how to gain a better understanding of this useful tool in the medical field and its most common terms.

To more precisely understand what relates to a weighted image, we must recall the basic planes of every magnetic resonance study, understanding that it works with three planes: the axial, coronal, and sagittal planes.

When it comes to gaining a deeper understanding of the qualities of this imaging study, in this case magnetic resonance imaging, it is important to be familiar with certain concepts described previously in order to understand what is meant by a weighted image. 

The pixel value and contrast of an image are determined by intrinsic and extrinsic factors:

• Intrinsic factors: proton density, T1, T2, flow, and diffusion.
• Extrinsic factors: TE, TR, flip angle, TI (inversion time), turbo factor, echo train length, b-value, among others.

Definition of Key Terms in Radiology

•  T1-weighted images. This is the measure of relaxation time as it manifests in the longitudinal plane. These images are created primarily using data from the relaxation rates that differentiate protons in the longitudinal plane of a main magnetic field.
  
• T2-weighted images. This refers to the measure of relaxation time as it manifests in the transverse plane. These images are created using the same principle as T1-weighted imaging, except that it occurs in the transverse plane.  
  
• TR-weighted images. Describes the measure of repetition time. In other words, it is the time needed to complete a full excitation/relaxation cycle for a pulse sequence, expressed in milliseconds (ms).
  
• TE-weighted images. This is the measure of echo time. That is, it is the time elapsed between the start of a pulse sequence and the acquisition of data from excited protons, expressed in milliseconds (ms).

What Is a Pulse Sequence? 

The echo time (TE) and the repetition time (TR) refer to a concept known as the pulse sequence, a series of instructions repeated numerous times, which allows data to accumulate in order to ultimately create an MRI image.

The pulse sequence has two essential variants:

• Spin echo pulse sequence. This event begins with a 90-degree pulse and continues with a 180-degree pulse, generating protons that create the MRI signal. This type of sequence is used to weight images in T1 and T2.
  
• Fast spin echo (FSE) pulse sequence. The advantage of this type of technique is that, after the 90-degree and 180-degree pulses, multiple echoes can be obtained. In other words, multiple slices of the scan are obtained.  This modality is much faster than conventional spin echo, especially for T2, since it requires a shorter repetition time (TR) to create the image.

Difference Between a T1-Weighted and T2-Weighted Image Based on TE and TR

Generally speaking, a T1-weighted image has a short TR and TE, the former being less than 1,000 ms and the latter less than 20 ms. On the other hand, substances with a long T1 will be hypodense, while a short T1 will result in a substance that is hyperdense in terms of intensity.

A T2-weighted image has a long TR and TE, the former being more than 2,000 ms and the latter more than 40 ms. In this case, substances with a long T2 will be hyperdense, while hypodense substances will remain hypodense.

How to Distinguish a T1-Weighted from a T2-Weighted Image?

• On  T2-weighted images, fluid is hyperintense, whereas on T1 it has an intermediate signal.
• Fat is brighter on T1, although it is not the ideal predictor. On T2 it is hypointense.
• On T1, hyperintense structures include blood, proteinaceous substances, melanin, and paramagnetic agents (gadolinium).
• On T1/T2, structures such as air, cortical bone, ligaments, tendons, fibrous tissue, and blood flow appear hypointense.

On a T1-weighted image, the bone marrow of a normal adult (fatty or yellow marrow) has high signal, that is, it is hyperintense or hyperdense. This means it appears white in tone, while cerebrospinal fluid has low signal,  that is, it is hypointense or hypodense, giving it a dark tone.

Nervous tissue, such as the spinal cord or nerve roots, has an intermediate signal intensity. Cortical bone, which lacks mobile protons to produce a signal, is hypointense on all pulse sequences.

On T2-weighted images, bone marrow has lower signal intensity, cerebrospinal fluid becomes hyperintense, and nervous tissue maintains an intermediate signal intensity. However, the spinal cord has relatively lower signal intensity, since it is surrounded by cerebrospinal fluid, which has a much higher signal intensity.

The intervertebral discs of normal individuals typically have an intermediate signal intensity on T1-weighted images and, due to their water content, appear hyperintense on T2-weighted images.

Diagnostic Value of T1- and T2-Weighted Images 

One of the main uses of a T1-weighted image lies in its application in neurology, since the image quality and the precision of anatomical detail allow for a more accurate diagnosis. It also helps determine the best therapeutic course for the patient.

The advantage of a T2-weighted image is that it shows fat as a low-intensity signal (hypo) and fluid as a high-intensity signal (hyper).  This, for example, is very useful in lesions and pathologies characterized by an increase in fluid content. There is also a reversal with respect to white and gray matter, with white matter showing lower intensity.

The mechanism used by radiology and imaging equipment may seem complex, but understanding how an image is obtained allows us to improve patient diagnosis. Let us remember that the type of contrast used is key when performing a paraclinical study.

Today, this type of procedure is enhanced thanks to the technology used by PACS systems (Picture Archiving and Communication System), which give specialists the opportunity to improve image contrast and quality using a variety of techniques and tools.

References

• E. Scott Pretorius and Jeffrey A. Solomon. 2006. Radiology Secrets. Elsevier.
• Joaquín Costa Subias and Juan Alfonso Soria Jerez. 2015. Resonancia magnética dirigida a técnicos superiores en imagen para el diagnóstico (Magnetic Resonance Imaging for Senior Diagnostic Imaging Technicians). Elsevier.
• Michael Y. M. Chen, MD, Thomas L. Pope Jr., MD, and David J. Ott, MD. 2006. Radiología básica (Basic Radiology). Mcgraw-hill - Interamericana de España.
• “Resonancia magnética” .Temas especiales. Manual MSD versión para profesionales.
• “Cómo interpretar las Imágenes de Resonancia Magnética”. Radiología 2.0.

What Is the ROI Tool and What Is It Used For?

This is a tool whose English acronym stands for “Region of Interest,” that is, region of interest. It refers to a part of the image that one wishes to filter or operate on in some way, for example to make an annotation or measurement. 

In a DICOM viewer, the ROI is one of the basic functions. Different PACS systems offer different ways to mark the region of interest, or ROI, on a study, for example circles, ellipses, polygons, and rectangles, among others. 

Through the properties of the viewer and the tool itself, both its appearance and its behavior can be customized.

Its main use is to perform measurements once the region of interest, or ROI, has been detected in an area of the medical image. This allows the physician to make comparisons with previous studies, adjust contrast or brightness, take measurements, and generally use all the tools of the DICOM viewer around the desired area.

Other tools of the DICOM viewer that most commonly interact once a region of interest, or ROI, has been detected include:

• Length measurement 
• Angle measurement
• Area measurement
• Volume measurement
• Annotations
• Polygonal area selection
• Freehand area selection

What Is DICOM?

An acronym for Digital Imaging and Communication in Medicine, DICOM is a standard for digital imaging and communication in medicine. It was designed to specify a protocol of rules for data exchange, the digital image format of medical studies, and a file structure for medical images and associated related information exchanged between imaging equipment from different vendors.

DICOM was originally developed by the National Electrical Manufacturers Association (NEMA) and the American College of Radiology for computed axial tomography (CT) and magnetic resonance imaging (MRI) scans. It is currently maintained by the DICOM Standards Committee and supports a wide range of medical images in the fields of radiology, cardiology, pathology, and dentistry.

DICOM is used in virtually every modern hospital. It ensures the interoperability of the systems used to produce, monitor, transmit, query, process, retrieve, and print medical images and derived structured documents, as well as to manage clinical workflow through a PACS system.

How Does the ROI Relate to the DICOM Viewer?

Generally, diagnostic modalities such as magnetic resonance imaging, computed tomography, and computed radiography, among others, can be costly in terms of both image storage and infrastructure. For this reason, a way was sought to compress these images to make them more manageable for both storage and distribution, without affecting their resolution or diagnostic capability.

The ROI tool is also a form of compression, such that the area of the image belonging to the region of interest can be compressed using a lossless algorithm in order to recover the original data without alteration. Likewise, the outer area is compressed using a lossy, or irreversible, algorithm, which can likewise achieve results with a visually indistinguishable reduction in quality.

The DICOM protocol introduces the ROI tool through the capabilities of the JPEG 2000 image standard, allowing the area of greatest diagnostic importance within the image to be compressed losslessly, while the remaining region is compressed with moderate loss. 

The ROI tool can be specified through a set of coordinates or as a binary mask the same size as the image. 

There are three alternatives for ROI-based encoding: 

• Tiling mechanisms 
• CodeBlock Selection  
• Coefficient Scaling (referred to as the Maxshift algorithm in the JPEG 2000 standard)

Among the functionalities of the DICOM protocol are extracting images in various formats, parsing the header, and packaging files into new DICOM files, as it is capable of writing headers that comply with the standard.

The ROI, in turn, must define a region of interest based on the interpretation of a set of coordinates or an image in PGM (portable graymap) format. The resulting ROI is returned in a standard format using JPEG 2000 compression. It accepts different input image formats and produces a sequence of output images with the (.jp2) extension. Its capabilities include the ability to apply lossy or lossless compression and interact with the ROI component to use the region-of-interest technique during compression.

References

• DICOM general description Overview.
• ROI-Based Processing. Math Works. 
• González, L. “An Approach to Medical Image Compression Based on Regions of Interest and Motion Compensation”. Congreso Argentino de Informática y Salud (Argentine Congress on Informatics and Health), CAIS 2013

With the world now fully immersed in a digital environment, and with so many technologies at our disposal, the healthcare system has found ways to innovate and develop solutions where they were needed. Learn how this has been achieved in Mexican hospitals.

Digitalization has become extremely important in today's modern world, and a sector as significant as healthcare and medicine could not be left behind. Digital transformation in hospitals must focus on improving patient care, facilitating physicians' work, reducing human error, and cutting costs.

2020 was identified as the year with the highest global investment in health technologies worldwide. In the context of the pandemic and everything happening at the healthcare level, investments in health digitalization tripled compared to previous years.

For the benefit of the healthcare system and patients, digital systems have now been incorporated into Mexican hospitals. Mexico's healthcare system is made up of several important entities, including physicians, patients, and private and public hospitals. All of them have advanced in this shift toward digitalization.

What Is Health Digitalization?

Health digitalization involves the use of technologies to eliminate the constraints of time and space, as well as extending the reach of the healthcare system to wherever patients are located. This makes it possible to achieve four important objectives:

1. Achieving better outcomes and increasing treatment quality through access to the right professional regardless of where the patient and specialist are located.
2. Improving access and convenience for patients, eliminating the need to travel or relocate when it is not possible or convenient to see a specialist, which improves the patient experience.
3. Improving physicians' experience by reducing the need to travel. This allows them to focus on patient care throughout their career and on more suitable workflows.
4. Cost reduction by leveraging scarce physicians and specialists across multiple clinical sites, hospitals, and offices simultaneously.

In other words, health digitalization helps provide specialized care and reduce the likelihood of medical errors. The use of technology makes it possible to integrate evidence-based best practices into professionals' clinical workflow, ensuring, for example, that the right medications are administered at the correct dose, at the right time. 

Many errors can be avoided by using the electronic health record, which is fundamentally important. The same applies to clearly defined and documented care plans, structured assessment tools, and clinical decision support for physicians.

On the other hand, PACS systems make a significant contribution to the digitalization of medical services, and also enable teleradiology. 

Benefits of Technology in the Healthcare System

1. Clinical records that are clearer, more accurate, and more accessible, staying continuously updated as healthcare providers collect data on their patients.
2. Critical processes are simplified, saving time whenever a patient has to fill out a form, since all information is linked and available in the event of an emergency.
3. Higher-quality data is collected, since it carries a lower margin of error than manual data entry.

Digitalization in Mexican Hospitals

According to one study, by 2016 health digitalization services had been installed in 30 hospitals in Mexico City, with the patient as the top priority. 

The digital clinical record is the first step toward securely managing each patient's data. As a result, interoperability is achieved among these hospital centers, improving patient safety and continuity of care. Likewise, greater service efficiency is achieved along with cost reduction from avoiding repeated tests.  

Some of the benefits obtained through this implementation included:

• Optimizing care processes and reducing patient wait times.
• Increasing prescription safety through the integration of standardized medication databases and the creation of drug alerts.
• Improving the informed consent management process (biometric signature).
• Improving the quality of health data through the implementation of the digital clinical record.
• Increasing patient safety and diagnostic accuracy.

Due to the pandemic, the use of available technologies had to be accelerated to avoid overwhelming Mexican hospitals. Both physicians and patients had to grow accustomed to using telemedicine as a way of accessing healthcare, starting with technological tools such as the phone, through video calls or virtual conferencing tools. 

At the public health level, the Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas (National Institute of Respiratory Diseases, INER) is Mexico's leading research center for respiratory diseases, as well as a highly specialized hospital in the field. With the support of Cisco, a global IT company, it installed a series of applications to improve service and open up new medical areas. This, in turn, provided the connectivity needed to implement remote visits, teleconsultation, streamlined medical reporting, and physician-patient interaction.

Impact on Mexican Society

The digitalization of Mexican hospitals has had a positive impact on society. With remote care, while preserving the quality of the physician-patient relationship, wait times are reduced without the need for exposure or travel. A mobile phone and an internet connection are all that is needed to establish highly effective communication. 

However, there is an economic barrier, since not all Mexicans have access to a mobile device, computer, or internet connection, which makes it difficult to reach every patient.  

This is according to statistical data presented in the 2020 Encuesta Nacional sobre Disponibilidad y Uso de Tecnologías de la Información en los Hogares (National Survey on Availability and Use of Information Technologies in Households, ENDUTIH), which found that only 78.3% of the urban population uses the internet. Among the rural population, usage stands at 50.4%. 

As for remote medical consultations, they account for 16% of private practice in Mexico, according to a study on the digital habits of the medical community. It was also found that 84% of physicians are connected online, mainly via smartphone. The main place of connection is the institution where they work (46%), followed by home (29%), which means continued investment is needed to consolidate this practice. 

Without a doubt, it remains a priority to keep investing in the shift toward digitalization of healthcare institutions in Mexico. Although significant investments have been made in infrastructure, more is still needed to consolidate these changes.

References

• Teleconsultation and Televisit INER. Cisco.

1.  Digitizing and connecting healthcare to improve efficiency and quality of care with ehCOS technology SAMIH_2016_v4 Success Story. 
2. Press Release. National Survey on Availability and Use of Information Technologies in Households, 2016. Inegi.
3. 1st Study on Physicians' Internet Habits in Mexico, April 2021. IRP.

Discover how you can digitize physical radiological plates to store them in the cloud. This is especially useful if you are considering migrating your practice to a PACS system.

Today, many technological advances have emerged that have improved and corrected small errors or complications in many aspects of the healthcare sector. 

Previously, in order to make diagnoses from the radiological images produced on plates, physicians had to view and analyze the image in analog form. Today, with all the advances available, diagnoses can be provided using nothing more than a computer and an internet connection through PACS systems.

What Devices Exist for Digitizing Physical Plates?

If your medical practice uses physical plates, but you are considering digitizing your system, there is an option that will allow you to back up studies digitally and in the cloud. One way to achieve this is with a plate digitizer.

A plate digitizer, also known as an X-ray digitizer, is a piece of equipment that converts your analog plate into a digital format in a matter of seconds so you can view and edit it on your computer.

Are Plate Digitizers Expensive?

X-ray digitizers can seem costly when purchasing the equipment. However, when thinking ahead, you will discover all the time and materials you can save over the equipment's service life.

The prices can vary, as with any product you might purchase. Prices also depend on the product's range and brand. A professional, medical-grade piece of equipment can cost between 10 and 14 thousand dollars. However, other manufacturers offer much more affordable options. Below, we discuss other alternatives for digitization.

Are They Easy to Obtain and Operate?

This equipment is not easy to find, in the sense that you will not find it in a shopping mall or store. You will most likely need to contact a manufacturer or supplier to request a quote and, if necessary, import the equipment.

Since these are digital, versatile, and not very complex devices, they will not be very complicated to use.

What Types of Radiological Plate Digitization Exist?

Digitization consists of transforming the original information from the analog or physical plate into a digital composition and format that will make it possible to view, process, and manipulate all the image data on a computer.

One type of plate digitizer develops the study without the need for conventional developers or darkrooms, which makes it possible to save a great deal of time and reduce development costs. 

On the other hand, when acquiring a PACS system, images are automatically converted into digital format using the DICOM protocol, the global standard for medical images. The most sophisticated and comprehensive PACS systems are compatible with all diagnostic modalities and perform this digitization step automatically.

Another advantage of being able to store all physical plates in a PACS system is that you can keep them in the cloud, as an extra layer of protection against data loss from theft, misplacement, or damage to computer equipment.

Radiographic plates can also be digitized using a CCD camera, which offers adjustment of the black-and-white and gray values of the image through an optical system.This camera, known as a charge-coupled device (its English acronym is CCD, charge-coupled device), uses an internal circuit for image digitization.

Finally, there are specialized medical scanners that operate with an optical system that measures the image point by point. In this way, a resolution superior to human vision is achieved.

How Are Images Archived in the PACS System?

The acronym PACS stands for Picture Archiving and Communication System. These are systems that enable the management of all medical information, improving the productivity of any medical organization.

Generally, the PACS archive consists of a short-term and long-term storage system.

• Short-term storage. This consists of a set of identical disks (RAID) that provide very fast access to image data.
• Long-term storage. This consists of magnetic tapes or optical discs. 

It works as follows: after 3 to 30 days, the image is moved from RAID to long-term storage. To access that information, it must be copied back to short-term storage.

Today, the cost of RAID storage has decreased thanks to cloud systems such as Eva PACS. This is because, being linked and stored in the cloud, they only use short-term storage (RAID), thereby eliminating the need to retrieve the long-term archive. This has also brought advantages in terms of security.

Why Were There Complications with Printed Plates in the Past?

In the past, there were various shortcomings when performing a radiology study in relation to image-based diagnoses. Such complications were associated with the following: 

• Difficulty comparing studies.
• Slowness in accessing all the patient's information.
• No database record or history was kept.
• Exams had to be repeated due to lost plates or errors in the original studies.

These were the main problems a physician could encounter when making a diagnosis, resulting in substandard patient care. 

Looking at today's advances, we find that with systems such as Eva PACS, there is not even a need for a special application, since the system can be accessed directly from a web browser. For this reason, with Eva PACS it is also possible to digitize all your physical plates and keep them in a very secure place using only your computer, saving you time and reducing costs.

References

• Information and Digitization: Centennial Congress of the Sociedad Argentina de Pediatría (Argentine Society of Pediatrics)
• Radiographic Digitization, Josep Alfred Piera i Pelliçer.
• Radiology Secrets, E. Scott Pretorius & Jeffrey A. Salomon.

Imaging studies have become the most important tool for assessing patients' conditions and making more reliable diagnoses, which can be reviewed with other specialists through teleradiology. For these results to be of high quality, however, image manipulation techniques also play a role, for example, in computed tomography (CT).

In tomography, images can be sectioned into parts using computer systems to obtain an image with a broader scope of analysis. These manipulations are image acquisition techniques. Below, we will look at some of them to provide patients with more accurate answers.

Preliminary Considerations for Quality Tomography

To begin using a scanner, certain steps must be followed, such as turning on the CT equipment, then connecting the Gantry console, which houses the X-ray tubes, the information panels, the radiation detection devices, and which activates the structure. The tubes must also be warmed up according to the manufacturer's manual, and finally, calibration must be performed.

This calibration is performed daily or monthly according to the provider's specifications. In this way, the software avoids errors to achieve quality, optimized images, as established by various image quality standards. This allows specialists to verify that the parameters and slices are correctly configured.

Additionally, to access image manipulation tools, it is necessary to have a PACS system whose DICOM viewer includes them.

Techniques for Image Manipulation in CT

Below, we will review some of the most widely used image manipulation techniques in interpreting CT scans. All of these techniques are made possible by the advanced tools of the DICOM viewers found in the best PACS systems.

Recall that image manipulation techniques are the techniques or processes that modify a radiological image to improve the visibility of useful information, while reducing information that is not useful for diagnosis, sometimes known as noise.

Multiplanar Reconstruction (MPR)

First, we will discuss multiplanar reconstruction (MPR), one of the most widely used techniques and one that offers the greatest benefits for accurate diagnoses. 

This technique makes it possible to go from a two-dimensional (2D) image to a three-dimensional (3D) plane in order to view cross-sections of the body area in question in axial, sagittal, and coronal planes.

The dimensional change in MPR is built from a single series or image acquisition, and there are no alterations in its quality. In effect, to be able to use this technique, the healthcare facility must have a cutting-edge technological architecture, like the DICOM viewers of the most sophisticated PACS systems.

Maximum or Minimum Intensity Projection (Mip/Minip)

Another manipulation technique is maximum or minimum intensity projection (Mip/Minip), which is useful for zooming in on and highlighting very small body structures that are therefore difficult to evaluate. Examples include blood vessels, specific tissues, bronchi, and areas to which contrast was applied for more precise observation.

Some experts consider the Mip/Minip technique to be a zoom tool, but in reality, knowing how to section the part to be evaluated requires skill in order to make the necessary close-ups, especially when dealing with small body structures that are difficult to visualize.

Hounsfield Scale (Measurement Tool)

For its part, the Hounsfield scale makes it possible to highlight the outline of the body area to be evaluated and to take measurements of the region. All of this is useful for differentiating the flow of blood, water, and other substances, which can likewise be highlighted with contrast.

Being able to take measurements and adjust the scale using the Hounsfield principle depends on the temperature and pressure of the attenuation or projection of the X-ray beams. Therefore, resolution can be enhanced in areas of the body where there was greater radiation absorption.

The Relationship Between PACS Systems and CT Manipulation Techniques

As mentioned earlier, for all image manipulation techniques to be possible, healthcare facilities need to have appropriate technological infrastructure. This is where PACS systems come in, which must offer viewing and reconstruction options for these studies.

This once again reinforces the importance of digitalization in the healthcare sector for the benefit of both physicians and patients. Additionally, PACS systems offer many other benefits, such as patient clinical history, task visualization, worklists, and much more. 

It should be noted that for these PACS systems to function properly, they need to be built on a cutting-edge technological infrastructure. In other words, a platform in which images can be processed smoothly while maintaining quality across the various slices and dimensional changes.

Recall that CT studies can contain around 125 images, weighing approximately 20 MB. Hence, the PACS provider's servers must have sufficient speed and capacity so that images can be accessed and manipulated with ease. Likewise, it is best for the healthcare facility to have access to a broadband internet connection.

Contact an Eva agent for advice on the best solution for your practice.

References

• González, C., et al. Computed Tomography and Ultrasound Techniques. Arán.
• Zúñiga, J. (2009). Picture Archiving and Communication Systems (PACS). Mexico, Secretaría de Salud (Ministry of Health).
• What Is Cloud Architecture?. Red Hat.