Detta arbete beskriver en examensuppsats i datateknik på Linnéuniversitetet. Röntgenavdelningen på SUS, Skånes Universitetssjukhus i Lund, använder en lättviktig flyttbar röntgenmaskin som väger endast cirka 90 kg, för röntgenundersökningar ute på äldreboenden. Bilderna överförs till sjukhusets PACS när maskinen är tillbaka på sjukhuset, genom att man kopplar in Dragon via kabel till sjukhusets nätverk. Målsättningen är att förbättra den trådlösa kommunikationen som för närvarande är för långsam och opålitlig, så att bilderna kan överföras till sjukhusets PACS direkt efter undersökningen. I detta arbete beskrivs vilka alternativ som kan användas. Samt om de mobila bredbandstjänster som finns tillgängliga i Region Skåne är bra nog för att kunna användas för uppgiften. Slutsatsen är att ett 3G HSDPA/HSUPA abonnemang kan vara tillförlitligt nog. Framför allt om extra redundans tillförs med dubbla SIM-kort som använder separata nät och att signalen förstärks med antenn placerad utomhus på transportfordonet. Transportfordonet används som brygga mellan Wifi och mobilt nätverk. Röntgenmaskinen kommunicerar med transportfordonet via Wifi. För de fall Wifi inte fungerar på grund av byggnader och omgivande miljö arbetades ett reservalternativ fram. Jag har också undersökt och jämfört DICOM protokollet mot FTP. Detta för att se om DICOM har en overhead som skulle motivera användet av FTP istället för sändning av bilder. Resultatet av jämförelsen visade att DICOM har 5-10 % overhead jämfört med FTP. / This abstract describes a degree project in computer engineering at Linnaeus University. The Department of Radiology at SUS, Skåne University Hospital in Lund, is using a lightweight portable x-ray machine that weights about 90 kg, for radiography services in nursing homes for elders. The images are transferred to hospital PACS when the machine returns to the hospital, this is done with Dragon connecting to hospital network via wire. The goal is to improve the currently too slow and unreliable wireless communication, so the images can be transferred to hospital PACS directly after examination. This report describes what alternatives can be used and investigates whether the mobile broadband services currently available in Skåne County are good enough to be relied on for the task. The conclusion is that a 3G HSDPA/HSUPA subscription can be used reliably enough, if extra redundancy is added via dual SIM cards using separate mobile networks and the signal is strengthen by an antenna placed outdoors on the transport vehicle. The transport vehicle is used as a bridge between Wifi and mobile networks. The mobile x-ray machine communicates with the transport vehicle via Wifi. In those cases Wifi does not work due to difficult building environments, a backup solution was worked out to be used. I also investigated and compared the DICOM protocol against FTP. This was to find out if DICOM has an overhead that would motivate using FTP instead for the transmission of the images, the result of the comparison showed that DICOM has an 5-10 % overhead compared with FTP. / Mobil röntgen Skånes Universitetssjukhus Lund

A qualidade dos exames mamográficos é uma preocupação constante do sistema de saúde mundial que se vê diante do desafio da detecção precoce do câncer de mama. As organizações responsáveis implementaram protocolos internacionais que consistem em testes de aceitação dos equipamentos mamográficos e de tomossíntese da mama, os quais estabelecem um padrão de qualidade nos serviços radiográficos. Porém, essas diretrizes têm como base o uso de objetos simuladores de mamas com espessuras e composições padrões, que muitas vezes não condizem com os perfis populacionais dos centros de diagnóstico. Neste trabalho, foi desenvolvido um sistema automatizado de rastreamento e gerenciamento de dados, que extrai as informações referentes ao processo de aquisição da mamografia digital e armazena-as em um servidor DICOM SCP (Service Class Provider). Após armazenadas, o sistema correlaciona os fatores de exposição das imagens, de forma a avaliar os níveis de referência em dose de radiação fornecidos pelos equipamentos. Como resultados, foi verificado que o perfil mamário dos centros institucionais de diagnóstico estudados não segue os valores de referência apresentados na literatura em termos de espessura e densidade mamária. Enquanto a mama padrão dos testes de garantia de qualidade é composta por 50 mm de espessura e 50% de densidade (50-50), a população estudada apresentou mamas comprimidas com média de 60 mm de espessura, com baixo percentual de tecido fibroglandular (menor que 25%). Portanto, o uso o sistema desenvolvido pode direcionar os testes de conformidade dos equipamentos para perfis mamários específicos. Esse direcionamento pode auxiliar na determinação de doses ótimas de radiação para melhoria da qualidade da imagem, produzindo valores de referência de grande utilidade para a qualidade dos serviços radiográficos. / Image quality assessment in mammography represents one of the greatest challenges that health services face in order to detect breast cancer early. The world health organization recommends quality assurance guidelines, which consist of acceptance tests for digital mammography (DM) and digital breast tomosynthesis (DBT), to standardize the radiological services. However, these guidelines are based on test objects widely used to simulate standard breasts in terms of composition and thickness, which often do not match with the demographic profiles in the breast care centers. In this thesis work, an automated system for tracking and data management was developed to extract the metadata (DICOM header) from the image acquisition process and to store it into a custom DICOM Service Class Provider (SPC). The developed system correlates the exposure factors\' info in order to evaluate the references for patient radiation dose provided by the manufacturers. As result of the data correlations, the reference required by the international guidelines for standard breasts are not a feasible representation for the demographic profile in the breast care center evaluated in terms of breast density and thickness. While the standard for quality assurance testing consists of breasts with 50 mm of thickness and 50% of density, the demographic population presented compressed breast thickness of approximately 60 mm and low fibroglandular tissue (less than 25%). Therefore, using the developed system should guide the quality assurance in digital mammography to specific breast profiles. This guidance may assist in determining optimal radiation doses to improve the image quality, producing useful benchmarks for the quality of radiological services.

A qualidade dos exames mamográficos é uma preocupação constante do sistema de saúde mundial que se vê diante do desafio da detecção precoce do câncer de mama. As organizações responsáveis implementaram protocolos internacionais que consistem em testes de aceitação dos equipamentos mamográficos e de tomossíntese da mama, os quais estabelecem um padrão de qualidade nos serviços radiográficos. Porém, essas diretrizes têm como base o uso de objetos simuladores de mamas com espessuras e composições padrões, que muitas vezes não condizem com os perfis populacionais dos centros de diagnóstico. Neste trabalho, foi desenvolvido um sistema automatizado de rastreamento e gerenciamento de dados, que extrai as informações referentes ao processo de aquisição da mamografia digital e armazena-as em um servidor DICOM SCP (Service Class Provider). Após armazenadas, o sistema correlaciona os fatores de exposição das imagens, de forma a avaliar os níveis de referência em dose de radiação fornecidos pelos equipamentos. Como resultados, foi verificado que o perfil mamário dos centros institucionais de diagnóstico estudados não segue os valores de referência apresentados na literatura em termos de espessura e densidade mamária. Enquanto a mama padrão dos testes de garantia de qualidade é composta por 50 mm de espessura e 50% de densidade (50-50), a população estudada apresentou mamas comprimidas com média de 60 mm de espessura, com baixo percentual de tecido fibroglandular (menor que 25%). Portanto, o uso o sistema desenvolvido pode direcionar os testes de conformidade dos equipamentos para perfis mamários específicos. Esse direcionamento pode auxiliar na determinação de doses ótimas de radiação para melhoria da qualidade da imagem, produzindo valores de referência de grande utilidade para a qualidade dos serviços radiográficos. / Image quality assessment in mammography represents one of the greatest challenges that health services face in order to detect breast cancer early. The world health organization recommends quality assurance guidelines, which consist of acceptance tests for digital mammography (DM) and digital breast tomosynthesis (DBT), to standardize the radiological services. However, these guidelines are based on test objects widely used to simulate standard breasts in terms of composition and thickness, which often do not match with the demographic profiles in the breast care centers. In this thesis work, an automated system for tracking and data management was developed to extract the metadata (DICOM header) from the image acquisition process and to store it into a custom DICOM Service Class Provider (SPC). The developed system correlates the exposure factors\' info in order to evaluate the references for patient radiation dose provided by the manufacturers. As result of the data correlations, the reference required by the international guidelines for standard breasts are not a feasible representation for the demographic profile in the breast care center evaluated in terms of breast density and thickness. While the standard for quality assurance testing consists of breasts with 50 mm of thickness and 50% of density, the demographic population presented compressed breast thickness of approximately 60 mm and low fibroglandular tissue (less than 25%). Therefore, using the developed system should guide the quality assurance in digital mammography to specific breast profiles. This guidance may assist in determining optimal radiation doses to improve the image quality, producing useful benchmarks for the quality of radiological services.

O uso de análise quantitativa em radiologia médica tem sido de grande valia na detecção de alterações não acessíveis à análise visual simples, dita qualitativa, seja por serem muito sutis, seja por não estarem presentes nas técnicas de imagem de ressonância magnética convencional. Porém, certos tipos de quantificação exigem a aquisição softwares e de plataformas computacionais de alto custo, além de mão de obra especializada com conhecimento técnico em computação para operar em ambientes não intuitivos. Neste cenário o objetivo deste trabalho foi a implementação de um software para análise de transferência de magnetização em imagens de ressonância magnética nuclear que funcionasse na plataforma IBM-PC e em sistemas operacionais livres como GNU/Linux. Com este intuito foi elaborado um algoritmo para leitura de imagens codificadas no padrão DICOM 3.0, um algoritmo para a construção dos mapas de Razão de Transferência de Magnetização do volume adquirido e um visualizador com interface amigável para a segmentação e análise dos resultados. Ao final, software possibilitou a abertura da imagem DICOM. Também construiu de maneira eficiente, os mapas de diferença de porcentagem entre as imagens sem e com o pulso de transferência de magnetização (MTR), possibilitando, inclusive, correções de artefatos de movimentos, quando pouco intensos. Permitiu o delineamento de regiões de interesse irregular, com boa visibilidade dos resultados. Como controle padrão, os resultados foram comparados com o conjunto de ferramentas da Universidade McGill (Brain Imaging Center, McGuill University, Montreal, Quebec, Canadá), amplamente testado em artigos publicados. / The use of quantitative analysis in medical radiology has been of great value in the detection of not accessible alterations in the simple visual analysis, said qualitative, for being very subtle, or for not being present in conventional magnetic resonance image techniques. However, certain types of quantification demand the acquisition of high cost softwares and computational platforms, beyond specialized workmanship, with technical knowledge in computation, to operate in non intuitive environments. In this scenery the objective of this work was the implementation of a software for analysis of transference of magneti zation in nuclear magnetic resonance images that works in IBM-PC platform and free operational systems as GNU/Linux. So, an algorithm for reading of standard DICOM 3.0 codified images was elaborated, an algorithm for the construction of Magnetization Transfer Ratio maps of acquired volume, and a visualizer with friendly interface for segmentation and analysis of the results. Finally the software made the opening of DICOM image possible. It also generated in efficient way the maps of percentage difference among the images without and with the pulse of magnetization transfer (MT), also making devices of movement corrections possible, when they are not very intense. It allowed the delineation of regions of irregular interest, with good visibility of the results. As standard control, the results were compared with the set of tools of the McGill University (Brain Imaging Center, McGuill University, Montreal, Quebec, Canada), widely tested in published articles. The elaborated program took care of the considered objectives.

Svenska socialstyrelsen presenterade år 2017 att lungcancer är den vanligaste cancerrelaterade dödsorsaken bland kvinnor i Sverige och den näst vanligaste bland män. Ett sätt att ta reda på om en patient har lungcancer är att en läkare studerar en tredimensionell-röntgenbild av en patients lungor. För att förebygga misstag som kan orsakas av den mänskliga faktorn är det möjligt att använda datorer och avancerade algoritmer för att upptäcka lungcancer. En nätverksmodell kan tränas att upptäcka detaljer och avvikelser i en lungröntgenbild, denna teknik kallas deep structural learning. Det är både tidskrävande och avancerat att skapa en sådan modell, det är därför viktigt att modellen tränas korrekt. Det finns flera studier som behandlar olika nätverksarkitekturer, däremot inte vad förbehandlingstekniken lung-segmentering kan ha för inverkan på en modell av denna signifikans. Därför ställde vi frågan: hur påverkas accuracy och loss hos en konvolutionell nätverksmodell när lung-segmentering appliceras på modellens tränings- och testdata? För att besvara frågan skapade vi flera modeller som använt, respektive, inte använt lung-segmentering. Modellernas resultat evaluerades och jämfördes, tekniken visade sig motverka överträning. Vi anser att denna studie kan underlätta för framtida forskning inom samma och liknande problemområde. / In the year of 2017 the Swedish social office reported the most common cancer related death amongst women was lung cancer and the second most common amongst men. A way to find out if a patient has lung cancer is for a doctor to study a computed tomography scan of a patients lungs. This introduces the chance for human error and could lead to fatal consequences. To prevent mistakes from happening it is possible to use computers and advanced algorithms for training a network model to detect details and deviations in the scans. This technique is called deep structural learning. It is both time consuming and highly challenging to create such a model. This discloses the importance of decorous training, and a lot of studies cover this subject. What these studies fail to emphasize is the significance of the preprocessing technique called lung segmentation. Therefore we investigated how is the accuracy and loss of a convolutional network model affected when lung segmentation is applied to the model’s training and test data? In this study a number of models were trained and evaluated on data where lung segmentation was applied, in relation to when it was not. The final conclusion of this report shows that the technique counteracts overfitting of a model and we allege that this study can ease further research within the same area of study.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-02-16T14:19:52Z No. of bitstreams: 1 arquivototal.pdf: 3167295 bytes, checksum: 34dcd049f9a42299f52a581ab2f3ac6d (MD5) / Made available in DSpace on 2016-02-16T14:19:52Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3167295 bytes, checksum: 34dcd049f9a42299f52a581ab2f3ac6d (MD5) Previous issue date: 2015-10-01 / Technological developments have provided a variety of integrated tools that favor the emergence of information technology solutions and hence the arising of new infrastructures, although there is an increase in the complexity of these solutions. Teleradiology and local solutions for distribution of medical images are evidences of such technological developments. However, it is not known the existence of an infrastructure for teleradiology with characteristics of the so called Information Infrastructures (II), such as: capacity for dynamic organization, built by a growing and heterogeneous technical and social elements with high levels of adaptation and variation, and also holding decentralized and episodic control, that can evolve unbounded and under various conditions. Such infrastructure, if applied to local and global solutions for teleradiology, favors the emergence of a public social space for radiology practices, breaking down the boundaries between the local and the global. This work aims to understand what obstacles hinder the formation of such an information infrastructure. For this, we used the design theory for dynamic complexity (DTDC) in information infrastructure, based on the theory of complex adaptive systems (CAS), as the main reference in the investigation of a series of case studies in teleradiology. To achieve this goal, a study was conducted based on empirical descriptions of solutions for teleradiology, seeking for evidence in each case, resulting in a compiled set of knowledge qualities, shortcomings and obstacles mapped to a set of design rules of the DTDC. The result of this investigation shows the technical and social disability around the adaptability as a major factor to hinder the expansion of teleradiology and hence the formation of an information infrastructure. Finally, it was concluded that despite the growing number of solutions for teleradiology, it was not observed an II for teleradiology; and that the key to the formation of such an II is designing to enable the maximum sociotechnical flexibility, i.e., the ability to adapt continuously with high level of independence between the elements and able to deal with diverse social and technical contexts. / A evolução tecnológica tem fornecido uma variedade de ferramentas que quando integradas favorecem o surgimento de soluções de tecnologia da informação e, consequentemente, o aparecimento de novas infraestruturas, embora haja um crescimento na complexidade dessas soluções. A telerradiologia e as soluções locais para distribuição de imagens médicas são evidências dessa evolução tecnológica. Apesar disso, ainda não se observou uma infraestrutura para teleradiologia com características das denominadas infraestruturas de informação (II), a saber: capacidade de organização dinâmica, constituída por uma quantidade crescente e heterogênea de elementos técnicos e sociais, com elevados níveis de adaptação e variação de componentes, possuindo ainda controle descentralizado e episódico e que evolui de forma não limitada e sob condições diversas. Tais infraestruturas, se aplicadas a soluções locais e globais para telerradiologia, favoreceriam o aparecimento de um espaço social público para práticas radiológicas, derrubando as fronteiras entre o local e o global. O objetivo desse trabalho é buscar compreender quais obstáculos dificultam a formação de tal II. Para isso, utilizou-se a teoria de projeto para complexidade dinâmica (TPCD) em infraestrutura de informação, baseada na teoria dos sistemas adaptativos complexos (SAC), como referência principal na investigação de uma série de estudos de caso em telerradiologia. Para alcançar tal objetivo, foi realizada uma pesquisa baseada em descrições empíricas de soluções para telerradiologia, buscando evidências em cada caso, resultando em um conjunto compilado de conhecimento acerca de qualidades, deficiências e obstáculos mapeados para o conjunto de regras de projeto da TPCD. O resultado dessa investigação evidencia a deficiência técnica e social em torno da capacidade de adaptação como um importante fator para dificultar a expansão da telerradiologia e, consequentemente, a formação de uma infraestrutura de informação. Finalmente, concluiu-se que, apesar da crescente quantidade de soluções para telerradiologia, não foi possível observar tal II; e que a chave para a formação desta II está em projetar visando a máxima flexibilidade sociotécnica, isto é, a capacidade de adaptação, de modo contínuo, com alto nível de independência entre os elementos constituintes e a capacidade de lidar com contextos sociais e técnicos diversificados.

O uso de análise quantitativa em radiologia médica tem sido de grande valia na detecção de alterações não acessíveis à análise visual simples, dita qualitativa, seja por serem muito sutis, seja por não estarem presentes nas técnicas de imagem de ressonância magnética convencional. Porém, certos tipos de quantificação exigem a aquisição softwares e de plataformas computacionais de alto custo, além de mão de obra especializada com conhecimento técnico em computação para operar em ambientes não intuitivos. Neste cenário o objetivo deste trabalho foi a implementação de um software para análise de transferência de magnetização em imagens de ressonância magnética nuclear que funcionasse na plataforma IBM-PC e em sistemas operacionais livres como GNU/Linux. Com este intuito foi elaborado um algoritmo para leitura de imagens codificadas no padrão DICOM 3.0, um algoritmo para a construção dos mapas de Razão de Transferência de Magnetização do volume adquirido e um visualizador com interface amigável para a segmentação e análise dos resultados. Ao final, software possibilitou a abertura da imagem DICOM. Também construiu de maneira eficiente, os mapas de diferença de porcentagem entre as imagens sem e com o pulso de transferência de magnetização (MTR), possibilitando, inclusive, correções de artefatos de movimentos, quando pouco intensos. Permitiu o delineamento de regiões de interesse irregular, com boa visibilidade dos resultados. Como controle padrão, os resultados foram comparados com o conjunto de ferramentas da Universidade McGill (Brain Imaging Center, McGuill University, Montreal, Quebec, Canadá), amplamente testado em artigos publicados. / The use of quantitative analysis in medical radiology has been of great value in the detection of not accessible alterations in the simple visual analysis, said qualitative, for being very subtle, or for not being present in conventional magnetic resonance image techniques. However, certain types of quantification demand the acquisition of high cost softwares and computational platforms, beyond specialized workmanship, with technical knowledge in computation, to operate in non intuitive environments. In this scenery the objective of this work was the implementation of a software for analysis of transference of magneti zation in nuclear magnetic resonance images that works in IBM-PC platform and free operational systems as GNU/Linux. So, an algorithm for reading of standard DICOM 3.0 codified images was elaborated, an algorithm for the construction of Magnetization Transfer Ratio maps of acquired volume, and a visualizer with friendly interface for segmentation and analysis of the results. Finally the software made the opening of DICOM image possible. It also generated in efficient way the maps of percentage difference among the images without and with the pulse of magnetization transfer (MT), also making devices of movement corrections possible, when they are not very intense. It allowed the delineation of regions of irregular interest, with good visibility of the results. As standard control, the results were compared with the set of tools of the McGill University (Brain Imaging Center, McGuill University, Montreal, Quebec, Canada), widely tested in published articles. The elaborated program took care of the considered objectives.

Modern surgery of the 21st century relies in many aspects on computers or, in a wider sense, digital data processing. Department administration, OR scheduling, billing, and - with increasing pervasion - patient data management are performed with the aid of so called Surgical Information Systems (SIS) or, more general, Hospital Information Systems (HIS). Computer Assisted Surgery (CAS) summarizes techniques which assist a surgeon in the preparation and conduction of surgical interventions. Today still predominantly based on radiology images, these techniques include the preoperative determination of an optimal surgical strategy and intraoperative systems which aim at increasing the accuracy of surgical manipulations. CAS is a relatively young field of computer science. One of the unsolved "teething troubles" of CAS is the absence of technical standards for the interconnectivity of CAS system. Current CAS systems are usually "islands of information" with no connection to other devices within the operating room or hospital-wide information systems. Several workshop reports and individual publications point out that this situation leads to ergonomic, logistic, and economic limitations in hospital work. Perioperative processes are prolonged by the manual installation and configuration of an increasing amount of technical devices. Intraoperatively, a large amount of the surgeons'' attention is absorbed by the requirement to monitor and operate systems. The need for open infrastructures which enable the integration of CAS devices from different vendors in order to exchange information as well as commands among these devices through a network has been identified by numerous experts with backgrounds in medicine as well as engineering. This thesis contains two approaches to the integration of CAS systems: - For perioperative data exchange, the specification of new data structures as an amendment to the existing DICOM standard for radiology image management is presented. The extension of DICOM towards surgical application allows for the seamless integration of surgical planning and reporting systems into DICOM-based Picture Archiving and Communication Systems (PACS) as they are installed in most hospitals for the exchange and long-term archival of patient images and image-related patient data. - For the integration of intraoperatively used CAS devices, such as, e.g., navigation systems, video image sources, or biosensors, the concept of a surgical middleware is presented. A c++ class library, the TiCoLi, is presented which facilitates the configuration of ad-hoc networks among the modules of a distributed CAS system as well as the exchange of data streams, singular data objects, and commands between these modules. The TiCoLi is the first software library for a surgical field of application to implement all of these services. To demonstrate the suitability of the presented specifications and their implementation, two modular CAS applications are presented which utilize the proposed DICOM extensions for perioperative exchange of surgical planning data as well as the TiCoLi for establishing an intraoperative network of autonomous, yet not independent, CAS modules. / Die moderne Hochleistungschirurgie des 21. Jahrhunderts ist auf vielerlei Weise abhängig von Computern oder, im weiteren Sinne, der digitalen Datenverarbeitung. Administrative Abläufe, wie die Erstellung von Nutzungsplänen für die verfügbaren technischen, räumlichen und personellen Ressourcen, die Rechnungsstellung und - in zunehmendem Maße - die Verwaltung und Archivierung von Patientendaten werden mit Hilfe von digitalen Informationssystemen rationell und effizient durchgeführt. Innerhalb der Krankenhausinformationssysteme (KIS, oder englisch HIS) stehen für die speziellen Bedürfnisse der einzelnen Fachabteilungen oft spezifische Informationssysteme zur Verfügung. Chirurgieinformationssysteme (CIS, oder englisch SIS) decken hierbei vor allen Dingen die Bereiche Operationsplanung sowie Materialwirtschaft für spezifisch chirurgische Verbrauchsmaterialien ab. Während die genannten HIS und SIS vornehmlich der Optimierung administrativer Aufgaben dienen, stehen die Systeme der Computerassistierten Chirugie (CAS) wesentlich direkter im Dienste der eigentlichen chirugischen Behandlungsplanung und Therapie. Die CAS verwendet Methoden der Robotik, digitalen Bild- und Signalverarbeitung, künstlichen Intelligenz, numerischen Simulation, um nur einige zu nennen, zur patientenspezifischen Behandlungsplanung und zur intraoperativen Unterstützung des OP-Teams, allen voran des Chirurgen. Vor allen Dingen Fortschritte in der räumlichen Verfolgung von Werkzeugen und Patienten ("Tracking"), die Verfügbarkeit dreidimensionaler radiologischer Aufnahmen (CT, MRT, ...) und der Einsatz verschiedener Robotersysteme haben in den vergangenen Jahrzehnten den Einzug des Computers in den Operationssaal - medienwirksam - ermöglicht. Weniger prominent, jedoch keinesfalls von untergeordnetem praktischen Nutzen, sind Beispiele zur automatisierten Überwachung klinischer Messwerte, wie etwa Blutdruck oder Sauerstoffsättigung. Im Gegensatz zu den meist hochgradig verteilten und gut miteinander verwobenen Informationssystemen für die Krankenhausadministration und Patientendatenverwaltung, sind die Systeme der CAS heutzutage meist wenig oder überhaupt nicht miteinander und mit Hintergrundsdatenspeichern vernetzt. Eine Reihe wissenschaftlicher Publikationen und interdisziplinärer Workshops hat sich in den vergangen ein bis zwei Jahrzehnten mit den Problemen des Alltagseinsatzes von CAS Systemen befasst. Mit steigender Intensität wurde hierbei auf den Mangel an infrastrukturiellen Grundlagen für die Vernetzung intraoperativ eingesetzter CAS Systeme miteinander und mit den perioperativ eingesetzten Planungs-, Dokumentations- und Archivierungssystemen hingewiesen. Die sich daraus ergebenden negativen Einflüsse auf die Effizienz perioperativer Abläufe - jedes Gerät muss manuell in Betrieb genommen und mit den spezifischen Daten des nächsten Patienten gefüttert werden - sowie die zunehmende Aufmerksamkeit, welche der Operateur und sein Team auf die Überwachung und dem Betrieb der einzelnen Geräte verwenden muss, werden als eine der "Kinderkrankheiten" dieser relativ jungen Technologie betrachtet und stehen einer Verbreitung über die Grenzen einer engagierten technophilen Nutzergruppe hinaus im Wege. Die vorliegende Arbeit zeigt zwei parallel von einander (jedoch, im Sinne der Schnittstellenkompatibilität, nicht gänzlich unabhängig voneinander) zu betreibende Ansätze zur Integration von CAS Systemen. - Für den perioperativen Datenaustausch wird die Spezifikation zusätzlicher Datenstrukturen zum Transfer chirurgischer Planungsdaten im Rahmen des in radiologischen Bildverarbeitungssystemen weit verbreiteten DICOM Standards vorgeschlagen und an zwei Beispielen vorgeführt. Die Erweiterung des DICOM Standards für den perioperativen Einsatz ermöglicht hierbei die nahtlose Integration chirurgischer Planungssysteme in existierende "Picture Archiving and Communication Systems" (PACS), welche in den meisten Fällen auf dem DICOM Standard basieren oder zumindest damit kompatibel sind. Dadurch ist einerseits der Tatsache Rechnung getragen, dass die patientenspezifische OP-Planung in hohem Masse auf radiologischen Bildern basiert und andererseits sicher gestellt, dass die Planungsergebnisse entsprechend der geltenden Bestimmungen langfristig archiviert und gegen unbefugten Zugriff geschützt sind - PACS Server liefern hier bereits wohlerprobte Lösungen. - Für die integration intraoperativer CAS Systeme, wie etwa Navigationssysteme, Videobildquellen oder Sensoren zur Überwachung der Vitalparameter, wird das Konzept einer "chirurgischen Middleware" vorgestellt. Unter dem Namen TiCoLi wurde eine c++ Klassenbibliothek entwickelt, auf deren Grundlage die Konfiguration von ad-hoc Netzwerken während der OP-Vorbereitung mittels plug-and-play Mechanismen erleichtert wird. Nach erfolgter Konfiguration ermöglicht die TiCoLi den Austausch kontinuierlicher Datenströme sowie einzelner Datenpakete und Kommandos zwischen den Modulen einer verteilten CAS Anwendung durch ein Ethernet-basiertes Netzwerk. Die TiCoLi ist die erste frei verfügbare Klassenbibliothek welche diese Funktionalitäten dediziert für einen Einsatz im chirurgischen Umfeld vereinigt. Zum Nachweis der Tauglichkeit der gezeigten Spezifikationen und deren Implementierungen, werden zwei modulare CAS Anwendungen präsentiert, welche die vorgeschlagenen DICOM Erweiterungen zum perioperativen Austausch von Planungsergebnissen sowie die TiCoLi zum intraoperativen Datenaustausch von Messdaten unter echzeitnahen Anforderungen verwenden.

Memoria (licenciado en ciencias jurídicas y sociales) / Este trabajo tiene por objeto establecer si la inclusión injusta de una persona en DICOM implica una vulneración a su derecho a la honra y si dicha situación lo facultaría para demandar una indemnización por el daño moral sufrido. El primer capítulo trata del derecho a la honra, teniendo por objeto determinar cual es su contenido y alcance. Para este efecto se analizan las distintas definiciones que ha elaborado la doctrina, como también la consagración que este derecho tiene en nuestra legislación, en los ordenamientos jurídicos comparados y en el derecho internacional. Además se analiza la posibilidad de que una persona jurídica pueda ser titular del mismo. El segundo capítulo está dirigido a entender DICOM, reparando por lo mismo en sus orígenes, finalidad, funcionamiento y en la legislación que le es aplicable. 6 El tercer capítulo está destinado a examinar recursos de protección, con el fin de esclarecer en qué casos el ingreso de una persona en DICOM va a ser producto de un acto ilegal o arbitrario que signifique una perturbación, privación o amenaza de su derecho a la honra. En el cuarto capítulo se desarrolla la eventual vinculación que pudiere existir entre el perjuicio sufrido por una persona injustamente ingresada en DICOM y el daño moral, estudiando al efecto el estatuto de responsabilidad civil que sería aplicable, el concepto de daño moral, la relación de éste con la afectación de la honra, la problemática que implica el artículo 2331 del Código Civil, la posibilidad de que las personas jurídicas puedan sufrirlo y la regulación que le es aplicable. Finalmente, en el quinto capítulo, se lleva a cabo un análisis de sentencias que se pronuncian sobre la posibilidad de demandar daño moral en virtud del perjuicio sufrido por haber sido ingresada una persona en DICOM.

Résumé indisponible / Medical data management has become a real challenge due to the emergence of new imaging technologies providing high image resolutions.This thesis focuses in particular on the management of DICOM files. DICOM is one of the most important medical standards. DICOM files have special data format where one file may contain regular data, multimedia data and services. These files are extremely heterogeneous (the schema of a file cannot be predicted) and have large data sizes. The characteristics of DICOM files added to the requirements of medical data management in general – in term of availability and accessibility- have led us to construct our research question as follows:Is it possible to build a system that: (1) is highly available, (2) supports any medical images (different specialties, modalities and physicians’ practices), (3) enables to store extremely huge/ever increasing data, (4) provides expressive accesses and (5) is cost-effective .In order to answer this question we have built a hybrid (row-column) cloud-enabled storage system. The idea of this solution is to disperse DICOM attributes thoughtfully, depending on their characteristics, over both data layouts in a way that provides the best of row-oriented and column-oriented storage models in one system. All with exploiting the interesting features of the cloud that enables us to ensure the availability and portability of medical data. Storing data on such hybrid data layout opens the door for a second research question, how to process queries efficiently over this hybrid data storage with enabling new and more efficient query plansThe originality of our proposal comes from the fact that there is currently no system that stores data in such hybrid storage (i.e. an attribute is either on row-oriented database or on column-oriented one and a given query could interrogate both storage models at the same time) and studies query processing over it.The experimental prototypes implemented in this thesis show interesting results and opens the door for multiple optimizations and research questions.