This dissertation thesis is focused on the optimization of bandwidth parameters for the transport of medical image data between medical devices and remote data storage. As real and fully functional structure, which will be analyzed in this work. It was selected system MeDiMed (Metropolitan Digital Imaging System in Medicine). The thesis examines the operation of the small health organizations and their modalities, which use this system for remote data archiving. Traffic analysis is then statistically processed. The thesis also deals with the analysis of increasing the security during accessing health system, and assesses its impact on transmitted data. The effect of setting the transmission parameters and the most widely used types of ciphers on the transfer speed is also compared.

Den ökade belastningen på akutmottagningar i Sverige bidrar till ett kraftigare flöde till röntgenavdelningar. Detta leder till en ökad arbetsbelastning för personalen på avdelningen och skulle med hjälp utav en skärm kunna underlättas. Syftet med studien var att se på möjligheter att implementera en sådan lösning på Södersjukhusets röntgenavdelning. Metoden innefattade en arbetsplatsstudie av röntgenavdelningen såväl som en analys av manualer samt intervjuer med personal associerade med sjukhusets olika databassystem, bland annat TakeCare, RIS och PACS. Resultaten visade att en sådan lösning går att finna i TakeCare, dock så skulle framtagningen av denna lösning vara en långdragen och avancerad process. Detta beror främst på de olika krav som ställs på medicintekniska produkter, bland annat på grund av patientdatasäkerhet. / The increasing encumbrance on Emergency Rooms in Sweden contributes to a vigorous flow to theX-ray Clinics. This leads to an increasing work load for the personnel on the X-ray Clinic, and theywould benefit from having a screen that shows the flow of patients from the Emergency Room tothe X-ray Clinic. The purpose of this study was to investigate possibilities to implement such an aidon the X-ray Clinic at Södersjukhuset. The method consisted of an observation of the X-ray Clinicand analyses of manuals and interviews with personnel associated to different database systems,such as TakeCare, RIS and PACS. The results showed that a solution exists in TakeCare. However,the production of this solution would result in a long and advanced process. This is due to the different requirements on medical products, partially because of the law regarding patient data security.

Este trabalho apresenta o estudo e implementação de um sistema para vinculação e visualização de imagens de ressonância magnética nuclear e tomografia computadorizada a partir de um sistema de informação em radiologia (RIS), possibilitando a recuperação e disponibilização dos exames (laudos e imagens), através de rede \"ethernet\", para visualização a partir de uma interface desenvolvida para \"browser\". Os exames podem ser recuperados através do número de registro (RGHC) ou do nome do paciente. As imagens utilizadas no trabalho estão nos padrões DICOM 3.0 (Digital Imaging and Communications in Medicine) e JPEG (Joint Photographic Experts Group). Para a vinculação dos exames que possuem suas imagens em JPEG foi desenvolvida uma interface para inclusão das informações necessárias que garantem a consistência deste processo. Para os exames que possuem suas imagens em formato DICOM 3.0 as informações foram extraídas automaticamente dos cabeçalhos e armazenadas no banco de dados. O sistema possui uma interface amigável ao usuário, podendo ser rapidamente incorporada ao projeto de um PACS (Picture Archiving and Communication System). A implementação foi idealizada para servir ao Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), com base no seu sistema de informação em radiologia. Os resultados demonstram que o tempo de retorno das imagens é clinicamente satisfatório e considerado bom pela avaliação qualitativa dos médicos. / This work presents the study and implementation of a system aiming the indexing and visualization of the images of nuclear magnetic resonance and computerized tomography from a radiology information system (RIS), allowing the retrieval and availability of the exams (results and images), through an ethernet net for visualization beginning with an interface developed to a browser. The exams may be recovered either through their register number (RGHC) or the patient\'s name. The images employed in the work follow the DICOM 3.0 (Digital Imaging and Communications in Medicine) and JPEG (Joint Photographic Experts Group) patterns. For the indexing of the exams that present images in JPEG, an interface was developed to include the information required to guarantee the consistency of the process. For the exams presenting the DICOM 3.0 format, information was extracted automatically from the heading and filed in the database. The system has a friendly interface for the user, it may be rapidly incorporated to the project of an PACS (Picture Archiving and Communication System). The implementation was idealized to serve the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, of the Universidade de São Paulo (HCFMRP/USP), based on its radiology information system (RIS). The results demonstrated that the time of retrieval of the images is satisfactory and considered good by evaluation qualified of the doctors.

Neste trabalho é apresentada a implantação de um servidor de imagens médicas com a implementação e integração de módulos para recuperação textual e baseada em conteúdo para o Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP) da Universidade de São Paulo (USP). O sistema permite a aquisição, gerenciamento, armazenamento e disponibilização das informações dos pacientes, seus exames, laudos e imagens através da internet. Os exames radiológicos e suas respectivas imagens podem ser recuperados por informações textuais ou por similaridade do conteúdo pictório das imagens. As imagens utilizadas são de ressonância magnética nuclear e tomografia computadorizada e são geradas no padrão DICOM 3.0. O sistema foi desenvolvido contemplando tecnologias para Web com interfaces amigáveis para recuperação das informações. Ele é composto por três módulos integrados, sendo o servidor de imagens, o módulo de consulta textual e o módulo de consulta por similaridade. Os resultados apresentados indicam que as imagens são gerenciadas e armazenadas corretamente, bem como o tempo de retorno das imagens é clinicamente satisfatório, tanto para a consulta textual como para a consulta por similaridade. As avaliações da recuperação por similaridade apresentam que o extrator escolhido pode ser considerado relevante para separar as imagens por região anatômica. / This work introduces an the development of a server of medical images with the implementation and integration of modules to query/retrieve text information and content-based to Radiology Service of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP) at Universidade de São Paulo (USP). The system allows the acquisition, management, archiving and availability of the patients information, theirs exams, results and images through of internet. The radiological exams and theirs respectives images can be retrieved by text information or similarity of pictorial content of images. Images are from magnetic resonance nuclear and computadorized tomography and are given using DICOM 3.0 protocol. The system has been developed considering web technologies with friendly interfaces to retrieval of information. It is composed by three integrated modules: the image server module, the query text module and query by similarity module. Results show that images are managed and archived exactly, retrieval time of images is clinically satisfactory, considering both the text query as well as the query by similarity. The evaluation of the retrieval by similarity shows the chosen extractor can be considerated relevant to separate the images by anatomic region.

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.

Este trabalho apresenta o estudo e implementação de um sistema para vinculação e visualização de imagens de ressonância magnética nuclear e tomografia computadorizada a partir de um sistema de informação em radiologia (RIS), possibilitando a recuperação e disponibilização dos exames (laudos e imagens), através de rede \"ethernet\", para visualização a partir de uma interface desenvolvida para \"browser\". Os exames podem ser recuperados através do número de registro (RGHC) ou do nome do paciente. As imagens utilizadas no trabalho estão nos padrões DICOM 3.0 (Digital Imaging and Communications in Medicine) e JPEG (Joint Photographic Experts Group). Para a vinculação dos exames que possuem suas imagens em JPEG foi desenvolvida uma interface para inclusão das informações necessárias que garantem a consistência deste processo. Para os exames que possuem suas imagens em formato DICOM 3.0 as informações foram extraídas automaticamente dos cabeçalhos e armazenadas no banco de dados. O sistema possui uma interface amigável ao usuário, podendo ser rapidamente incorporada ao projeto de um PACS (Picture Archiving and Communication System). A implementação foi idealizada para servir ao Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), com base no seu sistema de informação em radiologia. Os resultados demonstram que o tempo de retorno das imagens é clinicamente satisfatório e considerado bom pela avaliação qualitativa dos médicos. / This work presents the study and implementation of a system aiming the indexing and visualization of the images of nuclear magnetic resonance and computerized tomography from a radiology information system (RIS), allowing the retrieval and availability of the exams (results and images), through an ethernet net for visualization beginning with an interface developed to a browser. The exams may be recovered either through their register number (RGHC) or the patient\'s name. The images employed in the work follow the DICOM 3.0 (Digital Imaging and Communications in Medicine) and JPEG (Joint Photographic Experts Group) patterns. For the indexing of the exams that present images in JPEG, an interface was developed to include the information required to guarantee the consistency of the process. For the exams presenting the DICOM 3.0 format, information was extracted automatically from the heading and filed in the database. The system has a friendly interface for the user, it may be rapidly incorporated to the project of an PACS (Picture Archiving and Communication System). The implementation was idealized to serve the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, of the Universidade de São Paulo (HCFMRP/USP), based on its radiology information system (RIS). The results demonstrated that the time of retrieval of the images is satisfactory and considered good by evaluation qualified of the doctors.

Neste trabalho é apresentada a implantação de um servidor de imagens médicas com a implementação e integração de módulos para recuperação textual e baseada em conteúdo para o Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP) da Universidade de São Paulo (USP). O sistema permite a aquisição, gerenciamento, armazenamento e disponibilização das informações dos pacientes, seus exames, laudos e imagens através da internet. Os exames radiológicos e suas respectivas imagens podem ser recuperados por informações textuais ou por similaridade do conteúdo pictório das imagens. As imagens utilizadas são de ressonância magnética nuclear e tomografia computadorizada e são geradas no padrão DICOM 3.0. O sistema foi desenvolvido contemplando tecnologias para Web com interfaces amigáveis para recuperação das informações. Ele é composto por três módulos integrados, sendo o servidor de imagens, o módulo de consulta textual e o módulo de consulta por similaridade. Os resultados apresentados indicam que as imagens são gerenciadas e armazenadas corretamente, bem como o tempo de retorno das imagens é clinicamente satisfatório, tanto para a consulta textual como para a consulta por similaridade. As avaliações da recuperação por similaridade apresentam que o extrator escolhido pode ser considerado relevante para separar as imagens por região anatômica. / This work introduces an the development of a server of medical images with the implementation and integration of modules to query/retrieve text information and content-based to Radiology Service of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP) at Universidade de São Paulo (USP). The system allows the acquisition, management, archiving and availability of the patients information, theirs exams, results and images through of internet. The radiological exams and theirs respectives images can be retrieved by text information or similarity of pictorial content of images. Images are from magnetic resonance nuclear and computadorized tomography and are given using DICOM 3.0 protocol. The system has been developed considering web technologies with friendly interfaces to retrieval of information. It is composed by three integrated modules: the image server module, the query text module and query by similarity module. Results show that images are managed and archived exactly, retrieval time of images is clinically satisfactory, considering both the text query as well as the query by similarity. The evaluation of the retrieval by similarity shows the chosen extractor can be considerated relevant to separate the images by anatomic region.

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.

Made available in DSpace on 2014-12-17T14:20:04Z (GMT). No. of bitstreams: 1 ClidenorBSF_DISSERT.pdf: 414431 bytes, checksum: 9d70a6bf3c1b428bf9218a18430167ef (MD5) Previous issue date: 2011-11-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The reality experienced by many families and individuals who seek and require the services of the Unified Health System - SUS, the relationships between users, health professionals, and political representatives, establishes the core of the issue that guides the choice and interest of this study concerning the prominence of clientelist practices and gifts that permeate the health field. The research is based on the analysis and reflection of the intrinsic relationship between the health and political fields. It analyses the health field and its relationship with the dynamics and developments of the local political scenario relating it to the implementation of the Family Health Program and Community Health Agents Program (PACS/PSF health programs) in the city of Mossor?, State of Rio Grande do Norte which refers to the period 1991-2010; and falls into a methodological perspective of qualitative approach. The methodological tools and techniques used were based on semi-structured interviews, direct observation of the field, journalistic texts and documentary sources. The construction and questioning of the object of the research were based on theoretical contributions from authors discussing the social field and symbolic power: Bourdieu (2005); clientelist relationships and gifts from asymmetric exchanges: Rouland (1997), Lanna (1995), Martins (1999), Carvalho (1999), Diniz (1982); exercise of hegemony and political strategy from authors who analyse this subject: Gramsci (1995), Coutinho (1981), and Gruppi (1978). Furthermore, the research has established dialogues with authors who address the dynamics of Brazilian politics such as Baquero (2001) and Weffort (1993). The collected data were subjected to qualitative content analysis. The results showed that with the implementation of the PACS/PSF programs in the aforementioned city, the health field has established itself as a key scenario for the exercise of political hegemony of the factions that dominate this socio-political context, resizing clientelist practices, however, without modifying the power structures within this social scenario / A realidade vivenciada por in?meras fam?lias e indiv?duos que buscam e necessitam dos servi?os do Sistema ?nico de Sa?de SUS, as rela??es entre usu?rios, profissionais de sa?de, e representantes pol?ticos, instituem o cerne da problem?tica que norteia ? escolha e o interesse deste estudo sobre a proemin?ncia das pr?ticas clientelistas e d?divas que permeiam o campo da sa?de. A pesquisa se pauta na an?lise e reflex?o da rela??o intr?nseca entre o campo da sa?de e o campo pol?tico. Analisa o campo da sa?de e sua rela??o com a din?mica e os desdobramentos do cen?rio pol?tico local relacionando-o a implanta??o dos programas de sa?de PACS/PSF no munic?pio de Mossor?-RN que remete ao per?odo entre 1991-2010. Inscreve-se em uma perspectiva metodol?gica de abordagem qualitativa. Os instrumentos metodol?gicos e t?cnicas utilizadas pautaram-se em entrevistas semi-estruturadas, observa??o direta do campo, textos jornal?sticos e fontes documentais. A constru??o e problematiza??o do objeto da pesquisa fundamentou-se em aportes te?ricos de autores que discutem o campo social e poder simb?lico: Bourdieu (2005); rela??es clientelistas e d?divas a partir de trocas assim?tricas: Rouland (1997), Lanna (1995), Martins (1999), Carvalho (1999), Diniz (1982); exerc?cio da hegemonia e estrat?gia pol?tica em autores que analisam essa tem?tica: Gramsci (1995), Coutinho (1981) e Gruppi (1978). Ademais, a pesquisa estabeleceu di?logos com autores que versam sobre a din?mica da pol?tica brasileira como Baquero (2001) e Weffort (1993). Os dados coletados foram submetidos a uma an?lise qualitativa de conte?do. Os resultados evidenciaram que com a implanta??o dos programas PACS/PSF no munic?pio supracitado o campo da sa?de consolidou-se como um cen?rio essencial para o exerc?cio da hegemonia pol?tica das fac??es que dominam esse contexto sociopol?tico, redimensionando as pr?ticas clientelistas, entretanto, sem modificar as estruturas de poder no ?mbito deste cen?rio social

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.