Os grandes centros médicos e hospitais de todo o mundo têm procurado integrar as informações de seus pacientes incluindo os exames de imagens efetuados (tomografia computadorizada, tomografia por ressonância magnética, ultrasson, medicina nuclear, etc.). Um sistema que integra as imagens junto às informações tradicionais é chamado de Sistema de Arquivamento e Comunicação de Imagens (Picture Archive and Communication System - PACS). Os sistemas PACS comerciais associam as imagens de exames às informações de pacientes através de chaves de consultas textuais e numéricas, não suportando consultas baseadas no conteúdo pictórico das imagens. Entretanto, muitas vezes o médico gostaria de recuperar as imagens armazenadas que fossem semelhantes (similares) a uma determinada imagem de consulta. Por exemplo, seja a consulta: "encontre as 10 imagens mais semelhantes à imagem Raio-X-tórax do Jõao da Silva". Ao responder a consultas desse tipo, o sistema permite que o médico relembre casos ocorridos anteriormente. Além disso, o conhecimento já gerado de exames e tratamentos anteriores pode ser recuperado mais rapidamente do que utilizando apenas a memória humana ou um sistema não automático de recuperação de informações. Um sistema com a capacidade de recuperar imagens utilizando o seu conteúdo pictórico é uma ferramenta valiosa para o auxílio ao diagnóstico médico. Esta tese apresenta a arquitetura de um PACS atualmente em desenvolvimento. Este sistema está sendo denominado mini-PACS. Tal sistema necessita da integração de três sistemas, a saber: - Um Sistema de Processamento de Imagens (SPI), o qual é responsável pela leitura e pré-processamento das imagens que são recebidas de diferentes dispositivos e possuem diferentes formatos. O SPI extrai as características relevantes das imagens, as quais serão utilizadas para a sua indexação e recuperação por conteúdo. - Um Sistema de Gerenciamento de Bases de Dados e Imagens (SGBDI), que permite a armazenagem e a recuperação de imagens baseada em seu conteúdo. O SGBDI utiliza uma estrutura métrica, a Slim-tree, que indexa as imagens através das características extraídas pelo SPI e possibilita responder consultas por similaridade. - Um Servidor de Web (SW), que disponibiliza o acesso às informações através da internet. A construção do Servidor de Web encontra-se fora do escopo do desenvolvimento desta tese. Porém, testes iniciais sobre a transferência e comunicação de imagens utilizando um servidor e aplicativos Java foram desenvolvidos para avaliar o comportamento do sistema. Entre as principais contribuições deste trabalho encontra-se um novo método de extração de características de imagens chamado histograma métrico. Os histogramas métricos permitem comparar imagens de diferentes tamanhos e mapeadas em faixas de quantização diferentes (se a alteração de brilho for linear). O tempo de resposta às consultas por similaridade utilizando histogramas métricos é, em média, 5 vezes menor do que o tempo de resposta utilizando histogramas tradicionais. Para permitir a indexação das imagens utilizando a Slim-tree foi necessário desenvolver uma nova função de distância métrica. Tal função de distância utiliza a diferença entre as áreas das curvas do histograma métrico. A construção da árvore de indexação utilizando os histogramas métricos chega a ser 10 vezes mais rápida do que com os histogramas tradicionais. As inovações e aperfeiçoamentos oriundos deste trabalho estão sendo integrados ao mini-PACS. Este sistema vem sendo desenvolvido de forma conjunta entre o Grupo de Bases de Dados e Imagens (GDBI) do Instituto de Ciências Matemáticas e de Computação da USP e o Centro de Ciências de Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da USP.

Cette thèse porte sur les impacts économiques du pacs et du mariage en France. Elle s'articule autour de trois axes. Le chapitre 2 évalue l'impact de la fiscalité sur le nombre de pacs contractés en France. Le chapitre 3 cherche à déterminer si le pacs se substitue au mariage en étudiant l'évolution des taux de mariage et de l'âge au premier mariage depuis la mise en place du pacs in 1999. Le chapitre 4 s'interroge sur l'impact économique du mariage en évaluant l'effet du mariage sur les contraintes de crédit des couples. Si la fiscalité a joué un rôle indéniable dans la progression du nombre de pacs contractés chaque année en France, celui-ci ne semble pas avoir augmenté au détriment du mariage, dont l'évolution récente prolonge la modification du paysage matrimonial observée depuis 25 ans, à savoir une baisse des taux de mariage et un recul de l'âge au premier mariage. Si la baisse du nombre de mariages contractés, associée au développement de la cohabitation hors mariage introduit une distinction entre couples non-mariés et couples mariés, ces derniers ont plus souvent des projets d'investissement mais ils ne sont pas pour autant avantagés sur le marché du crédit. Ils souffrent de plus mauvaises conditions d'emprunt, traduisant une sélection dans le mariage des couples les plus enclins à investir.

<p>The Swedish field of digital X-ray imaging has since several years relied heavily on distributed information systems and digital storage containers. </p><p>To ensure accurate and safe radiological reporting, Swedish software-firm eCare AB delivers a system called Feedback—the first and only quality assurance IT support product of its kind. This thesis covers several aspects of the design and implementation of future versions of this software platform. </p><p>The focus lies on distributed directory services and models for secure and robust data propagation in TCP/IP networks. For data propagation, a new application, InfoBroker, has been designed and implemented to facilitate integration between Feedback and other medical IT support systems. The directory services, introduced in this thesis as the Feedback Directory Services, have been designed on the architectural level. A combination of CORBA and Java Enterprise Edition is suggested as the implementation platform.</p>

<p>In this thesis, a very flexible framework for simulating RIS is designed to beused for Infobroker testing. Infobroker is an application developed by MawellSvenska AB that connects RIS and PACS to achieve interoperability by enablingimage and journal data transmission between radiology sites. To put the project in context, the field of medical informatics, RIS and PACS systems and common protocols and standards are explored. A proof-of-concept implementation of the proposed design shows its potential and verifies that it works. The thesis concludes that a more specialized approach is preferred.</p>

Many medical imaging applications have been developed so far; however, many of them do not support collaboration and are not remotely accessible (i.e., Telemedicine). Medical imaging applications are not practical for use in clinical workflows unless they are able to communicate with the Picture Archiving and Communications System (PACS). This thesis presents an approach based on a three-tier architecture and provides several components to transform medical imaging applications into collaborative, PACS-based, telemedical systems. A novel method is presented to support PACS connectivity. The method is to use the Digital Imaging and COmmunication in Medicine (DICOM) protocol and enhance transmission time by employing a combination of parallelism and compression methods. Experimental results show up to 1.63 speedup over Local Area Networks (LANs) and up to 16.34 speedup over Wide Area Networks (WANs) compared to the current method of medical data transmission.

Many medical imaging applications have been developed so far; however, many of them do not support collaboration and are not remotely accessible (i.e., Telemedicine). Medical imaging applications are not practical for use in clinical workflows unless they are able to communicate with the Picture Archiving and Communications System (PACS). This thesis presents an approach based on a three-tier architecture and provides several components to transform medical imaging applications into collaborative, PACS-based, telemedical systems. A novel method is presented to support PACS connectivity. The method is to use the Digital Imaging and COmmunication in Medicine (DICOM) protocol and enhance transmission time by employing a combination of parallelism and compression methods. Experimental results show up to 1.63 speedup over Local Area Networks (LANs) and up to 16.34 speedup over Wide Area Networks (WANs) compared to the current method of medical data transmission.

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In this thesis, a very flexible framework for simulating RIS is designed to beused for Infobroker testing. Infobroker is an application developed by MawellSvenska AB that connects RIS and PACS to achieve interoperability by enablingimage and journal data transmission between radiology sites. To put the project in context, the field of medical informatics, RIS and PACS systems and common protocols and standards are explored. A proof-of-concept implementation of the proposed design shows its potential and verifies that it works. The thesis concludes that a more specialized approach is preferred.

The Swedish field of digital X-ray imaging has since several years relied heavily on distributed information systems and digital storage containers. To ensure accurate and safe radiological reporting, Swedish software-firm eCare AB delivers a system called Feedback—the first and only quality assurance IT support product of its kind. This thesis covers several aspects of the design and implementation of future versions of this software platform. The focus lies on distributed directory services and models for secure and robust data propagation in TCP/IP networks. For data propagation, a new application, InfoBroker, has been designed and implemented to facilitate integration between Feedback and other medical IT support systems. The directory services, introduced in this thesis as the Feedback Directory Services, have been designed on the architectural level. A combination of CORBA and Java Enterprise Edition is suggested as the implementation platform.

The purpose of this dissertation is to explore the contemporary area of information technologies employed in health care (eHealth). Focusing on the systems already employed in the Czech Republic, it aims to analyse them, to quantify expenditures of their introduction and maximum benefits derived from these, as well as to evaluate their real current profit. Out of the three existing national systems, this dissertation concentrates on the two only (eRecept, ePACS), as it became impossible to evaluate the third -- IZIP system due to scarcity of the relevant information available. In the field of expenditures not only generally published numbers are taken into consideration, but this dissertation also evaluates the expenditures of other subjects involved (IT systems producers, health care providers, etc.). As the first dissertation in the Czech Republic it quantifies benefits derived from the existing eHealth systems and unlike foreign theses it greatly emphasizes just the expenditures of other subjects involved. Included in this dissertation is also the evaluation of achievements of the eHealth systems in the Czech Republic complete with supposed grounds for this situation. This dissertation also recommends courses of action for contractors of these systems to ensure future basis for more economical and successful eHealth systems. These recommendations are mainly based on analysis of development of the existing national eHealth systems. For the complex evaluation of the costs, maximum of possible and real benefit of the individual eHealth systems the research approach adopted in this dissertation includes descriptive method and SWOT analysis, extrapolation and abstraction, comparative and factor analysis.