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研究生:張美彥
研究生(外文):Mei-Yen Chang
論文名稱:透視動態影像數位化系統建置及評估(以神經放射血管攝影為例)
論文名稱(外文):Design and Evaluation of a DICOM compliant Video-fluoroscopy Imaging System(An Investigation in Neuroradiology Angiography)
指導教授:劉建財劉建財引用關係
指導教授(外文):Chien-Tsai Liu
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫學資訊研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:60
中文關鍵詞:動態透視檢查影像訊號壓縮使用者接受度評估DICOM標準
外文關鍵詞:Video-fluoroscopy imagessignal compressionUser acceptance evaluationDICOM
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透視檢查是屬於一種特殊的X光檢查,可以即時提供病患身體內部器官或組織構造之連續X光影像或即時動態視訊。在放射線學的檢查中,它被應用於許多不同的檢查或流程中,例如經皮腎造口術(PCN)、鋇劑食道吞嚥攝影檢查、心導管等等介入性檢查。這些即時動能透視影像同樣具有診斷回顧、教學及研究的價值,應該被視為病人的診療紀錄,和病歷一樣的被完整保存。傳統的動態透視影像可以利用外接的錄放影機,以錄影帶做為媒介儲存、記錄。但受限於錄影帶的本身的性質,只能從頭開始依序的搜尋段落,即便已經知道想查閱的某段影像在那個段落,卻也無法直接播放該影像。這使得這些錄影帶的資料無法有效的管理。在現階段中,DICOM 3.0(Digital Imaging and Communications in Medicine)標準中已公告支援MPEG-2的動態影像壓縮格式。在國內,多數已完成建置影像儲傳系統(Picture Achieving and Communication Systems,簡稱PACSs)的醫院,依據DICOM的標準來儲存和管理一般靜態的X光影像。現在正是時候將動態透視影像擷像、數位化並整合到醫院的PACS系統中,這樣可以有更佳的儲存方式、影像資源共享及影像資料管理。雖然DICOM標準中定義了支援MPEG-2的壓縮結構,但卻也表示,臨床醫學是否可以接受MPEG2失真壓縮的影像,不在DICOM標準的研究範圍內。本研究論文的目的在於建立「透視動態影像數位化系統」,將動態透視影像轉為符合DICOM MPEG2標準的影像,並整合入醫院的PACS系統中,並且從臨床診斷的觀點評估系統接受度。我們利用現有血管攝影的系統中,同時具備傳統的錄影機及數位擷像系統的檢查儀器,針對頭頸部之透視檢查影像,分別錄製「傳統錄影帶的NTSC訊號影像」及「DICOM-MPEG2數位影像」,請放射專科醫師針對所收集個案進行評估,證實DICOM MPEG2格式的動態透視影像與傳統的錄影帶所記錄影像,且有相同或更佳的影像品質。
Fluoroscopy is a special type of x-ray that provides continuous x-ray images (or live video) of a patient’s organ structures in real time. It is used in many types of examinations and procedures, such as Percutaneous Nephrostomy (PCN), Barium Swallow, cardiac catheterization, and so on. The live fluoroscopy video is valuable for diagnosis review, teaching and research. They need to be stored as a part of the patient’s medical records. Traditionally, the live fluoroscopic video can be saved by using video tapes. Since the nature of sequential access to a video tape, we cannot directly play or view a specific image. This makes the management of video tapes inefficient. Currently the DICOM 3.0 (Digital Imaging and Communications in Medicine) Standard supports the MPEG-2 live video compression format. Most hospitals in Taiwan have developed their Picture Achieving and Communication Systems (PACSs) based on the DICOM standard to store and manage static x-ray images. Thus, it is the time for live fluoroscopic video to be captured, digitalized and integrated into the PACS for better storage, sharing and management. Although the DICOM supports the MPEG-2 compression scheme, it indicates that whether the clinicians can accept the lossy compression of MPEG-2 images is beyond the scope of the DICOM Standard. The paper presented here proposes approaches to develop a DICOM MPEG2 compliant fluoroscopic video management system integrated seamlessly with other hospital systems, and presents methods to evaluate the system acceptance from the viewpoint of clinicians. We conclude that the quality of the fluoroscopic video represented by the DICOM MPEG-2 specification is as good as or better than that represented by traditional video tapes.
標題 i
審定書 ii
上網授權書 iii
誌謝 iv
目錄 v
表目錄 vi
圖目錄 vii
中文摘要 viii
英文摘要 ix
第一章 緒論 1
1.1 背景 1
1.2 現況 6
1.3 動機與目的 9
第二章 文獻 12
2.1 動態影像原理 12
2.2 動態影像擷取靜態影像 13
2.3 動態影像擷取多框架(Multi-Frame)的動態影像 14
2.4 動態影像擷取MPEG影像 14
2.5 DICOM standard (DICOM標準) 18
第三章 透視動態影像數位化系統建置 21
3.1 透視動態影像擷取系統架構 21
3.2 透視儀器及其輸出介面 22
3.3 NTSC / MPEG2轉譯器 22
3.4 聲音訊號的合成 24
3.5 透視同步訊號的控制 25
3.6 DICOM格式檔案的封裝 26
3.7 擷像系統流程及說明(如圖十四) 30
3.8 影像管理及成果 31
第四章 透視動態影像數位化系統評估 38
4.1 系統評估方法 38
4.2 評估的結果及分析 41
第五章 討論 44
5.1 五位評估醫師T檢定分析 44
5.2 五位評估醫師ANOVA分析 49
5.3 系統評估的限制 57
5.4 動態透視影像系統的其他優勢 57
第六章 結論 59
第七章 參考文獻(References) 61
中文期刊及書藉
1.王彥迪, 醫學影像之無失真動態壓縮技術的研發, 國立成功大學電機工程學系研士論文, 2005.06
2.王保進, 英文視窗版SPSS與行為科學研究(第三版), 心理出版社, 2006.09
3.林惠玲、陳正倉, 基礎統計學 觀念與應用, 雙葉書廊, 2004.02
4.郭英調, 臨床研究手冊(第二版), 九州圖書文物有限公司, 2005.10

英文期刊及書藉
5.Barbier P, Alimento M, Berna G, Cavoretto D, Celeste F, Muratori M, Guazzi MD. Clinical validation of different echocardiographic motion pictures expert group-4 algorythms and compression levels for telemedicine. Medinfo. 2004;11(Pt 2):1339-42.
6.Bassignani MJ, Dwyer SJ 3rd, Ciambotti JM, Olazagasti JM, Moran R, Moynihan S, Weaver AC, Snyder AM. Review of technology: planning for the development of telesonography. J Digit Imaging. 2004 Mar;17(1):18-27.
7.Bezold LI, Lewin MB, Vick GW 3rd, Pignatelli R. Update on new technologies in pediatric echocardiography. Tex Heart Inst J. 1997;24(4):278-86.
8.Cabral, J.E., Jr. Yongmin Kim. Multimedia systems for telemedicine and their communications requirements. Volume: 34, Issue: 7. Communications Magazine, IEEE. Jul 1996.
9.Close RA, Abbey CK, Morioka CA, Whiting JS. Evaluation of layer decomposition for multiframe quantitative coronary angiography. Med Phys. 2002 Mar;29(3):311-8.
10.Doyley MM, Mastik F, de Korte CL, Carlier SG, Cespedes EI, Serruys PW, Bom N, van der Steen AF. Advancing intravascular ultrasonic palpation toward clinical applications. Ultrasound Med Biol. 2001 Nov;27(11):1471-80.
11.Firstenberg MS, Greenberg NL, Garcia MJ, Morehead AJ, Cardon LA, Klein AL, Thomas JD. Internet-based transfer of cardiac ultrasound images. J Telemed Telecare. 2000;6(3):168-71.
12.Garcia MJ, Thomas JD, Greenberg N, Sandelski J, Herrera C, Mudd C, Wicks J, Spencer K, Neumann A, Sankpal B, Soble J. Comparison of MPEG-1 digital videotape with digitized sVHS videotape for quantitative echocardiographic measurements. J Am Soc Echocardiogr. 2001 Feb;14(2):114-21.
13.Harris KM, Schum KR, Knickelbine T, Hurrell DG, Koehler JL, Longe TF. Comparison of diagnostic quality of motion picture experts group-2 digital video with super VHS videotape for echocardiographic imaging. J Am Soc Echocardiogr. 2003 Aug;16(8):880-3.
14.Ichige A, Sakakibara A, Sakai M, Ohki M, Suzuki Y, Okuyama T, Sakata K. Storage and utilization of images in otorhinolaryngology. Acta Otolaryngol Suppl. 1994;511:233-5.
15.Ledesma-Carbayo MJ, Kybic J, Desco M, Santos A, Suhling M, Hunziker P, Unser M. Spatio-temporal nonrigid registration for ultrasound cardiac motion estimation. IEEE Trans Med Imaging. 2005 Sep;24(9):1113-26.
16.Main ML, Foltz D, Firstenberg MS, Bobinsky E, Bailey D, Frantz B, Pleva D, Baldizzi M, Meyers DP, Jones K, Spence MC, Freeman K, Morehead A, Thomas JD. Real-time transmission of full-motion echocardiography over a high-speed data network: impact of data rate and network quality of service. J Am Soc Echocardiogr. 2000 Aug;13(8):764-70.
17.Matani A, Yagi H, Umeda T, Chihara K. A compression and transmission system of ultrasonic image sequence for telemedicine. Telemed J. 1999 Winter;5(4):385-9.
18.Moreno R, Zamorano JL, Serra V, Almeria C, Perez de Isla L, Rodrigo JL, Mataix L, Herrera D, Aubele A, De Marco E, Sanchez-Harguindey L, Macaya C. Evaluation of myocardial perfusion with grey-scale ultra-harmonic and multiple-frame triggering. The need for quantification. Int J Cardiol. 2003 Nov;92(1):77-82.
19.Sable C. Digital echocardiography and telemedicine applications in pediatric cardiology. Pediatr Cardiol. 2002 May-Jun;23(3):358-69.
20.Selzer RH, Mack WJ, Lee PL, Kwong-Fu H, Hodis HN. Improved common carotid elasticity and intima-media thickness measurements from computer analysis of sequential ultrasound frames. Atherosclerosis. 2001 Jan;154(1):185-93.
21.Sigmund Silber MD, Rolf D?rr MD, Gunnar Zindler MD, Holger M?hling MD, Thomas Diebel RN. Impact of Various Compression Rates on Interpretation of Digital Coronary Angiograms. International Journal of Cardiology 60 (1997) 195-200.
22.Soble JS, Yurow G, Brar R, Stamos T, Neumann A, Garcia M, Stoddard MF, Cherian PK, Bhamb B, Thomas JD. Comparison of MPEG digital video with super VHS tape for diagnostic echocardiographic readings. J Am Soc Echocardiogr. 1998 Aug;11(8):819-25.
23.Spencer K, Solomon L, Mor-Avi V, Dean K, Weinert L, Gulati M, Herle A, Spiegel A, Balasia B, Pionke T, Sieb L, Lang RM. Effects of MPEG compression on the quality and diagnostic accuracy of digital echocardiography studies. J Am Soc Echocardiogr. 2000 Jan;13(1):51-7.
24.Spencer K, Weinert L, Mor-Avi V, Dean K, Balasia B, Solomon L, Pionke T, Sieb L, Lang RM. Electronic transmission of digital echocardiographic studies: effects of MPEG compression. Int J Cardiol. 2000 Sep 15;75(2-3):141-5.
25.Stewart C. Bushong. Radiologic Science for Technologists. Eighth Edition,2004.
26.Trimarchi M, Lund VJ, Nicolai P, Pini M, Senna M, Howard DJ. Database for the collection and analysis of clinical data and images of neoplasms of the sinonasal tract. Ann Otol Rhinol Laryngol. 2004 Apr;113(4):335-7.
27.Umeda A, Iwata Y, Okada Y, Shimada M, Baba A, Minatogawa Y, Yamada T, Chino M, Watanabe T, Akaishi M. A low-cost digital filing system for echocardiography data with MPEG4 compression and its application to remote diagnosis. J Am Soc Echocardiogr. 2004 Dec;17(12):1297-303.
28.Woodson KE, Sable CA, Cross RR, Pearson GD, Martin GR. Forward and store telemedicine using Motion Pictures Expert Group: a novel approach to pediatric tele-echocardiography. J Am Soc Echocardiogr. 2004 Nov;17(11):1197-200.
29.Yasuhiko Okura, Yasushi Matsumura, Kuniyuki Hidaka, Hiromichi Yokoyama, Hiroshi Inada, Hajime Harauchi, Hiroko Kou, Kiyonari Inamura. Evaluation of the Effect of Varying MPEG-2 Compression Ratios on Digital Coronary Angiographic Assessment of Stenosis Severity, Volume 15, Journal of Digital Imaging. Number 4 / December, 2002.
30.Yoo SK, Kim DK, Jung SM, Kim EK, Lim JS, Kim JH. Performance of a web-based, realtime, tele-ultrasound consultation system over high-speed commercial telecommunication lines. J Telemed Telecare. 2004;10(3):175-9.
中文網路資料
31.電子化政府開放系統使用指引(政府機關資訊處理共通規範)/3.正式規範使用指引/3.4資料交換規範 (Data Interchange Services)/3.4.6動態影像壓縮(Moving Pictures Experts Groups, MPEG)http://cww.rdec.gov.tw/mis/standard92/ipcs/mpeg.htm
英文網路資料
32.DICOM Standard PS 3 - 2007 (Part 3) December 28, 2006 (ftp://medical.nema.org/medical/dicom/2007/07_03pu.pdf )
33.DICOM Standard PS 3 - 2007 (Part 5) December 28, 2006 (ftp://medical.nema.org/medical/dicom/2007/07_05pu.pdf)
34.DICOM Strategic document Version 5.6, October 24, 2006 (http://medical.nema.org/dicom/geninfo/Strategy.pdf )
35.BG Haskell, AN Netravali, A Puri. Digital Video: An Introduction to Mpeg-2, 1996 (books.google.com.)
36.http://en.wikipedia.org/wiki/MPEG-2
37.http://vaplab.ee.ncu.edu.tw/~cfwang/4.html
38.http://www.mpeg.org/MPEG/DVD/Book_B/Video.html
39.Michael Isnardi, MPEG-2 Video Compression, November 29, 1999 (http://www.leitch.ca/resources/tutorials/mpeg-2VideoCompression.pdf)
40.MPEG2 Overview (http://erg.abdn.ac.uk/research/future-net/digital-video/mpeg2.html)
41.Short MPEG-2 description. MPEG-2: ISO/IEC JTC1/SC29/WG11:Generic Coding of Moving Pictures and Associated Audio Information. October 2000 (http://www.chiariglione.org/mpeg/standards/mpeg-2/mpeg-2.htm)
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