國內醫療影像系統發展之過去、現在與未來

醫療影像（如：X-ray, CT, MRI…等儀器設備之產出）是病歷資料之一。而影像儲傳系統(Pictures archive and communication systems, PACS)正是處理數位醫療影像儲存與傳輸的系統。影像儲存及傳輸的觀念源自於遠距放射線學(teleradiology)，後來延伸到醫院內部，PACS因應而生。本文透過國內外文獻之分析整理，了解我國PACS發展之過去與現況及實施PACS所面臨之問題，希望能對國內PACS之未來發展趨勢，提出建議以供產官學界之參考。國內醫院導入PACS之概況從民國八十九年11家到民國九十二年44家，大幅成長了四倍，其中遭遇許多問題，如：1．系統整合問題，2．院內PACS系統之資訊與院外互通問題，3．中文碼之問題，4．影像上傳監測與追蹤之問題等。為解決相關問題，PACS之發展趨勢如下：1．相關標準之制定與誰廣，2．醫療資訊系統相互整合，3．應用範圍不斷擴大，4.採用最先進的儲存技術，5．從遠距會診到行動醫療，6．多媒體技術之引進，7.口述報告，8．結合電腦輔助偵測或診斷系統來進行判讀等。有鑑於PACS之相關問題及未來發展趨勢，本文做出下列幾項建議：1．對醫院而言：(1)因應電子病歷，PACS勢在必行，應儘早規劃，(2)慎選供應商，(3)PACS之建置必須與醫院各資訊系統整合。2．對本土供應商而言：(l)加強自己本身的技術能力，(2)依循標準開發系統，(3)學習先進國家之經驗。3．對政府而言：(l)制定相關標準，建立誰動機制，(2)誰動相關法律之制定及落實施行相關配套措施，(3)仿效國外經驗，整合醫療相關之事業，(4)鼓勵醫院建置。4．對學術界而言：可從管理議題上多方進行研究。

關鍵字

醫療影像儲存傳輸系統；電腦輔助診斷

並列摘要

A medical image (such as the images are produced by X-ray, CT, MR) is a part of medical records. The system for archiving medical images and process is PACS (Pictures archive and communication systems). The concept of PACS came from teleradiology originally, and then applied in hospital. This article reviewed many papers from domestics and overseas to describe the past and present situation, and to find the problems on implementing PACS. The goal of this article is to make suggests for hospital, supplier, government and researcher to prepare for the future of PACS. The number of domestic hospitals who implement PACS has grown up 4 times from 2000 to 2003, but they still encounter some problems, such as system integration, the data transmission between hospitals, Chinese character code, and the uploaded images need to be monitored and traced. The trend of development in PACS is towards several ways, just like to establish and implement the standards, to integrate PACS with HIS, to expand the scope of application in PACS, to choose the advanced storage skills, to extend from telemedicine to mobile medicine, to lead in multimedia skills, to generate the report by dictation, and to combine the computer-aided detection or diagnosis system to assist radiologists. In consideration of the problems on implementing PACS and the trends of PACS development, we make some suggestions. For hospital, there are three advices as follows: the first is to make a plan to implement PACS as soon as possible for EMR, the second one is to choose the PACS supplier carefully, the last one is to integrate PACS with HIS. For domestic PACS suppliers, there are three recommendations: The first one is to enhance the skills, the next one is to develop PACS following the acknowledged standards, the last recommendation is to learn a lesson from the developed countries. For government, there are four suggestions proposed. The First one is to set up the standards and establish the mechanism of implementation. The Second one is to push legislation about EMR. The third one is to refer to foreign countries to integrate the health enterprises. The fourth suggestion is to encourage hospitals to construct PACS. For academic, we suggest that researchers could emphasize the research issues on management about PACS.