- 學位論文
非結構化資料的儲存應用於醫療手術紀錄報告系統之開發
The Storage of Unstructured Data Applies to the Development of Surgical Report System in Medical Treatment
若您是本文的作者，可授權文章由華藝線上圖書館中協助推廣。
摘要
民眾在醫療院所的就醫診療紀錄，包含主訴、病史、診斷、用藥、檢查、檢驗、手術等資料，都記載在個人病歷檔案中。有些醫療檢查會產出醫療影像圖片，提供醫師診療參考，並且存檔作為病情診斷的依據。各種造影儀器設備產出的影像圖片，可以直接在設備主機上存檔查看，也可以利用醫療影像儲存暨通訊系統（Picture Archiving and Communications System，簡稱PACS）統一集中管理，方便醫師隨時隨地調閱病患的各項醫療影像，減少資料傳送的人力成本，降低調閱等待的時間成本。 衛生署積極推廣電子病歷（Electronic Medical Record，簡稱EMR），鼓勵醫療院所透過彼此互相調閱EMR的互通機制，達到分享醫療資源、降低醫療成本、提升醫療品質等優點。對於手術病歷而言，一份手術紀錄報告的文字報告，可以透過打字輸入而儲存至電子病歷。但是手術相關圖片可能分散在各種的造影儀器設備主機，由PACS集中管理，其中也包括手術部位標記、植入物、檢體等影像。另外，在手術臨床上，也廣泛使用人體或器官幾何圖，醫師經常會用手繪方式，勾勒或標記病灶的位置和範圍。這些都是屬於手術相關資料，必須要能夠呈現於手術紀錄報告之中。 基於此動機，本文研究開發一個以圖檔處理為導向的醫療手術紀錄報告系統，合併手術相關的醫療圖片和文字報告，產生一份圖文並茂的醫療手術紀錄報告。本系統開發的關鍵技術在於，影像圖片屬於非結構化的多媒體資料，存取時必須考量檔案的大小、儲存體的配置、以及資料流的處理效能，本文研究在這方面相當有成果。本系統經過測試使用一段時間，參考醫師提供的寶貴意見，加以改善各項功能，現在已經實際上線使用且評價良好。
並列摘要
The medical treatments of people in hospitals or clinics, including chief complaint, medical history, diagnosis, medication, inspection, test, surgery operation, are recorded in a personal anamnesis. Some medical examinations produce medical images for treatment reference and these images must be archived as the basis of the disease diagnosis. Medical images produced by various image-making devices can be directly archived and accessed on the device host. However, these images are always managed by Picture Archiving and Communications System (PACS) to facilitate physician access patient medical images anytime and anywhere. Thus, the cost of manpower for data delivery and time for access waiting can be reduced. Department of Health actively popularizes Electronic Medical Record (EMR) and encourages hospitals to exchange EMR through each other in order to share medical resources, to reduce medical costs, and to enhance the quality of medical care. For a surgical medical anamnesis, the text of a surgical report can be typewritten and saved into an EMR. However, pictures of surgery operations may distribute over various image-making devices, or be managed by PACS, including the images of location marks of surgical operations, implants, specimen etc. Besides, the human body or organ geometric figures are popularly used in clinical surgery. Physicians often use handwritten method to draw or mark the location and extent of nidus. These are all related data of surgical operations and must be presented in a surgical operation report. Based on this motivation, this thesis studies how to develop a graphic-process-oriented medical surgery report system. It can combine medical images and text reports to produce a completely medical surgery report. The key technology of developing this system is about the medical images which belong to unstructured multimedia data. When accessing unstructured data, we must take into account the size of the data file, storage configuration, and processing performance of data flow. This study has fruitful results in this area. The system has been tested a period of time and has been improved according to the invaluable opinions of physicians. Now this system is on line and has good evaluations.
參考文獻
[14]江永言、吳帆（2009），「牙科之醫學影像處理系統與醫院資訊系統之整合建置」，臺灣口腔醫學科學雜誌，第35-48頁。
[7]Windows Communication Foundation的主要概念，http://msdn.microsoft.com/zh-tw/library/ms731079.aspx。
[20]A. I. Backer, K. J. Mortele, B. L. Keulenaer (2004), “Picture Archiving and Communication System – Part One Filmless Radiology and Distance Radiology”, JBR VBTR, 87, pp. 234-241.
[21]Andre J. Duerinckx (2003), “Introduction to two PACS ‘82 Panel Discussion edited by Andre J. Duerinckx, M.D., Ph.D.: Equipment Manufacturers’ View on PACS and The Medical Community’s View on PACS,” Journal of Digital Imaging, Vol. 16, No. 1, pp. 29-31.
[22]N. H. Strickland (1996), “Review article: Some cost-benefit considerations for PACS: a radiological perspective,” The British Journal of Radiology, Vol. 69, pp. 1089-1098.