**Part 2**

**Image Processing Techniques** 

86 Medical Imaging

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**0**

**5**

*Portugal*

**Current Trends in Archiving and**

**Transmission of Medical Images**

Luís S. Ribeiro, Carlos Costa and José Luís Oliveira

The traditional Picture Archiving and Communication System (PACS) model consists of one PACS serving one healthcare institution (i.e. hospital-centered). Typically, a healthcare institution does not possess all the modalities or experts to evaluate a patient. Therefore, patients tend to move across several healthcare institutions to undergo all the required exams or diagnosis. These high levels of patient mobility produce huge amounts of medical data spread among different healthcare institutions without being shared conveniently, making the traditional PACS model obsolete. The current solutions for sharing non-anonymous medical images (i.e. HIPAA's Protected Health Information - PHI) rely mainly on point-to-point trust relationships (e.g. the radiologist trusts the physician sending image reports by e-mail) or ad-hoc solutions between few institutions (Jacq, 2007). The main problem of the ad-hoc solutions is interoperability, caused by the heterogeneity of methods to exchange information. To overcome this and other issues, the health industry, research and professionals around the world joined forces and started an initiative entitled Integrating the Health Enterprise <sup>1</sup> (IHE) with the main purpose of defining which standards (e.g. DICOM, HL7, ISO, OASIS, etc) may be used in a given situation of the healthcare workflow. IHE does not design standards, but defines integration profiles, i.e. blueprints that describe real-world scenarios or specific characteristics for building integration-ready systems (Størkson & Aslaksen, 2009). Among several integration profiles, one stands out: the Cross-Enterprise Document Sharing (XDS). XDS is gaining momentum and nowadays there are several implementations working in the field. XDS for imaging (XDS-I) is a content profile based on XDS that takes into consideration the particularities of the medical imaging field. However, XDS or XDS-I assume that their architectural components are located inside trustworthy domains, i.e. owned and maintained by Healthcare institutions. Planning and maintaining the IT infrastructure required to support the XDS-I architecture is not simple and demands a significant human and financial effort. Therefore, it would be desirable to delegate this task to a third-party entity and pay for it as a service. For instance, delegating the IT infrastructure to a Cloud Computing provider where the healthcare institutions would just pay to use the data-sharing service and not for the entire

Cloud is a computing paradigm that intends to deliver computation and data storage as a utility service (Faruqui, 2005; Michael Armbrust, 2009; Rajkumar Buyya, 2009). A utility

**1. Introduction**

IT infrastructure required to support XDS.

<sup>1</sup> http://www.ihe.org

*Universidade de Aveiro, IEETA*
