結合醫療影像資訊系統之病理組織顯微影像系統建構之分析與評估

Abstract

隨著數位科技快速發展，電腦成本降低、儲存技術進展以及高解析度的螢幕及列印設備的出現，加上近年來由醫院放射科開始的無片化成功的推廣，PACS(Picture Archiving and Communications System)已經從以往為利基型產品，轉變成為醫院使用醫學影像產品的標準配備之一，許多科別與儀器都已藉由DICOM (Digital Imaging and Communications in Medicine) 標準化將所產生之影像資料納入PACS系統架構，只有少數科別例如病理科尚未進入PACS系統，本論文以SWOT分析病理組織數位化產業所面臨的技術問題與發展潛力，並以PACS產業經營者角度，以五力分析探討競爭者、顧客、供應商、潛在競爭者與替代者之間關連。 顯微鏡是病理科主要觀察工具，也是病理數位化關鍵所在，本論文實際操作兩種方式：一、利用顯微鏡外接攝影系統，以不改變病理醫師使用習慣，擷取關鍵影像方式；二、虛擬切片(Virtual Slide)方式，利用顯微鏡掃描系統，將病理切片做整片的掃描成數位化影像，病理醫師判斷病理切片是利用電腦觀察影像的方式進行。兩者影像皆與現有PACS做結合測試，並由相關人員角度探討數位化病理發展與問題。本論文也模擬病理單位在全面數位化顯微鏡判讀作業的成本效益分析。 本研究發現目前雖有檔案太大導致與PACS結合進度較慢問題，但病理數位化是必然的趨勢，尤其以Virtual Slide概念發展的儀器與系統架構已經能有效率將組織切片儲存，並隨著頻寬的日益增加，以Web介面方式的病理組織資料庫推廣亦讓病理遠距教學與會議得以蓬勃發展。雖然以PACS的系統建構廠商角度目前尚不用積極將病理科別納入系統，但需要密切觀察Virtual Slide的軟硬體公司發展，並藉由與病理醫學教育及研究單位合作，開發有關病理科別的PACS系統，以期在未來醫院系統的病理數位化之PACS建構中取得先機。

Advancement of digital technology in combination with lower cost of computer storage equipment, high resolution monitor and printer, Picture Archiving and Communications System (PACS) has been successively implemented in a number of hospitals over a decade in Taiwan. Today, PACS plays an essential role in the hospital information system. Many medical images in different departments have been transferred into PACS system using the protocol of Digital Imaging and Communications in Medicine (DICOM), a common standard for transmission and storage of medical images. There are only a few of departments that do not use PACS to store their images like department of pathology. In this essay, SWOT method was used to study the potential market and technical bottleneck in digital pathology. The method of Porter’s 5 Force was used to study relationships among competitors, customers, suppliers, potential competitors, substitutes, and PACS developer in digital pathology. As a major tool for pathological examination, microscope plays an important role in digital pathology. In this essay, two different methods were used for digital pathology. The first method is to use a photo camera on microscope to take the images of pathological sample in the slide based on a pathologist decision. The other method is to scan the sample in a glass slide and to create seamless true color digital images stored in the computer. Pathologist can then view different sections with various magnification of histopathology sample in the slide on computer screen. Images from both methods were transformed into PACS system. Comparisons in easiness to use, and the cost benefit between these two methods were evaluated by pathologists and researchers in the pathology department. Large memory requirement for the image in a virtual pathology slide in the PACS is the biggest challenge as discussed in this essay. However, virtual microscopy has many advantages as compared with traditional slide in pathology. Virtual slide can be accessed from the web, transportable media, or a network server used for image archiving and distribution. Within an internal network of a hospital or pathology department, virtual slides can be used for a variety of tasks, such as case meetings, slide seminars, and didactic live audience presentations. Through the web, virtual slides can be widely used in the pathology education and in inter-laboratory quality control programs. Even though PACS developer doest not put much of its efforts in digital pathology for the time being, it shall watch the development of virtual slide technology very closely. In order to take the advantage in this business, a PACS developer company can build its PACS system in digital pathology in collaboration with medical pathologists and researchers in pathology and related departments.