Practical mini-PACS based on a hybrid video and digital network.
The Department of Radiology of the Shinshu University Hospital is presently in the process of developing a new type of mini-PACS with a hybrid architecture consisting of a video and a digital image archiving network. The video block consists of a server station with a video write-once optical disk (LD) and three workstations which are connected to two ultrasound imaging devices and an MRI device. The video images from any of these imaging devices are transferred immediately onto an LD. The examiner can observe the archived images immediately without any interruption of the examination. The image transmission time, including the record and play-back, is within 3 s. The digital block consists of a personal computer server and various workstations linked to the ETHERNET. This digital system supports database management, and archives digital images. This prototype system was used for daily clinical examinations from February 1989 to January 1990 and 31,366 images from 1561 patients were stored on the video disk. This one year experience suggests that a hybrid mini-PACS system is practical for total image archiving when the image matrix is less than 512 x 512 and selected digital image archiving.
Progress and Problems of Interhospital Consulting by Computer Networking
In recent years we have seen a steady deterioration in rural health delivery both in the United States and also in developing countries.' More than 28 million Americans live in rural communities that are underserved by the health care system. Loss of acute care and specialist consultation can be partly restored by the development of efficient telecommunication patient-data links to main medical centers.2 Larger hospitals in North Amcrica often have a multitude of computers (from PCs and workstations to mainframes). They have been mostly used for hospital administration (e.g., scheduling of procedures and financing). Some states have networked all their hospitals because they require weekly bed-occupancy and insurance information by electronic mail (e-mail). Many access their computerized clinical pathology results and other reports via local area networks (LANs). A few make archiving and image processing of digitized x-rays available to departments outside of the radiology department. Intensive care units (and emergency rooms) are sometimes islands of intensely computerized, automated monitoring. They often successfully assist staff in watching over many simultaneous critical-care situations. Isolated efforts are under way to facilitate record kccping by using text or voiceactivated computer entry directly from the bedside to standardized patient-data forms. Underlying all these efforts is the need to deal with masses of nonstandardized hospital administration and patient data. This overwhelming problem has revived interest in the study and teaching of the long-established science of medical informatics.' The general picture of Hospital Information Systems (HIS) is, all too often, one of multiple types of poorly integrated computer systems and local networks. Much of this confusion can be traced to a lack of accepted hardware and software standards for commercial suppliers; also, to a deficiency of network engineering expertise for choosing and coordinating the multitude of available commercial systems. Western countries with national health systems have the advantage of being able to standardize countrywide. They are also stimulated by the requirement to centralize the reporting and analysis of patient and administrative data. But what o f smaller hospitals in rural areas or developing countries? There may be a PC or two, but no funds or expertise to d o much more than keep patient records
Shoeless Joe: Fantasy and the Humor of Fellow-Feeling
In his essay on Jean Paul Friedrich Richter, Thomas Carlyle writes of a humor that manifests itself in smile rather than laughter. "Richter is a man of mirth," says Carlyle, whose humor is "capricious . . . quaint . . . [and] heartfelt" (15). The three adjectives represent for Carlyle the essence of what he terms "true humor" because they suggest Richter's enormous respect for humanity. "True humor," he goes on to say, "springs not more from the head than from the heart; it is not contempt, its essence is love; it issues not in laughter, but in still smiles, which lie far deeper" (17). These smiles are not Hobbesian smirks of superiority1 but genuine signs of compassion for, sympathy toward, and empathy with the object of the humor. Carlyle further provides a direct link between humor and both pathos and nobility; the link is the smile of the caring man. For Carlyle, this smile is one of "fellow-feeling":