Design methods and architectural issues of integrated medical image data base systems

The past 20 years have seen tremendous changes in medical imaging techniques. New modalities and protocols are expanding the available digital image data at a rapid rate. Yet a framework for gathering, managing, and using multimodal image information in an integrated database environment is missing. The purpose of this paper is to present the experience of implementing an integrated medical image database system at UCSF. We discuss the general system architecture, software design methods, and specific database tools and illustrate them with application examples. Two immediate issues confounding the building of medical image database systems are: lack of supporting infrastructure and inability to index images by content. To circumvent these problems, the evolutionary medical image database system being implemented at UCSF is based on a three-tiered client-server architecture: client medical workstations, database application servers, and a hospital-integrated picture archiving and communication system (HI-PACS). The approach used is to integrate content-based retrieval and knowledge base techniques within the existing HI-PACS to make the whole database system useful in medicine.