医疗信息系统的共享与协同技术研究
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摘要
医疗信息系统的发展已经进入医疗业务数字化和区域医疗的阶段，地区之间、系统之间以及医患之间，都需要通过医疗信息系统开展医疗活动的合作和协同，技术上开始向共享和协同方向发展。
医疗信息系统的数据共享和协同问题，从范围上可分为医院间或医院内的区域的共享和协同，以及作为补充医疗业务的远程医疗系统与医院信息系统之间广域的共享与协同，从研究对象上可分为文本信息以及图像等多媒体信息的共享与协同，本文分别从医院内医疗协同诊断系统、远程医疗系统与医院信息系统之间协同诊断以及医学图像数据共享与应用等三个方面描述所做主要工作：
1、会诊系统是医疗业务系统的重要补充，本文分析了医疗会诊系统的工作过程及要素，提出了一种基于组播技术的“不均等信息流”远程医疗会诊模型，配合医疗会诊工作方式，采用组播通讯技术实现了针对医疗会诊流程和特点的远程医疗会诊的系统。
2、提出了一种基于Multi-Agent的远程医疗系统协作模型，建立了Agent间协同工作的多参数医疗评估决策体系，根据此模型，论文设计和实现了用于注意力缺陷伴多动症(ADHD)的远程评估和反馈治疗系统，采用层次分析法用于多参数协同医疗决策和对ADHD的评估，系统结合评估结果指导脑电反馈仪对患者进行治疗，达到远程治疗ADHD的目的。
3、医学图像共享与处理是医疗活动的重要内容，DICOM作为医疗领域关于数字图像的国标标准，也是设计医学图像的信息系统必须遵循的标准，论文设计和实现基于TCP／IP的DICOM网关，用于医学图像共享和交互，并实现了RT S.S，RT Plan及RT Image三个DICOM对象，完成了放射治疗计划系统重要信息的共享，实现不同设备厂商的放射治疗计划系统之间的信息交换和共享。
4、在医学图像共享的基础上，展开针对医学图像的进一步分割处理的应用，提出一种基于形变模型的最小路径分割算法，算法使用动态规划方法对多目标进行最小路径的搜索，评估使用的能量函数结合了距离和梯度信息，指导最佳路径的选择和分割曲线的前进。能量函数中还加入了由主成分分析(PCA)方法导出的形变模型，该形变模型作为先验信息帮助算法在图像分割过程中克服图像噪声和边界模糊等因素的干扰。针对传统活动轮廓模型分割前对于初始点选择敏感的问题，本文设计了一种可以自动产生和更新初始点的方法，使分割算法更加自动化，算法还具有快速准确及鲁棒性的特点。
Now, as the development of medical information system has entered a new era with digitized medical service and regional medical system, it is necessary for different areas and different systems, as well as the doctors and patients to cooperate and coordinate through the medical information systems. Data sharing and cooperation are the characters of the medical information systems currently.
Problems of the data sharing and cooperation of the medical information systems can be put into two categories when studied from its scope, they are: data sharing and cooperation within a hospital or among different hospitals, and data sharing and cooperation of a wide area between medical information system and remote medical system. When studied its content, it can also be put into two categories: sharing and cooperation of text information and that of the multimedia, such as the medical images. Focusing on medical consultation system within a hospital, the cooperated diagnosis decision-making among telemedicine system and hospital information systems, and the data sharing and processing of medical images, this paper covers the following contents:
1. Telemedicine consultation system is an important part of regional medical information systems. In this paper, the author analyses the process and factors of telemedical consultation and proposes a model of telemedical consultation based on multicast technologies. The work flows of consultation and the technology of IP-multicasting are discussed in details. The telemedical consultation system based on IP-multicasting is implemented.
2. The author also proposes a cooperated model of remote medical system based on Multi-Agent and set up an evaluation and decision-making system of multi-parameters among Agents. And using this model, the author designed a new telemedicine pattern of the evaluation and therapy for Attention Deficit Hyperactivity Disorder(ADHD) using electroencephalogram (EEG) biofeedback. Analytic Hierarchy Process is used for the decision-making of cooperative medicine and for the evaluation of ADHD. The efficiency of the evaluation and therapy of ADHD is improved by using the telemedicine system.
3. Digital Imaging Communications in Medicine(DICOM) is the core of medical images sharing. As a national standard for digital images in medical area, DICOM is also a standard that must be followed in information systems involving medial images. In this paper, the author designed a DICOM gateway based on TCP/IP for medical images to share and interact. DICOM objects of RT S.S, RT Plan , RT Image are designed and implemented for the information exchanging and sharing of the radiotherapy planning systems(TPS) of different manufactories.
4. Based on the data sharing of medical images, the deep research on the medical images segmentation method is carried on. A robust, automated, model-based segmentation method for medical Images is presented. We used dynamic programming and a minimal path approach to detect the optimal path within a weighted graph between two end points. The energy function combines distance and gradient information to guide the marching curve and thus to evaluate the best path and to span a broken edge. An algorithm was developed to automatically place initial end points. Dynamic programming was used to automatically optimize and update end points in the procedure for searching curves. Principle component analysis (PCA) was used to generate a deformable model, which serves as the prior knowledge for the evaluation of the best path. To quantitatively assess the automatic segmentation method, we compared the automatic segmentation results with manual segmentation.
医疗信息系统的数据共享和协同问题，从范围上可分为医院间或医院内的区域的共享和协同，以及作为补充医疗业务的远程医疗系统与医院信息系统之间广域的共享与协同，从研究对象上可分为文本信息以及图像等多媒体信息的共享与协同，本文分别从医院内医疗协同诊断系统、远程医疗系统与医院信息系统之间协同诊断以及医学图像数据共享与应用等三个方面描述所做主要工作：
1、会诊系统是医疗业务系统的重要补充，本文分析了医疗会诊系统的工作过程及要素，提出了一种基于组播技术的“不均等信息流”远程医疗会诊模型，配合医疗会诊工作方式，采用组播通讯技术实现了针对医疗会诊流程和特点的远程医疗会诊的系统。
2、提出了一种基于Multi-Agent的远程医疗系统协作模型，建立了Agent间协同工作的多参数医疗评估决策体系，根据此模型，论文设计和实现了用于注意力缺陷伴多动症(ADHD)的远程评估和反馈治疗系统，采用层次分析法用于多参数协同医疗决策和对ADHD的评估，系统结合评估结果指导脑电反馈仪对患者进行治疗，达到远程治疗ADHD的目的。
3、医学图像共享与处理是医疗活动的重要内容，DICOM作为医疗领域关于数字图像的国标标准，也是设计医学图像的信息系统必须遵循的标准，论文设计和实现基于TCP／IP的DICOM网关，用于医学图像共享和交互，并实现了RT S.S，RT Plan及RT Image三个DICOM对象，完成了放射治疗计划系统重要信息的共享，实现不同设备厂商的放射治疗计划系统之间的信息交换和共享。
4、在医学图像共享的基础上，展开针对医学图像的进一步分割处理的应用，提出一种基于形变模型的最小路径分割算法，算法使用动态规划方法对多目标进行最小路径的搜索，评估使用的能量函数结合了距离和梯度信息，指导最佳路径的选择和分割曲线的前进。能量函数中还加入了由主成分分析(PCA)方法导出的形变模型，该形变模型作为先验信息帮助算法在图像分割过程中克服图像噪声和边界模糊等因素的干扰。针对传统活动轮廓模型分割前对于初始点选择敏感的问题，本文设计了一种可以自动产生和更新初始点的方法，使分割算法更加自动化，算法还具有快速准确及鲁棒性的特点。
Now, as the development of medical information system has entered a new era with digitized medical service and regional medical system, it is necessary for different areas and different systems, as well as the doctors and patients to cooperate and coordinate through the medical information systems. Data sharing and cooperation are the characters of the medical information systems currently.
Problems of the data sharing and cooperation of the medical information systems can be put into two categories when studied from its scope, they are: data sharing and cooperation within a hospital or among different hospitals, and data sharing and cooperation of a wide area between medical information system and remote medical system. When studied its content, it can also be put into two categories: sharing and cooperation of text information and that of the multimedia, such as the medical images. Focusing on medical consultation system within a hospital, the cooperated diagnosis decision-making among telemedicine system and hospital information systems, and the data sharing and processing of medical images, this paper covers the following contents:
1. Telemedicine consultation system is an important part of regional medical information systems. In this paper, the author analyses the process and factors of telemedical consultation and proposes a model of telemedical consultation based on multicast technologies. The work flows of consultation and the technology of IP-multicasting are discussed in details. The telemedical consultation system based on IP-multicasting is implemented.
2. The author also proposes a cooperated model of remote medical system based on Multi-Agent and set up an evaluation and decision-making system of multi-parameters among Agents. And using this model, the author designed a new telemedicine pattern of the evaluation and therapy for Attention Deficit Hyperactivity Disorder(ADHD) using electroencephalogram (EEG) biofeedback. Analytic Hierarchy Process is used for the decision-making of cooperative medicine and for the evaluation of ADHD. The efficiency of the evaluation and therapy of ADHD is improved by using the telemedicine system.
3. Digital Imaging Communications in Medicine(DICOM) is the core of medical images sharing. As a national standard for digital images in medical area, DICOM is also a standard that must be followed in information systems involving medial images. In this paper, the author designed a DICOM gateway based on TCP/IP for medical images to share and interact. DICOM objects of RT S.S, RT Plan , RT Image are designed and implemented for the information exchanging and sharing of the radiotherapy planning systems(TPS) of different manufactories.
4. Based on the data sharing of medical images, the deep research on the medical images segmentation method is carried on. A robust, automated, model-based segmentation method for medical Images is presented. We used dynamic programming and a minimal path approach to detect the optimal path within a weighted graph between two end points. The energy function combines distance and gradient information to guide the marching curve and thus to evaluate the best path and to span a broken edge. An algorithm was developed to automatically place initial end points. Dynamic programming was used to automatically optimize and update end points in the procedure for searching curves. Principle component analysis (PCA) was used to generate a deformable model, which serves as the prior knowledge for the evaluation of the best path. To quantitatively assess the automatic segmentation method, we compared the automatic segmentation results with manual segmentation.
引文
[1]W. R. Hersh, Medical Informatics: Improving Health Care Through Information, JAMA, 2002, 288(16): 1955-1958
[2]傅征，任连中．医院信息系统建设与应用．北京：人民军医出版社，2003：8-13
[3]S. B. Alice, S. F. S(?)rgio, Sharing and Archiving Medical Knowledge Through Collaborative Tools, Medical Imaging 2004: PACS and Imaging Informatics, Bellingham, SPIE V5371:418-427
[4]J．H．Bemmel and M．A．Musen著．包含飞，郑学侃译．医学信息学．上海：上海科学技术出版社，2002：11-15
[5]丁宝芬．实用医学信息学．东南大学出版社，2003年版：13-14
[6]李慷．医院信息系统建设．医学综述．2003，9(增刊)：57-59
[7]P. Frazier, A. Rossi-Mori, RH. Doh, et. al, The creation of an ontology of clinical document names. MedInfo 2001. Studies in Health Technology and Informatics, 2001, Amsterdam, The Netherlands: IOS Press, 2001, 84:235-248
[8]白净，张永红．远程医疗概论．北京：清华大学出版社，2000：33-40
[9]庄天戈．计算机在生物医学中的应用．北京：科学出版社，2000：37-39
[10]尧德中，李永杰，周山宏．生物医学中的信息技术．电子科技大学学报社科版．2001，2：3-9
[11]金新政，陈敏．医院信息系统．北京．科学出版社．2004：7-15
[12]罗述谦，周果宏．医学图象处理与分析．北京．科学出版社，2003：5-8
[13]D. W. Forslund, M. Kratz, J. E. George, et. al. The importance of distributed, component-based healthcareinformation systems: the role of a service-based architecture. Proc. 14th IEEE Symposium on Computer-Based Medical Systems. Bethesda, MD, USA, 2001:79-82
[14]H. Ean-Wen, L. Der-Ming, Performance Analysis of a Medical Record Exchanges Model, IEEE Transactions on Information Technology in Biomedicine, 2007, 11(2): 153-160
[15]R. S. Kazemzadeh, K. Sartipi. Interoperability of Data and Knowledge in Distributed Health care Systems. Proc. of the 13th IEEE International Workshop on Software Technology and Engineering Practice. IEEE, 2005:1-10
[16]T. B. Pedersen, C. S. Jensen. Research Issues in Clinical Data Warehousing. Proceedings of the Tenth Intemational Conference on Scientific and Statistical Database Management. Capri. Italy, IEEE Computer Society (July 1998): 43-52.
[17]W．H．Inmon，王志海等泽，数据仓库，北京，机械工业出版社，2000：20-24
[18]A. Sheth, J. Larson, Federated Database Systems for Managing Computing Distributed, Heterogeneous and Autonomous Database, ACM Computing Surveys, 1990, 22(3): 88-97
[19]王宁，陈滢，俞本权，等．一个基于CORBA的异构数据源集成系统的设计．软件学院，1998，5(9)：321-325
[20]李巍，李冠宇，张俊．基于CORBA的智能异构数据集成系统的存储机制研究．交通与计算机．2004，5：15-19
[21]贺天章，王盼卿，李晓辉．基于CORBA的构件组装研究与应用．科学技术与工程，2008，8(1)：84-86
[22]曲红亭，申瑞民．COM/DCOM与CORBA互操作的实现．计算机应用与软件，2003，5(3)：33-34．
[23]赵红宇，黎茂锋，刘志勤．Java/COM集成技术研究．西南科技大学学报，2004，19(2)：49-54
[24]李磊，王怀民．CORBA与EJB集成技术的研究，计算机科学，2001，28(6)：27-30
[25]章明，许青松，沈锡臣．基于XML的数据交换共享平台清华大学学报(自然科学版)2003，43(1)：105-107
[26]范玉顺，李建强编著．企业集成与集成平台技术．北京：机械工业出版社，2004：48-51
[27]L. Boqiang, L. Xiaomei , L. Zhongguo, et. al, Design and Implementation of information exchange betweenHIS and PACS Based on HL7 standard, Proc. of the 5th International Conference on Information Technology and Application in Biomedicine, in conjunction with The 2nd International Symposium & Summer School on Biomedical and Health Engineering, China, Shenzhen, IEEE, 2008:552-555
[28]S. L. Fritz, S. R. Roys, S. Munjal, et. al, Design requirements for DICOM patient, study, and results management. Medical Imaging 1996: PACS Design and Evaluation: Engineering and Clinical Issues, 13 February 1996, Newport Beach, CA, USA, SPIE 2711:98
[29]ACR-NEMA. Digital imaging and communication in medicine(DICOM). PS3. 3,2003
[30]M. Ferraris, P. Frixione, MedicalImagesRemoteConsultation, International Journal of Modern Physics C, 2001,12(4):481-486
[31]T. Hacklander, J. Martin, K Kleber. Informatics in Radiology (infoRAD): An Open Source Framework for Modification and Communication of DICOM Objects. RadioGraphics, 2005, 25(6): 1709-1721.
[32]J. Sim, S. Choi., Connecting and sharing medical images in three big hospitals in Korea, EuroPACS 2002 Proceeding, 2002, 20:22-24
[33]CI. Buddelmeijer, AW. Huisman. PL. de. Haan, et. al, Implementation of a Cardiology Information System in AMC, a Large Academic Hospital. Analysis of biomedical signals and images 2002, 16:460-462
[34]M．Wooldridge，石纯一，张伟，等．多Agent系统引论．北京：电子工业出版社，2003
[35]M. Beer, M. D. Inveruo, M. Luck, et. al. Negotiation in multi-agent systems. Workshop ofthe UK Special Interest Group on Multi-Agent Systems(UKMAS 98), DEC, 1998. KNOWLENG REV, 1999, 14(3): 285-290
[36]V. G. Koutkias, I. Chouvarda, N. Maglaveras, A. multiagent system enhancing home-care health services for chronic disease management, IEEE Transactions on Information Technology in Biomedicine, 2005, 9(4): 528-537
[37]L. M. Camarinha-Matos, H. Afsarmanesh, Infrastructures for collaborative networks - an application in elderly care, The 2005 Symposium on Applications and the Internet, 2005. Proceedings, 31 Jan.-4 Feb. 2005, IEEE: 94-101
[38]V. G. Koutkias, I. Chouvarda, N Maglaveras, Multi-agent system architecture for heart failure management in a home care environment, Computers in Cardiology, 2003, INSPECT: 383-386
[39]张元亭，李莉．面向21世纪的远程医疗和数码医院．99’中国生物医学电子学学术年会论文集．南京，东南大学，1999：1-3
[40]徐昌彪．IP组播及其核心技术探讨．计算机应用研究．2001，18(8)：49-53
[41]师军．Multicast技术及其应用．计算机与应用．2000，2：29-30
[42]王孝礼．多点广播与多点广播路由的研究与实现．计算机应用研究．2001，18(1)：92-93
[43]朱利，郑志军．基于IP的音频通信系统设计．西安建筑科技大学学报．2000．32(2)：196-202
[44]D．E．Comer，D．L．Stevens著．张娟等译．用TCP/IP进行网络互联(第一卷)．电子工业出版社，2001：221-242
[45]王兴伟等．分布式多媒体系统中的多点播送与组通信机制．计算机工程与设计，1998，19(5)：36-41
[46]钮焱，张颖江．基于WinSock的IP组播网络研究及应用．湖北工学院学报，2000，15(2)：28-30
[47]蒋东兴等．Windows Sockets网络程序设计大全．清华大学出版社．1999：61-70
[48]朱康辛，李珂．基于IP多播的视频监控系统．通信技术，2000，33(2)：17-20
[49]S M Alhashmi, Design of an internet-based advisory system: A multi-agent approach. 11th Pacific Rim International Conference on Multi-Agents, PRIMA 2008, Dec 15-16 2008, Hanoi, Viet Nam: p14-25
[50]韩江洪，江波，杜诗研等．一种基于多Agent系统的智能家庭网络研究．电子科技大学学报．2005，34(2)：233-235
[51]L. M. Hirshberg, Place of electroencephalograpic biofeedback for attention deficit hyperactivity disorder, Expert Review of Neurotherapeutics, 2007, 7(4): 315-319
[52]钱秋谨，杨莉，王玉凤．儿童注意缺陷多动障碍的研究进展．北京大学学报(医学版)．2007，39(3)：323-328
[53]G. K. Vassilis, C. Ioanna, M. Nicos, A Multiagent SystemEnhancing Home-Care Health Services for Chronic Disease Management. IEEE Trans-Information Technology in Biomedicine, 2005, 9(4):528-537.
[54]A. Diaf, N. Noroozi, Some practical issues on implementing distributed multi-agent reasoning systems. 2008 IEEE International Conference on Electro/Information Technology, IEEE EIT 2008 Conference, May 18-20 2008, Ames, IA, United States: 30-36
[55]J. M. Lee, B. H. Cho, J. H. Ku. et al. A study on the system for treatment of ADHD using virtual reality. Annual Reports of the Research Reactor Institute, Kyoto University, 2001, 4:3754-3757
[56]B. H. Cho, J. M. Lee, J. H. Ku. et al. Attention enhancement system using virtual reality and EEG biofeedback. Proc. Virtual Reality Annual International Symposium, 2002:156-163
[57]B. H. Cho, J. Ku, D. P. Jang, et, al. The effect of virtual reality cognitive training for attention enhancement. Cyberpsychol Behav. 2002 Apr; 5(2): 129-37
[58]R. M. Costa, L. A. de Carvalho, et, al. The UFRJ-UERJ group: interdisciplinary virtual reality experiments in neuropsychiatry. Cyberpsychol Behav. 2002, 5(5): 423-31
[59]吴松华，基于多Agent的医疗急救系统的研究与设计．[学位论文]，大连：大连理工大学，2006：48-50
[60]刘光陵，伏洁，夏正坤等，脑电生物反馈治疗小儿注意力缺陷伴多动障碍的疗效及合适疗程探讨，中国全科医学，2006，9(22)：1853-1855
[61]A I Fedotchev, E V Kim, Correction of Functional Disturbances during Pregnancy by the Method of Adaptive EEG Biofeedback Training, Human Physiology, 2006, 32(6): 65-70
[62]翟杰，省金岭，仇新华，脑电反馈治疗对共患ADHD和学习障碍患儿注意、智力影响，中国儿童保健杂志，2008，4：407-409
[63]V. G.. Koutkias, I. Chouvarda, N Maglaveras, Multi-Agent System Architecture for Heart Failure Management in a Home Care Environment. Computers in Cardiology, 2003, 30:383-386
[64]於文雪，张惠，罗立民．DICOM标准在放射治疗中的应用．中国医疗器械杂志．2002，26(5)：352-355
[65]吴磊，於文雪，章敏娟等，基于DICOM RT标准的射野数据传输，医疗卫生装备，2006，27(6)：48-50
[66]S. Nedevschi, D. Olinic, R. Popovici, F. Rusu , A. Smeu, C. Homorodean "DICOM Compliant Environment for Structured Reporting in Echocardiography", IEEE International Conference on Computers in Cardiology, Thessaloniki, September 21-24, IEEE, 2003: 24-27.
[67]钟金宏，李兴国，马溪骏等．医学影像建档与通信传输系统综述．计算机工程与应用．2003，39(14)．22-24，54
[68]叶建江，张金艳，赵晨辉．DICOM服务器中间层的设计与实现．中国医疗器械杂志．2002，26(4)：271-274
[69]W. D. Bidgood. Clinical importance of the DICOM structured reporting standard, International Journal of Cardiac Imaging 1998, 14:307-315
[70]黄洁，DICOM标准在放射治疗中的应用．[学位论文]，成都：电子科技大学，2002：17-20
[71]何清华，胡建华，欧晓光等．基于DICOM协议的医学图像传输的实现．医疗卫生装备．2002。 4：25-27
[72]叶建江，张金艳，赵晨辉．DICOM服务器中间层的设计与实现．中国医疗器械杂志．2002，26(4)：271-274
[73]杨晓鹏，杨守义，高剑波．基于DICOM RT的放射治疗计划系统研究，临床医学，2005，25(5)：71-72
[74]M. Kass, A. Witkin, D Terzopoulos. Snake: Active contour models. International Journal of Computer Vision, 1988, 1(4): 321-331.
[75]U. Roman, K. Kazufumi, Y Hideo. Dynamic contour: a texture approach and contour operations. The Visual Computer. 1995, 11(6): 277-289
[76]T. McInerney, D. Terzopoulos. Topologically adaptable snakes. Proc. Fifth International Conf. on Computer Vision (ICCV'95). Cambridge: INSPEC, 1995: 840-845
[77]V. Caselles, F. Catte, T. Coll, et al., A Geometric Model for Active Contours in Image Processing. Numerische Mathematik, 1993, 66(1): 1-31.
[78]R. Malladi, R. Malladi, J. A. Sethian, et al., Shape modeling with front propagation: a level set approach. IEEE Transactions on Pattern Analysis and Machine Intelligence. 1995, 17(2): 158-175
[79]S. Guillermo, T. Allen, Affine invariant scale-space. International Journal of Computer Vision. 1993, 11(1): 25-44
[80]L. Alvarez, F. Guichard, P. L. Lions, et al., Axioms and fundamental equations of image processing. Archive for Rational Mechanics and Analysis. 1993, 123(3): 199-257
[81]R. Kimmel, A. Amir, et al., Finding shortest paths on surfaces using level sets propagation. Transactions on Pattern Analysis and Machine Intelligence. 1995, 17(1): 635-640
[82]B. K. Benjamin, RT. Allen, WZ. Steven, Shapes, shocks, and deformations Ⅰ: the components of two-dimensional shape and the reaction-diffusion space. International Journal of Computer Vision. 1995, 15:189-224
[83]S. Osher, J. A. Sethian, Fronts propagating with curvature-dependent speed: algorithms based on Hamilton-Jacobi formulations. Journal of Computational Physics. 1988, 79:12-49
[84]J. A. Sethian, Level Set Methods and Fast Marching Methods: Evolving Interfaces in Computational Geometry, Fluid Mechanics, Computer Vision, and Materials Science, Cambridge University Press, 1999.
[85]N. M. Eric, A. B. William., Interactive segmentation with intelligent scissors. Graphical Models and Image Processing. 1988, 60(5): 349-384
[86]J. A. Sethian, Fast marching methods. SIAM review. 1999, 41: 199-235
[87]E, W. Dijkstra, A note on two problems in connection with graphs. Numerical Mathematics. 1959, 1: 269-271
[88]L D Cohen, R Kimmel. Global minimum for active contour models: a minimal path approach. Conference on Computer Vision and Pattern Recognition (CVPR'96), Washington: IEEE Computer Society, 1996, 666-673
[89]B. Verdonck, I. Bloch, H. Muitre, et al., Accurate segmentation of blood vessels from 3D medical images. International Conference on Image Processing, Lausanne, INSPEC, 1996, 3: 311-314
[90]P. Chaturvedi, M. F. Insana, T. J. Hall. Testing the limitations of 2-D companding for strain imaging using phantoms. IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control, 1998, 45(4): 1022-1031
[2]傅征，任连中．医院信息系统建设与应用．北京：人民军医出版社，2003：8-13
[3]S. B. Alice, S. F. S(?)rgio, Sharing and Archiving Medical Knowledge Through Collaborative Tools, Medical Imaging 2004: PACS and Imaging Informatics, Bellingham, SPIE V5371:418-427
[4]J．H．Bemmel and M．A．Musen著．包含飞，郑学侃译．医学信息学．上海：上海科学技术出版社，2002：11-15
[5]丁宝芬．实用医学信息学．东南大学出版社，2003年版：13-14
[6]李慷．医院信息系统建设．医学综述．2003，9(增刊)：57-59
[7]P. Frazier, A. Rossi-Mori, RH. Doh, et. al, The creation of an ontology of clinical document names. MedInfo 2001. Studies in Health Technology and Informatics, 2001, Amsterdam, The Netherlands: IOS Press, 2001, 84:235-248
[8]白净，张永红．远程医疗概论．北京：清华大学出版社，2000：33-40
[9]庄天戈．计算机在生物医学中的应用．北京：科学出版社，2000：37-39
[10]尧德中，李永杰，周山宏．生物医学中的信息技术．电子科技大学学报社科版．2001，2：3-9
[11]金新政，陈敏．医院信息系统．北京．科学出版社．2004：7-15
[12]罗述谦，周果宏．医学图象处理与分析．北京．科学出版社，2003：5-8
[13]D. W. Forslund, M. Kratz, J. E. George, et. al. The importance of distributed, component-based healthcareinformation systems: the role of a service-based architecture. Proc. 14th IEEE Symposium on Computer-Based Medical Systems. Bethesda, MD, USA, 2001:79-82
[14]H. Ean-Wen, L. Der-Ming, Performance Analysis of a Medical Record Exchanges Model, IEEE Transactions on Information Technology in Biomedicine, 2007, 11(2): 153-160
[15]R. S. Kazemzadeh, K. Sartipi. Interoperability of Data and Knowledge in Distributed Health care Systems. Proc. of the 13th IEEE International Workshop on Software Technology and Engineering Practice. IEEE, 2005:1-10
[16]T. B. Pedersen, C. S. Jensen. Research Issues in Clinical Data Warehousing. Proceedings of the Tenth Intemational Conference on Scientific and Statistical Database Management. Capri. Italy, IEEE Computer Society (July 1998): 43-52.
[17]W．H．Inmon，王志海等泽，数据仓库，北京，机械工业出版社，2000：20-24
[18]A. Sheth, J. Larson, Federated Database Systems for Managing Computing Distributed, Heterogeneous and Autonomous Database, ACM Computing Surveys, 1990, 22(3): 88-97
[19]王宁，陈滢，俞本权，等．一个基于CORBA的异构数据源集成系统的设计．软件学院，1998，5(9)：321-325
[20]李巍，李冠宇，张俊．基于CORBA的智能异构数据集成系统的存储机制研究．交通与计算机．2004，5：15-19
[21]贺天章，王盼卿，李晓辉．基于CORBA的构件组装研究与应用．科学技术与工程，2008，8(1)：84-86
[22]曲红亭，申瑞民．COM/DCOM与CORBA互操作的实现．计算机应用与软件，2003，5(3)：33-34．
[23]赵红宇，黎茂锋，刘志勤．Java/COM集成技术研究．西南科技大学学报，2004，19(2)：49-54
[24]李磊，王怀民．CORBA与EJB集成技术的研究，计算机科学，2001，28(6)：27-30
[25]章明，许青松，沈锡臣．基于XML的数据交换共享平台清华大学学报(自然科学版)2003，43(1)：105-107
[26]范玉顺，李建强编著．企业集成与集成平台技术．北京：机械工业出版社，2004：48-51
[27]L. Boqiang, L. Xiaomei , L. Zhongguo, et. al, Design and Implementation of information exchange betweenHIS and PACS Based on HL7 standard, Proc. of the 5th International Conference on Information Technology and Application in Biomedicine, in conjunction with The 2nd International Symposium & Summer School on Biomedical and Health Engineering, China, Shenzhen, IEEE, 2008:552-555
[28]S. L. Fritz, S. R. Roys, S. Munjal, et. al, Design requirements for DICOM patient, study, and results management. Medical Imaging 1996: PACS Design and Evaluation: Engineering and Clinical Issues, 13 February 1996, Newport Beach, CA, USA, SPIE 2711:98
[29]ACR-NEMA. Digital imaging and communication in medicine(DICOM). PS3. 3,2003
[30]M. Ferraris, P. Frixione, MedicalImagesRemoteConsultation, International Journal of Modern Physics C, 2001,12(4):481-486
[31]T. Hacklander, J. Martin, K Kleber. Informatics in Radiology (infoRAD): An Open Source Framework for Modification and Communication of DICOM Objects. RadioGraphics, 2005, 25(6): 1709-1721.
[32]J. Sim, S. Choi., Connecting and sharing medical images in three big hospitals in Korea, EuroPACS 2002 Proceeding, 2002, 20:22-24
[33]CI. Buddelmeijer, AW. Huisman. PL. de. Haan, et. al, Implementation of a Cardiology Information System in AMC, a Large Academic Hospital. Analysis of biomedical signals and images 2002, 16:460-462
[34]M．Wooldridge，石纯一，张伟，等．多Agent系统引论．北京：电子工业出版社，2003
[35]M. Beer, M. D. Inveruo, M. Luck, et. al. Negotiation in multi-agent systems. Workshop ofthe UK Special Interest Group on Multi-Agent Systems(UKMAS 98), DEC, 1998. KNOWLENG REV, 1999, 14(3): 285-290
[36]V. G. Koutkias, I. Chouvarda, N. Maglaveras, A. multiagent system enhancing home-care health services for chronic disease management, IEEE Transactions on Information Technology in Biomedicine, 2005, 9(4): 528-537
[37]L. M. Camarinha-Matos, H. Afsarmanesh, Infrastructures for collaborative networks - an application in elderly care, The 2005 Symposium on Applications and the Internet, 2005. Proceedings, 31 Jan.-4 Feb. 2005, IEEE: 94-101
[38]V. G. Koutkias, I. Chouvarda, N Maglaveras, Multi-agent system architecture for heart failure management in a home care environment, Computers in Cardiology, 2003, INSPECT: 383-386
[39]张元亭，李莉．面向21世纪的远程医疗和数码医院．99’中国生物医学电子学学术年会论文集．南京，东南大学，1999：1-3
[40]徐昌彪．IP组播及其核心技术探讨．计算机应用研究．2001，18(8)：49-53
[41]师军．Multicast技术及其应用．计算机与应用．2000，2：29-30
[42]王孝礼．多点广播与多点广播路由的研究与实现．计算机应用研究．2001，18(1)：92-93
[43]朱利，郑志军．基于IP的音频通信系统设计．西安建筑科技大学学报．2000．32(2)：196-202
[44]D．E．Comer，D．L．Stevens著．张娟等译．用TCP/IP进行网络互联(第一卷)．电子工业出版社，2001：221-242
[45]王兴伟等．分布式多媒体系统中的多点播送与组通信机制．计算机工程与设计，1998，19(5)：36-41
[46]钮焱，张颖江．基于WinSock的IP组播网络研究及应用．湖北工学院学报，2000，15(2)：28-30
[47]蒋东兴等．Windows Sockets网络程序设计大全．清华大学出版社．1999：61-70
[48]朱康辛，李珂．基于IP多播的视频监控系统．通信技术，2000，33(2)：17-20
[49]S M Alhashmi, Design of an internet-based advisory system: A multi-agent approach. 11th Pacific Rim International Conference on Multi-Agents, PRIMA 2008, Dec 15-16 2008, Hanoi, Viet Nam: p14-25
[50]韩江洪，江波，杜诗研等．一种基于多Agent系统的智能家庭网络研究．电子科技大学学报．2005，34(2)：233-235
[51]L. M. Hirshberg, Place of electroencephalograpic biofeedback for attention deficit hyperactivity disorder, Expert Review of Neurotherapeutics, 2007, 7(4): 315-319
[52]钱秋谨，杨莉，王玉凤．儿童注意缺陷多动障碍的研究进展．北京大学学报(医学版)．2007，39(3)：323-328
[53]G. K. Vassilis, C. Ioanna, M. Nicos, A Multiagent SystemEnhancing Home-Care Health Services for Chronic Disease Management. IEEE Trans-Information Technology in Biomedicine, 2005, 9(4):528-537.
[54]A. Diaf, N. Noroozi, Some practical issues on implementing distributed multi-agent reasoning systems. 2008 IEEE International Conference on Electro/Information Technology, IEEE EIT 2008 Conference, May 18-20 2008, Ames, IA, United States: 30-36
[55]J. M. Lee, B. H. Cho, J. H. Ku. et al. A study on the system for treatment of ADHD using virtual reality. Annual Reports of the Research Reactor Institute, Kyoto University, 2001, 4:3754-3757
[56]B. H. Cho, J. M. Lee, J. H. Ku. et al. Attention enhancement system using virtual reality and EEG biofeedback. Proc. Virtual Reality Annual International Symposium, 2002:156-163
[57]B. H. Cho, J. Ku, D. P. Jang, et, al. The effect of virtual reality cognitive training for attention enhancement. Cyberpsychol Behav. 2002 Apr; 5(2): 129-37
[58]R. M. Costa, L. A. de Carvalho, et, al. The UFRJ-UERJ group: interdisciplinary virtual reality experiments in neuropsychiatry. Cyberpsychol Behav. 2002, 5(5): 423-31
[59]吴松华，基于多Agent的医疗急救系统的研究与设计．[学位论文]，大连：大连理工大学，2006：48-50
[60]刘光陵，伏洁，夏正坤等，脑电生物反馈治疗小儿注意力缺陷伴多动障碍的疗效及合适疗程探讨，中国全科医学，2006，9(22)：1853-1855
[61]A I Fedotchev, E V Kim, Correction of Functional Disturbances during Pregnancy by the Method of Adaptive EEG Biofeedback Training, Human Physiology, 2006, 32(6): 65-70
[62]翟杰，省金岭，仇新华，脑电反馈治疗对共患ADHD和学习障碍患儿注意、智力影响，中国儿童保健杂志，2008，4：407-409
[63]V. G.. Koutkias, I. Chouvarda, N Maglaveras, Multi-Agent System Architecture for Heart Failure Management in a Home Care Environment. Computers in Cardiology, 2003, 30:383-386
[64]於文雪，张惠，罗立民．DICOM标准在放射治疗中的应用．中国医疗器械杂志．2002，26(5)：352-355
[65]吴磊，於文雪，章敏娟等，基于DICOM RT标准的射野数据传输，医疗卫生装备，2006，27(6)：48-50
[66]S. Nedevschi, D. Olinic, R. Popovici, F. Rusu , A. Smeu, C. Homorodean "DICOM Compliant Environment for Structured Reporting in Echocardiography", IEEE International Conference on Computers in Cardiology, Thessaloniki, September 21-24, IEEE, 2003: 24-27.
[67]钟金宏，李兴国，马溪骏等．医学影像建档与通信传输系统综述．计算机工程与应用．2003，39(14)．22-24，54
[68]叶建江，张金艳，赵晨辉．DICOM服务器中间层的设计与实现．中国医疗器械杂志．2002，26(4)：271-274
[69]W. D. Bidgood. Clinical importance of the DICOM structured reporting standard, International Journal of Cardiac Imaging 1998, 14:307-315
[70]黄洁，DICOM标准在放射治疗中的应用．[学位论文]，成都：电子科技大学，2002：17-20
[71]何清华，胡建华，欧晓光等．基于DICOM协议的医学图像传输的实现．医疗卫生装备．2002。 4：25-27
[72]叶建江，张金艳，赵晨辉．DICOM服务器中间层的设计与实现．中国医疗器械杂志．2002，26(4)：271-274
[73]杨晓鹏，杨守义，高剑波．基于DICOM RT的放射治疗计划系统研究，临床医学，2005，25(5)：71-72
[74]M. Kass, A. Witkin, D Terzopoulos. Snake: Active contour models. International Journal of Computer Vision, 1988, 1(4): 321-331.
[75]U. Roman, K. Kazufumi, Y Hideo. Dynamic contour: a texture approach and contour operations. The Visual Computer. 1995, 11(6): 277-289
[76]T. McInerney, D. Terzopoulos. Topologically adaptable snakes. Proc. Fifth International Conf. on Computer Vision (ICCV'95). Cambridge: INSPEC, 1995: 840-845
[77]V. Caselles, F. Catte, T. Coll, et al., A Geometric Model for Active Contours in Image Processing. Numerische Mathematik, 1993, 66(1): 1-31.
[78]R. Malladi, R. Malladi, J. A. Sethian, et al., Shape modeling with front propagation: a level set approach. IEEE Transactions on Pattern Analysis and Machine Intelligence. 1995, 17(2): 158-175
[79]S. Guillermo, T. Allen, Affine invariant scale-space. International Journal of Computer Vision. 1993, 11(1): 25-44
[80]L. Alvarez, F. Guichard, P. L. Lions, et al., Axioms and fundamental equations of image processing. Archive for Rational Mechanics and Analysis. 1993, 123(3): 199-257
[81]R. Kimmel, A. Amir, et al., Finding shortest paths on surfaces using level sets propagation. Transactions on Pattern Analysis and Machine Intelligence. 1995, 17(1): 635-640
[82]B. K. Benjamin, RT. Allen, WZ. Steven, Shapes, shocks, and deformations Ⅰ: the components of two-dimensional shape and the reaction-diffusion space. International Journal of Computer Vision. 1995, 15:189-224
[83]S. Osher, J. A. Sethian, Fronts propagating with curvature-dependent speed: algorithms based on Hamilton-Jacobi formulations. Journal of Computational Physics. 1988, 79:12-49
[84]J. A. Sethian, Level Set Methods and Fast Marching Methods: Evolving Interfaces in Computational Geometry, Fluid Mechanics, Computer Vision, and Materials Science, Cambridge University Press, 1999.
[85]N. M. Eric, A. B. William., Interactive segmentation with intelligent scissors. Graphical Models and Image Processing. 1988, 60(5): 349-384
[86]J. A. Sethian, Fast marching methods. SIAM review. 1999, 41: 199-235
[87]E, W. Dijkstra, A note on two problems in connection with graphs. Numerical Mathematics. 1959, 1: 269-271
[88]L D Cohen, R Kimmel. Global minimum for active contour models: a minimal path approach. Conference on Computer Vision and Pattern Recognition (CVPR'96), Washington: IEEE Computer Society, 1996, 666-673
[89]B. Verdonck, I. Bloch, H. Muitre, et al., Accurate segmentation of blood vessels from 3D medical images. International Conference on Image Processing, Lausanne, INSPEC, 1996, 3: 311-314
[90]P. Chaturvedi, M. F. Insana, T. J. Hall. Testing the limitations of 2-D companding for strain imaging using phantoms. IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control, 1998, 45(4): 1022-1031