MacMahon H, Doi K
Department of Radiology, University of Chicago, Illinois.
Clin Chest Med. 1991 Mar;12(1):19-32.
It is apparent that digital radiography holds considerable promise. Although there are some immediate advantages to be gained from using digital technology at present, such as more consistent image quality in portable radiography, most of the benefits have not been fully realized. To do so requires a completely integrated digital radiology department using high-resolution video displays throughout the hospital connected to a large digital image archiving system. This concept, referred to as picture archiving and communication systems (PACS), represents the logical culmination of the extensive research that is continuing in this area. Because of the great expense involved, it is likely that the transition from conventional to digital radiography will be evolutionary in most medical centers, with establishment of local PACS networks initially, such as between the intensive care units and the radiology department. At a more basic level, limited digital radiography systems can function in isolation and address specific needs successfully. Although the science of computer-aided diagnosis is at an early stage, it seems likely that the sensitivity and specificity of these programs will continue to improve. Their eventual utility will depend on their accuracy and ease of use. The ultimate goal would be a relatively "transparent" multifaceted program that would screen all radiographs prior to interpretation to provide the radiologist or clinician with diagnostic suggestions and quantitative data. Given the present rate of progress in this area, such a concept is not unrealistic. However, even the most ardent enthusiasts do not envision totally independent computer-based interpretation of radiographic images for some time. Although digital image processing has not greatly improved diagnostic accuracy merely by enhancing the appearance of the radiographs, there are other potential diagnostic advantages in using digital images, such as rapid retrieval of previous examinations and the ability to correlate chest radiographs with CT or MRI studies rapidly on a video display. Direct image correlation with registration and superimposition has been achieved in the case of positron-emission tomography and MRI studies of the brain. For chest radiograph examinations, superimposition and subtraction of earlier radiographs to enhance the detection of interval change is being studied. The question of when digital chest radiography will replace conventional imaging is controversial. In a recent multiauthored review of this subject, it was estimated that digital chest radiography will replace conventional film radiography in at least 50% of large teaching hospitals by the turn of the century.(ABSTRACT TRUNCATED AT 400 WORDS)
显然，数字放射摄影有着巨大的前景。尽管目前使用数字技术能立即获得一些优势，比如在便携式放射摄影中图像质量更稳定，但大多数益处尚未完全实现。要实现这些益处，需要一个完全集成的数字放射科，在医院各处使用高分辨率视频显示器，并连接到一个大型数字图像存档系统。这个概念，即图像存档与通信系统（PACS），代表了该领域正在持续进行的广泛研究的合理成果。由于涉及巨大成本，在大多数医疗中心，从传统放射摄影向数字放射摄影的转变可能是渐进式的，最初会建立局部的PACS网络，比如重症监护病房和放射科之间的网络。在更基础的层面，有限的数字放射摄影系统可以独立运行并成功满足特定需求。尽管计算机辅助诊断科学尚处于早期阶段，但这些程序的敏感性和特异性似乎会持续提高。它们最终的效用将取决于其准确性和易用性。最终目标将是一个相对“透明”的多方面程序，在解读之前对所有X光片进行筛查，为放射科医生或临床医生提供诊断建议和定量数据。鉴于该领域目前的进展速度，这样一个概念并非不切实际。然而，即使是最热心的支持者也预计在一段时间内不会完全实现基于计算机的独立X光图像解读。尽管数字图像处理仅仅通过改善X光片的外观并没有大幅提高诊断准确性，但使用数字图像还有其他潜在的诊断优势，比如能快速检索先前的检查结果，以及在视频显示器上快速将胸部X光片与CT或MRI研究进行关联。在正电子发射断层扫描和脑部MRI研究中已经实现了直接的图像配准和叠加相关。对于胸部X光检查，正在研究叠加和减去早期X光片以增强对间隔期变化的检测。数字胸部放射摄影何时会取代传统成像存在争议。在最近一篇关于这个主题的多作者综述中，据估计到世纪之交，数字胸部放射摄影将在至少50%的大型教学医院取代传统胶片放射摄影。（摘要截选至400字）
