Journal of Pathology Informatics Journal of Pathology Informatics
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J Pathol Inform 2012,  3:7

Review of "Informatics in Medical Imaging" by Kagadis GC, Langer SG (Editors)

Department of Biomedical Informatics, University of Pittsburgh, 5150 Centre Avenue, Suite 301, Room 304, Pittsburgh, PA 15232, USA

Date of Submission01-Dec-2011
Date of Acceptance28-Dec-2011
Date of Web Publication29-Feb-2012

Correspondence Address:
Claudia Mello-Thoms
Department of Biomedical Informatics, University of Pittsburgh, 5150 Centre Avenue, Suite 301, Room 304, Pittsburgh, PA 15232
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Mello-Thoms C. Review of "Informatics in Medical Imaging" by Kagadis GC, Langer SG (Editors). J Pathol Inform 2012;3:7

How to cite this URL:
Mello-Thoms C. Review of "Informatics in Medical Imaging" by Kagadis GC, Langer SG (Editors). J Pathol Inform [serial online] 2012 [cited 2019 May 20];3:7. Available from:

Although a universal definition of " informatics" does not exist, it is generally agreed upon that this field deals with how information is conveyed between source and receiver, as well as how information is processed at each end. In light of this, " biomedical informatics" constricts this broad definition to the study of information involved either in healthcare delivery or in biomedical research. At the intersection between biomedical informatics and medical imaging we find " medical imaging informatics", which deals with the study of information in medical images. This is the focus of this timely book, which covers a range of topics from standard protocols in imaging informatics to operational issues and technologies to applications in Radiology departments and beyond.

Traditionally the majority of medical images have resided in Radiology, and as such most technologies in medical imaging informatics have their roots in this specialty as well. However, the evolution of computers has made fast/powerful hardware and software more accessible, which has caused not only a "digital revolution" in Radiology but also the beginning of such movements in other fields (such as Pathology, Dermatology, Cardiology, etc.). As a result, the application of medical imaging informatics can be seen in almost all medical fields, albeit the bulk of the developments are still carried out in Radiology. This by no means reduces the applicability of these techniques in other domains; however, sometimes what is developed for Radiology has to be expanded in order to be useful for others (such as DICOM for Pathology, which we will discuss in more detail below).

Keeping Radiology's historical role in mind, it is easier to see why the majority of the chapters in this excellent book are either directly related to it or have a strong Radiology flavor. At this juncture the Pathology community may be wondering, "what is in it for us?" As it turns out, plenty.

The book is divided into six sections. Section one (I) gives an introduction to informatics in the healthcare environment, and it contains two chapters. Although the first chapter discusses ontologies in the Radiology department, pathologists can gain a general understanding of what ontologies are and their key role in knowledge representation, which should give them an idea of the fundamental role that ontologies will play in Digital Pathology. Section two (II) presents overviews of standard protocols in imaging informatics, such as DICOM (Digital Imaging and Communications in Medicine). This section is divided into three chapters, and even though the issues discussed in all of them are pertinent to Pathology, perhaps the most immediately applicable are those discussed in Chapter 4, entitled 'DICOM'. As most informaticists probably know, DICOM is an imaging standard that has played a fundamental role in the integration and dissemination of medical images throughout the healthcare enterprise, via Picture Archiving and Communication Systems (PACS). What they may not know, and it is nicely explained in the chapter, is that the large images generated by whole slide imaging are beyond DICOM's current capabilities (but one of the many dedicated Working Groups is currently seeking solutions to this problem). Other issues, such as storage for large pathology files, are briefly discussed as well.

Section three (III) concentrates on several key technologies for medical imaging informatics, and it contains the largest number (10) of chapters. Within this section pathologists will certainly be interested in Chapter 9 (''Displays''), as it discusses some key issues with soft copy image presentation pertinent to digital pathology. Section four (IV) discusses, in separate chapters, PACS and hospital information systems. The latter chapter also delves in a more detail about departmental information systems, and it uses as an example the RIS (radiology information systems). The LIS (laboratory information systems) that most pathologists are familiar with is not much different, so there is enough information here to elucidate how these systems (in general) work.

Section five (V) presents general operational issues. Here, there is a mix of chapters with a broader focus, which look at the future of the healthcare enterprise and how one can prepare to supply the estimated demand for imaging services, and chapters that deal with day-to-day operations. For example, Chapter 18 (''Procurement'') provides an encompassing overview of how to prepare for the future, and is highly recommended reading for pathologists involved in the adoption of digital protocols in their departments. Furthermore, if one overlooks the fact that the examples given pertain to Radiology, the contents of Chapter 20 (''Teleradiology'') and Chapter 21 (''Ethics in the Radiology Department'') apply directly to Pathology, as a discussion of patient privacy, e-Learning and conflicts of interest are of common interest for both disciplines. Finally, Section six (VI) introduces a discussion on medical imaging informatics beyond Radiology, and in these final two chapters applications in Radiation Oncology other domains, such as Pathology, are briefly covered. It is here in Chapter 22 that digital Pathology, virtual microscopy, whole slide imaging and telepathology are discussed in a little more detail. Albeit a significant portion of the information presented in this chapter can also be found in the preceding chapters, as it is scattered in these chapters, it may be more interesting for pathologists to read this chapter first and then go and get more details about related topics of interest in the other chapters.

In summary, this book contains some valuable insights into medical imaging informatics. Because of Radiology's historical role, most of the chapters are written emphasizing informatics' role in that domain, which at first glance may initially frustrate pathologists. However, careful selection of content to focus on can yield a wealth of information about the obstacles that Radiology faced along its conversion to a digital environment, how the issues were dealt with in that domain, what needs to be done to expand those solutions so they can be applicable in other domains and how to plan for the clinical demands in the future.




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