Breast Imaging Reporting and Data System (BI-RADS®): a success history and particularities of its use in Brazil.

BI-RADS® is a standardization system for breast imaging reports and results created by the American College of Radiology to initially address the lack of uniformity in mammography reporting. The system consists of a lexicon of descriptors, a reporting structure with final categories and recommended management, and a structure for data collection and auditing. It is accepted worldwide by all specialties involved in the care of breast diseases. Its implementation is related to the Mammography Quality Standards Act initiative in the United States (1992) and breast cancer screening. After its initial creation in 1993, four additional editions were published in 1995, 1998, 2003 and 2013. It is adopted in several countries around the world and has been translated into 6 languages. Successful breast cancer screening programs in high-income countries can be attributed in part to the widespread use of BI-RADS®. This success led to the development of similar classification systems for other organs (e.g., lung, liver, thyroid, ovaries, colon). In 1998, the structured report model was adopted in Brazil. This article highlights the pioneering and successful role of BI-RADS®, created by ACR 30 years ago, on the eve of publishing its sixth edition, which has evolved into a comprehensive quality assurance tool for multiple imaging modalities. And, especially, it contextualizes the importance of recognizing how we are using BI-RADS® in Brazil, from its implementation to the present day, with a focus on breast cancer screening.

Medical imaging, PACS, and imaging informatics: retrospective.

Historical reviews of PACS (picture archiving and communication system) and imaging informatics development from different points of view have been published in the past (Huang in Euro J Radiol 78:163-176, 2011; Lemke in Euro J Radiol 78:177-183, 2011; Inamura and Jong in Euro J Radiol 78:184-189, 2011). This retrospective attempts to look at the topic from a different angle by identifying certain basic medical imaging inventions in the 1960s and 1970s which had conceptually defined basic components of PACS guiding its course of development in the 1980s and 1990s, as well as subsequent imaging informatics research in the 2000s. In medical imaging, the emphasis was on the innovations at Georgetown University in Washington, DC, in the 1960s and 1970s. During the 1980s and 1990s, research and training support from US government agencies and public and private medical imaging manufacturers became available for training of young talents in biomedical physics and for developing the key components required for PACS development. In the 2000s, computer hardware and software as well as communication networks advanced by leaps and bounds, opening the door for medical imaging informatics to flourish. Because many key components required for the PACS operation were developed by the UCLA PACS Team and its collaborative partners in the 1980s, this presentation is centered on that aspect. During this period, substantial collaborative research efforts by many individual teams in the US and in Japan were highlighted. Credits are due particularly to the Pattern Recognition Laboratory at Georgetown University, and the computed radiography (CR) development at the Fuji Electric Corp. in collaboration with Stanford University in the 1970s; the Image Processing Laboratory at UCLA in the 1980s-1990s; as well as the early PACS development at the Hokkaido University, Sapporo, Japan, in the late 1970s, and film scanner and digital radiography developed by Konishiroku Photo Ind. Co. Ltd. (Konica-Minolta), Japan, in the 1980-1990s. Major support from the US National Institutes of Health and other federal agencies and private medical imaging industry are appreciated. The NATO (North Atlantic Treaty Organization) Advanced Study Institute (ASI) sponsored the International PACS Conference at Evian, France, in 1990, the contents and presentations of which convinced a half dozen high-level US military healthcare personnel, including surgeons and radiologists, that PACS was feasible and would greatly streamline the current military healthcare services. The impact of the post-conference summary by these individuals to their superiors opened the doors for long-term support of PACS development by the US Military Healthcare Services. PACS and imaging informatics have thus emerged as a daily clinical necessity.

History of PACS in Asia.

First, history of PACS (picture archiving and communication system for medical use) in Japan is described in two parts: in part 1, the early stage of PACS development from 1984 to 2002, and in part 2 the matured stage from 2002 to 2010. PACS in Japan has been developed and installed by local manufacturers by their own technology and demand from domestic hospitals. Part 1 mainly focuses on quantitative growth and part 2 on qualitative change. In part 2, integration of PACS into RIS (radiology information system), HIS (hospital information system), EPR (electronic patient record), teleradiology and IHE (integrating healthcare enterprise) is reported. Interaction with other elements of technology such as moving picture network system and three dimensional display is also discussed. Present situation of main 4 large size hospitals is presented. Second, history of PACS in Korea is reported. Very acute climbing up of filmless PACS diffusion was observed from 1997 to 2000. The reasons for such evolution are described and discussed. Also changes of PACS installation and system integration with other systems such as HIS and role of them in radiological diagnoses in Korea since 2002 are described. Third, history in China is investigated by checking international academic journals in English and described as far as events are logically linked and consistently meaningful.

Short history of PACS (Part II: Europe).

Although the concept of picture archiving and communications systems (PACS) was developed in Europe during the latter part of the 1970s, no working system was completed at that time. The first PACS implementations took place in the United States in the early 1980s, e.g. at Pennsylvania University, UCLA, and Kansas City University. Some more or less successful PACS developments also took place in Europe in the 1980s, particularly in the Netherlands, Belgium, Austria, the United Kingdom, France, Italy, Scandinavia, and Germany. Most systems could be characterized by their focus on a single department, such as radiology or nuclear medicine. European hospital-wide PACS with high visibility evolved in the early 1990s in London (Hammersmith Hospital) and Vienna (SMZO). These were followed during the latter part of the 1990s by approximately 10-20 PACS installations in each of the major industrialized countries of Europe. Wide-area PACS covering several health care institutions in a region are now in the process of being implemented in a number of European countries. Because of limitations of space some countries, for example, Denmark, Finland, Spain, Greece, as well as Eastern European countries, etc. could not be appropriately represented in this paper.

Short history of PACS. Part I: USA.

This historical review covers the PACS development in the USA during the past 28 years from 1982 to 2010. General historical remarks of PACS and international scene in three stages from infancy, puberty to adolescence are presented. Early PACS development was mostly financed by the federal government including the National Institutes of Health (NIH) and the U.S. Army Medical Research and Materiel Command. PACS evolution went through several stages. The earliest stages included the definition of large-scale PACS, establishment of the DICOM and other standards, the development of some early key PACS related technologies, and PACS implementation strategies. The later stages were in the concept of enterprise PACS, IHE (Integrating the Healthcare Enterprise) workflow profiles, and ePR with image distribution. The current most excited accomplishment is in the development of the new field in medical imaging informatics. This review goes through these stages and events in the USA during these 28 years, whenever an event involved participants from other countries, the contributors are cited.

The ACR BI-RADS experience: learning from history.

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

Imaging informatics: from image management to image navigation.

OBJECTIVE: To review the rapid evolution of imaging informatics dealing with issues of management and communication of digital images starting from the era of simple storage and transfer of images to today's world of interactive navigation in large sets of multidimensional data. METHODS: This paper will review the initial concepts of Picture Archiving and Communication Systems (PACS) and the early developments and standardization efforts that lead to the deployment of large intra-institutional networks of image distribution allowing radiologists and physicians to access and review images digitally. With the deployment of PACS came along the need for advanced tools for image visualization and image analysis. RESULTS: Review of the history of PACS and Imaging Informatics clearly shows that the early developments were focused on the radiologist's requirements for diagnosis and image interpretation. These early developments lagged behind the rapid adoption of digital imaging in areas outside radiology. Only recently, imaging informatics shifted toward the development of new tools geared toward the needs of other users such as surgeons, referring physicians and care-providers, and even for the patients themselves. Also in the recent years, the development of multimedia and communication tools in the consumer market has influenced the design and strategic development of image management platforms inside and outside healthcare institutions. CONCLUSIONS: The focus of imaging informatics has clearly shifted in the last decade from basic infrastructure design to complete data and image navigation systems. While the challenge of storing and managing large volumes of imaging data have slowly vanished with the rapid development if information technology, the new challenge emerged from the new requirements of image manipulation and analysis in clinical practice.

Retos éticos de la Radiología contemporánea: justificación para un código de ética / Ethic challenges in contemporaneous Radiology: support for an ethic code

Ciertos aspectos de la medicina son fundamentales y eternos. En cambio, su ejercicio, siempre está variando; por ello, los médicos deben estar preparados para hacer frente a los cambios y para reafirmar aquello que es fundamental. Aquí caracterizamos la Radiología contemporánea y abordamos algunos aspectos y juicios éticos relacionados con la especialidad. A manera de juego mental se asocian ideas y hechos establecidos con otros que deseamos, y de manera similar en contextos diferentes; pero que justificarían y quasi proponen, un código de ética. El trabajo constituye, en definitiva, un recordatorio de las obligaciones y los deberes comunes a los que ejercen la profesión médica en cualquiera de sus formas y en particular la Imagenología.

Some aspects of medicine are fundamental and endless. Instead, its practice is always changing; that is why, doctors should be prepared to face changes and to reaffirm what is important. Here we characterize the contemporaneous Radiology and we deal with some aspects and ethic judgments related with the speciality. In a way of mental joke, ideas are associated and facts established with others, and in a similar way, in different contexts, but justifying and proponing an ethic code. In fact, this job constitutes a recollection of the duties and common obligations to the ones who practice the medical profession in every way, particularly the Imagenology.

Personal digital assistants.

Personal digital assistant sales are growing exponentially, and as medical technology advances the amount of information available becomes staggering, making a handheld device, with the ability to store a great amount of information, progressively more valuable to health care providers. Mobile computing allows for a great deal of knowledge in a small package, creating a "walking library" with a mobile collection of data always accessible. There are many diverse types of PDAs, and this article discusses the history of PDAs, general purchasing issues, general PDA features, and the most significant differences between the Palm and the Windows CE operating systems.