This volume contains the proceedings of the NATO Advanced Study Institute on "Picture Archiving and Communication Systems (PACS) in Medicine" held in Evian, France, October 14- 26, 1990. The program committee of the institute consisted of H.K. Huang (Director), Osman Ratib, Albert Bakker, and Gerd Witte. This institute brought together approximately 90 participants from 15 countries. These proceedings are the accumulation of eight years of research and development results in PACS by various dedicated groups throughout the world. The purpose of this institute was to review the most recent technology available for PACS and some clinical results. The readers should notice the remarkable advances in this field by comparing the contents in these proceedings with those in a previous institute on "Pictorial Information Systems in Medicine" held August 27 - September 7, 1984 in Braunlage/Harz, Federal Republic of Germany, and published as Vol. 19 in this series. The institute was organized according to four categories: PACS components and system integration, PACS and related research in various countries and manufacturing companies, clinical experience and research support, and participants' scientific communications. In PACS components, we included image acquisition, workstations, data storage and networking. In system integration, topics on interfaces between Hospital Information System (HIS), Radiology Information System (RIS) and PACS, clinical reports, the ACR/NEMA standard, databases, reliability, and system integration were discussed. This lecture series emphasized the technical detail and "how to" aspects.

Both engineers and physicians present possible tools of integration in order to build an ISCAMI. A radiologist, who wants to acquire a PACS, or a mathematician asking for pertinent applications of image processing techniques will find recent information guiding their choice in research or in acquisition of imaging or computing devices of a hospital information system.

Thoroughly revised to present the very latest in PACS-based multimedia in medical imaging informatics—from the electronic patient record to the full range of topics in digital medical imaging—this new edition by the founder of PACS and multimedia image informatics features even more clinically applicable material than ever before. It uses the framework of PACS-based image informatics, not physics or engineering principles, to explain PACS-based multimedia informatics and its application in clinical settings and labs. New topics include Data Grid and Cloud Computing, IHE XDS-I Workflow Profile (Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging), extending XDS to share images, and diagnostic reports and related information across a group of enterprise health care sites. PACS-Based Multimedia Imaging Informatics is presented in 4 sections. Part 1 covers the beginning and history of Medical Imaging, PACS, and Imaging Informatics. The other three sections cover Medical Imaging, Industrial Guidelines, Standards, and Compliance; Informatics, Data Grid, Workstation, Radiation Therapy, Simulators, Molecular Imaging, Archive Server, and Cloud Computing; and multimedia Imaging Informatics, Computer-Aided Diagnosis (CAD), Image-Guide Decision Support, Proton Therapy, Minimally Invasive Multimedia Image-Assisted Surgery, BIG DATA. New chapter on Molecular Imaging Informatics Expanded coverage of PACS and eHR's (Electronic Health Record), with HIPPA compliance New coverage of PACS-based CAD (Computer-Aided Diagnosis) Reorganized and expanded clinical chapters discuss one distinct clinical application each Minimally invasive image assisted surgery in translational medicine Authored by the world's first and still leading authority on PACS and medical imaging PACS-Based Multimedia Imaging Informatics: Basic Principles and Applications, 3rd Edition is the single most comprehensive and authoritative resource that thoroughly covers the critical issues of PACS-based hardware and software design and implementation in a systematic and easily comprehensible manner. It is a must-have book for all those involved in designing, implementing, and using PACS-based Multimedia Imaging Informatics.

First multi-year cumulation covers six years: 1965-70.

The term picture archiving and communications system (PACS) was initiated during the first International conference and workshop on the topic sponsored by The International Society for Optical Engineering (SPIE) in Newport Beach, California in 1982. The research and development (R&D) progress for PACS has been slow until 1988. The earlier PACS modules were mostly off the shelf components connected together to solve a very specific clinical problem. The three major players in PACS R&D are the European countries, United States of America, and Japan. For various reasons, the European coun tries concentrated in modeling and simulation, U.S.A. pre ferred in-house development or purchased PACS modules from a manufacturer, whereas Japan organized the PACS as a national project. Between 1989 and 1990 PACS R&D took a dramatic positive turn. Large scale P ACS projects were planned and some are of implementation, especially in newly con at various stages structed hospitals. Examples are the Hokkaido University, Japan; Hammersmith Hospital, United Kingdom; Social and Medical Center East (SMZO), Vienna, Austria; the U.S. Armed Force Medical Diagnostic Imaging Support (MDIS) project; and the UCLA Medical Plaza ambulatory care center. Another phenomenon is the organization of the EC-countries which provides a tremendous impetus for the European PACS R&D efforts. This book "Hospital Integrated Picture Archiving and Communication Systems: edited by Professor M. Osteaux and others is a direct product from these efforts.

I am very pleased to have been asked to write the foreword to this book. The technical advances in diagnostic radiology in the last few decades have transformed clinical practice and have been nothing short of astonishing. The subject of diagnostic radiology is now very large and radiology depa- ments are involved in all areas of modern patient care.The defining event in m- ern radiology,and arguably the most significant development in radiology since Wilhelm Röntgen discovered X-rays, was the invention of the CT scanner in the 1970s.The CT scanner introduced modern cross-sectional imaging and also di- tal imaging.We now have MRI and ultrasound and these techniques are replacing many traditional X-ray procedures.The developments in radiology have been the result of a fruitful interaction between the basic sciences, clinical medicine and the manufacturers. This can be seen by looking at the various sources of these publications. Change is produced by the interactions between the various dis- plines. The editors have had a very difficult task in selecting the key discoveries and descriptions.The radiological literature is very large.Medical imaging continues to develop rapidly and these papers are the foundations of our current practice.