In the past decade, digital pathology and whole-slide imaging (WSI) have been gaining momentum with the proliferation of digital scanners from different manufacturers. The literature reports significant advantages associated with the adoption of digital images in pathology, namely, improvements in diagnostic accuracy and better support for telepathology. Moreover, it also offers new clinical and research applications. However, numerous barriers have been slowing the adoption of WSI, among which the most important are performance issues associated with storage and distribution of huge volumes of data, and lack of interoperability with other hospital information systems, most notably Picture Archive and Communications Systems (PACS) based on the DICOM standard. This article proposes an architecture of a Web Pathology PACS fully compliant with DICOM standard communications and data formats. The solution includes a PACS Archive responsible for storing whole-slide imaging data in DICOM WSI format and offers a communication interface based on the most recent DICOM Web services. The second component is a zero-footprint viewer that runs in any web-browser. It consumes data using the PACS archive standard web services. Moreover, it features a tiling engine especially suited to deal with the WSI image pyramids. These components were designed with special focus on efficiency and usability. The performance of our system was assessed through a comparative analysis of the state-of-the-art solutions. The results demonstrate that it is possible to have a very competitive solution based on standard workflows.

Electronic Health Records (EHR) have a distributed nature and can be managed by distinct affinity domains. Sharing patient health information across distinct organisations helps to deliver a wellinformed diagnosis, improving the quality of healthcare service. The federation of those information systems can take the form of a distributed database where data are partitioned and possibly replicated across distinct computational systems. However, the benefits of having a distributed system, such as consistency, availability, and data protection, are mostly absent. This article proposes a distributed database consensus protocol designed to improve the performance of EHR insertion operations, a particularly critical issue in medical imaging cases due to the data volume. It explores the personal and non-transferable nature of EHR and the proposed methodology reduces the data contention through data isolation, improving the overall retrieval performance and detection of misbehaving parties. Furthermore, the proposal follows the recent European General Data Protection Regulation (GDPR), which states that appropriate mechanisms should be used in order to protect data against accidental loss, destruction, or damage, using appropriate technical or organisational measures.INDEX TERMS blockchain, consensus protocol, distributed ledger, distributed databases, electronic health records

One of the most noticeable trends in healthcare over the last years is the continuous growth of data volume produced and its heterogeneity. In the medical imaging field, the evolution of digital systems is supported by the PACS concept and the DICOM standard. These technologies are deeply grounded in medical laboratories, supporting the production and providing healthcare practitioners with the ability to set up collaborative work environments with researchers and academia to study and improve healthcare practice. However, the complexity of those systems and protocols makes difficult and time-consuming to prototype new ideas or develop applied research, even for skilled users with training in those environments. Dicoogle emerges as a reference tool to achieve those objectives through a set of resources aggregated in the form of a learning pack. It is an open-source PACS archive that, on the one hand, provides a comprehensive view of the PACS and DICOM technologies and, on the other hand, provides the user with tools to easily expand its core functionalities. This paper describes the Dicoogle framework, with particular emphasis in its Learning Pack package, the resources available and the impact of the platform in research and academia. It starts by presenting an overview of its architectural concept, the most recent research backed up by Dicoogle, some remarks obtained from its use in teaching, and worldwide usage statistics of the software. Moreover, a comparison between the Dicoogle platform and the most popular open-source PACS in the market is presented. Xebra: sourceforge.net/projects/xebra 4 CDMedic: sourceforge.net/projects/ cdmedicpacsweb

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