RSNA 2013 - SSM11 - Image Sharing

The RSNA Image Share Network: 20 Month Follow-up Results from a Pilot Site

An interesting presentation covered automatic rule-based deletion of data in PACS. Based on regulations and actual measurement of the use of older data (retrievel of data >1 yo was less then 5%) they deviced rule based deletion to free up space in PACS and reused the free space. This avoids vast  growth of the PACS database and saves money in the long run.

Strategies for Foreign Study Ingestion by a PACS Interfaced to a XDS Affinity Domain

Quebec (canada) has a regional XDS environment connecting all hospitals and clinics with a single registry for the whole province. There are three repositories with multiple hospitals pushing data to each of the repositories. The repositories take care of the central registration in the registry.

Problem they ran into was the lack of XDS-I consumer support by the PACS providers. Each hospital is fitted by a proxy which queries the registry and get the images from the repository. Subsequently data coercion (pat ID and acc nr correction) is performed and data stored in local PACS.

RSNA 2013 - RC526 - Cool technologies for radiologists

Tablet applications. 

- Pocket

Collecting bookmarks to websites into your pocket for later acces on any device.

- PDF readers

Examples are GoodReader, iAnnotate PDF, expert PDF. They allow reading and annotation of different files. However, they all are paid apps.

- Educational tools

Audience response apps are Poll everywhere (over 40 respondents requires a monthly payment), Poll runner ($10 per year), socrative (free and easy to use but a bit simple compared to others)

Baiboard collaborative whiteboard allowing multiple users that can join a board.

- technology tools

Editorially.com is a website to cooperate on writing a paper. It includes a full version tracking. This is a free tool.

Udutu online course authoring tool. Pre designed course templates can be used to design and share courses. Sharing either by webpage or by building a zip.

Udemy has a simpler GUI with less style which is also free to use.

Dropbox alternatives that can be used are Spideroak. Drawback is that it does not provide sharing. However, the data security level is higher than when using dropbox.

Infographic Health Informatics

This infographics by the University of Illinois at Chicago gives details on what Health Informatics is and which role it will play in healthcare in the future. They state that the future is in desperate need of a large number of health IT professionals that will help to keep the healthcare system affordable.

This link will give you access to the original on the website of the University of Illinois: http://healthinformatics.uic.edu/resources/infographics/the-intersection-of-healthcare-and-it/

Full version to be found here

CARS 2013 - Image Processing Workflow and Management in Clinical Practice

Regge gave an interesting presentation on getting from bench to desktop with image processing illustrated with his own example on CT colonography. His take home points are that an Imaging lab should be embedded in a cliinical unit, should be cautious with industrial partners, and must start from a clinical problem and build the software on that problem.

Glinkowski presented about what information the clinician really needs. The questions a clinician asks are: what? Where? How? Decision making - what to do? In answering these question the clinicians are heavily depending on imaging an Radiology is essential in answering many of the questions a clinician may have in a muti disciplinary collaborative effort to get the optimal outcome for the patient.

Where we stand on costs and reimbursements of image processing was the topic of a presentation by Turchetti. He started to show that the total healthcare expenditure in Europe and the US is increasing. First cause of this increase is innovation because of growing indications and applications of the innovations, growing area of treatable conditions, increasing use of technologies for the same conditions with less discomfort, broadening definition of diseases and life extending effects. Note that all issues are positive: we live longer and better... Most countries try to tackle these issues with increasing efficiency, redesign of the supply side (closing hospitals, reducing beds, etc), regulation of price and/or quantity of services, and the reduction of the services granted for free and introduction of higher level of co-payment.
The reimbursement mechanism could stimulate efficiency and reduce the opportunistic behavior of hospitals. But if not used properly it could impede the transfer of innovation to the clinical practice.
Studies to calculate real cost of procedures should be promoted and reimbursement should be defined accordingly. Define for which indications the image processing is approriate from a clinical point of view and from a cost effectiveness point of view. Cost and reimbursement should be properly aligned.

In the next presentation Fatehi discussed the composition of the image processing research team including the clinician, radiologist, radiographer, computer scientist, biomedical engineers, and ... He stated that image processing reeserach is done to answer a clinical need, to refine engineering methods and to support management. As stated already many times during the conference he also stresses that imaging research should be a multi-disciplinary effort. The cooperation should include the following topics.

Clinical to Technical:

• Defining the clinical question


• Defining the components of the applications


• Providing the most relevant datatsets


• Defining the workflow before and after the image processing


• Validating the test protocol


• Improving the user interface

Technical to clinical:

• Specify potential methods to achieve the clinical goal


• Specify technical limitations of implementing the application development


• Provide a comparative list of already tested methods in the literature


• Translating the clinical workflow into an engineering language with technical block diagrams


• Keeping engineering standards in the final product/application


• Taking care of the integration issues


• Taking care of the licensing issues


• Providing information about open source to avoid high costs.

Finally, Schilling presented on bridging the radiology/surgery gap. He advocated the introduction of new visualization protocols with higer dimension imaging with direct interaction with the data using easy to use devices. They want to have intuitive 2D and true 3D. Clinical efficacy and worflow can both be optimal using true 3D.

CARS 2013 - PACS Workflow

In a presentation from the Neterlands, Jorritsma discussed the necessity to introduce usability to the PACS selection process. He stated that in PACS replacement functionality is regarded but not usability, while this should be a major criterion in the PACS selection process. Subjective measures should be complemented with objective usability data to be valuable in the selection process.

Next, Procida from Italy presented on 'PACS independent and IHE-like approach method for the analysis of PACS in a healthcare enterprise'. they noticed that the hospital had over 100, high cost, workstations connected to the PACS. However, the usage of these systems is unknown and many of them might be used only for a small part of the time. The display on/off status was recorded in a database and provided the possibility to record system usage. This method was limited by the fact that the displays had a delay of 10 min inactivity before they turned off automatically. The IHE ATNA (Audit Trail Node Authentication) profile was utilized to determine the exact use of the workstations since information about each exam view was recorded with the user information. A more accurate status was obtained with this second method about the workstation usage per workstation. This allowed reallocation and discontinuation of underused, high cost, workstations. Proposals are made to the IHE to adopt the ATNA profile to fully support this non-intended but very interesting use.

Final presentation was from Japan, presented by Ito on the improvement of clinical workflow of thoracic surgeons in distant hospitals by interactive teleconference using open source software. They used Osirix, VNC, Voice Chatter (voice communication software) and Wireshark (packet analyzer) to setup teleconference with only open source software. Using this they setup a four hospital teleconference system using VPN connection. Instead of travelling up and down they now upload anonymized DICOM data to the university hospital and do the consultation using the teleconference method saving hours of travelling time.

CARS 2013 - Image Distribution and Cloud Computing

Aryanto presented on an institutional DICOM data distribution system called RadTransceiver. They have built an environment to distribute DICOM data throughout the health enterprise using a webbased, standards based, environment. The setup allows easy distribution using different protocols either with or without anonymization.

Mahmoudi touched the topic of medical image annotation and retrieval. This group from Belgium uses CBIR to support a decision support system by providing similar previous exams based on a query image.

A zero footprint application of mobile devices in radiolgy was presented by dr. Engelmann. He showed that starting early this century the developments of mobile devices for medical image review has progressed steps until their now marketed product that is device independent and available from CHILI as CHILI/Mobile.

Final presentation by Kondoh on development of hybrid medical record sharing system, EPR and PACS of each hospital on cloud technology plus XDS and XDS-I on cloud technology.

CARS 2013 - Content based retrieval from DICOM images

In a very interesting presentation, dr. Caramella stated that making full use of PACS content goes beyond the images and involves teaching files, content based retrieval, dose information extraction both regarding radiation and contrast media use, and proactive quality assurance.

Dr. Kozuka showed image based retrieval in a clinical database of lung CT images. They defined image features in the lung CT scans with a new approach to dynamically assign weights to image features for each query by also using written findings descriptions to extract information from the database. They showed higher succes rates with their weighted method (71%) when compared to the conventional method (61%).

The next presentation was about user interface design to enhance human interpretation of content based image retrieval by dr. Kubar. Using 8 literature based UI requirements and recommendations. Their novel approach is a graph showing a representation of the data by providing anatomical region nodes and tumour region nodes and the connection between the node that define their relationship. The nodes are linked to the images allow the user to utilize the nodes to jump to the correct image. A full paper on the presenation can be found in the Int. journal of CARS.

Bastião from Portugal presented on analyzing of efficiency and service quality of digital imaging laboratories. They use DICOM (meta)data to perform knowledge extraction to get quality indicators and evaluate performance. They used a DICOM data mining tool called dicoogle available at www.dicoogle.com which permits extraction of DICOM meta data allowing a variety of analyses based on the DICOM header information.

CARS 2013 - Medical Imaging Informatics Simulators

After a short introduction and welcome by prof. Neri, prof. Huang presented a tutorial on Medical Imaging Informatics Simulators. In this tutorial a Medical Imaging Informatics Infrastructure was introduced together with its simulator environment. The simulators are plugged into the MIII layers which integrates with PACS/RIS/ePR/HIS/etc. The simulators can be built in different forms for a variety of applications utilizing different components. They use the actual 'live' information to provide a simulated environment for training and testing. The other simulators described by prof Huang are systems setup to achieve the standards based integration of different components within one single workflow enabling easy acces to and deployment of those different components. After a proven implementation in the simulator environment, the simulators can be moved into patient care.

Preliminary version of e-book on Medical Visualization published

I've just published a preliminary version of my e-book on medical visualization at this blog. It is far from complete and some whole chapters are still unfinished or even empty, but I wanted to put out this priliminary version out for my students in the Biomedical Engineering course that I am teaching. So please download the e-book and give me your comments. Do you like it or not? What should be changed or added? Any comments are most welcome. New versions will appear in the near future on this page.

Just go to the e-books and whitepapers tab on this blog to get to the download location.

Computer Magazine November 2012 - The move toward electronic health records

Check out Computer Magazine November 2012 for a whole series on the move toward electronic health records. Selected articles are also available Bericht publicerenfor free at the computer magazine website.

The next step in augmented reality

Published at ISMAR conference 2012. This video shows first steps towards a Superman-like X-ray vision where a brain-computer interface (BCI) device and a gaze-tracker are used to allow the user controlling the augmented reality (AR) visualization. A BCI device is integrated into two medical AR systems. To assess the potential of this technology first feedback from medical doctors is gathered. While in this pilot study not the full range of available signals but only electromyographic signals are used, the medical doctors provided very positive feedback on the use of BCI for medical AR.

Virtual Holography for Medical 3D imaging?

Check out the coverage on the diagnostic imaging website on the topic of virtual holography.

They have an article on the development of two companies called Echopixel Technologies and Infinite Z that are attempting to join forces to develop these kind of displays in order to provide the 'real 3D experience'.

Infinite Z already is distributing holographic devices for mechanical engineering as can be seen from their website and the movie displayed below of a product called zSpace.

Top 25 articles in Journal of Medical Informatics

The Journal of Medical Informatics has published a list of the 25 most downloaded articles of 2011. The list provide a good overview of the field of Medical Informatics and contains top-rated papers on all kind of different topics. The list can be found here.

Four new serious healthcare games by Dutch gaming companies

Four Dutch gaming companies dug deep into the complex topic of patient safety for a week. Advised and guided by Dutch Game Garden, medical doctors and medical students they each developed concepts for games to help improve patient safety in hospitals.
More information can be found here (in Dutch)

RSNA 2011 - Pre-meeting Glance at the schedule

During the RSNA, the largest radiology conference in the world running from November 27 to December 2, many sessions will focus on medical imaging informatics. Topics included into the programme are for example:

1. Informatics (Education and Research) in room S403A on Sunday
2. Informatics support for Quantitative Imaging in room E353A on Sunday
3. Advanced Image Analysis in room S401CD on Monday
4. Practical Informatics for the Practicing Radiologist: Part One in room S501ABC on Monday
5. Decoding the Alphabet Soup (IHE, MIRC, RADLEX, Reporting): Worldwind Tour on RSNA Informatics Projects in room S401AB on Monday
6. Standardized Terminology in Radiology: Applications and New Developments in room S403A on Tuesday
7. Virtualization and remote rendering for Medical Imaging in room E263 on Friday

Besides these scientific sessions, the technical exhibit includes virtually all major players in the field of Medical Imaging Informatics and in many cases the RSNA is used to launch and introduce new developments.

I will be attending RSNA and use this blog during the meeting to report on the scientific sessions I attend and to share news from the technical exhibit.

Health Informatics Congress 2012

BCS and The Chartered Institute for IT have announced the dates of next year's Health Informatics Congress (HC2012), which will be held at the Business Design Centre in London, England.

The conference, which will run from May 2-3, will feature a range of high profile speakers from across the globe, who will discuss the latest developments in health informatics.

Cloud Computing in Imaging Informatics

Also from the HealthImaging Virtual Conference a nice presentation on Cloud Computing in Imaging Informatics.

During this presentation Dr. Shrestha indicates the following issues as being the big issues facing Imaging Informatics:

1) Imaging Overload
2) Pay for Performance
3) Clinical Validation
4) System Integration
5) Reforming the Imaging Report
6) Image Sharing

The question he addresses based on these issues is "Is 'Cloud' the big saver?"

New blog on Medical Imaging Informatics

This new blog will cover Medical imaging informatics in the broadest sense. Ranging from HIS and RIS to advanced visualization I will be covering conference sessions, publications, scientific research and scientific papers.