ECR 2014 - session SS105 - Trends in reporting, image management and mobile computing

10 presentations on different topics were covered in this scientific session:

CAD

Evaluation of a Siemens software tool called FastSpine to perform analysis of the spine with automatic labeling and curved reconstruction. They showed a high percentage of correct automatic labeling of 93.5%. FastSpine took about a minute to perform on average with manual correction where needed. The CAD provided time saving in more complex cases and had a comparable performance.

Two presentations focused on RECIST implementation. One looked at the implementation of dedicated tools for RECIST analysis and showed a clear saving in reading time while maintaing reproducibility. A Japanese group presented a cloud-based Lesion Management Solution that is used to track patients in lung cancer screening workup.

MOBILE DEVICES

This session showed again that mobile devices are of great interest and interesting applications are identified and implemented. Four of the presentations covered this topic.

A by dr von Falk showed that an iPad could be used for diagosis of CT data although screen size and security are still hampering the implementation. Another issue with mobile devices is the diiffering reading environments that cannot be controlled and thus could influence the reading quality. Mobile devices should probably be implemented as additional possibility and not for primary use. 

The dkfz demonstrated the use of an iPad for offline analysis of radiology information at a distant location to be used during autopsy. 

A group from Pisa also evaluated the iPad on CT images and showed the iPad to be faster for evaluation with even higher sensitivity and specificity for the iPad.

An important point to keep in mind with all the evidence for using iPads in radiology is that it is all focused on a limited, well defined, clinical question and mostly limits to CT.

Another group from Germany introduced the iPad in anatomical courses. The developed AnatomyMap a dedicated software tool for interactive exploration of volume rendered data running on a remote server using a web based interface.

QUALITY CONTROL

A group from switzerland showed that after transfer from free text to structured reporting they needed quaity control of those structured reports. They analysed about 250 reports on over 30 criteria. They showed that one third was excellent, one third good and one third non-optimal. The two worst performing radiologists were those not (properly) using the structured reporting. 

USABILITY

A Dutch group presented their work on interface customization. Most PACS systems have an adaptable interface, but the radiologist do not optimally use this capability. The showed that using adaptive support suggestions based on usage could help to improve radiology workflow and workstation usage. 

RSNA 2013 - RC725 - quantitative imaging: informatics

Radiology currently is primarily concerned with pattern recognition with some linear measurments. Therefore, the demand for quantitative tools is little in radiology. Residents should be trained in using 3d software and planning during their regular rotations. To determine the correct measurements validation datasets are needed. What is required:

1. Better tools to create measurements are required with integration into the PACS to integrate into the regular workflow.

2. Better tools for representing the results (DICOM SR and AIM are available but adoption by vendors is slow).

3. Education.

4. Validation datasets. How to use existing tools and how not to mis-use them.

The main immediate informatics challenge is that the workflow for 3D postprocessing is poor.

QIBA is trying to streamline the process of obtaining quantitative imaging biomarkers. Using standards is a prerequisite in this effort.

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 - RC326 - Quantitative Imaging: A Revolution in Evolution (In Association with the Society for Imaging Informatics in Medicine)

Vendors provide easy tools to perform quantitative imaging but the question is how reliable and repeatable this quantification is. 

Many clinical examples can already be listed where quantitative imaging is used in clinical practice. Such as carotid stenosis, coronary artery stenosis, calcium scoring, pulmonary nodules, renal donor evaluation, liver and tumor volumetry, brain perfusion, emphysema quantification. 

Each of these show good results in literature and could be applied in clinical practice.

However, the question is whether the numbers we get out of the software are usefull and what is reality. Different vendors provide different results in the same patient and even within one software system measurements are influenced by postprocessing choices but also by decisions during the acquisiiton. 

One of the things that can be done to get proper quantification we should provide reference datasets.

QIBA is ran by a group of stakeholders to improve quantitative imaging. They define profiles to get precise, repeatable measurements. QIBA has setup a imaging data warehouse (QIDW) including standard datasets that can be used to validate quantitative imaging algorithm.

The QIDW is free, open source, modular software based on MIDAS.

In conclusion tagging of the image data in radiology is essential to allow computers to work with the information. The quantification is part of this tagging. Developments like AIM are trying to cover this and allow export in XML or DICOM SR, however current PACSs and EMRs do not yet support these kind of measurement. When the storage and data mining of all the information available in the images becomes possible it will provide the key information to get to personalized diagnosis and treatment.

RSNA 2013 - VSIN21 - radiology informatics series: mobile computing devices

Mobile is the single largest disruptive technology for the next decade. While desktop PCs are reducing in number the number of tablets is rising steadily. The number of smartphones is exploding right now showing an enormous increase (half of the facebook users are mobille only).

Eighty percent of smartphones shipped today are running android. This shows that android is starting to takeover apple iOS. This is also shown in tablets where android is also more sold nowadays than the iPad while the iPad currently still is the most used tablet based on network traffic measurements.

In terms of security, android shows a higher number of malware apps than apple iOS. Also in terms of enterprise security policies, VPN handling, etc, iOS is way ahead of android with for example enterprise single sign on and VPN per app.

The iOS first approach to develop an app seems to be the way to go in radiology because of the wider acceptance and use of apple devices.

To develop an app the steps to take are identify concept, user interface design, programming, construct app, and finally polish the app.

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.

IHE for Dummies - Free eBook NOW available!!!

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IHE Basics: find out how IHE can help you meet your interoperability goals.
Secure Document Sharing: examine the current state of document exchange, look at some different scenarios for exchanging information, and find out how IHE is improving the process.
Get Involved: Discover the many opportunities IHE offers for stakeholders and clinicians to work together.
The complimentary eBook is now available!

Follow this link

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.

iPod during knee surgery

A novel application of the iPod was recently published. The iPod is used to display pre-operatively acquired images of the patient operated upon. These images are displayed on the iPod correctly by using tracking devices to detect the position and orientation of the iPod in the operating theatre. The surgeon can review images during surgery of specific locations on the iPod. An iPad can be placed in the operating theatre to allow other people involved in the procedure see the images the surgeon has on his/her iPod.

Read this article of USA Today on the use of an iPod during knee surgery.

RSNA 2012 - Poster stating the top 5 apps for radiological images on the iPad

According to a poster presented at RSNA, the top five apps to get onto your IPad for reviewing radiological images are:
1- Mobile MIM
2- ResolutionMD mobile
3- eFIlm mobile HD
4- OsirixHD
5- iClarity
Of these ResolutionMD Mobile and Mobile MIM have obtained FDA approval. All these viewers have basic viewing functionality and safe connection protocols.
The authors conclude that 'far from substituting radiologists workstations, the iPad can be a good and useful portable device for visualizing radiological images'

RSNA 2012 - IT should be embraced by radiology

As stated by the cover story of today's RSNA daily bulletin, IT is required to become a value innovator in radiology. In future radiology, IT influence should not be restricted to RIS and PACS, but extend to embracing new developments in mobile computing, social networking and virtual collaboration.

3Gear kinect gesture based interaction system

Check out 3Gear systems for their approach to use two kinect cameras to track motion.

According to their website their technology enables the Kinect to reconstruct a finger-precise representation of what the hands are doing. This allows us to build simple and intuitive interactions that leverage small, comfortable gestures: pinching and small wrist movements instead of sweeping arm motions, for example.

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.

ESCR 2012: workstation session

Yesterday a workstation session at the ESCR 2012. We choose not to have a face off since that always comes down to comparing quantitative measurements but to have a workstation demonstration.

Three vendors: Siemens, Philips and Circle Cardiovascular Imaging participated in this session. All companies had ample time to present their workstation and show how cardiac cases can be read. Both Siemens and Philips focused on presenting CT while Circle presented MR cases.

It was interesting to see the differences and similarities between the workstations in this well attended session.

A interesting thing was to see that for left ventricular analysis the CT softwares moved to implementing model based approaches while in MR Circle showed a bloodpool approach. Providing both methods and measurement in both modalities might increase the comparability between them for the quantitative analysis.