CMInen 2012 Event

Prof. Klink, former Minister of Health, gave a presentation on Why the healthcare system is obstructing innovation and how it can be restored. More and more diagnosis is possible in screening, however, the effects on mortality are marginal. Therefore, anxiety for patients and costs for (unnecessary) treatment are the result. This way of working is advocated by the current healthcare system. However, getting more precision in the diagnosis will decrease the over diagnosis and treatment and reduce the negative effects of current screening. Technological innovation is required to achieve this increase in precision in the diagnosis. However, promising areas for technological break are available but innovations often fail to break through in oud health care system. One of the problems is the fragmentation of healthcare, which hampers investment into innovations. Not only price of treatment should be the focus of research but also the decrease of volume since that is one of the major drivers behind the cost increase in healthcare.

Mr. van Schaik, director healthcare Rabobank, discussed Innovation in high technology health care environments in the perspective of the financial sector. In 2010 a book was published on diagnose 2025 to start the discussion on where the health sector would end up. This resulted in 17 trends in healtcare such as for example individualism, prevention, power to the patient, healthy ageing. The most important drivers for healthcare are the macro economy and politics. In 2010 they concluded at the healthcare system was not sustainable and needed disruptive changes in which technological innovations have to play an important role. Currently, this is further explored in a new initiative called diagnosis technology. This new initiative should provide insight in how and where technology can be used to improve healthcare. Currently we are at a point of a paradigm shift in healthcare from more cost reduction centric to innovation and patient centric.

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 - Technologies for Creating Educational Content and Teaching Files

Podcasting and Screencasting for Teaching
Mahesh M. Thapa MD, Seattle, WA

Enhanced podcasts can be used to publish both vocal information and the display of images in time with the audio, chapter markers in the audio file and URL Hyperlinks.
Enhanced podcasts benefit both auditory and visual learners and allows mobile learning anytime anywhere. Furthermore it allows a further distribution of lectures.
Audacity and snapkast are two PC based software tools to make enhanced podcasts.
Suggestions when preparing and enhanced podcast:
- have a scripts
- get a headset to dictate
- normalize the audio content to make sure the volume is correct
- good hardware should be available to create the podcast
- podcast should be between 12 and 15 minutes

Another option is screencasting where the actions on the screen are recorded and can be used to construct demonstration video's. Screencasting on the ipad can be done by using 'Explain everything'. Screencasting is ideal for step by step processes and provides a movie as result that can be viewed on any platform.

e-Publishing
Michael L. Richardson MD, Seattle, WA

Currently, making your own book is easily done by publishing an ebook which provides many advantages such as easy distribution, good images, interactive content, etc.
On pc you can use Sigil to create an epub file in a wysiwyg method. On the Mac iBooks Author is the most prominent choice which is also free and provides a very powerfull tool. The books can be easily distributed through amazon or the apple store.

RSNA 2012 - ISP: Informatics (Education and Research)

A diverse group of different presentations in this session about informatics aspects in education and research. I've included a short note on the presentations I found most interesting.

MIRC in the Cloud
Houman Ebrahimi MBBS * , New Lambton Heights, NSW, AUSTRALIA • Arash Jalalian PhD *

Presentation on how to use MIRC, the free RSNA teaching file system. MIRC viewer app can be used on the iphone and ipad to review cases inside the MIRC system. The app can access the public servers and allows entry of a private server, if available, using login credentials. Images are shown full screen both on iphone and ipad. Cases can be saved on the local device for later review. The locally stored collection is shared through the icloud and thus available on all devices connected.

Decision Support for Radiological Interpretation Using Online Knowledge
Mina Ghaly BA , Palo Alto, CA • Daniel L. Rubin MD *

Challenges for radiology are the increase in imaging, the variation in the interpretation of imaging studies, and the lack of immediate access of knowledge sources.
Semantic wiki is used to setup the data collection for the decision support system. Using this, the authors made a lilver pathology system. The semantic wiki system is used to provide a support by providing a differntial diagnosis with a confidence percentage per specific diagnosis. Percentage correct diagnosis in a test with 8 residents increased as did the confidence in their final diagnosis. The system also allowed faster reading time.

Making PowerPoint Work for the Radiologist: Visual-enhancement Techniques to Improve Education
Jonathan Edward Scalera MD , Boston, MA • Stephan W. Anderson MD

Powerpoint fails to provide image stacking, magnification, and real-time contrast and brightness adjustment. The authors have developed a portable solution using VBA within powerpoint.
They provide advanced capabilities within a powerpoint
- a real time pop-up zoom window
- brightness and contrast setting in both the main window and zoom window
- In presentation mode you have real time editing possibilities such as move around, crop and zoom
- image stacks with jump to first and last and the abity to go through the stack at different speeds

It is a great tool and can be obtained from http://scalera.dyndns.org

De-identification of DICOM Image to Meet Good Clinical Practice Guidelines and European Union Data Protection Regulations
K. Y. E. Aryanto , Groningen, Groningen, NETHERLANDS • Matthijs Oudkerk • Bert Moorlag • Peter M.A. van Ooijen

The use of medical data in research projects is subjected to diffferent guidelines and regulations that dictate how the patient privacy should be protected. A set of DICOM header elements is suggested to obtain optimal de-identification of medical data.
This work was highlighted on auntminnie.

RSNA 2012 - Next Generation Infrastructure for Medical Imaging

Interoperability and Integration—from HL7, DICOM, IHE, to SOA

Modern radiology workflow requires consumption, choreography, and orchestration of content from multiple disparate information systems that do not natively “talk to each other.” Without optimal integration and interoperability amongst these systems, humans are required to serve as “integrating agents:” this frequently results in inefficiency and error because humans are not good as a integrating agent.
Examples of practical integration strategies that have been used successfully are web viewer EHR integration, single sign-on, RIS vs PACS driven workflow).
Advanced integration strategies, include using vendor APIs, state aggregation, SOA, and IHE.
Interopability is not just about single logon but should address the integration of the different software tools on a granular scale.
IT should move from choreography to orchestration. Instead of just providing a static edge environment, a more versatile system should be available which is loosely coupled using a middle (bus) layer and move towards a service oriented architecture. A component based architecture that supports composite applications and orchestrates these applications into complex workflows.
SOA is, according to dr. Chang, not going to work in healthcare although everyone else is doing it since healthcare IT groups will not make the effort to go for SOA. However, applications can be implemented to mimic a similar environment collecting and combining all available data in the hospital that can go into a dashboard. In this action, normalization of medical data is essential.

Image Sharing—A Fond Farewell to CDs

We are currently moving from sharing data on CDs to Sharing healthcare information in the cloud. Although it is solving part of the problems with CDs a major concern becomes security and confidentiality when moving to network sharing. Some proprietary enviroments are available but the industry should move to the available standards. The IHE XD profiles should be used when applicable.

RSNA 2012 - Leveraging Imaging Informatics to Improve RadiologyEducation: Beyond the Teaching File

Simulation is prominent in many specialties and jobs and should also play a more important role in radiology.

To make a Simulation two steps are fundamental:
1. Make a model of the system
2. Run the model over time

Simulation is done to practice situations that in real are difficult, expensive or dangerous to perform or to train and model new situations.
In the future Simulation has a potential in educational, training, evaluation and quality improvement settings within radiology. Many opportunities of simulation are apparent in radiology ranging from low to high fidelity simulation.

A lot of information is collected in training and daily work in radiology using Google. More dedicated search engines are much less frequently used (e.g. Yottalook or GoldMiner).
Radiology education could also leverage the PACS and RIS and thus use the material available in the hospital. RIS and PACS are tremendous resources of data to be used for systems like:

1. Report comparator (providing a list of reports showing both temporary and final report with tracked changes)
2. Quantitative reporting skills evaluation (computation of changes percentage in each report, should go down in time)
3. Discrepancy logger (the trainee will receive a mail from a attending radiologist based on a small form filled out after evaluation of the report)
4. call simulator (residents can look into the cases reported by the discrepancy logger as a learning tool)
5. Resident educational dashboard (a full access to different teaching tools with the ability to compare the own performance with peers)

In summary this sessions showed that IT technology can be implemented to improve radioogy education. This ranges from simulation in different ways to implementation of data mining and use of interactive devices such as clickers during classroom sessions. Interesting tools were presented to provide residents with information about thei performance and to support them in the evaluation of their own reports. Furthermore, the use of simulation in many different ways in radiology to increasae knowledge or awareness is also demonstrated as being an important topic for the future. The final presenter talked about how to introduce clickers and how you can increase the interaction by having group based learning by having students discuss their answers with their neighbors.

RSNA 2012 - Rapid Application Development with XIP™ - the eXtensible Imaging Platform

The eXtensible Imaging Platform (XIP™) is an open source framework supporting rapid development of imaging and visualization applications. Imaging software developers can utilize XIP's visual ‘drag-and-drop’ programming tool (the XIP Builder™) and associated libraries (the XIP Libraries™) in creating applications. In addition to functions from the popular ITK and VTK libraries, the XIP Libraries include modules tailored for medical imaging, many of which are hardware accelerated via GPU programming (e.g., OpenGL® GLSL or OpenCL or CUDA C). Applications created with XIP can either run standalone, or as DICOM Hosted Applications. Through the DICOM Application Hosting interfaces (DICOM WG-23), a Hosting System, such as the XIP Host™, relieves the application developer from the need to re-implement infrastructure common to all applications (e.g.DICOM network connectivity, database, etc.). Users can execute Hosted Applications, such as those created with the XIP Libraries, via the XIP Host.

URL's http://www.OpenXIP.org

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.

RSNA 2012 - Radiology Informatics Series: Mobile Computing Devices

This early morning a whole session on Mobile Computing Devices. Apperent from the attention mobile devices get both from the industry and the RSNA itself, this is a very important topic that will greatly influence the future of radiology.


Mobile lessons from other failures are:

1. Make sure your app works very well

2. Native apps win hands-on over web-apps


Both healthcare professionals and patients will be demanding the use of mobile devices. Although ipads and iphones are used prominently in industry and hospitals, the consumer market is dominated by Android because of the much larger market share in smartphones of Android.

To keep up to pace, healthcare institutions should pay attention to mHealth and start developing apps for both their employees and customers.

VSIN31-03 • Comparative Efficacy of Intra-operative Interfaces for Interventional Radiologists: The Microsoft Kinect Device, Hillcrest Labs Loop Pointer and the Apple iPad

Cherng Chao et al


Intra opative image review is challenging and standard setups using keyboard and mouse are not optimal. This group compared the used of Microsoft Kinect, hillcrest labs loopp pointer, apple iPad for image interaction all using mimcloud software. Time, measurement and easy of use was determined for a prototypical task measuring a liver lesion. The Kinect software used a button approach to switch tasks. 29 radiologists participated in this study. The iPad was the fastest in performing the task while the Kinect was the slowest. However, sterility requirements hampers the use of the loop and the iPad. All three devices were believed to be usefull in the future. Windowing and measuring proved to be the most challenging tasks. Users with video game experience and experience with a particular interaction method showed a better performance.


Main shortcoming of this study was that the users using the Loop and iPad did not use gloves.

VSIN31-04 • Modular Design of a Mobile Web-app Clinical Decision Support and Communication Tool for Radiologists and Ordering Clinicians in a Multi-Facility Academic Medical Center

Loyrirk Temiyakarn , MD et al


This group used iwebkit 5 to build a modular webapp that provided all kind of information beneficial to different healthcare providers such as guidelines, phone lists, protocols, etc.

VSIN31-05 • Enhancing Utilization of Mobile Imaging: Assessing Variation in Diagnostic Accuracy of iPad with the Nature of Radiological Findings on Chest Radiographs

Supriya Gupta et al


30 cases following tube placement at ICU were evaluated on iPad and (after one week) on a PACS workstation. The conclusion is that the iPad still has to be evaluated for image quality and to determine that it can be used for a certain task. Image quality heavily depends on the app. DICOM calibration of iPad screens is becoming a critical issue and methods have to be developed specifically for tablets.