Tuesday, December 18, 2012

New on this blog! Whitepapers as e-books

In an additional tab to this blog I've started to include e-books of whitepapers I wrote earlier. During the coming weeks I will attempt to add more if time permits.

The first whitepaper is on "Classification of Different Server-Client Models in PACS and Advanced Visualization".

Furthermore, somewhere in the coming weeks I will include an e-book that I'm composing for my teaching course in Medical Imaging Informatics shortly in a first, rudimentary, version. This version will be freely available provided that when you download and read it you also provide me with comments and feedback on how to improve it.

Thursday, December 13, 2012

Cybercriminals Hold Australian Medical Clinic Electronic Patient Records Hostage

The danger of having an EPR that is not properly project. Read the news story on IEEE about cybercriminals that have hyjacked the electronic patient record of an Australian clinic. They broke into the computer system, encrypted all patient data on the system and are now asking for randsom money to decrypt the data again.

Go here for an ABC news TV item, click below to read the story on the IEEE Spectrum website.

Cybercriminals Hold Australian Medical Clinic Electronic Patient Records Hostage

Wednesday, December 12, 2012

RSNA 2012 - IHE Image Sharing Demonstration

IHE Image Sharing Demonstration
The IHE Image Sharing Demonstration will showcase developments in radiology informatics, standards-based interoperability and image sharing. The demonstration will include: Exchange The IHE Image Sharing Demonstration will showcase developments in radiology informatics, standards-based interoperability and image sharing. The demonstration will include: Exchange of medical images and reports using personal health record (PHR) accounts as in the RSNA Image Share pilot project, funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The image exchange architecture is based on the IHE Cross-enterprise Document Sharing for Imaging (XDS-I) profile.Patient radiation dose monitoring in local and national settings based on DICOM Dose Structure Reports (SRs) and the IHE Radiation Exposure Monitoring (REM) profile.Ordering and scheduling of radiology procedures using procedure names from the RSNA RadLex Playbook.Generation of radiology diagnostic reports using structured templates developed by the RSNA Reporting Committee and including RadLex terminology.Exporting image data exported from PACS using the IHE Teaching File and Clinical Trial Export (TCE) profile and using this data to author teaching files and processing of images for clinical trials using the RSNA MIRC software.

Tuesday, December 4, 2012

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.

Thursday, November 29, 2012

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.

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.

Wednesday, November 28, 2012

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

Tuesday, November 27, 2012

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.

RSNA 2012 - The Use of Business Analytics for Improving Radiology Operations, Quality, and Clinical Performance

Data needed for business analytics for radiology is distributed over many different source systems (RIS, PACS, IHE, etc, etc). The data in those systems can provide vital information. However, to use this information we have to be able to gather and combine this information in an easy and fast manner.
Leveraging informatics tools such as business analytics can help a practice transform its service delivery to improve performance, productivity and quality. BA tools can be used for quality assurance, maintenance of certification (MOC) and pracitce quality improvement (PQI).
The general steps involved in business analytics, include extract, transform, load (ETL) and key performance indicators (KPI). BI involves: Aggregation, Integration (ETL), Storage (data warehouse), Analysis(OLAP, data mining), and Presentation. Relational databases are concerted to an OLAP configuration to allow fast data searching and analytics.
Before starting with Business Analytics, the goals and metrics needed to achieve those goals need to be defined.

Business intelligence maturity from least to most mature:
1. Standard reports
2. Ad hoc reports
3. Drilldown
4. Alerts
5. Statistical analysis
6. Forecasting
7. Pre modeling

- Business intelligence tools can leverage radiology systems' utility and empower executive decisions.
- The selection of the most appropriate KPIs are critical.

Monday, November 26, 2012

RNSA 2012 - Decision Support in Clinical Practice

Decision support systems use knowledge -- ranging from books, to web sites, to real-time artificial intelligence systems -- to help physicians improve their decision making.
Passive decision support leav responsibility to search the data with the radiologist while active decision support uses artificial intelligence and computer software to actively provide relevant information and guidance to the radiologist.
In the US a lot of the work in decision support in order entry is stimulated by the appropriateness criteria for radiological examinations.
Decision support systems have to be real time and integrated to be able to be a success in clinical practice.
Recipe for success of decision support depends on the system being:
- available
- easy to use
- integrated
- collaborative
- good medicine
- aware of limits

Predicting Diagnosis and Outcome
Currently there is a clearly identified role for informatics in predicting diagnosis and outcome based on variables derived from imaging. However, there are important trade-offs that exist when developing or using predictive models.
The goal of decision suppprt is to take predictive information and assist the physician in quantifying risk of disease or probability.
An important trade-off is that In most cases the correctness of the outcome of decision support heavily depends on the dataset used to construct or train the decision support system.

Quantitative Image Analysis for Image Retrieval, Decision Support, and Knowledge Discovery
Quantitative image analysis is to characterize images and or parts of images with rich features that can be accessed by computers for comparison or decision support.
Image characterization can be done by annotation and computing of image features. This characterization (among others based on quantitative image analysis) can be used for content based image retrieval by defining a vector of different features. The acknowledged features in this vector should be weighted to determine their relative importance. This weighting can either be done by human definition or by computer learning or training and depends on what you are interested in. In radiology this can be used to retrieve similar images from the PACS or, more challenging, find images with similar lesions. Standardization using e.g. RadLex and identifying exact locations is vital to obtain usefull desciptions to use as image features.

Key points
1) Evolving technologies provide new ways to integrate advanced decision support into routine clinical practice, and decision support systems can improve outcomes in patient care.
2) Decision support gives radiology a chance to transform to a more proactive role in the managing of patients and examinations.

RSNA 2012 - New and Improved Features and Functionality of the RSNAMIRC Teaching File Software(LL-INE1201)

New and Improved Features and Functionality of the RSNA MIRC Teaching File Software
William Weadock, MD , Sarah Abate, BS

Over the past few years, the RSNA MIRC system has undergone significant improvements in functionality. Installation, creation and display of teaching file, and conferencing have been significantly improved. The MIRC system has become the standard format for teaching file software. The software is free to download and use and is supported by the RSNA. This exhibit will show how the system can be incorporated in daily workflow.

Key inprovements in functionality shown at the demonstration at RSNA are the ability to further anonymize or de-identify the DICOM data not only by de-identification of DICOM fields but also by removing parts of the image that could possibly contain patient related information such as in ultrasound captures or secondary captures. Another feature is the ability to export directly to powerpoint of one or more cases to construct a presentation on a certain topic.

Sunday, November 25, 2012

RSNA 2012 - ISP: Informatics (Image Sharing, Management and Display)

ISP: Informatics (Image Sharing, Management and Display)

SSA11-01 • 10:45 AM
Informatics Keynote Speaker: Image Sharing

Network based sharing, probably using cloud services, is mainly the replacement of the sneaker net (CD transfer) and comes with the same challenges. One has to be careful not to use tools that are used daily like Dropbox for patient related data sharing. Standards like XDR and XDM should be used to ensure safe transfer of patient data. Cloud services have to be standards based (IHE XDS.i) as implemented in the RSNA image sharing project. The exchange is based in a money transfer system where the patient gets an eight digit code and password. With these codes the patient can access the data and grant access to healthcare providers.

SSA11-02 • 10:55 AM
The RSNA’s Image Sharing Project: Initial Challenges from the Patients’ Perspective
Yousaf Awan et al

Traditionally patients are not involved in data sharing. The push to patient centered healthcare lead to the implementation of the RSNA image sharing project where the patient has control over his/her own data. Inability to access their images was the biggest issue with the current system looking at the helpdesk calls. In general, not many problems occurred.

SSA11-03 • 11:05 AM
Outcomes of an Automated System of Importation of Outside Imaging Studies into the Radiology Information System
Jonelle Marie Petscavage et al 

Patient data from CDs is uploaded decentrally and recorded in RIS and PACS. Sending AE title is set to 'OUTSIDE CD'. The error rate was less than 1%. interesting report, check our publications by van Ooijen et al in the Journal of Digital Imaging where we demonstrated something similar quite some years ago (free fulltext available)

SSA11-04 • 11:15 AM
Introducing Intuitive Simplicity in a New Type of Browser-based Dicom-Viewer for Non-Radiologists' Daily Clinical Routine
Sebastian Bickelhaupt et al

Many users are presented with non intuitive viewers that either have too much or too little functionality. The new viewer presented by this group is based on the body regions on an anatomic picture of a human. A model of human anatomy is given with colored dots on the model where the color indicates the modality and the datasets are shown next to it. After selecting the dataset of interest the DICOM data is shown and direclt connected to a 3D anatomical atlas. They showed that the new prototype speeds up and simplifies DICOM image viewing.

SSA11-05 • 11:25 AM
Influence of Medical Display System on Productivity and Eye-strain of Radiologists
Mony Weschler et al

This group compared setups with two 3MP screens to one 6MP screen both from Barco. Factors like eyestrain are evaluated using a questionnaire. It is show by this study that 6MP provides significantly less eyestrain and higher reading speeds. Although this is only based on manual registration of findings by the radiologists on a questionnaire.

RSNA 2012 - Cloud Computing for Radiologists—A Primer

Cloud computing session. See below for the learning objectives of this session.
Cloud computing involves both applications and services delivered over the internet using hardware and servers in a data center.
Virtual systems and cloud based systems can be used both within radiology as well as outside. Cloud computing provide referring clinicians with both image interpretation as well as teaching capabilities.

Cloud Computing can be applied for
1) Using virtualized systems to improve access to advanced image processing tools.
2) Using cloud based systems to provide access to advanced imaging tools.
3) Getting hands on experience using 2D / 3D / 4D tools to process data in near realtime in a virtual environment.

advantages of cloud computing
1) should lower IT costs
2) automate storage management
3) improve scalability
4) improve accessibility (e.g. improve access to advanced image processing tools)
5) fast deployment of services

Currently, people are net centered and used to being online and connected at all times. This is one of the main drivers behind cloud computing since the investment in having the best technology on the serverside is the responsiblity of the service provider and not the user.

Problems or challenges in cloud computing are:
1) can the networks available service all the cloud based applications?
2) how do we ensure patient data security and privacy?
3) is it really saving money?

when using Citrix like solutions, a major problem is that Citrix will not notify that the displayed information is compressed. If the software you use is not Citrix aware then it says that diagnostic quality data without compression is displayed while it actually is compressed by Citrix to preserve bandwidth.

Trade-offs of local storage versus cloud storage should be considered in terms of reliability, latency, costs, and scalability.
Keep in mind that the bandwidth of the network is not all, the latency is dictating how much you can transfer over that network. Therefore, testing or computing the transfer time based on the latency is essential.

RSNA 2012 - RadSnap - A Free iPhone Application for Cloud Based Consultation Between Referring Physicians and Radiologists(LL-INE1245)

Interesting poster at RSNA of a iPhone application for Cloud Based Consultation. It is freely available from the appstores.

RadSnap - A Free iPhone Application for Cloud Based Consultation Between Referring Physicians and Radiologists

Roland Talanow, MD,PhD

Referring physicians are often in a situation where they need a quick professional consultation for images at hand. Also radiologists in poor areas of this world may have not the expensive equipment to exchange studies with professionals. A solution is desired where radiologists or referring physicians who are in need for a quick case consultation receive such in a timely manner.

We developed an iPhone app that allows sending images of an indeterminate case into a dedicated section of a protected community of over 10.000 Radiology professionals. Case consultations and opinions are usually provided within a few minutes to hours. The program mask is short and intuitive and after taking the picture, it provides several options for a title, short description where a question can be placed and optional case relevant parameters. The user may choose to display their name or stay anonymous. As soon as a peer provides an opinion, the user will be notified via email. The user may also discuss this case with peers in the protected community to get more insight.

RadSnap is a free clinical tool that allows receiving quickly and easily professional consultations for difficult cases sent via iPhone. This tool helps especially referring physicians and radiologists in areas of the world who cannot afford expensive PACS software.

RSNA 2012 - Ensuring Research Subject Privacy: Anonymization andObscuring of Facial Features of Shared Head Volumes Using Open SourceOnline Tools in XNAT (LL-INE1243)

One of the tricky things about anonymization of image data for scientific research is the fact that although we de-identify the DICOM header and textual content of the images, an additional issue is involved in CT and MR of the head. This issue involves the fact that based on the data acquired a three dimensional visualization of the face can be reconstructed on which the patient could be identified. This work provides a solution to deface MR data in order to tackle this problem.

Ensuring Research Subject Privacy: Anonymization and Obscuring of Facial Features of Shared Head Volumes Using Open Source Online Tools in XNAT
Mikhail Milchenko, PhD , Kevin Archie , Daniel Marcus, PhD
1. To understand anonymization requirements for DICOM tags;
2. To understand whether a 3D rendering of head anatomy scan (e.g. MR) can identify a person;
3. To understand the difference between de-identified and original head scans for the identification purposes, and for the purposes of automatic post-processing.
4. To learn to share MR head data using automatic online de-identification tools based on pipelines in XNAT (open source research image sharing database);
1. 3D head visualizations based on high resolution MR scan vs. photographs for identification purposes.
2. Obscuring facial features: registering the image into atlas space combined with anatomical surface obscuring
3. Sharing data using the open source research database engine (XNAT) with DICOM anonymization and face obscuring pipeline
4. Comparison of original and face-obscured MR head renderings.
5. Outcomes of post-processing tools (gain field correction, skull stripping, registration) on original and face-obscured MR images
The exhibit will review the de-identification technique that consists of DICOM anonymization and obscuring of face anatomy. The emphasis will be made on learning the impact of face obscuring algorithm on visual change in a 3D rendering appearance, and of examining the outcomes of post-processing tools used on obscured images.

Wednesday, November 21, 2012

TEDxToronto 2012 Talk - Dr. Joseph Cafazzo

Dr. Cafazzo is a biomedical engineer who has spent his entire career in a hospital setting. By observing healthcare delivery from the inside, he works on ways to keep people out of hospital by creating technologies that allow for self-care at home. At the same time, Joe and his team are the biggest critics of poorly designed health technologies and their ineffectiveness. He surrounds himself with whip-smart, and passionate engineers and designers who are creating technologies that are spirited, modern, people-focused, and hopefully, suck less.

Monday, November 12, 2012

Use of Mobile Devices in Healthcare institutions

Amcom Software surveyed nearly 300 healthcare organizations to better understand how healthcare facilities are addressing questions about the use of mobile devices and to see how far along hospitals are in devising their strategies. This white paper report titles "The Role of Mobility Strategies in Healthcare" examines the top three topics and discusses solution ideas.

Cycle while you work

A new product to increase activity during a busy working day. You can actually buy this!

Thursday, November 8, 2012

World Usability Day 2012 - Workshops

Besides the Apple presentation in the previous blog, other presentations were given by people from different companies and consultants on their approach to user centered design. This gave a lot of differnt insights.

After lunch the workshops were planned.

My first one was by the University Twente about participatory design. They developed a tool to facilitate this process by a game. The aim of this game is to include users in exploration and establishment of requirements of products, software or environments which are to be used in complex, activity flow oriented situations.
The case during the workshop was to develop a weight loss app for an insurance company. It was really fun to do and it stimulated the process of discussing by providing a flexible envrironment to start with with predefined roles. The parcipatory workflow design game will be available soon in the UCD Toolbox

The second worshop was about the UCD toolbox itself by Tristan Weevers. The UCD toolbox is to find, learn and apply methods for UCD. Determining the right method from the over twohundred available methods is extremely difficult and the knowledge about these methods is not centrally available but spread over a large amount of sources. The UCD toolbox provides a filter, compare and get info sequence to facilitate this selection process. The filtering process is based on what you are creating, what the goal is and how much resources you have. Based on this a basic comparison is provided of the most usefull tools. After selection of one of the choices more information is provided about the methods including indepth information and possible tweaks. It's not online yet completely but we were able to work with the prototype which really looked great. This will allow easy communication with different stakeholders about usability. Keep an eye on www.ucdtoolbox.com to see when it comes available.

World Usability Day 2012 - Apple design

Visit the conference home page here.

Design in general is discussed in this session by Apple. However, many of these ideas for products can and should also apply to medical devices to ensure adoption and make them more user friendly.

The revival of apple was really started with the iPod which became a more wellknown brand than Apple itself. Now they sold 380 million iPods in 11 year.
1. How to design a good product
I=I2 innovation is iteration on iteration.
Design should not be about the product but about the experience.
I=A2 Innovation is an application.
People want the application not the product itself.

Target your audience! Make the devices not for the 'nerds' but for the regular users. Addressing the right people is really important. Apple design for the 12 o'clock flashers (people that have devices in their home with the clock flashing at 12 o'clock). In Apple the software teams include people from all kind of different people like musicians, etc to make sure what is developed makes sence to 12 o'clock flashers.

Bond with your user!
I=U2 innovation is what a user wants. Don't ask the user but look at what they do. Observe the user to see what they want.

It's not the feature set that counts but it's all about the user experience!

The lock down of IT in organizations causes a second layer of communication where users use devices and tools that are public. Organizations need to allow BYOD because if they don't they will lose their best people because they want to have the possiblities available. Apple allows organisations to block certain capabilities of their devices in the organizational network, e.g. disable the icloud ability.

Thursday, November 1, 2012

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.

Saturday, October 27, 2012

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.

Monday, October 15, 2012

FlipPad - rugged iPad case for medical use

The FlipPad™ is a new medical grade ruggedized case for the iPad 2 and the new iPad HD. Its is designed to pass tough standards on waterproofing and shock protection. In addition, the whole shape of the FlipPad is easy to clean with standard infection control sprays. The FlipPad™ will be available in with a LasarPen™ which is also waterproof and made of the same durable material.

Check out their website at http://www.flippad.co.uk

Thursday, October 11, 2012

Digits: Hands-Free 3-D

A new motion capture gadget from Microsoft Research provides all the control of a 3-D gaming glove. But Digits is a wrist worn sensor that leaves you barehanded and free to touch other objects. With an infrared camera, a MEMS motion sensing chip, and some software trickery it creates a 3-D model of your hand that responds to movements with fingertip precision.

Check it out at IEEE Spectrum
Digits: Hands-Free 3-D

Wednesday, October 3, 2012

IHE TCE Selector demonstration with Mirc

At the Dutch radiologists days we demonstrated the IHE TCE Selector profile together with a central Mirc server. Besides a KPacs implementation, three companies on the exhibit floor also connected to the server using either the freely available TCE selector or their own implementation (Rogan Delft, Sectra and Alphatron).
It proved to be an easy setup that could be configured quickly with high stability. A lot of interest from the participants in the RSNA Mirc teaching file software with special interest for the implementation of more structural setup of teaching files using RadLex (a radiology lexicon also developed by RSNA).

Wednesday, September 19, 2012

Health and Technology 2012 - Serious gaming = Serious business

Training of medical professionals can use serious gaming. Training became a serious issue for the European Design Center several years ago because doctors presented to them the fact that 36000 patients in the Netherlands have complications caused by errors during the intervention. In 1960 of these cases the patient dies because of these complications. It is expected that training could reduce this by 55%. This resulted in Medsim, a spinoff company where multidisciplinary teams work on training methods and devices for medical interventions. Medsim provides high tech and realistic simulators in a safe environment.

These training sessions are very expensive and cannot be done more than 2 or 3 times per year per team. To allow additional training, serious gaming could have a major role. In serious games fun = learning. An interesting result is that a study showed that high school kids were better in operating on a simulator than gynacologists.

A demonstration was given of the serious game in development called birthplay for gynacologists to practice delivery of a child in breech. It is a role playing game in which the player can assume different roles such as nurse or gynacologist.

Go to www.hat-congres.nl for acces to the presentations of the conference

Health and Technology 2012 - Doctor's case 2.0

Holland initiative for the tri-corder. Most of the diagnosis in the first line is referred by the GP, only a very small portion is performed by the GP. More diagnosis direcly performed by the GP could reduce healthcare costs significantly (approximately €900.000.000 per year in the Netherlands). A clear trend to group practices of GPs can be observed for flexiblity and cost efficiency. This trend could help to shift the diagnosis from the second to the first line (by GP).

Development and validation of medical devices and medical imaging informatics tools are a requirement to achieve this shift.

TNO has the ambition to develop within a period of 5 years the tricorder as anology to the tricorder used by dr McCoy in Star Trek. This tricorder should be used to provide test values that help the diagnosis as addition to the anamnese and the general impression/intuition of the GP. The tricorder should measure a list of 17 values within 5 minutes, be diagnostic effective with low false negative rate, and cost effective.

Go to www.hat-congres.nl for acces to the presentations of the conference

Health and Technology 2012 - Better care by secure data sharing

Presentation by two employees of NEN, the Dutch normalization institute. Medical technology and data sharing are getting more a joined issue. Legislation for medical technology/ devices is in place or developed, but legislation for medical data sharing are not specified yet. There are multiple standards and legislation relevant for medical devices and data sharing such as standards and legislation for ICT, quality and risk management, EU legislation, information exchange, apps and social media. Currently, projects are ongoing nationally and internationally to provide an overview of the available standards (e.g. By Nictiz in the Netherlands).

An important issue is that software is regarded to be a medical device and should apply to the legislation. The NEN has developed a decision tree to determine whether the software is a medical device or not.

This means that most software used in healthcare should be confirming to the guidelines and thus be tested and validated. To determine if software should be regarded tot be a medical device, the Intended use of the software is an important issue. The risk level of the software will dictate the requirements for approval.

These risk levels are:
1. No injury or damage to health is possible.
2. Non serious injury is possible.
3. Death or serious injury is possible.

Go to www.hat-congres.nl for acces to the presentations of the conference

Health and Technology 2012 - Towards empowerment for wellbeing and healthy living

Prof. Hummels started with a movie showing the problems in healthcare. Technology could help tackle a lot of the problems but the patient should be central. Fundamental science only is not the way to solve all problems, science for society is required to have the link to evereyday life. One of the areas of research of the TU/e are smart environments. The aim is empowerment of people to live healthy using technology.

Development and trends in health And healthcare are:
1. Aging and chronic diseases
2. Transforming the healthcare system
3. Healthy lifestyle: primary prevention
4. Integrative care
5. Unique personalized solutions
6. Self-management via networked technology
7. Ethics, safety and privacy

Technology trend such as social networking, knowledge economy could help tackle the challenges involved in healthcare if we can evolve to a transformation economy where solutions are developed locally with collaboration of involved stakeholders.

Smart environments involve staying healthy (prevention), empowerment in daily life, and making healthcare sustainable.

Go to www.hat-congres.nl for acces to the presentations of the conference

Monday, September 10, 2012

Virtual Surgery on iPad

Virtual surgery is a free iPad app to go through a surgical total knee replacement procedure. The app is fully narrated and interactive and also includes multiple choice questions to test the knowledge of the 'player'. This is really put on the market as being a serious game and is really well designed. Apps like these really show the ability of the iPad as an educational device.

Wednesday, September 5, 2012

OTech: Ready to throw out your RIS/PACS vendor: prevent t...

OTech: Ready to throw out your RIS/PACS vendor: prevent t...: 18% of the users are ready to throw out their system Our newsletter poll showed that 18 percent of current PACS users are unhappy with the current vendor and another 18 percent is very frustrated, which could be a good reason to consider switching vendors.

HL7 to license standards for free in 2013

Good news for the "Open" community!
Health Level Seven International (HL7), which develops interoperability standards for health IT, will make much of its intellectual property, including standards, freely available under licensing terms.
Read more here: HL7 to license standards for free in 2013

Friday, August 3, 2012

Motion simulation of joints based on CT

A spin-off company of the Delft University of Technology in the Netherlands called Clinical Graphics has developed software to simulate joint motion based on CT datasets for diagnosis and treatment planning. Their results look very impressive and the first hospital in the Netherlands just started using the system (see press announcement here).
Check out the product movies:

Tuesday, July 31, 2012

Keeping Hackers Out of Implanted Medical Devices - IEEE - The Institute

The hacking of medical devices is not only limited to equipement in the hospital containing patient related information but, according to some, also could happen to implanted medical devices such as pacemakers.
A group of researchers therefore developed a prototype of a firewall for such devices to guard them from malicious attacks.
Check out the coverage from IEEE: Keeping Hackers Out of Implanted Medical Devices - IEEE - The Institute

Monday, July 23, 2012

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.

Tuesday, July 3, 2012

Emerging mHealth: Paths for growth

PWC published a report entitled "Emerging mHealth: Pahts for growth" that shares the results of a global research study about the opportunities and challenges of mobile health from the perspective of patients, payers and providers. The pdf of the report can be found here. The presentation on the report can be found on slideshare here

Wednesday, June 27, 2012

LEAP Motion sensor - DEMO by ENGADGET

Now there are also other movies with a more 'live' demonstration of the amazing leap motion sensor. Here is one from engadget. This really seems to be true!!

Thursday, June 14, 2012

Next-gen PACS according to Eliot Siegel

Look at this Diagnostic Imaging interview with Eliot Siegel recorded at SIIM with his vision of the next generation PACS with, what he calls, clinical analytics. http://bcove.me/nfo2uwot

Wednesday, June 6, 2012

Using the Microsoft Kinect for Patient Size Estimation and Radiation Dose Normalization: Proof of Concept and Initial Validation

An alternative way to use the kinect camera to estimate patient size and normalize the patient dose will be presented at the SIIM 2012. 

The authors conclude that as the need for more accurate dose monitoring increases, the best surrogates for patient size are being sought. While weight and body mass index are easily obtained, they do not always provide an accurate estimate of patient size, particularly of the region of the patient being imaged. Using the preliminary results from this novel method for estimating patient size, we can work towards more accurate means of estimating patient volume. These improved estimates of patient size can ultimately be used to correct CT dose estimates to better reflect both regional and global patient body habitus as well as patient positioning within the scanner bore. Ultimately, more accurate dose estimation improves care of our radiology patients by supplementing and improving the information that radiologists and non-radiologist physicians can use to order and protocol imaging studies appropriately.
The abstract can be found here.

Tuesday, June 5, 2012

Tablets Make Good Educational Tool for Radiology Residents

The iPad and other tablets are gaining ground in Healthcare, not only in practical use but also in education. Use of tablet devices, such as iPads, by radiology residents would enhance their education, allowing them to keep up with evolving technology, said researchers in a study published in the June issue of the Journal of the American College of Radiology.
A short article on this can be found at the website of Diagnostic Imaging.
The full paper can be found at the site of the JACR.

Monday, June 4, 2012

HIMSS Health IT Virtual Conference and Expo

Coming up June 6-7, 2012 the HIMSS Health IT Virtual Conference and Expo.
Free registration through their website for qualified individuals.

Monitoring of Health IT systems

According to a webpublication of Hospital IT Europe, there are five steps to simplify IT infrastructure monitoring. These steps are:

1.  Filter your data to only show information which is relevant - minimise the noise
2.  Correlate your monitoring data to identify where you need to focus resources
3.  Track end-user experience to identify changes in performance before the users notice
4. Outsource your infrastructure monitoring to a dedicated managed service provider (MSP)
5. Install modelling software

For a description of the steps, please visit the HITE website.

Thursday, May 31, 2012

Kinect imaging lets surgeons keep their focus - tech - 17 May 2012 - New Scientist

THE surgeon enters the operating theatre, covered in sterile blue scrubs. Machines beep and hiss. Nurses wait, tools at the ready: scalpel, forceps, bandage, Xbox... Xbox?
On Tuesday last week, a surgeon at Guy's and St Thomas' hospital in London began trials of a new device that uses an Xbox Kinect camera to sense body position. Just by waving his arms the surgeon can consult and sift through medical images, such as CT scans or real-time X-rays, while in the middle of an operation.

Read the full article at:

Kinect imaging lets surgeons keep their focus - tech - 17 May 2012 - New Scientist

Wednesday, May 23, 2012

LEAP Motion sensor - Novel gesture-based interaction at high accuracy

Leap represents an entirely new way to interact with your computers. It’s more accurate than a mouse, as reliable as a keyboard and more sensitive than a touchscreen.  For the first time, you can control a computer in three dimensions with your natural hand and finger movements.
This isn’t a game system that roughly maps your hand movements.  The Leap technology is 200 times more accurate than anything else on the market — at any price point. Just about the size of a flash drive, the Leap can distinguish your individual fingers and track your movements down to a 1/100th of a millimeter.
This is like day one of the mouse.  Except, no one needs an instruction manual for their hands.

If this is for real they really have a breakthrough technology at their hands. This would really enable the introduction of gesture-based interaction into medicine with high accuracy and flexibility with minimal movements.
Check it out at their website.

Friday, May 18, 2012

Report: Docs are adopting tablets more than you think

Physicians’ device and digital media adoption are evolving much faster than anticipated, especially when it comes to tablets, according to a May report from healthcare market research firm Manhattan Research.
Report: Docs are adopting tablets more than you think

Tuesday, May 15, 2012

Cross enterprise data sharing

In radiology the data sharing between healthcare enterprises is a growing challenge and concern. Large amounts of CDs and DVDs are being shipped daily with big problems concerning the handling, viewing, upload, etc. Health Imaging has published a short article about 5 tips for optimizing image sharing. It is worth to read for those involved.

Monday, May 14, 2012

iPad as good in interpretation of pulmonary embolism as PACS workstation

The iPad is gaining ground in medical imaging. In a recent (online) publication in the journal Emergency Radiology entitled "The iPad as a mobile device for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism", the authors demonstrated the use of iPad interpretation of CT scans in patients suspected with Pulmonary Embolism. They conclude that:
CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists’ availability for consultation and expedite emergency patient management.

Thursday, May 10, 2012

Interaction Beyond the Keyboard

IEEE Computing Now features an article on interaction beyond the keyboard. In this article Albrecht Schmidt from the University of Stuttgart, Germany and Elizabeth Churchill from Yahoo Research explore possibilities to replace the conventional mouse and keyboard to achieve a more intuitive and versatile way of interacting with computers to explore the world of online communications and information access.

Monday, May 7, 2012

Advanced viz points way to personalized medicine

The era of personalized medicine has dawned. At its best, personalized medicine promises to improve patient care and outcomes, while better allocating healthcare resources, by individualizing treatment to specific characteristics of a patient’s disease.
Health Imaging News Portals | Advanced Visualization | Advanced viz points way to personalized medicine

Thursday, May 3, 2012

DIY (Diagnose It Yourself) Medicine Begins With An Open Source Reinvention Of The Stethoscope

Check this great movie showing the capabilities of home operated devices. http://www.healthimaginghub.com/index.php?option=com_jomtube&view=video&id=547

Filmless Regions in France

Although recent reports of the European Union should that France is behind in implementation of PACS they are trying to catch-up with a large projects to achieve filmless regions.
The RĂ©gion Sans Film (Filmless Region) project is now underway after its launch in 2008 to spur PACS adoption in the greater Paris area. Four hospitals are already utilizing elements of the program's cloud-based RIS, PACS, and archiving platform, with more than 25 additional hospitals scheduled to follow in the next two years.
Check-out the coverage on Auntminnie here

Thursday, April 26, 2012

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.

Monday, April 16, 2012

Google Glasses - Augmented reality of the future

Really fantastic how Google sees the world of tomorrow with a HUD displaying all kinds of information. Check out the movie on YouTube. Where are the applications in the medical field? In my opinion there are plenty! Now demonstration yet, but a more general movie, however it provides the general idea.

Wednesday, April 11, 2012

KPMG Report on Global Lessons in E-Health Implementation

A report entitled "Accelerating Innovation: The Power of the Crowd" was recently published by KPMG.
In this report it is stated that eHealth requires a holistic and integrated approach. To achieve this they propose three basic concepts:

  1. Crowd accelerated innovation
  2. Collaborative alignment
  3. Creative dislocation
By doing this they propose to use the crowd to develop sustainable e-health initiatives.
Download the full report here.

Wednesday, April 4, 2012

RADbook available for free for the iPad

RADbook 2012 is now available for free for the iPad. The RADbook app provides a 168 page overview of what is available on the radiology market today subdivided into 11 categories. These categories are: IT, CT, MRI, Interventional, Mammo, R/F, Nuclear, Displays/Printers, Ultrasound, Injectors, and Testing Devices.
It provides a listing of the available devices/systems with a direct link to the website of the vendor. A valuable tool for anyone looking to buy new equipment.

Tuesday, April 3, 2012

Study: Poor health IT implementation planning affects patient care

Every hospital is running IT implementation plans and has procedures and regulations to follow and obey to. In all cases it is advocated and believed that implementation of new IT systems such as Electronic Patient Records, and Radiology and Hospital Information Systems will have positive effects on the Healthcare institutions involved in increase of productivity and decrease of cost. However, planning is everything in projects like these as was shown by a paper in the American Journal of Managed Care.
A poorly planned health IT implementation can have deleterious effects on the quality of patient care, and can even increase inpatient mortality, according to an article published in the March edition of theAmerican Journal of Managed Care.
Study: Poor health IT implementation planning affects patient care