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
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'
Thursday, November 29, 2012
According to a poster presented at RSNA, the top five apps to get onto your IPad for reviewing radiological images are:
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.
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.
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
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.
Tuesday, November 27, 2012
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.
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.
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
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
5. Statistical analysis
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
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:
- easy to use
- 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.
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
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.
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)
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
Monday, November 19, 2012
Monday, November 12, 2012
Thursday, November 8, 2012
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.
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.