Using the Medical Image Resource Center (MIRC) Teaching File Software (Hands-on)

1. Using the Medical Image Resource Center (MIRC) Teaching File Software (Hands-on) Using MIRC for Departmental Teaching Files Adam E. Flanders, MD Thomas Jefferson University Hospital Philadelphia, Pennsylvania

2. Segment Objectives • Features of a digital teaching file. • The MIRC solution • MIRC authoring.

3. What is a Teaching File? • An organized repository of clinical images and documentation. • Used primarily to supplement learning process for trainees. • Source material for lectures, publications. • Film library model • Shelves of cases (film jackets) • Organized by anatomy, disease, ACR codes.

4. What are the Qualities of a “Great” Radiology Teaching File • High quality Images • Comprehensive supplemental Information: • path reports, path images, discussion etc. • Organization • Indexed and searchable • Fresh content. • Easily accessed from anywhere. • Easy to navigate. • Secure

5. Problems with Film-Based TF • Limited access. • Typically, a lot of work to submit a case. • Difficult to solicit “voluntary” contributions. • Difficult to keep organized. • Missing or misfiled cases or films. • Need a librarian/policeman • Securing files = limited access. • Searching file is problematic. • Inconvenient to use for decision support. • Difficult to update/maintain – keeping material current.

6. Analog to Digital Transformation • Inexpensive digital cameras / scanners. • Retirement of hard copy (film) • Proliferation of PACS. • Proliferation of workstations.

7. Digitizing Analog Images

8. Digitizing Analog Images Digital Camera on PACS or Viewbox Laborious but effective!

9. Personal Image Storage Solutions

10. Digitized Images: Big Step Forward! • Advantages • Lightweight and reusable • No deterioration, loss, resistant to theft. • Modifiable • Easy to adjust, crop, contrast, brightness • Easy to add annotation. • Problems • Access remained limited. • Organization! • Large collections, difficult to find images without meticulous labeling methods • Sharing material?

11. Where to Put Your Images? - Personal DTF • Copy images into folders labeled appropriately. • Nested file structure • Need to open content in another application for use. • Not very versatile

12. Personal Teaching Files • Thousands of radiologists have amassed “personal” collections of images. • Solutions include cases on email, upload of cases to free digital photo services (ie Ophoto, Picassa, Shutterfly etc.) • Generally used by a single user. • Accessible from a single computer • Image collections are limited in scope. • Difficult to enhance content. • Not readily sharable

13. Personal DTF Organization with Picassa

14. The Next Phase • Web browser is the most appropriate vehicle for delivery of educational content. • Browsers are designed to display written and visual content efficiently. • Including multimedia. • Early DTF contained “static” web pages. • Laborious to produce. • Time consuming to update and index. • Modern DTF coupled to a database generates content dynamically (“on-the-fly”). • Easier to modify • More conducive to search mechanisms

15. Components of a Modern DTF • Fileserver • Database • Webserver Fileserver Database Webserver Ethernet

16. What Do People Want? • Radiologists want a simple method to create teaching materials from their existing PACS systems. • Ease of use • Time efficient • Simple to access • Scalable in terms of size & complexity.

17. What Is Available NOW? • Commercial turnkey systems available for a price which will provide: • Method to save images & data from PACS. • Storage local or off-site for your cases • Web server to display cases • Organizational repositories (e.g. ACR Case-In-Point, Aunt Minnie etc.) • You can develop your own… • Or there is MIRC!!!!

18. What Does The MIRC Software Suite Do For Me? Medical Imaging Resource Center

19. Da’ Answer • Set of software tools that allow you to create, index, search and display teaching materials. • Repository for educational content. • Including peer review content (via RSNA). • Ability to selectively share this material in a consistent manner within your institution on your local intranet or worldwide on the internet.

20. MIRC factoids • An RSNA sponsored initiative. • Software toolkit that can be used for creation of teaching repositories and clinical trials databases. • Built on open-source principles. • No proprietary technology. • Uses available standards DICOM, XML, HTTP, JSP, Java • Software is free-of-charge, no licensing. • Software designed to operate on most common operating systems incl. Windows, Apple OSX and Linux. • PACS vendor neutral.

21. MIRC Components • Web server • File server • Self updating index • Powerful administrative functions

22. MIRC Features • Individualized file storage • Multiple document “templates” • Multiple methods to author content • Multiple methods to display content • Web-based DICOM viewer. • Web-based editor. • DICOM receiver (DICOM SCP) • DICOM anonymizer • Administrative control of viewing, editing, deletion. • Scalable and expandable from one author/PC to hundreds. • Easy to install & configure.

23. MIRC Services • MIRC functions are known as services • File service • Storage service • Query service • Author service • Submit service • DICOM service • Most services can be administered.

24. Scalability of MIRC • MIRC has the unique ability to scale from one computer / one user to many computers / many users. • Potential configurations include: • One MIRC repository for one or more users. • Multiple MIRC repositories in one or many institutions. • Software enables development of cooperative libraries. • Each library is individually administered yet portions can be made accessible to all.

25. MIRC Community • Multiple MIRC sites (“MIRClets”) can function as one large library accessible from the internet. • Conceptually a peer-to-peer model ( ala Napster) allowing individuals to share specific content with other users. • A MIRC user can query one or more MIRClets using the query service.

26. MIRC Community User Query Service MIRC site Index RSNA site Internet Server Index MIRC site Index Index Server Server Server MIRC site

27. MIRC supports all information storage formats. • Images: DICOM, GIF, JPEG, PNG • Hyperlinks to other web content. • Virtually any content that is displayable in a web browser. • Pointers to other files for downloading. • Display support for other types in the future…

28. Key MIRC Server Components • Storage Service (Warehouse for material) • A cooperating information library. • Index: the library’s card catalog. • Server: the library’s shelves. • Responds to MIRCquery using the MIRCqueryresponse schema. • Query Service (“Google-like” search portal) • An entry point into the MIRC community for a user on the Internet. • Creates queries using MIRCquery schema.

29. MIRC TF Configuration Scenarios • Private Mode • Departmental Mode • Division Mode • Worldwide Mode • Variations

30. My Stuff MIRC TF ScenariosPrivate (selfish) Mode • Single-user contributor • Single-user access • No sharing of content

31. MIRC TF ScenariosDivisional / Semi-Private Mode • Each division or key individual maintains a server. • Division is responsible for maintaining their content. • All or a portion of content can be made public. • Any individual can access public records on other MIRC servers within institution. • Much more difficult to administer.

32. MIRC TF ScenariosDepartmental Mode Neuro • Multiple users or divisions contribute to a single departmental MIRC server. • All users have controlled access. • All can view public cases. • Only owners can modify data. • Private cases are supported. • One server to manage for all content. • Easier to administer. MSK BIG MIRC Mammo User

33. MIRC TF ScenariosWorldwide Mode • Multiple MIRC sites (“MIRClets”) expose content to the Internet. • This public content is accessible to other computers that can perform a query of MIRC content. Internet

34. The MIRC Authoring Process

35. Four Ways to Author • Basic authoring tool. • Advanced authoring tool. • Submit Service • ZIP Service

36. MIRC Case Authoring Process • Collect your images. • Send your images to the MIRC file service. • Login to MIRC author service. • Create a new case using a template • Fill in textual content in fields. • Select appropriate images from the MIRC file service to include with case. • Case is published

37. Getting Images to MIRC

38. Storing Images in MIRC • MIRC software was designed to utilize common features available by most PACS vendors to export images. • DICOM SCU/SCP (i.e. DICOM export) • Saving images locally to PACS desktop or folder (subdirectory) • Images are uploaded to the MIRC file service in one of three ways:

39. Storing Images in MIRC • 3 Methods • DICOM export • Upload single image • Upload multiple files (using ZIP archive) PACS DICOM Export ZIP File Single Image

40. MIRC File Service Individualized file browser for each registered user • Container for images. • Two File Storage Areas • Public • Private • Can Transfer Files Between Public and Private Repositories. • Delete, Add or Update files to the File Service. • File Service Function Buttons • Add Files • Delete Files • Update Name • Find by Name • Export File to Desktop • Copy to Public (shared files) Other File Types Native DICOM Support

41. From DICOM SCP or copied from personal file cabinets • Files in the shared file cabinet are available to all users. • Select one or more images. • Copy to personal file cabinet. • Begin submission process.

42. New MIRC Stuff

43. ZIP Service • Method to convert an existing teaching file system to MIRC from a conventional teaching file hierarchy. • This will bulk convert all your images that are in folders in a hierarchical structure to MIRC. • Supplement information as needed. • Is a great way to get started with MIRC!

44. TCE Service • The TCE service is an implementation from the Teaching Files and Clinical Trials Export Integration Profile from IHE. • Enables one to author teaching file cases directly from PACS. • Select key images. • Add pre-defined text elements. • Submit directly to your MIRC service. • This closes the loop for efficient authoring.

45. TCE Service • Five vendors support and have working demonstrations of the TCE export profile at RSNA 2006. • Agfa • Fuji • GE • Soft Medical • Vital Images • Please go for a demonstration at the XDS-I demonstration area.

46. Powerpoint Tool • There is a handy (free) Powerpoint add-in which will take an entire presentation and convert each slide to a MIRC TF document. • Many people use Powerpoint as their teaching file repository; this is another way to convert to MIRC. • Add-in has been revised, is easy to use and install. • Available on the MIRC Wiki.

47. MIRC Wiki • All of the MIRC documentation has been uploaded to a new Wiki site which is easy to navigate and search. • All docs and downloads available there.

48. UAM User Account Manager • Besides the powerful administrative functions in MIRC. • There is now a UAM which allows users to maintain and manage several account parameters such as password and group subscriptions. • Configuration possible to limit query results to logged in users. • Users can register credentials with other storage services. • Users can create private groups and subscribe to these groups, allowing members to share private documents.

49. Explore the MIRC Software

50. Lets get Started!!