RC226 Using the Medical Image Resource Center (MIRC) Software (Basic Imaging Informatics)

1. RC226 Using the Medical Image Resource Center (MIRC) Software (Basic Imaging Informatics) 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 design features. • TJUH configuration(s) of MIRC software. • Challenges of departmental DTF deployment.

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. • 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. • Ability to selectively share this material in a consistent manner within your institution on your local intranet or worldwide on the internet.

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

21. 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.

22. 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.

23. 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.

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

25. MIRC Software Supports Many 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…

26. 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.

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

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

29. 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.

30. 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

31. 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

32. The TJU Experience

33. MIRC TF Installation at TJU • Two MIRC servers currently installed. • One departmental (private) server behind university firewall (2003 Server) • One Neuroradiology (public) server residing on the public DMZ of the firewall (2000 Server). • Uses • Primarily Teaching Files • Repository for clinical research data.

34. Public Neuroradiology Server • Resides on the public internet. • Contains interesting Neuroradiology/ENT cases. • Is listed with the RSNA portal. • Contains a subset of our proprietary DTF. • Does not contain the majority of our DTF. • Uses: • PR device for the division. • Provides opportunity for former fellows to “give back” to the division. • Consultation cases are reviewed in weekly case conference.

35. Internet “Home Grown” Neuroradiology DTF Linked to PACS Features of the Public TF MIRC Registered Author Public User Registered Authors (former fellows & staff) Can Contribute to the Public NeuroRadiology/ENT MIRC Server Selected Neuro/ENT Cases Are Pushed Out to Public NeuroRadiology MIRC Server Using Custom Script Cases on NeuroRadiology/ENT MIRC Server are Available for Public Access Public Neuroradiology MIRC Server firewall

36. How is the Public Site Used? • Public Teaching File Repository for Neuroradiology/ENT Cases. • Repository for consult cases from prior fellows and colleagues. • Marketing tool for the TJUH NeuroRad fellowship. • Central image server for multi-institutional SCI pharma imaging data.

37. Private Departmental MIRC Server

38. Departmental MIRC Server • Serves multiple functions. • Heterogeneous case mix (> 12,000 cases) • Largest proportion MSK (>8300 cases). • Over four thousand Neuro/ENT cases from “home-grown” server are indexed on server with links back to DTF (index card). • Provides support for four clinical research databases.

39. Neuro DTF Index Teaching Cases Exported from PACS Image Storage for Research Teaching Cases Exported from Other DTF using ZIP Service “Feeds” to Departmental MIRC Server

40. Departmental MIRC Server

41. Departmental MIRC Server HAGL

42. Users of Departmental Server • Medical students • Residents • Fellows • Rad Faculty • Trainees & staff from clinical services • Researchers

43. Uses of Dept MIRC Teaching File • Decision Support • Source of images for presentations. • Case Conferences • Pre-boards warmup

44. The Single Biggest Obstacle to Success in the DTF World…. Compliance with the authoring process.

45. Community vs Personal Libraries • MIRC supports creation of “private” libraries. • The best way to realize the full potential of a shared community teaching collection is to build a community of users/contributers. • The value of MIRC software, is that you can support both!

46. The Authoring Problem “If you build it…”

47. Lessons Learned • The MIRC software suite is scalable: from a single user/contributor private DTF to a large multi-user/multi-contributor public DTF. • The software will not build the collection for you… • Only people will! • The only way to build a great collection is to encourage multi-user contribution and to build a community that promotes knowledge sharing. • Even with the best of intentions, it is not as easy as you might think!

48. Lessons Learned • The biggest obstacles to creating a useful teaching repository are not technical. • The “ownership” issue… • Community property or personal property? • Building a great collection requires cooperation from the community (the entire department or division). • Collecting images and a diagnosis are a good start, but is not enough. • Need librarians that will create complete documentation of cases.

49. Lessons Learned • Authoring must occur at the point-of-care, that is during clinical readout. • Avoid retrospective submission. • Authoring process must be fast and ridiculously simple! • At minimum, key images, diagnosis, and a clinical history. • The rest can be supplemented later.

50. Lessons Learned • Case material with limited content have limited value. • Most of our cases are Dx and images alone. • Limited content still has value for: • Decision support • Case conferences • Creating presentations • Self-assessment board prep. • Limited content not effective for self-study.