MIRC: Case Study

1. MIRC: Case Study Using MIRC Software for Education and Research

2. The Children’s Hospital of Philadelphia Since CHOP is a teaching hospital, our main focus is using the MIRC Teaching File system for Educational purposes

3. Basic Setup Overview • At CHOP we have a designated server for the Teaching File which resides in our data center. • We have used the Teaching File Software to create two storage services: • Primary Storage(containing teaching files) • Secondary Storage(containing normal cases)

4. Why Normal Cases? • Normal Cases are a valuable tool to Non-Radiology Personnel • By giving access to cases that are considered “normal”, a ER resident can decipher where a problem area exists.

5. Image on the left is technically inadequate as the patient is swallowing during the exposure, giving the false impression of pre-vertebral soft tissue thickening.

6. Image on the left is that of a normal High KV magnified airway in a normal patient without symptoms. The patient on the right is experiencing a barking cough, clinically concerning for croup. This image shows the textbook finding of the “steeple sign”, which is the hallmark of croup on a frontal High KV magnified view of the airway.

7. MIRC System Setup

8. A quick peek at the CHOP Teaching File Website

9. Login:

10. Security Levels • To prevent untrained users editing and deleting cases. • Allow Attending Radiologists access to modify all teaching files. • Security levels are also setup to gain access to different storage services.

11. What do the levels look like? • Support staff has Admin access. • Attending doctors have access to edit, delete, and submit cases to all storages. • Radiology residents/fellows have access to submit, review cases in all storages, and edit their cases. • Non-Radiology doctors have access to view only.

12. How do we create our Teaching Files?

13. Creation through Radpix • Our department utilizes Weadock Inc. Software called Radpix. • This allows us to create teaching files from specific areas while watermarking our images that are sent to the system.

14. How does this work? • Images are sent to one destination from any PACS workstation. • The images are then available at any “Radpix” workstation in the department. • The resident or fellow can then create their teaching files and send them to the server for publication.

15. A brief look at how our system is set up.

16. Let’s take a look at how this works:

17. Program Startup

18. Opening Images

19. Choose the images you want to open

20. Once your images are open:

21. Let’s create the teaching file

22. This is what the authoring tool looks like

23. First we must configure the authoring tool.

24. Choose your Options:

25. Adding a watermark:

26. Fill in your History, Abstract and Keywords for the case along with patient information if you are including it.

27. Fill in any areas that apply:

28. Add a title and your image properties:

29. The images sections allows you to move images up and down and add captions

30. You can annotate images to point out specific areas of interest:

31. You can annotate images to point out specific areas of interest:

32. Authentication avoids untrained entries:

33. Adding a quiz to aid in education:

34. Now lets upload and see what our teaching file looks like on the web.

38. One Nice Feature: MIRC Software allows for GIF uploads which let you as the user Add moving files to the teaching file which can enhance the learning Experience for the resident/fellow that is using the case.

39. Requirements for entry? • All teaching file cases must be approved by an Attending Radiologist before entry. • Substantial documentation as to reasoning, interest factor and diagnosis explanation are required. • Also a helpful number of images should accompany the documentation.

40. Benefits of Digital Teaching File? The implementation of an electronic teaching file in a busy academic practice/training program is initially cumbersome, but like any computer based system, once the initial data are entered, becomes an invaluable resource, replacing standard analog film teaching files with easily accessible JPEG file, either from the digital DICOM source image in the case of newer studies, or digitized analog cases from cases that predate digitally aquired images.

41. Benefits of Digital Teaching File? • This provides for a large bank of teaching file cases • that are stored on their own dedicated server, and • that are accessible through the hospital intranet, and • if desired, through the internet (world wide web). • The cases are a resource for teaching of not only • the Radiology trainees, technologists, and staff, but • also allow for further education of the general • medicine trainees and other subspecialties within • the hospital and the university.

42. Benefits of Digital Teaching File? Cases can be compared to a bank of normal cases, corrected for age, and be correlated with clinical and pathological findings. Online references can be provided, and links to these sites can be created in order to provide up to the date literature that applies to the case at hand.

43. Benefits of Digital Teaching File? Cases can be coded by ACR codes, actual diagnoses, or the combination of the two. This allows for review of individual cases, or if desired, by group of cases with the same or similar diagnoses, therefore facilitating research possibilities, provided appropriate IRB approval is received prior to the start of the cases to be reviewed for the purposes of clinical research.

44. Plans for the future: • Children’s Hospital of Philadelphia plans to expand its teaching file to be the most comprehensive collection of cases. With full server expandability our storage is limitless. • Also we plan to move forward with making our site available to other organizations so that we can share in the knowledge to aid our patients

45. Thank you for joining us today Special thanks to Dr. Avrum Pollock for your help.