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

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

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

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

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

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

Digitizing Analog Images

Digital Camera on PACS or Viewbox Laborious but effective!

Personal Image Storage Solutions

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

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

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

Personal DTF Organization with Picassa

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

Components of a Modern DTF Fileserver Fileserver Database Database Webserver Webserver Fileserver Database Webserver Ethernet

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

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

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

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

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

MIRC Components Web server Web server File server File server Self updating index Self updating index Powerful administrative functions Powerful administrative functions

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.

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

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

MIRC Community Multiple MIRC sites (“MIRClets”) can function as one large library accessible from the internet. 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. 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. A MIRC user can query one or more MIRClets using the query service.

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

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

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

MIRC TF Configuration Scenarios Private Mode Private Mode Departmental Mode Departmental Mode Division Mode Division Mode Worldwide Mode Worldwide Mode Variations Variations

MIRC TF Scenarios Private (selfish) Mode My Stuff Single-user contributor Single-user contributor Single-user access Single-user access No sharing of content No sharing of content

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

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

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

The MIRC Authoring Process

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

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

Getting Images to MIRC

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

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

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

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

New MIRC Stuff

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

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

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

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. 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. 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. Add-in has been revised, is easy to use and install. Available on the MIRC Wiki. Available on the MIRC Wiki.

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

UAM User Account Manager Besides the powerful administrative functions in MIRC. 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. 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. Configuration possible to limit query results to logged in users. Users can register credentials with other storage services. Users can register credentials with other storage services. Users can create private groups and subscribe to these groups, allowing members to share private documents. Users can create private groups and subscribe to these groups, allowing members to share private documents.

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Hands On!

Tasks Accomplished Tour of the query page. Tour of the query page. Uploading of images to File Service. Uploading of images to File Service. Copying of images between shared and personal file cabinet. Copying of images between shared and personal file cabinet. Tour of the file cabinet. Tour of the file cabinet. Simple authoring. Simple authoring.

Tasks Accomplished Editing of the case. Editing of the case. Tour of the editor Tour of the editor Adding sections/elements Adding sections/elements Adding additional images. Adding additional images. Adding annotation to images. Adding annotation to images. Adding captions to images. Adding captions to images. Adding a quiz. Adding a quiz. Previewing the results. Previewing the results. Changing permissions. Changing permissions. Publishing the case. Publishing the case. Viewing the case from the query window. Viewing the case from the query window.

Questions?

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