1. Phillip Cheng, MD MS Assistant Clinical Professor of Radiology
CaseMaker: An Open Source Desktop Mediator Between PACS and the RSNA Teaching File System
Phillip Cheng, MD MS
Assistant Clinical Professor of Radiology

2. Objective
The purpose of this exhibit is to illustrate an open source desktop tool for facilitating transfer of case images from PACS to the current version of the RSNA Teaching File System.

3. Introduction
Teaching files are an essential educational resource in academic radiology departments.
Some PACS do not provide a centralized data store for teaching files. For such systems, ancillary teaching file systems provide networked database resources to receive images from PACS.
A notable example is the RSNA Teaching File System (TFS), developed under the RSNA MIRC project.

4. RSNA Teaching File System
Sample case viewed in a browser window in the RSNA Teaching File System

5. Case Authoring for RSNA TFS
RSNA TFS provides easy-to-use web-based authoring tools for creating cases.
However, due to lack of direct integration with PACS, case authoring can be tedious and error-prone.

6. User Interface Barriers for TFS
TFS Basic Author Service
Drag each image from PACS to desktop
Switch to web browser and log into MIRC TFS
Open authoring tool and manually add metadata
Name, date, MRN, location
(Tedious and subject to typographical error)
Open file browser to add each image
Three mouse clicks per image
(No image preview)
Submit
The user interface gap between the PACS and the browser creates a “last mile” barrier for teaching file creation.

7. Introducing a Mediator
RSNA
TFS
PACS
Mediator
(CaseMaker)
CaseMaker is a desktop application that serves as a mediator to reduce user interface friction for creating teaching cases from the PACS.

8. CaseMaker: A Desktop Mediator
Open source, portable Windows desktop application
Written in C#, requires .NET Framework 2.0
Has special features to interact with Fuji Synapse PACS (but can be extended to support other PACS)

9. CaseMaker – Drag and Drop
Drag-and-drop of image from PACS triggers automatic population of demographic information.

10. Drag and Drop Mechanism
Dragging an image from Synapse PACS carries both bitmap and metadata…
S= … P= U=
A=R V=
Medical record number
Accession number
Metadata
Dragged bitmap

11. Drag and Drop Mechanism
CaseMaker uses metadata from the drag-and-drop to search for matching DICOM file in Synapse cache, acquiring additional metadata to populate the form.
S= … P= U=
A=R V=
PACS DICOM Cache
(0010,0010) TEST^ANOTHER
(0010,0040) F
(0020,0010)
(0030,0010)
(0050,0008) R …

12. Managing multiple images
Multiple images can be dragged into window and reordered by drag- and-drop in the image gallery.

13. Case Annotations
Text fields for history, findings, and diagnosis. Other lesser-used text fields appear on a separate “Extra” tab.
Checkboxes based on ABR exam categories.
Each image can have its own caption.

14. Case File Format
Cases are saved as a single .zip file containing a case XML file and associated image PNG files.
The XML file is stored according to the RSNA MIRCDocument Schema.

15. Case Preview
The preview feature transforms the case XML file using the MIRC teaching file style sheet (MIRCDocument.xsl).

16. Case Submission to RSNA TFS
Submission to MIRC server requires input of username and password, once per CaseMaker session. After the first case, later submissions require only 1 mouse click.

17. Case Submission to RSNA TFS
Case file is submitted to the TFS Zip Service without further user intervention.
At USC, more than 500 cases have been submitted to a TFS server using CaseMaker.

18. TFS Authoring Simplified
TFS Basic Author Service
Drag each image from PACS to desktop
Switch to web browser and log into MIRC TFS
Open authoring tool and manually add metadata
Including name, date, MRN, location
(Tedious and subject to typographical error)
Open file browser to add each image
Three mouse clicks per image
(No image preview)
Submit
CaseMaker + TFS
Drag each image to CaseMaker
Fill in case description
(Name, date, MRN, location already populated)
Submit

19. Source Code Availability
CaseMaker source code is available under the Apache 2.0 open source license.
CaseMaker works with unmodified RSNA TFS server. However, we use a patch that automatically applies the username’s preferred author name to the submitted case.
All source available at Github:

20. Summary
CaseMaker, an open source desktop mediator application, facilitates frictionless transfer of PACS teaching file cases to the RSNA Teaching File System.