1. MIRC Clinical Trials Medical Imaging Resource Center

2. RSNA2006 MIRC Courses Overview of the RSNA MIRC Software Installing MIRC on Your Laptop Using MIRC for Clinical Trials Hands ON: Using the RSNA Teaching File

3. MIRC Project Objective Support the production, storage, indexing and distribution of medical imaging resources: –Teaching files –Scientific & technical documentation –Research images & datasets –Clinical trials data

4. MIRC Concepts The key concepts: –MIRC is a community of cooperating libraries on the Internet. –The libraries cooperate by supporting a common query mechanism. –The query mechanism allows users to find information wherever it is stored.

5. The RSNA MIRC Software Query Service Storage Service Document index and storage Author services DICOM services File Service Public and private file cabinets

6. XMLServer OS File System InputQueue StorageServiceMIRCIndex AdminService AuthorServicesFileService Object Processor MIRCAnonymizerDICOMImport QueryService MIRC Site Services SubmitService ZipService TCEService HTTPExport HTTPImport DICOMExport DICOMImport MIRCAnonymizerDatabaseExport

7. DICOM Service Receives DICOM objects from PACS, workstations, modalities, … Automatic document generation –Images grouped into documents by study –Template-driven –Automatic JPEG generation from DICOM –Programmable anonymization (de­ identification and re-identification)

8. DICOM Service Automatic trial patient ID generation Connection to other DICOM Services for clinical trials –Support for encrypted communications (SSL) DICOM import / DICOM export HTTP(S) import / HTTP(S) export Database export

9. Database Interface Links to an externally developed database Provides classes for interrogating: –DICOM objects –Metadata files: XML ZIP (with manifest) Anonymization for DICOM and XML objects

10. FC DICOM FC DICOM PI DICOM MIRC Clinical Trial Data Flow FieldCenter Application: - Image reception - Anonymization - Transmission to PI MIRC Site: - Image reception - Image Storage - Transfer to PACS and/or workstations Database HTTP Internet HTTP / HTTPS

11. Anonymization & Pseudonymization

12. Real-World Data Modification Anonymization –Removal of PHI –Replacement of PHI with values that are the same for all patients Pseudonymization –Replacement of PHI with values that are specific to the patient and the trial but which are not available anywhere else

13. Pseudonymization Element types –Patient ID –Dates Birth Study –UIDs –Accession, non-unique IDs Central vs distributed remapping

14. The HIPAA 18 1.Name 2.Location; all geographic subdivisions smaller than a state, including street address, city, county, precinct, zip code, and their equivalent geocodes. 3.Dates (all dates related to the subject of the information, e.g. birth dates, admission dates, discharge dates, encounter dates, surgery dates, etc.) 4.Telephone numbers 5.Fax numbers 6.Electronic mail addresses 7.Social security numbers 8.Medical record numbers 9.Health plan beneficiary numbers 10.Account numbers 11.Certificate / license numbers 12.Vehicle identifiers and serial numbers, including license plate numbers 13.Device identifiers and serial numbers 14.Web Universal Resource Locators (URLs) 15.Internet Protocol (IP) address numbers 16.Biometric identifiers, including finger and voice prints 17.Full face photographic images and any comparable images 18.Any other unique identifying number, characteristic, or code

15. Anonymizer Scripting Modality-specific Manufacturer-specific MIRC-defined script languages –DICOM –XML Shared remapping tables –Self-consistency

16. DICOM Anonymization Parameter access @param(@ParameterName) Date/time @date(separator) @time(separator) Element access @contents(ElementName) @contents(ElementName,"regex") @contents(ElementName,"regex","replacement") Element creation and deletion @require() @require(ElementName) @require(ElementName,"default value") @empty() @blank(n) @remove() @keep()

17. DICOM Anonymization Special purpose data modification @initials(ElementName) @scramble(ElementName,word1skip,word1take,word2skip,word2take,...) @alphabetichash(ElementName,maxCharsOutput) @alphabetichash(ElementName,maxCharsOutput,maxWordsInput) @numerichash(ElementName,maxCharsOutput) @numerichash(ElementName,maxCharsOutput,maxWordsInput) @ptid(siteid,ElementName,prefix,first,width,suffix) @ptid(@SITEID,ElementName,@PREFIX,first,width,@SUFFIX) @hashptid(siteid,ElementName,prefix,suffix) @hashptid(@SITEID,ElementName,@PREFIX,@SUFFIX) @offsetdate(siteid,ElementName,basedate) @offsetdate(@SITEID,ElementName,@BASEDATE) @incrementdate(ElementName,incInDays) @round(ElementName,groupsize) @round(ElementName,@ParameterName)

18. DICOM Anonymization UID functions @uid(root,ElementName) @uid(@UIDROOT,ElementName) @hashuid(root,ElementName) @hashuid(@UIDROOT,ElementName) Non-unique identifier functions @accession(ElementName) @id(ElementName) @integer() Conditional functions @if(ElementName,exists){true clause}{false clause} @if(ElementName,isblank){true clause}{false clause} @if(ElementName,matches,"regex"){true clause}{false clause} @quarantine() @skip()

19. XML Anonymization Comment:#comment Identifier:$name Path:/tag[n]/... /tag[n]/…/@attr with wildcards [*] Methods: Remapping:$uid( expression ) Creation:$require( expression ) Destruction:$remove() Debugging:$print( expression ) Expression:path “text” identifier $method() etc. Assignment:identifier = expression path = expression

20. Mapping / Hashing Central vs local mapping –Central mapping is more controlled, but it requires that PHI be kept at the PI’s site. –Local mapping is more susceptible to data loss, but has a different security profile. Hashing –Very convenient in a multi-center trial and very secure, but inversion can only be done through a dictionary attack.

21. Data Formats: Beyond DICOM

22. Clinical Trial Data Files Images –DICOM, multi-media Text data –XML Trial-specific file collections –Zip Undefined file type

23. Data Object Classes FileObject File management methods Common data access methods overridden by subclasses: –getUID –getStudyUID –getDescription –Subclasses DicomObject XmlObject ZipObject

24. DicomObject Encapsulates a DICOM file Key methods: –getMircImage –getBufferedImage –getElementValue –41 methods in all

25. XmlObject Encapsulates an XML file Key methods: –getDocument –getText –getDocumentElementName –getValue –7 methods in all Problem: lack of standardization for UID, StudyUID, and Description

26. ZipObject Encapsulates a zip file containing: An XML file named manifest.xml –MIRC-defined schema for key elements Any other files Key methods: –getManifestDocument –getEntries –extractFile –extractFileText –15 methods in all

27. Managing Software and Configuration Updates

28. Lessons from Field Centers IT support is almost unavailable. Initial software installation requires a human being, but it should be simple. Software updates should require a person to trigger them. Anonymizer scripts should be automatically updated.

29. MIRC Update Service MIRCUpdateServlet HTTP(S) FieldCenter Storage SCP HTTP Server Anonymizer Storage SCU S/W Update S/W Config 1 Config 2 Config n FieldCenter Sites

30. FieldCenter

31. Typical Imaging Dataflow PrincipalInvestigator PACS MIRC Modality Field Center Database Work- stations PACS FieldCenter Storage SCP HTTP Server Anonymizer Storage SCU S/W Update DICOM HTTP(S) DICOM

32. The FieldCenter Application Runs at the image acquisition site Receives images and metadata files via the DICOM and HTTP(S) protocols Anonymizes images and metadata files Transmits to the PI MIRC site via HTTP(S) Automatically links to the PI MIRC site for remapping tables and software updates

33. The FieldCenter Application

40. The RSNA MIRC Software Available on the RSNA MIRC site (mirc.rsna.org) –Click the Downloads link in the header

41. The RSNA MIRC Software Runs on Windows, Mac, Linux, Solaris Three components: Java / Tomcat / MIRC All components are free MIRC Users Group meetings: 11/27 1:30 - 3:30E262 11/3012:15 - 2:15E257

42. Questions/Answers & Help The MIRC Wiki –http://mircwiki.rsna.orghttp://mircwiki.rsna.org RSNA Forums: –http://forums.rsna.orghttp://forums.rsna.org –User Comments, Questions and Answers –RSNA MIRC Software Announcements –MIRC Implementers’ Corner Subscribe on the Forums site