1. Teaching File Creation with MIRC Adam E. Flanders, MD Thomas Jefferson University Hospital Philadelphia, Pennsylvania Using MIRC for Departmental Teaching Files

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

3. 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.

4. 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

5. 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.

6. 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.

7. Digitizing Analog Images

8. Digital Camera on PACS or Viewbox Laborious but effective!

9. Personal Image Storage Solutions

10. 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?

11. 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

12. 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 email, upload of cases to free digital photo services (ie Google, Flikr, Picassa, Shutterfly etc.) Solutions include cases on email, upload of cases to free digital photo services (ie Google, Flikr, 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

13. Personal DTF Organization with Picassa

14. The Next Best Thing The Internet allows unlimited distribution of content from one central location. The Internet allows unlimited distribution of content from one central location. Modern radiology digital teaching files provide access to large volumes of content via the internet browser. Modern radiology digital teaching files provide access to large volumes of content via the internet browser. Content is generated dynamically as content is requested, this permits access to most updated content. Content is generated dynamically as content is requested, this permits access to most updated content. Submitting content directly from PACS environment remains problematic for many users. Submitting content directly from PACS environment remains problematic for many users.

15. 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

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

17. DTF Solutions Many DTF solutions are available, some commercially, others relatively free. Many DTF solutions are available, some commercially, others relatively free. Many “free” components available to cobble together a web based teaching solution. Many “free” components available to cobble together a web based teaching solution. Apache, mySQL, Linux, PHP, Javascript, Java Apache, mySQL, Linux, PHP, Javascript, Java No uniform method for packaging, or submitting content from PACS. No uniform method for packaging, or submitting content from PACS.

18. 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.

19. 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, MyPACS etc.) Organizational repositories (e.g. ACR Case-In-Point, Aunt Minnie, MyPACS etc.) You can develop your own… You can develop your own… Or there is MIRC!!!! Or there is MIRC!!!!

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

21. 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.

22. 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.

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

24. 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.  Many more…

25. 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.

26. 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.

27. 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.

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

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

30. 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…

31. 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.

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

33. 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

34. 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.

35. 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

36. 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

37. How do you access content through MIRC?

38. Public MIRC Sites RSNA Public Site RSNA Public Site http://mirc.rsna.org/mirc/query http://mirc.rsna.org/mirc/query http://mirc.rsna.org/mirc/query TJUH Public Site TJUH Public Site http://popeye.rad.tju.edu:8080 http://popeye.rad.tju.edu:8080

39. MIRC Query A search is initiated through the MIRC query page. A search is initiated through the MIRC query page. MIRC query page is a portal or point-of-entry to search & access MIRC content. MIRC query page is a portal or point-of-entry to search & access MIRC content. Key Concepts: Key Concepts: All MIRC sites “host” a query page that can access local content. All MIRC sites “host” a query page that can access local content. All MIRC query pages can list other public MIRC sites. All MIRC query pages can list other public MIRC sites. From the query page, a user can search one or more public MIRC sites for content. From the query page, a user can search one or more public MIRC sites for content. You don’t need to be a MIRC site to perform a MIRC query. You don’t need to be a MIRC site to perform a MIRC query. My MIRC Site Metropolis University MIRC Site Big University MIRC Site UltraBig University MIRC Site UltraExclusive University MIRC Site WhatsaMattaU MIRC Site RSNA MIRC Site Neuroradiology MIRC General Radiology MIRC Nuclear Medicine MIRC CVIR MIRC Body CT MIRC MSK MIRC Bob’s MIRC Pete’s MIRC Joe’s MIRC Public Departmental MIRC RSNA MIRC Site UCSF MIRC

40. MIRC Query Query Local MIRC MIRC Query The Internet MIRC Query

41. Title Bar MIRC Links List of Accessible MIRC Indexes Query Form Query Submit Button & Options MIRC Services Details of the MIRC Query Page

42. MIRC Query Form Useful set of search categories that are clustered into related groups. Useful set of search categories that are clustered into related groups. Groups: Groups: Basic Terms (default) Basic Terms (default) Document Type Document Type Content Type Content Type Clinical Info Clinical Info Image Type Image Type Patient Info Patient Info

43. How Does the MIRC Query System Work?

46. The MIRC Authoring Process

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

48. Three Kinds of Authoring Point-of-care Point-of-care Bookmarking Bookmarking Retrospective Retrospective Combination Combination

49. 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

50. Getting Images to MIRC

51. 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:

52. 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

53. 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)

54. 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.

55. New Stuff on MIRC

56. 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!

57. 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. Brings point-of-care authoring to all PACs users. Brings point-of-care authoring to all PACs users. 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.

58. TCE Service Four PACS vendors support and have working demonstrations of the TCE export profile at RSNA 2006 & 2007. Four PACS vendors support and have working demonstrations of the TCE export profile at RSNA 2006 & 2007. Agfa Agfa Fuji Fuji GE GE Vital Images Vital Images Come see the demonstration in LLC and in technical exhibits area on a real PACS system. Come see the demonstration in LLC and in technical exhibits area on a real PACS system.

59. 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.

60. 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.

61. 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.

62. Explore the MIRC Software

63. Tasks for Today Logon to Local RSNA MIRC site. Logon to Local RSNA MIRC site. Explore the image file cabinet. Explore the image file cabinet. Perform a basic authoring with a few images and text. Perform a basic authoring with a few images and text. Edit our case with the advanced authoring tool. Edit our case with the advanced authoring tool. Add annotations, captions, text. Add annotations, captions, text. Preview our case. Preview our case. Publish. Publish. Query our cases on the RSNA server. Query our cases on the RSNA server.

64. Lets get Started!!

65. Check Favorites Menu Otherwise type: http://127.0.0.1:8080/mirc/query

66. To Begin Double click on the MIRC icon on your desktop to launch your browser on the MIRC server Double click on the MIRC icon on your desktop to launch your browser on the MIRC server

67. MIRC Front Page

68. Let’s Look Around

70. Authoring Sequence for Today Login Login Explore the File Cabinet Explore the File Cabinet Copy images to personal cabinet Copy images to personal cabinet Add, delete, copy Add, delete, copy Basic Authoring Basic Authoring Launch Basic authoring page. Launch Basic authoring page. Upload one or more images from directory. Upload one or more images from directory. Edit Case on Advanced Tool Edit Case on Advanced Tool Explore advanced tool Explore advanced tool Add more text. Add more text. Annotate images Annotate images Add images Add images Preview case. Preview case. Publish!!! Publish!!! Query the site to see the collective work!!! Query the site to see the collective work!!!

71. Let’s Author

72. Let’s Log in…. Username: user + [1 – 20] Username: user + [1 – 20] Password: user Password: user

73. Functions to Focus On These tools appear once you’re logged on to system. These tools appear once you’re logged on to system. These are all on the left side of the query page. These are all on the left side of the query page. Concentrations Concentrations Basic authoring Basic authoring Advanced authoring Advanced authoring File Cabinet File Cabinet

75. What Are My Options? What if you would like to explore the MIRC software, but don’t want to have to set up your own system? What if you would like to explore the MIRC software, but don’t want to have to set up your own system? MyMIRCFiles 2008 MyMIRCFiles 2008 RSNA is offering to all members an open MIRC repository to store all of your materials. RSNA is offering to all members an open MIRC repository to store all of your materials. Utilizes the MIRC software. Utilizes the MIRC software. Any RSNA member can use it for FREE! Any RSNA member can use it for FREE! Gives you an opportunity to “kick-the-tires” before you commit to building your own. Gives you an opportunity to “kick-the-tires” before you commit to building your own.

76. What About PACS Interfaces? MIRC software is vendor neutral. MIRC software is vendor neutral. Therefore it tries to adhere to existing or upcoming standards. Therefore it tries to adhere to existing or upcoming standards. The TCE profile is getting more attention from PACS vendors. The TCE profile is getting more attention from PACS vendors. This will allow you to send directly from PACS using key images. This will allow you to send directly from PACS using key images. Obviate the need to open a web browser to author cases. Obviate the need to open a web browser to author cases.

77. More Information Check out the MIRC Wiki: Check out the MIRC Wiki: http://mircwiki.rsna.org http://mircwiki.rsna.org http://mircwiki.rsna.org Look over your handout & syllabus. Look over your handout & syllabus. A full installation of MIRC software with documentation is on the CDs. A full installation of MIRC software with documentation is on the CDs.

78. Authoring Process Authoring on MIRC is easy! Authoring on MIRC is easy! It can be time consuming at first. It can be time consuming at first. Process begins by accessing the MIRC query page. Process begins by accessing the MIRC query page. Select button for the Author Service. Select button for the Author Service.

79. Author Identity Information goes here. Template Selection Menu Four Basic Templates Are Listed Here Standard TF Template Page-format Document Template Tab-format Document Template Tab-format Document Template Type II There are others… Create your own!

80. Types of MIRC Documents MIRC uses templates to build your content in a consistent manner. MIRC uses templates to build your content in a consistent manner. Template specifies the content and the display format Template specifies the content and the display format You can create you own! You can create you own! Four Standard MIRC content formats. Four Standard MIRC content formats. Standard Teaching File Template Standard Teaching File Template Page Format Document Template Page Format Document Template Tab Format Document Template Tab Format Document Template Tab Format Document Template – Option 2 Tab Format Document Template – Option 2 Three Standard display formats. Three Standard display formats. Page Page Tabbed Tabbed Teaching File Teaching File

81. Page Format (Explorer)

82. Page Format (Mac Explorer)

83. Tabbed Display (Mac Safari)

84. Tabbed Display - Quiz

85. MIRC Standard Teaching File (Mac Safari)

86. Non-Standard Display

89. Non-Standard Display??? How Does that work? How Does that work? Remember that MIRC is designed to index any content, even content that you don’t own on your server. Remember that MIRC is designed to index any content, even content that you don’t own on your server. That includes any file or web page that is accessible via a URL (e.g. http, ftp etc.). That includes any file or web page that is accessible via a URL (e.g. http, ftp etc.). This means that you can index other peoples content on your MIRC index. This means that you can index other peoples content on your MIRC index. That includes… existing public teaching files. That includes… existing public teaching files. Provided that you index them first! Provided that you index them first!

90. Back to Authoring…

91. Left slider pans through the blank document fields Right slider pans through images in your file cabinet MIRC sets you up with a blank document with lots of fields you can fill in. Your Personal File Cabinet Appears on the Right Pull slider to bottom to see end of document Click Submit Changes every time you update content

92. Your Author information is automatically populated on the form.

93. Left Click selects one image Control + Left Click selects more than one image Shift + Left Click selects a range of images. Press “Submit Changes” saves selected images.

94. Images display lower in the web form

95. Features of the Authoring Tool Set of buttons on the top. Set of buttons on the top. Set of section tabs. Set of section tabs. Image pane showing contents of your file cabinet. Image pane showing contents of your file cabinet. Area to enter your content Area to enter your content

96. Features of the Authoring Tool Float over individual buttons and their function will be displayed to you. Float over individual buttons and their function will be displayed to you. Click on the various section tabs and you will see the content page change. Click on the various section tabs and you will see the content page change. Pull the right scroll slider down to see other images. Pull the right scroll slider down to see other images.

97. Sections in Authoring Tool

104. The Final Product? The web page that we entered the case information is not how the case will appear when viewed. The web page that we entered the case information is not how the case will appear when viewed. The template we chose determines how the fields will be displayed. The template we chose determines how the fields will be displayed. To see how the case will appear, we need to search for it from the query page. To see how the case will appear, we need to search for it from the query page. ependymoma

105. The case is automatically indexed and displays title, author & abstract.

106. Template Features The MIRC template brings your case to life! The MIRC template brings your case to life! Tabs organize the content into themes. Tabs organize the content into themes. You can navigate through imageset via icons in the lower left or by next/prior arrows. You can navigate through imageset via icons in the lower left or by next/prior arrows. The document tab has links which allow authorized user(s) to delete, publish or edit this document. The document tab has links which allow authorized user(s) to delete, publish or edit this document.

107. Case first displays with “History” tab open. This hides the diagnosis initially. Support for font styles Browse images by selecting icons here …or here Annotation Support

108. To re-edit the document. Exports the contents to your desktop Delete the entire document. Publishes this document for public access

109. What’s Going on Behind the Scenes? The actual displayed document is not fixed. The actual displayed document is not fixed. MIRC uses the scalability of XML and stylesheets to transform your content to a custom display. MIRC uses the scalability of XML and stylesheets to transform your content to a custom display. This gives you the flexibility to modify display without changing all your MIRC documents. This gives you the flexibility to modify display without changing all your MIRC documents. The “brains” behind the case is in the XML document. The “brains” behind the case is in the XML document. This contains all the elements of your document identified by tags that MIRC understands. This contains all the elements of your document identified by tags that MIRC understands. “real” contents of the case MIRC XML Document

110. The Transformation Case Content Content Processed for Display by Instructions in this stylesheet

111. Permissions MIRC has a powerful/flexible role-based permissions system. MIRC has a powerful/flexible role-based permissions system. By default, all cases that you create can only be viewed, edited or deleted by the owner. By default, all cases that you create can only be viewed, edited or deleted by the owner. Once “published” – gives public access. Once “published” – gives public access. You can modify these settings when you create or update a case. You can modify these settings when you create or update a case. The “public” setting is always an asterick “*” The “public” setting is always an asterick “*” Groups can be defined by the MIRC administrator. Groups can be defined by the MIRC administrator. * To make your case “public” use the asterisk symbol Leaving the field blanks gives only the owner/creator access. Use specific user names or “role” names to give individuals or group permissions republicans democrats [bush] [kerry]

112. Administrator Functions The Apache Tomcat server offers a very flexible administration platform. The Apache Tomcat server offers a very flexible administration platform. Can assign or limit access to specific MIRC services for users/groups of the system to: Can assign or limit access to specific MIRC services for users/groups of the system to: Services Services Group access Group access users/groups MIRC services roles

113. The Geek Factor Lots of configuration pages for administrators to customize/monitor your MIRC site. Lots of configuration pages for administrators to customize/monitor your MIRC site. Check/approve submissions Check/approve submissions Check log files for DICOM SCP Check log files for DICOM SCP Rebuild index files Rebuild index files Check health of Tomcat server Check health of Tomcat server Many other functions…. Many other functions….

114. The TJU Experience

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

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

117. Neuroradiology Server Contributors Contributors Former fellows & staff with interesting material who do not have a site of their own. Former fellows & staff with interesting material who do not have a site of their own. Custom export application from home- grown DTF creates TF cases on MIRC server as needed. Custom export application from home- grown DTF creates TF cases on MIRC server as needed. MIRC TF server functions as an extension of our internal “home grown” DTF. MIRC TF server functions as an extension of our internal “home grown” DTF.

118. TJUH Neuroradiology MIRC Model Internet Public Neuroradiology MIRC Server firewall “Home Grown” Neuroradiology DTF Linked to PACS Public User 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 Registered Author Registered Authors (former fellows & staff) Can Contribute to the Public NeuroRadiology/ENT MIRC Server

119. How is the Public Site Used? Public Teaching File Repository for Neuroradiology/ENT Cases. Public Teaching File Repository for Neuroradiology/ENT Cases. Repository for consult cases from prior fellows and colleagues. Repository for consult cases from prior fellows and colleagues. Marketing tool for the TJUH NeuroRad fellowship. Marketing tool for the TJUH NeuroRad fellowship. Point of entry for multi-institutional SCI pharma imaging data. Point of entry for multi-institutional SCI pharma imaging data.

120. Departmental MIRC Server

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

122. Departmental MIRC Server Teaching Cases Exported from PACS Teaching Cases Exported from Other DTF using ZIP Service Neur o DTF Index Neur o DTF Index Image Storage for Research

123. Features of Departmental MIRC Server System is internal to University Firewall. System is internal to University Firewall. Performs multiple functions. Performs multiple functions. Teaching Files Teaching Files Submitted Directly From PACS (custom app). Submitted Directly From PACS (custom app). Bulk conversion of over 8000 MSK cases from a shared server. Bulk conversion of over 8000 MSK cases from a shared server. Index of other TF servers (Neuro TF ~ 7000 cases) Index of other TF servers (Neuro TF ~ 7000 cases) Clinical Trials Repository Clinical Trials Repository Multiple Sclerosis Project Multiple Sclerosis Project Migaine Project Migaine Project American Paraplegia Society Project American Paraplegia Society Project Cerebral CT Perfusion Project Cerebral CT Perfusion Project

124. Departmental MIRC Server

125. HAGL

126. Administration of Departmental MIRC Server Teaching Files Teaching Files Public access on intranet. Public access on intranet. Now password protected because of PHI. Now password protected because of PHI. Each division has signon/password. Each division has signon/password. Each division has full editorial control of cases that they contribute. Each division has full editorial control of cases that they contribute. Clinical Trials Repository Clinical Trials Repository Each investigator assigned login/password Each investigator assigned login/password Viewing protected by password. Viewing protected by password. Selected examinations/images exported to MIRC from PACS via DICOM SCU. Selected examinations/images exported to MIRC from PACS via DICOM SCU.

127. Users of Departmental Server Medical students Medical students Residents Residents Fellows Fellows Trainees & staff from clinical services Trainees & staff from clinical services Researchers Researchers

128. How Are Cases Authored in Our Departmental Server?

129. Authoring Bulk conversion of individual or division collections of digital images sorted into subdirectories – MSK Bulk conversion of individual or division collections of digital images sorted into subdirectories – MSK Direct transport of selected images from PACS using a custom script. Direct transport of selected images from PACS using a custom script. Direct authoring (least used). Direct authoring (least used).

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

131. Community vs Personal Libraries MIRC supports creation of “private” libraries. MIRC supports creation of “private” libraries. You will not realize the full potential of a teaching collection unless you foster a community library. You will not realize the full potential of a teaching collection unless you foster a community library. The value of MIRC software, is that you can support both! The value of MIRC software, is that you can support both!

132. The Authoring Problem

133. 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 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… The software will not build the collection for you… Only people will! 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. 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! Even with the best of intentions, it is not as easy as you might think!

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

135. Lessons Learned Authoring must occur at the point-of-care, that is during readout. Authoring must occur at the point-of-care, that is during readout. Avoid retrospective submission. Avoid retrospective submission. Authoring process must be fast and ridiculously simple! Authoring process must be fast and ridiculously simple! At minimum, key images & a diagnosis. At minimum, key images & a diagnosis. The rest can be supplemented later. The rest can be supplemented later. Shame people into cooperating! Shame people into cooperating! Incorporate your DTF into a regular case conference. Incorporate your DTF into a regular case conference. Even “suspicious” people will gradually see the benefit. Even “suspicious” people will gradually see the benefit.

136. Lessons Learned Through group cooperation, we have amassed over 11,000 Neuroradiology cases (non-MIRC). Through group cooperation, we have amassed over 11,000 Neuroradiology cases (non-MIRC). You need at least one person to champion the process! You need at least one person to champion the process! Encourage staff, residents and fellows to contribute. Encourage staff, residents and fellows to contribute. Participation is rewarded through discussion at the weekly case conference. Participation is rewarded through discussion at the weekly case conference. Participation is rewarded by access to a large, indexed repository of images for self learning, conferences and lectures. Participation is rewarded by access to a large, indexed repository of images for self learning, conferences and lectures.

137. Confession Everything is not perfect at home….. Everything is not perfect at home….. Even in a controlled environment in my own division, compliance with authoring is far from 100%. Even in a controlled environment in my own division, compliance with authoring is far from 100%. Staff tend to pass the buck to busy trainees who “forget” to author at the end of the day. Staff tend to pass the buck to busy trainees who “forget” to author at the end of the day. Variable definition of a valuable case. Variable definition of a valuable case. Lack of appreciation of “the classics”. Lack of appreciation of “the classics”. A generalized “fear” to save a case without pathologic proof. A generalized “fear” to save a case without pathologic proof. “What if I’m wrong????” “What if I’m wrong????”

138. Confession My influence on other divisions in my own department has been less than ideal. My influence on other divisions in my own department has been less than ideal. 2 nd largest DTF collection is MSK (>10K cases) all located on a poorly organized fileserver. 2 nd largest DTF collection is MSK (>10K cases) all located on a poorly organized fileserver. Pilot project: Converted >8K to MIRC, now web enabled and indexed. Pilot project: Converted >8K to MIRC, now web enabled and indexed. Division director “prefers” the old method. Division director “prefers” the old method. Built a simple authoring tool for PACS to MIRC transfer for all divisions to use. Built a simple authoring tool for PACS to MIRC transfer for all divisions to use. Utilization has been poor. Utilization has been poor. The reason? You need more than one champion in a large, dispersed department. The reason? You need more than one champion in a large, dispersed department.

139. Final Thoughts People will tend to gravitate to what they already know or do: People will tend to gravitate to what they already know or do: Email images to themselves. Email images to themselves. Save images to USB/CD. Save images to USB/CD. Changing behavior is difficult, unless you can convince users that the secondary gain is better than the current solution. Changing behavior is difficult, unless you can convince users that the secondary gain is better than the current solution. Contributing to the TF must tied to the academic mission. Contributing to the TF must tied to the academic mission. Make it fun! Make it fun! Have a yearly contest for the largest number of contributions by a single individual/division. Have a yearly contest for the largest number of contributions by a single individual/division. Unknown case contest! – encourages residents/fellows to use the file. Unknown case contest! – encourages residents/fellows to use the file.

140. The Future The one key technical element to a successful departmental teaching file is to simplify the authoring process so that it is always performed during clinical read out. The one key technical element to a successful departmental teaching file is to simplify the authoring process so that it is always performed during clinical read out. IHE has come to the rescue with the Teaching File and Clinical Trial Export profile. IHE has come to the rescue with the Teaching File and Clinical Trial Export profile. PACS vendors must be pressured into supporting this profile. PACS vendors must be pressured into supporting this profile. Four vendors at RSNA this year are demonstrating this piece. Four vendors at RSNA this year are demonstrating this piece.

141. Summary MIRC Teaching File Software Suite offers a viable, robust and scalable system for creating comprehensive DTF collections. MIRC Teaching File Software Suite offers a viable, robust and scalable system for creating comprehensive DTF collections. The sofware is well supported by the RSNA. The sofware is well supported by the RSNA. Free for use Free for use Project is being driven by the user community. Project is being driven by the user community. Two user group meetings at RSNA! Two user group meetings at RSNA! Software itself will not build a great collection: Software itself will not build a great collection: People and Cooperation are the key! People and Cooperation are the key!