mirc: case study using mirc software for education and research

MIRC: Case StudyMIRC: Case Study

Using MIRC Software for Education and Research

The Children’s Hospital The Children’s Hospital of of PhiladelphiaPhiladelphia

Since CHOP is a teaching hospital, our main focus is using the MIRC Teaching File system for Educational purposes

Basic Setup OverviewBasic 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)

Why Normal Cases?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.

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.

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.

MIRC System SetupMIRC System Setup

A quick peek at the CHOP Teaching File Website

Login:

Security LevelsSecurity 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.

What do the levels look like?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.

How do we create our How do we create our Teaching Files?Teaching Files?

Creation through RadpixCreation 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.

How does this work?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.

A brief look at how our system is set up.

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

Program StartupProgram Startup

Opening ImagesOpening Images

Choose the images you want to openChoose the images you want to open

Once your images are open:Once your images are open:

Let’s create the teaching fileLet’s create the teaching file

This is what the authoring tool looks likeThis is what the authoring tool looks like

First we must configure the First we must configure the authoring tool.authoring tool.

Choose your Options:Choose your Options:

Adding a watermark:Adding a watermark:

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

Fill in any areas that apply:Fill in any areas that apply:

Add a title and your image properties:Add a title and your image properties:

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

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

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

Authentication avoids untrained entries:Authentication avoids untrained entries:

Adding a quiz to aid in education:Adding a quiz to aid in education:

Now lets upload and see what Now lets upload and see what our teaching file looks like on our teaching file looks like on

the web.the web.

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

Requirements for entry?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.

Benefits of Digital Teaching Benefits of Digital Teaching File?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 aninvaluable resource, replacing standard analog filmteaching files with easily accessible JPEG file,either from the digital DICOM source image in thecase of newer studies, or digitized analog cases fromcases that predate digitally aquired images.

Benefits of Digital Teaching Benefits of Digital Teaching File?File?

•This provides for a large bank of teaching file casesthat are stored on their own dedicated server, andthat are accessible through the hospital intranet, andif desired, through the internet (world wide web).

•The cases are a resource for teaching of not onlythe Radiology trainees, technologists, and staff, butalso allow for further education of the generalmedicine trainees and other subspecialties withinthe hospital and the university. 

Benefits of Digital Teaching Benefits of Digital Teaching File?File?

Cases can be compared to a bank of normal cases,corrected for age, and be correlated with clinicaland pathological findings. Online references canbe provided, and links to these sites can be createdin order to provide up to the date literature that applies to the case at hand.

Benefits of Digital Teaching Benefits of Digital Teaching File?File?

Cases can be coded by ACR codes, actualdiagnoses, or the combination of the two. Thisallows for review of individual cases, or if desired,by group of cases with the same or similardiagnoses, therefore facilitating researchpossibilities, provided appropriate IRB approval isreceived prior to the start of the cases to bereviewed for the purposes of clinical research.

Plans for the future: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

Thank you for joining us todayThank you for joining us today

Special thanks to Dr. Avrum Pollock for your help.