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Oracle Multimedia DICOM API: Next-Generation Platform for Medical Imaging Solutions

Melli AnnamalaiPrincipal Product Manager, Oracle Multimedia and Medical ImagingDongbai GuoDICOM Architect and Senior Development Manager

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Program Agenda

• Medical Image Data Management Challenges

• Oracle Multimedia DICOM– Advantages of database infrastructure

– Native DICOM Support

• Use Cases– Image-enabled Electronic Health Records– Clinical Trials Image Management

– Medical Research

• Summary

What are Medical Images?

• X-Rays, CTs, MRIs, Pathology images, etc.

• DICOM (Digital Imaging and Communications in Medicine) is the universal standard data format– Images– Video

– Structured Reports

• Non-DICOM formats for legacy and other medical images– TIFF, JPEG, etc.

Medical Images Ubiquitous in Healthcare Applications

• Image data is pervasive across all departments and clinical specialties

• Key component of evidence-based medicine

• Image data used in a variety of applications

Courtesy: Louis Humphrey

Medical Image Data Management Challenges

• Share images across multiple systems: interoperability

• Save costs– Storage (hardware)

– Development, deployment and maintenance (labor)

• Scalability– Handle massive increase in data volume (image volume doubles

every 18 to 20 months*)

– Scale to large information networks

• Security and privacy while sharing and accessing images

• Protect against data loss

• Performance– Fast access to local, remote, and archived medical images

* Frost & Sullivan

Oracle Multimedia DICOM for Managing Medical Images

Oracle Database 11g

Patient id Patient Name

DICOM

John1005

…….

…….

Patient DOB

02-20-48

• Oracle Database 11g provides native and complete support for storing and managing medical images– Standard and Enterprise editions

• Address medical image data management challenges with database infrastructure

• Store and manage images together with other patient data in the database

Oracle Database 11g


• Standards based open programmable platform for sharing and interoperability– Vendor-neutral DICOM storage and DICOM data model – Data accessible for secondary use– Future proof: Protect against changes in DICOM standard and

modalities– One database, one data model, multiple applications

• Low costs even as volume grows– Flexible choice for hardware – Eliminates maintenance of specialized code for image stores– Manage medical images with DBA and database developer skills– Information Lifecycle Management: Transparently move data to

cheaper disks with DICOM tags based transfer policy


• Scalable to petabyte and exabyte medical image archives

• Guaranteed security and privacy – Uniform security policies across all types of data and all tiers of data

– Access control at the data level

– Audit access

– Anonymize for privacy, Ex: mask patient names

• Performance: As fast as underlying hardware device– Ex: Read 850 CT images/sec, Write 550 CT images/sec

• Reduces Risk– Protect images against loss with backup and recovery

• High Availability

Oracle Multimedia DICOM: Native DICOM Support

• Reduce development costs – APIs for rapid development and deployment

• (zero code) Metadata extraction– Extract all 2028 standard tags– Extract vendor-specific extensions– Fast, accurate, search based on any DICOM attribute

• (zero code) Automated DICOM data validation– Check conformance to application requirements and verify data quality– Easily develop workflows that are conformance aware

• (zero code) Include DICOM content in reports and display in browsers– Convert DICOM to web-friendly formats like JPEG– Create thumbnails

• (zero code) Create DICOM images from legacy non-DICOM images

Oracle Multimedia DICOM: Native DICOM Support

• Future Proof: Model driven architecture

• Changes managed through configuration documents in the event of– New version of DICOM standard

– New modality– New vendor-specific metadata

• No change in application, no downtime, no database upgrade

Image-enabled Electronic Health Records

Electronic Health Records

• Electronic Health Records (EHRs) reduce healthcare costs– 360 degree view of all patient data + images as an integrated

whole– Longitudinal: Throughout the lifetime of the patient

– Latitudinal: Across all healthcare disciplines and specialties

• Link all patient information and patient images– Access from any location in multi-site hospitals

– Access across national and regional networks

– Access by physicians from work, home, other hospitals, access by patients

• Oracle Multimedia DICOM platform for image-enabled EHR

Image-enabled EHR: the i-engineers health engine

• Image-enabled “health engine”– Integrate images from PACS systems with patient health record– Use Oracle Multimedia DICOM to

• Extract DICOM metadata for physicians’ access and for driving workflow

• Convert to web-friendly formats for display in browsers and reports

• Customer case study: Spitalnetz Bern Hospital (Bern Health Network, Switzerland)– Universal archive for all content (images and patient data)– Provides access to complete patient health records for

• Physicians in hospital • Primary care physicians in clinics outside the hospital• 2000+ users

The health engine - Architectural Overview

Oracle Application Server

The Health Engine

Oracle Multimedia DICOM Support

DICOM Node

JDBC

DICOMHTTP(S) / SOAP

ASM

Courtesy: AdNovum and the i-engineers


“The unique features of Oracle Multimedia in Oracle Database 11g

together with the i-engineers ‘health engine’ application helped us to

significantly reduce costs and improve quality and security of our

clinical document processing.”

Peter GerberCIO, Spital Netz Bern Hospital

Switzerland

Clinical Trials Image Management

Customer Drivers and Business Needs

• Images are part of clinical trial evidence, ex: Tumors, MRIs, X-Rays– Images are an essential part of the Clinical Trials and

Pharmaceutical Research process

• Images are scattered across pharma departments and Contract Research Organizations working on the clinical trial

• Image sharing and transfer is not managed– Use FTP, courier, CDs/DVDs/printouts

– Not secure, data is lost, data quality is compromised– Identifying metadata tags are lost/incorrect

Clinical Research at AstraZeneca

• Problem: – Exponential growth in clinical trials images (nearly 100

terabytes in one year) from X-Rays to microscopic images – Difficult to manage, index, access, and share

• Oracle Multimedia DICOM enables:– A centralized clinical image repository for rapid access,

data integrity, streamlining of compliance, multiple workflows

– A system as scalable and robust for managing images as for other clinical data

– Security to restrict access to authorized users– Data validation– A platform to collect, store and view images throughout

the enterprise

Clinical Research at Novartis

• Problem: Clinical trial images managed by third party Contract Research Organizations (CROs)– Poor Quality Management– Difficult Cost Control – Direct access to images limited and expensive for pharmas

• IBIS solution on Oracle 11g Multimedia DICOM enables– Efficient, lower-cost solution– Improved data quality– Security to restrict access to authorized users– Compliance– Data validation– Quick deployment of standard Oracle Database-based solution

Clinical Research Image Management: IBISimg

Oracle Multimedia

DICOMSite

CRO

Site

User Systems Adm. Reports

Presentation

Authentication

Data Export

Integration Module

Target Systems

CDMS

Study Management

Systems

Data Acquisition Interface

Rules Engine

DICOM Image Files

Study Data

DICOM Image Data

Security

Archive

Backup

Migration

Synchronized metadata with images

Data Archive

IBISimg

Image/data Viewer

Courtesy: IBISWorks

Clinical Research at University of Wisconsin

• Problem: – Pointers to images on file system where invariably lost

– Infrastructure of multiple systems for multiple studies impractical to continue

• Oracle Multimedia DICOM infrastructure– Provided a solution that is configurable and robust

– All studies housed in the same database instance and accessed using the same software

– Enabled workflow: Data stored in two temporary tables for processing before being moved to archive tables

– Non-DICOM (TIFF) images coming in converted into DICOM

• Data will come in from 50 studies (5000 images in each study)

• Ophthalmology images (YBR photometric interpretation)

Research at University Hospitals

Multi-disciplinary Medical Research: BioGrid Australia

• Simplifies research– Integrates health research data collated by clinicians in

different institutions

– Links data from multiple institutions in disparate silos

– 12 years of MRI images was scattered on 1000 tapes, taking weeks to months for retrieval

• Multi-terabyte Archive– Consolidates 32 databases from 14 institutions across 4

Australian states– Intranet based solution with 7 million images

– Image retrieval in seconds

– Continues to grow

Courtesy: Naomi Rafael, BioGrid Australia

BioGrid Australia

Authorised researchers query the federated research

repository & download data to their workstations for

computer aided diagnosis.

RMH –LRR(Inc WH Data) ‏

PMC -LRR

Austin -LRR

Institute specific data loaded into institute

specific Local Research Repository

De-identified data

Oracle Database

11g

Extract T

ransform &

Load

Public Data Sources

GenBank

UniProt LocusLink

PubMed

PeterMac

Oncologyn=1,265

uArrayn=80 test

Tissue Bankn=1,764

Austin

Oncologyn=965

Biomarkersn=0

Tissue Bankn=1,663

Melbourne

Diabetesn=21,048

Surveillancen=3,541

Familial Can=3,758

Tissue Bankn=454

Oncologyn=3,600

Epilepsyn=1,823

Biomarkersn=50

Growing research data

Nightly updates

Researchers’ feedback is

input back to the system

BioGrid Australia

• Chose Oracle Multimedia DICOM because:– Simplified IT requirements through native processing of

DICOM images

• Accelerated development and deployment

– Preserved patient privacy by anonymizing DICOM images without losing the link between the image and patient record

– Reduced storage requirements

– Superior functionality at lower cost– Re-use implementation for future projects

– Skilled programmers readily accessible


“Oracle Database 11g gives us functionality that allows us to preserve patient

confidentiality while allowing experts to undertake valuable research that can lead to

greater insight into epilepsy and other conditions.”

Naomi RafaelTechnology and Systems

Manager, BioGrid Australia

Medical Image Archives

Diagnostic Workstations


Computed Radiography

Digital Modality Metadata,

reports in the database

DICOM Images on the file system

•File systems need specialized

•Security

•Backup

•Recovery

•…

•Metadata management

DICOM Application

Server

•DICOM Protocol

•Light-weight processing

Database Image Storage in a PACS System




Digital Modality

DICOM Application

Server

•DICOM Protocol



Oracle

Multimedia DICOM




Digital Modality

Metadata, reports and

DICOM images in the database

DICOM Application

Server

•DICOM Protocol



Oracle

Multimedia DICOM




Digital Modality




•Integrated search

•Validation

•Anonymization

•As fast as file systems

DICOM Application

Server

•DICOM Protocol



Oracle

Multimedia DICOM




Digital Modality



•Database Supported

•Security

•Availability

•Backup

•Recovery

•…for all data

•Scalable: Grid, ASM, fast incremental backup …..


•Integrated search

•Validation

•Anonymization

•As fast as file systems

DICOM Application

Server

•DICOM Protocol



Oracle

Multimedia DICOM

Oracle Multimedia DICOM with other Oracle Technologies and Solutions

Oracle Secure Enterprise Search

• Search across multiples of content: Patient notes, research papers, medical images

Oracle Universal Content Management

• Add DICOM content into Oracle Universal Content Management

• Extract DICOM metadata using Oracle Multimedia DICOM mid-tier APIs during check-in of content

• Use metadata for search in Oracle Universal Content Management

• Unable to share patients’ medical images between systems, labs, hospitals.

• Hard to search and manage.

ISSUES

Oracle Differentiator

Berkeley DB and Oracle Database 11gSometimes-Connected Mobile Health Care Devices



ISSUES

• Centralized management in DICOM-tailored database -Oracle Database Multimedia.

• Digitization and telemedicine


TREND


Oracle Database 11g Multimedia

DICOM



ISSUES

• Centralized management in DICOM-tailored database -Oracle Database Multimedia.

• Digitization and telemedicine

• Doctors needs fast, easy access - local persistence.

• Multiple Data Sources needs embedded database

• Telemedicine - anytime and anywhere?


TREND CHALLENGES


Oracle Database 11g Multimedia

DICOM

What’s Noteworthy?

• Data available to physicians on the go - secure

• Improved patient care at a lower cost• ACID transactions protect critical patient data

• Small– Footprint: 904KiB

– 60MiB DICOM files -> 600KiB database file

• High performance, low power• Reduce DICOM server’s traffic

• Synchronize DICOM data with Oracle Database

• Images might be annotated using multiple sets of terms• Might be annotated with

‘mandible’ but query with ‘Jaw’ should find the image

• Semantic relationships enhance keyword only search

Semantic Web Technology Search

Find me all DICOM images that contain the term ‘Jaw’

Semantic Relationships

Anatomical partSNOMED CodeAlias

MaxillaT11170Maxilla and

MandibleT-D1217Jaw Mandible

T-11180

SkullT-11100

Jaw=Maxilla+Mandible=T-D1217=T-11170+T-11180

source of image: www.wikipedia.org

End Note

Do we want to be in a world where images are disconnected from other data?

Summary

• No, not really!

• Oracle Multimedia DICOM Infrastructure– With native support for DICOM eliminates the need to

manage DICOM data with special ways– Brings the advantage of the database to managing DICOM

data

– Unified management of image data with other patient data– One database, one data model, multiple applications

– Facilitates rapid development and deployment of a range of healthcare applications

Multimedia/DICOM at OOW 2009 - Sessions

Hilton Hotel Continental Parlor 1/2/3

Build Fast, Secure Web Applications with the PL/SQL Gateway and Oracle Multimedia

2:30 p.m.

Marriott Salon 5Scalable and Efficient Archives 11:30 a.m.

Moscone West L3 Room 3000

health engine: Image-Enabled Patient Health Records with Oracle Multimedia DICOM

11:30 a.m.

Hilton Hotel Golden Gate 2

Oracle Database Multimedia: Fast Performance and Deployment for Media Asset Applications

11:30 a.m.

Title

Tuesday, Oct. 13

LocationDate/Time

Multimedia/DICOM at OOW 2009 - Sessions

Moscone South Room 270

Oracle’s Multimedia DICOM API: Next-Generation Platform for Medical Imaging Solutions

11:45 a.m.

Moscone South Room 270

Overlook II: Mod PL/SQL Development Tips – including Google Maps, Spatial Integration and Sending HTML Formatted Emails with Graphics

1:00 p.m.

Title

Wednesday, Oct. 14

LocationDate/Time

•DEMOgrounds

•Enterprise Multimedia Management and Medical Imaging - Moscone West W-021

•Sun Microsystems (Scalable and Efficient Tiered Archive) – Moscone South - 1101

•LSI Systems (IBM Booth) – Moscone South - 733

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