Using the Medical Image Using the Medical Image Resource Center (MIRC) Resource Center (MIRC) Teaching File Software Teaching File Software

(Hands-on)(Hands-on)

Adam E. Flanders, MDThomas Jefferson University HospitalPhiladelphia, Pennsylvania

Using MIRC for Using MIRC for Departmental Teaching Departmental Teaching Files Files

Segment ObjectivesSegment Objectives

Features of a digital teaching Features of a digital teaching file.file.

The MIRC solutionThe MIRC solution MIRC authoring.MIRC authoring.

What is a Teaching File?What is a Teaching File?

An organized repository of clinical An organized repository of clinical images and documentation.images and documentation.

Used primarily to supplement learning Used primarily to supplement learning process for trainees.process for trainees.

Source material for lectures, Source material for lectures, publications.publications.

Film library modelFilm library model Shelves of cases (film jackets)Shelves of cases (film jackets) Organized by anatomy, disease, ACR codes.Organized by anatomy, disease, ACR codes.

What are the Qualities of a What are the Qualities of a “Great” Radiology Teaching “Great” Radiology Teaching

FileFile High quality ImagesHigh quality Images Comprehensive supplemental Comprehensive supplemental

Information:Information: path reports, path images, discussion etc.path reports, path images, discussion etc.

OrganizationOrganization Indexed and searchableIndexed and searchable Fresh content.Fresh content. Easily accessed from anywhere.Easily accessed from anywhere. Easy to navigate.Easy to navigate. SecureSecure

Problems with Film-Problems with Film-Based TFBased TF Limited access.Limited access.

Typically, a lot of work to Typically, a lot of work to submit a case.submit a case. Difficult to solicit Difficult to solicit

“voluntary” contributions.“voluntary” contributions. Difficult to keep Difficult to keep

organized.organized. Missing or misfiled cases Missing or misfiled cases

or films.or films. Need a librarian/policemanNeed a librarian/policeman Securing files = limited Securing files = limited

access.access. Searching file is Searching file is

problematic.problematic. Inconvenient to use for Inconvenient to use for

decision support.decision support. Difficult to Difficult to

update/maintain – update/maintain – keeping material keeping material current.current.

Analog to Digital Analog to Digital TransformationTransformation

Inexpensive digital cameras / Inexpensive digital cameras / scanners.scanners.

Retirement of hard copy Retirement of hard copy (film)(film)

Proliferation of PACS.Proliferation of PACS. Proliferation of workstations.Proliferation of workstations.

Digitizing Analog ImagesDigitizing Analog Images

Digitizing Analog ImagesDigitizing Analog Images

Digital Camera on PACS or ViewboxLaborious but effective!

Personal Image Personal Image Storage Storage

SolutionsSolutions

Digitized Images: Big Step Digitized Images: Big Step Forward!Forward!

AdvantagesAdvantages Lightweight and reusableLightweight and reusable No deterioration, loss, resistant to theft.No deterioration, loss, resistant to theft. ModifiableModifiable Easy to adjust, crop, contrast, brightnessEasy to adjust, crop, contrast, brightness Easy to add annotation.Easy to add annotation.

ProblemsProblems Access remained limited.Access remained limited. Organization!Organization! Large collections, difficult to find images Large collections, difficult to find images

without meticulous labeling methodswithout meticulous labeling methods Sharing material?Sharing material?

Where to Put Your Images? - Personal Where to Put Your Images? - Personal DTFDTF

Copy images Copy images into folders into folders labeled labeled appropriately.appropriately.

Nested file Nested file structurestructure

Need to open Need to open content in content in another another application for application for use.use.

Not very Not very versatileversatile

Personal Teaching FilesPersonal Teaching Files Thousands of radiologists have amassed Thousands of radiologists have amassed

“personal” collections of images.“personal” collections of images. Solutions include cases on email, upload Solutions include cases on email, upload

of cases to free digital photo services (ie of cases to free digital photo services (ie Ophoto, Picassa, Shutterfly etc.)Ophoto, Picassa, Shutterfly etc.)

Generally used by a single user.Generally used by a single user. Accessible from a single computerAccessible 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 sharableNot readily sharable

Personal DTF Organization Personal DTF Organization with Picassawith Picassa

The Next PhaseThe Next Phase Web browser is the most appropriate vehicle for Web browser is the most appropriate vehicle for

delivery of educational content.delivery of educational content. Browsers are designed to display written and Browsers are designed to display written and

visual content efficiently.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 Modern DTF coupled to a database generates content dynamically (“on-the-fly”).content dynamically (“on-the-fly”). Easier to modifyEasier to modify More conducive to search mechanismsMore conducive to search mechanisms

Components of a Modern Components of a Modern DTFDTF

FileserverFileserver DatabaseDatabase WebserveWebserve

rr

Fileserver

Database

Webserver

Ethernet

What Do People Want?What Do People Want?

Radiologists want a simple method Radiologists want a simple method to create teaching materials from to create teaching materials from their existing PACS systems.their existing PACS systems.

Ease of useEase of use Time efficientTime efficient Simple to accessSimple to access Scalable in terms of size & Scalable in terms of size &

complexity.complexity.

What Is Available NOW?What Is Available NOW?

Commercial turnkey systems available Commercial turnkey systems available for a price which will provide:for a price which will provide: Method to save images & data from Method to save images & data from

PACS.PACS. Storage local or off-site for your casesStorage local or off-site for your cases Web server to display casesWeb server to display cases

Organizational repositories (e.g. ACR Organizational repositories (e.g. ACR Case-In-Point, Aunt Minnie etc.)Case-In-Point, Aunt Minnie etc.)

You can develop your own…You can develop your own… Or there is MIRC!!!!Or there is MIRC!!!!

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

Da’ AnswerDa’ Answer

Set of software tools that allow you to Set of software tools that allow you to create, index, search and display create, index, search and display teaching materials.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 Ability to selectively share this material in a consistent manner within your in a consistent manner within your institution on your local intranet or institution on your local intranet or worldwide on the internet.worldwide on the internet.

MIRC factoidsMIRC factoids An RSNA sponsored initiative.An RSNA sponsored initiative. Software toolkit that can be used for creation of Software toolkit that can be used for creation of

teaching repositories and clinical trials databases.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, JavaUses 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 Software designed to operate on most common

operating systems incl. Windows, Apple OSX and operating systems incl. Windows, Apple OSX and Linux.Linux.

PACS vendor neutral.PACS vendor neutral.

MIRC ComponentsMIRC Components

Web serverWeb server File serverFile server Self updating indexSelf updating index Powerful administrative Powerful administrative

functionsfunctions

MIRC FeaturesMIRC Features Individualized file storageIndividualized file storage Multiple document “templates”Multiple document “templates” Multiple methods to author contentMultiple methods to author content Multiple methods to display contentMultiple methods to display content Web-based DICOM viewer.Web-based DICOM viewer. Web-based editor.Web-based editor. DICOM receiver (DICOM SCP)DICOM receiver (DICOM SCP) DICOM anonymizerDICOM anonymizer Administrative control of viewing, editing, Administrative control of viewing, editing,

deletion.deletion. Scalable and expandable from one author/PC to Scalable and expandable from one author/PC to

hundreds.hundreds. Easy to install & configure.Easy to install & configure.

MIRC ServicesMIRC Services

MIRC functions are known as MIRC functions are known as servicesservices File service File service Storage serviceStorage service Query service Query service Author serviceAuthor service Submit serviceSubmit service DICOM serviceDICOM service

Most services can be administered.Most services can be administered.

Scalability of MIRCScalability of MIRC MIRC has the unique ability to scale from MIRC has the unique ability to scale from

one computer / one user to many one computer / one user to many computers / many users.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 Multiple MIRC repositories in one or many

institutions.institutions. Software enables development of Software enables development of

cooperative libraries.cooperative libraries. Each library is individually administered yet Each library is individually administered yet

portions can be made accessible to all.portions can be made accessible to all.

MIRC CommunityMIRC Community

Multiple MIRC sites (“MIRClets”) can Multiple MIRC sites (“MIRClets”) can function as one large library function as one large library accessible from the internet.accessible from the internet.

Conceptually a peer-to-peer model Conceptually a peer-to-peer model ( ala Napster) allowing individuals to ( ala Napster) allowing individuals to share specific content with other share specific content with other users.users.

A MIRC user can query one or more A MIRC user can query one or more MIRClets using the MIRClets using the query servicequery service..

MIRC MIRC CommunityCommunity

InternetInternet

ServerServer

Index

ServerServer

IndexMIRC site

ServerServer

Index

QueryService

MIRC siteServerServer

Index

RSNA site

User

MIRC site

MIRC supports all MIRC supports all information storage information storage

formats.formats. Images: DICOM, GIF, JPEG, Images: DICOM, GIF, JPEG,

PNGPNG Hyperlinks to other web Hyperlinks to other web

content.content. Virtually any content that is Virtually any content that is

displayable in a web browser.displayable in a web browser. Pointers to other files for Pointers to other files for

downloading.downloading. Display support for other types Display support for other types

in the future…in the future…

Key MIRC Server Key MIRC Server ComponentsComponents

Storage Service (Warehouse for material)Storage Service (Warehouse for material) A cooperating information library.A cooperating information library. IndexIndex: the library’s card catalog.: the library’s card catalog. ServerServer: the library’s shelves.: the library’s shelves. Responds to MIRCquery using the Responds to MIRCquery using the

MIRCqueryresponse schema.MIRCqueryresponse schema. Query Service (“Google-like” search Query Service (“Google-like” search

portal)portal) An entry point into the MIRC community for a user An entry point into the MIRC community for a user

on the Internet.on the Internet. Creates queries using Creates queries using MIRCquery schemaMIRCquery schema..

MIRC TF Configuration MIRC TF Configuration ScenariosScenarios

Private ModePrivate Mode Departmental Departmental

ModeMode Division ModeDivision Mode Worldwide ModeWorldwide Mode VariationsVariations

MIRC TF ScenariosMIRC TF ScenariosPrivate (selfish) ModePrivate (selfish) Mode

My Stuff

Single-user Single-user contributorcontributor

Single-user Single-user accessaccess

No sharing No sharing of contentof content

MIRC TF ScenariosMIRC TF ScenariosDivisional / Semi-Private ModeDivisional / Semi-Private Mode

Each division or key Each division or key individual maintains a individual maintains a server.server.

Division is responsible Division is responsible for maintaining their for maintaining their content.content.

All or a portion of All or a portion of content can be made content can be made public.public.

Any individual can Any individual can access public records access public records on other MIRC on other MIRC servers within servers within institution.institution.

Much more difficult to Much more difficult to administer.administer.

MIRC TF ScenariosMIRC TF ScenariosDepartmental ModeDepartmental Mode Multiple users or Multiple users or

divisions contribute divisions contribute to a single to a single departmental MIRC departmental MIRC server.server.

All users have All users have controlled access.controlled access.

All can view public All can view public cases.cases.

Only owners can Only owners can modify data.modify data.

Private cases are Private cases are supported.supported.

One server to One server to manage for all manage for all content.content.

Easier to administer.Easier to administer.

BIG MIRC

NeuroNeuro NMNM ChestChest

CTCT Body Body MRMR

MammMammoo

CVIRCVIR MSKMSK PrivatePrivate

Neuro

MSK

Mammo

User

MIRC TF ScenariosMIRC TF ScenariosWorldwide ModeWorldwide Mode

Multiple MIRC Multiple MIRC sites sites (“MIRClets”) (“MIRClets”) expose content expose content to the Internet.to the Internet.

This public This public content is content is accessible to accessible to other computers other computers that can perform that can perform a query of MIRC a query of MIRC content.content.

Internet

The MIRC Authoring The MIRC Authoring ProcessProcess

Four Ways to AuthorFour Ways to Author

Basic authoring tool.Basic authoring tool. Advanced authoring tool.Advanced authoring tool. Submit ServiceSubmit Service ZIP ServiceZIP Service

MIRC Case Authoring MIRC Case Authoring ProcessProcess

Collect your images.Collect your images. Send your images to the Send your images to the MIRC file MIRC file

serviceservice.. Login to Login to MIRC author service.MIRC author service. Create a new case using a templateCreate a new case using a template Fill in textual content in fields.Fill in textual content in fields. Select appropriate images from the Select appropriate images from the

MIRC file serviceMIRC file service to include with case. to include with case. Case is publishedCase is published

Getting Images to MIRCGetting Images to MIRC

Storing Images in MIRCStoring Images in MIRC MIRC software was designed to MIRC software was designed to

utilize common features available by utilize common features available by most PACS vendors to export most PACS vendors to export images.images. DICOM SCU/SCP (i.e. DICOM export)DICOM SCU/SCP (i.e. DICOM export) Saving images locally to PACS desktop Saving images locally to PACS desktop

or folder (subdirectory)or folder (subdirectory) Images are uploaded to the Images are uploaded to the MIRC MIRC

file service file service in one of three ways:in one of three ways:

Storing Images in MIRCStoring Images in MIRC 3 Methods3 Methods

DICOM DICOM exportexport

Upload Upload single imagesingle image

Upload Upload multiple files multiple files (using ZIP (using ZIP archive)archive)

PACSPACS

DICOM Export

Single ImageSingle Image

ZIP File

MIRC File ServiceMIRC File Service Container for images.Container for images. Two File Storage AreasTwo File Storage Areas

PublicPublic PrivatePrivate

Can Transfer Files Between Can Transfer Files Between Public and Private Public and Private Repositories.Repositories.

Delete, Add or Update files to Delete, Add or Update files to the File Service.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)

From DICOM From DICOM SCP or SCP or copied from copied from personal file personal file cabinetscabinets

Files in the Files in the shared file shared file cabinet are cabinet are available to available to all users.all users.

Select one or Select one or more images.more images.

Copy to Copy to personal file personal file cabinet.cabinet.

Begin Begin submission submission process.process.

New MIRC StuffNew MIRC Stuff

ZIP ServiceZIP Service

Method to convert an existing Method to convert an existing teaching file system to MIRC from a teaching file system to MIRC from a conventional teaching file hierarchy.conventional teaching file hierarchy.

This will bulk convert all your images This will bulk convert all your images that are in folders in a hierarchical that are in folders in a hierarchical structure to MIRC.structure to MIRC.

Supplement information as needed.Supplement information as needed. Is a great way to get started with Is a great way to get started with

MIRC!MIRC!

TCE ServiceTCE Service The TCE service is an implementation The TCE service is an implementation

from the Teaching Files and Clinical from the Teaching Files and Clinical Trials Export Integration Profile from Trials Export Integration Profile from IHE.IHE.

Enables one to author teaching file cases Enables one to author teaching file cases directly from PACS.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 This closes the loop for efficient authoring.authoring.

TCE ServiceTCE Service Five vendors support and have working Five vendors support and have working

demonstrations of the TCE export profile demonstrations of the TCE export profile at RSNA 2006.at RSNA 2006. AgfaAgfa FujiFuji GEGE Soft MedicalSoft Medical Vital ImagesVital Images

Please go for a demonstration at the XDS-Please go for a demonstration at the XDS-I demonstration area.I demonstration area.

Powerpoint ToolPowerpoint Tool

There is a handy (free) Powerpoint add-in There is a handy (free) Powerpoint add-in which will take an entire presentation and which will take an entire presentation and convert each slide to a MIRC TF convert each slide to a MIRC TF document.document.

Many people use Powerpoint as their Many people use Powerpoint as their teaching file repository; this is another teaching file repository; this is another way to convert to MIRC.way to convert to MIRC.

Add-in has been revised, is easy to use Add-in has been revised, is easy to use and install.and install.

Available on the MIRC Wiki.Available on the MIRC Wiki.

MIRC WikiMIRC Wiki

All of the MIRC documentation has All of the MIRC documentation has been uploaded to a new Wiki site been uploaded to a new Wiki site which is easy to navigate and which is easy to navigate and search.search.

All docs and downloads available All docs and downloads available there.there.

UAM User Account UAM User Account ManagerManager

Besides the powerful administrative functions in Besides the powerful administrative functions in MIRC.MIRC.

There is now a UAM which allows users to There is now a UAM which allows users to maintain and manage several account parameters maintain and manage several account parameters such as password and group subscriptions.such as password and group subscriptions.

Configuration possible to limit query results to Configuration possible to limit query results to logged in users.logged in users.

Users can register credentials with other storage Users can register credentials with other storage services.services.

Users can create private groups and subscribe to Users can create private groups and subscribe to these groups, allowing members to share private these groups, allowing members to share private documents.documents.

Explore the MIRC Explore the MIRC SoftwareSoftware

Lets get Started!!Lets get Started!!

Check Favorites MenuCheck Favorites Menu

Otherwise type: http://127.0.0.1:8080/mirc/query

MIRC Front PageMIRC Front Page

Let’s Look AroundLet’s Look Around

Let’s Look AroundLet’s Look Around

Let’s Look AroundLet’s Look Around

Let’s AuthorLet’s Author

Hands On!Hands On!

Tasks AccomplishedTasks Accomplished

Tour of the query page.Tour of the query page. Uploading of images to File Service.Uploading of images to File Service. Copying of images between shared Copying of images between shared

and personal file cabinet.and personal file cabinet. Tour of the file cabinet.Tour of the file cabinet. Simple authoring.Simple authoring.

Tasks AccomplishedTasks Accomplished Editing of the case.Editing of the case.

Tour of the editorTour of the editor Adding sections/elementsAdding sections/elements Adding additional images.Adding additional images. Adding annotation to images.Adding annotation to images. Adding captions to images.Adding captions to images. Adding a quiz.Adding a quiz.

Previewing the results.Previewing the results. Changing permissions.Changing permissions. Publishing the case.Publishing the case. Viewing the case from the query window.Viewing the case from the query window.

Questions?Questions?

Remember: For all things Remember: For all things MIRC…..MIRC…..

http://mircwiki.rsna.org