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Gerard R, Makeeva V, Vey B, Cook TS, Nagy P, Filice RW, Wang KC, Balthazar P, Harri P, Safdar NM. Imaging Informatics Fellowship Curriculum: Building Consensus on the Most Critical Topics and the Future of the Informatics Fellowship. J Digit Imaging 2023; 36:1-10. [PMID: 36316619 PMCID: PMC9984571 DOI: 10.1007/s10278-022-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/18/2022] [Accepted: 09/08/2022] [Indexed: 03/05/2023] Open
Abstract
The existing fellowship imaging informatics curriculum, established in 2004, has not undergone formal revision since its inception and inaccurately reflects present-day radiology infrastructure. It insufficiently equips trainees for today's informatics challenges as current practices require an understanding of advanced informatics processes and more complex system integration. We sought to address this issue by surveying imaging informatics fellowship program directors across the country to determine the components and cutline for essential topics in a standardized imaging informatics curriculum, the consensus on essential versus supplementary knowledge, and the factors individual programs may use to determine if a newly developed topic is an essential topic. We further identified typical program structural elements and sought fellowship director consensus on offering official graduate trainee certification to imaging informatics fellows. Here, we aim to provide an imaging informatics fellowship director consensus on topics considered essential while still providing a framework for informatics fellowship programs to customize their individual curricula.
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Affiliation(s)
- Roger Gerard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA.
| | - Valeria Makeeva
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Brianna Vey
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Tessa S Cook
- Department of Radiology, Ground Floor, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard Atrium, Philadelphia, PA, 19104, USA
| | - Paul Nagy
- Department of Radiology, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, USA
- Division of Health Science Informatics, Johns Hopkins University School of Public Health, 2024 East Monument St. S 1-200, Baltimore, MD, 21205, USA
| | - Ross W Filice
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA
| | - Kenneth C Wang
- Department of Diagnostic Radiology and Nuclear Medicine, Medical Center, University of Maryland, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA
| | - Nabile M Safdar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, NE Suite D112, 1364 Clifton Road, Atlanta, GA, 30322, USA
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Kawa J, Pyciński B, Smoliński M, Bożek P, Kwasecki M, Pietrzyk B, Szymański D. Design and Implementation of a Cloud PACS Architecture. SENSORS (BASEL, SWITZERLAND) 2022; 22:8569. [PMID: 36366266 PMCID: PMC9654824 DOI: 10.3390/s22218569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The limitations of the classic PACS (picture archiving and communication system), such as the backward-compatible DICOM network architecture and poor security and maintenance, are well-known. They are challenged by various existing solutions employing cloud-related patterns and services. However, a full-scale cloud-native PACS has not yet been demonstrated. The paper introduces a vendor-neutral cloud PACS architecture. It is divided into two main components: a cloud platform and an access device. The cloud platform is responsible for nearline (long-term) image archive, data flow, and backend management. It operates in multi-tenant mode. The access device is responsible for the local DICOM (Digital Imaging and Communications in Medicine) interface and serves as a gateway to cloud services. The cloud PACS was first implemented in an Amazon Web Services environment. It employs a number of general-purpose services designed or adapted for a cloud environment, including Kafka, OpenSearch, and Memcached. Custom services, such as a central PACS node, queue manager, or flow worker, also developed as cloud microservices, bring DICOM support, external integration, and a management layer. The PACS was verified using image traffic from, among others, computed tomography (CT), magnetic resonance (MR), and computed radiography (CR) modalities. During the test, the system was reliably storing and accessing image data. In following tests, scaling behavior differences between the monolithic Dcm4chee server and the proposed solution are shown. The growing number of parallel connections did not influence the monolithic server's overall throughput, whereas the performance of cloud PACS noticeably increased. In the final test, different retrieval patterns were evaluated to assess performance under different scenarios. The current production environment stores over 450 TB of image data and handles over 4000 DICOM nodes.
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Affiliation(s)
- Jacek Kawa
- Radpoint Sp. z o.o., Ceglana 35, 40-514 Katowice, Poland
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland
| | - Bartłomiej Pyciński
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland
| | | | - Paweł Bożek
- Radpoint Sp. z o.o., Ceglana 35, 40-514 Katowice, Poland
- Department of Radiology and Radiodiagnostics in Zabrze, Medical University of Silesia in Katowice, 3 Maja 13/15, 41-800 Zabrze, Poland
| | - Marek Kwasecki
- Radpoint Sp. z o.o., Ceglana 35, 40-514 Katowice, Poland
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The Current State and Path Forward For Enterprise Image Viewing: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2018; 29:567-73. [PMID: 27473474 PMCID: PMC5023528 DOI: 10.1007/s10278-016-9887-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.
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Clunie DA, Dennison DK, Cram D, Persons KR, Bronkalla MD, Primo HR. Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2016; 29:583-614. [PMID: 27576909 PMCID: PMC5023533 DOI: 10.1007/s10278-016-9899-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This white paper explores the technical challenges and solutions for acquiring (capturing) and managing enterprise images, particularly those involving visible light applications. The types of acquisition devices used for various general-purpose photography and specialized applications including dermatology, endoscopy, and anatomic pathology are reviewed. The formats and standards used, and the associated metadata requirements and communication protocols for transfer and workflow are considered. Particular emphasis is placed on the importance of metadata capture in both order- and encounter-based workflow. The benefits of using DICOM to provide a standard means of recording and accessing both metadata and image and video data are considered, as is the role of IHE and FHIR.
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Affiliation(s)
- David A Clunie
- Pixelmed Publishing LLC., 943 Heiden Rd, Bangor, PA, 18013, USA.
| | - Don K Dennison
- Don K Dennison Solutions Inc., 205 Fern Cres, Waterloo, ON, N2V 2P9, Canada
| | - Dawn Cram
- Department of Information Technology, University of Miami Health System, Miami, FL, 33136, USA
| | - Kenneth R Persons
- Mayo Clinic and Foundation, 200 First St. SW, Pb 2-58, Rochester, MN, 55905, USA
| | - Mark D Bronkalla
- Merge Healthcare, 900 Walnut Ridge Drive, Hartland, WI, 53029, USA
| | - Henri Rik Primo
- Digital Health Services, Siemens Healthineers, 65 Valley Stream Parkway, Malvern, PA, 19355, USA
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Amin M, Sharma G, Parwani AV, Anderson R, Kolowitz BJ, Piccoli A, Shrestha RB, Lauro GR, Pantanowitz L. Integration of digital gross pathology images for enterprise-wide access. J Pathol Inform 2012; 3:10. [PMID: 22530178 PMCID: PMC3327039 DOI: 10.4103/2153-3539.93892] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/31/2012] [Indexed: 11/17/2022] Open
Abstract
Background: Sharing digital pathology images for enterprise- wide use into a picture archiving and communication system (PACS) is not yet widely adopted. We share our solution and 3-year experience of transmitting such images to an enterprise image server (EIS). Methods: Gross pathology images acquired by prosectors were integrated with clinical cases into the laboratory information system's image management module, and stored in JPEG2000 format on a networked image server. Automated daily searches for cases with gross images were used to compile an ASCII text file that was forwarded to a separate institutional Enterprise Digital Imaging and Communications in Medicine (DICOM) Wrapper (EDW) server. Concurrently, an HL7-based image order for these cases was generated, containing the locations of images and patient data, and forwarded to the EDW, which combined data in these locations to generate images with patient data, as required by DICOM standards. The image and data were then “wrapped” according to DICOM standards, transferred to the PACS servers, and made accessible on an institution-wide basis. Results: In total, 26,966 gross images from 9,733 cases were transmitted over the 3-year period from the laboratory information system to the EIS. The average process time for cases with successful automatic uploads (n=9,688) to the EIS was 98 seconds. Only 45 cases (0.5%) failed requiring manual intervention. Uploaded images were immediately available to institution- wide PACS users. Since inception, user feedback has been positive. Conclusions: Enterprise- wide PACS- based sharing of pathology images is feasible, provides useful services to clinical staff, and utilizes existing information system and telecommunications infrastructure. PACS-shared pathology images, however, require a “DICOM wrapper” for multisystem compatibility.
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Affiliation(s)
- Milon Amin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Duncan LD, Gray K, Lewis JM, Bell JL, Bigge J, McKinney JM. Clinical Integration of Picture Archiving and Communication Systems with Pathology and Hospital Information System in Oncology. Am Surg 2010. [DOI: 10.1177/000313481007600934] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The complexity of our current healthcare delivery system has become an impediment to communication among caregivers resulting in fragmentation of patient care. To address these issues, many hospitals are implementing processes to facilitate clinical integration in an effort to improve patient care and safety. Clinical informatics, including image storage in a Picture Archiving and Communication System (PACS), represents a tool whereby clinical integration can be accomplished. In this study, we obtained intraoperative photographs of 19 cases to document clinical stage, extent of disease, disease recurrence, reconstruction/grafting, intraoperative findings not identified by preoperative imaging, and site verification as part of the Universal Protocol. Photographs from all cases were stored and viewed in PACS. Images from many of the cases were presented at our interdepartmental cancer conferences. The stored images improved communication among caregivers and preserved pertinent intraoperative findings in the patients’ electronic medical record. In the future, pathology, gastroenterology, pulmonology, dermatology, and cardiology are just a few other subspecialties which could accomplish image storage in PACS. Multidisciplinary image storage in a PACS epitomizes the concept of clinical integration and its goal of improving patient care.
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Affiliation(s)
- Lisa D. Duncan
- Departments of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Keith Gray
- Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
| | - James M. Lewis
- Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
| | - John L. Bell
- Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Jeremy Bigge
- Departments of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - J. Mark McKinney
- Radiology, University of Tennessee Medical Center, Knoxville, Tennessee
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Taberner R, Contestí T. Sistemas de almacenamiento en fotografía clínica dermatológica. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Taberner R, Contestí T. Digital Photograph Storage Systems in Clinical Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kotas M, Schmitt P, Jakob PM, Flentje M. Monitoring of tumor oxygenation changes in head-and-neck carcinoma patients breathing a hyperoxic hypercapnic gas mixture with a noninvasive MRI technique. Strahlenther Onkol 2009; 185:19-26. [PMID: 19224143 DOI: 10.1007/s00066-009-1870-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 09/09/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE : To implement and evaluate a noninvasive functional MRI technique for measuring tumor tissue oxygenation changes in head-and-neck carcinoma patients. PATIENTS AND METHODS : Tissue oxygenation changes were determined quantitatively in 13 patients with head-and-neck cancer. The MR examinations were performed on a clinical MR scanner at 1.5 T. Different breathing gases (air, 2% CO(2) and 98% O(2), 100% oxygen) were administered to induce oxygenation changes. A multigradient echo sequence was used for quantification of the apparent transverse relaxation time T2*. RESULTS : Pixel-by-pixel analysis of the T2* values in tumors showed a shift toward higher values corresponding to oxygenation increase and correlated with a median shift toward positive values in the DeltaT2* fraction under carbogen and oxygen breathing in most but not all patients. A slightly pronounced T2* increase breathing oxygen compared with 2% CO(2)/98% O(2) was found. Furthermore, a statistically significant difference in the heterogeneity of oxygenation changes induced by oxygen or 2% CO(2)/ 98% O(2) breathing was seen. CONCLUSION : Measurement of oxygenation changes in head-and-neck tumor patients is feasible by the presented MRI technique. Tumor oxygenation and oxygenation changes were heterogeneous among the investigated patients. To the authors' knowledge, they are the first to describe a statistically significant difference in the heterogeneity of oxygenation changes induced by oxygen or 2% CO(2)/98% O(2) breathing using a noninvasive MRI technique.
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Affiliation(s)
- Markus Kotas
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany.
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Zwönitzer R, Kalinski T, Hofmann H, Roessner A, Bernarding J. Digital pathology: DICOM-conform draft, testbed, and first results. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2007; 87:181-8. [PMID: 17618703 DOI: 10.1016/j.cmpb.2007.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/16/2007] [Accepted: 05/16/2007] [Indexed: 05/16/2023]
Abstract
Hospital information systems are state of the art nowadays. Therefore, Digital Pathology, also labelled as Virtual Microscopy, has gained increased attention. Triggered by radiology, standardized information models and workflows were world-wide defined based on DICOM. However, DICOM-conform integration of Digital Pathology into existing clinical information systems imposes new problems requiring specific solutions concerning the huge amount of data as well as the special structure of the data to be managed, transferred, and stored. We implemented a testbed to realize and evaluate the workflow of digitized slides from acquisition to archiving. The experiences led to the draft of a DICOM-conform information model that accounted for extensions, definitions, and technical requirements necessary to integrate digital pathology in a hospital-wide DICOM environment. Slides were digitized, compressed, and could be viewed remotely. Real-time transfer of the huge amount of data was optimized using streaming techniques. Compared to a recent discussion in the DICOM Working Group for Digital Pathology (WG26) our experiences led to a preference of a JPEG2000/JPIP-based streaming of the whole slide image. The results showed that digital pathology is feasible but strong efforts by users and vendors are still necessary to integrate Digital Pathology into existing information systems.
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Affiliation(s)
- Ralf Zwönitzer
- Department of Biometry and Medical Informatics, Otto-von-Guericke-University, Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany
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