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Chandramohan A, Krothapalli V, Augustin A, Kandagaddala M, Thomas HM, Sudarsanam TD, Jagirdar A, Govil S, Kalyanpur A. Teleradiology and technology innovations in radiology: status in India and its role in increasing access to primary health care. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100195. [PMID: 38404514 PMCID: PMC10884973 DOI: 10.1016/j.lansea.2023.100195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 02/27/2024]
Abstract
Background There is an inequitable distribution of radiology facilities in India. This scoping review aimed at mapping the available technology instruments to improve access to imaging at primary health care; to identify the facilitators and barriers, and the knowledge gaps for widespread adaptation of technology solutions. Methods A search was conducted using broad inclusive terms non-specific to subtypes of medical imaging devices or informatics. Work published in the English language between 2005 and 2022, conducted primarily in India, and with full manuscripts were included. Two authors independently screened the abstracts against the inclusion criteria for full-text review and a senior author settled discrepancies. Data were extracted using DistillerSR software. Findings 43 original articles and 52 non-academic materials were finally reviewed. The data was from 10 Indian states with n = 9 from rural settings. The broad trends in original articles were: connectivity using teleradiology (n = 7), mobile digital imaging units (n = 9), artificial intelligence (n = 16); mobile devices and smartphone applications (n = 7); data security (n = 7) and web-based technology (n = 2); public-private partnership (n = 9); cost (n = 2); concordance (n = 19); evaluation (n = 4); implementation (n = 2). Interpretation Available evidence suggests that teleradiology when combined with AI and mobile digital imaging units can address radiologist shortages; strengthen programs aimed at population screening and emergency care. However, there is insufficient data on the scale of teleradiology networks within India; needs assessment; cost; facilitators, and barriers for implementation of technologies solutions in primary healthcare settings. Regulations governing quality standards, data protection, and confidentiality are unclear. Funding The authors are The Lancet Citizen's Commission fellows. The Lancet Commission has received financial support from the Lakshmi Mittal and Family South Asia Institute, Harvard University; Christian Medical College, Vellore (CMC), Vellore; Azim Premji Foundation, Infosys; Kirloskar Systems Ltd.; Mahindra & Mahindra Ltd.; Rohini Nilekani Philanthropies; and Serum Institute of India. The views expressed are those of the author(s) and not necessarily those of the Lancet Citizens' Commission or its partners.
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Affiliation(s)
| | | | - Ann Augustin
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | | | | | | | | | - Shalini Govil
- Department of Radiology, Christian Medical College, Vellore, 632004, India
- Naruvi Hospital, Vellore, India
- Pun Hlaing Hospital, Myanmar
| | - Arjun Kalyanpur
- Teleradiology Solutions, Whitefield, Bengaluru, Karnataka, 560048, India
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Chen TT, Sun YC, Chu WC, Lien CY. BlueLight: An Open Source DICOM Viewer Using Low-Cost Computation Algorithm Implemented with JavaScript Using Advanced Medical Imaging Visualization. J Digit Imaging 2023; 36:753-763. [PMID: 36538245 PMCID: PMC10039132 DOI: 10.1007/s10278-022-00746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Recently, WebGL has been widely used in numerous web-based medical image viewers to present advanced imaging visualization. However, in the scenario of medical imaging, there are many challenges of computation time and memory consumption that limit the use of advanced image renderings, such as volume rendering and multiplanar reformation/reconstruction, in low-cost mobile devices. In this study, we propose a client-side rendering low-cost computation algorithm for common two- and three-dimensional medical imaging visualization implemented by pure JavaScript. Particularly, we used the functions of cascading style sheet transform and combinate with Digital Imaging and Communications in Medicine (DICOM)-related imaging to replace the application programming interface with high computation to reduce the computation time and save memory consumption while launching medical imaging interpretation on web browsers. The results show the proposed algorithm significantly reduced the consumption of central and graphics processing units on various web browsers. The proposed algorithm was implemented in an open-source web-based DICOM viewer BlueLight; the results show that it has sufficient rendering performance to display 3D medical images with DICOM-compliant annotations and has the ability to connect to image archive via DICOMweb as well.Keywords: WebGL, DICOMweb, Multiplanar reconstruction, Volume rendering, DICOM, JavaScript, Zero-footprint.
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Affiliation(s)
- Tseng-Tse Chen
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Chou Sun
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Deptartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Woei-Chyn Chu
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Yueh Lien
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Doran SJ, Al Sa’d M, Petts JA, Darcy J, Alpert K, Cho W, Sanchez LE, Alle S, El Harouni A, Genereaux B, Ziegler E, Harris GJ, Aboagye EO, Sala E, Koh DM, Marcus D. Integrating the OHIF Viewer into XNAT: Achievements, Challenges and Prospects for Quantitative Imaging Studies. Tomography 2022; 8:497-512. [PMID: 35202205 PMCID: PMC8875191 DOI: 10.3390/tomography8010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: XNAT is an informatics software platform to support imaging research, particularly in the context of large, multicentre studies of the type that are essential to validate quantitative imaging biomarkers. XNAT provides import, archiving, processing and secure distribution facilities for image and related study data. Until recently, however, modern data visualisation and annotation tools were lacking on the XNAT platform. We describe the background to, and implementation of, an integration of the Open Health Imaging Foundation (OHIF) Viewer into the XNAT environment. We explain the challenges overcome and discuss future prospects for quantitative imaging studies. Materials and methods: The OHIF Viewer adopts an approach based on the DICOM web protocol. To allow operation in an XNAT environment, a data-routing methodology was developed to overcome the mismatch between the DICOM and XNAT information models and a custom viewer panel created to allow navigation within the viewer between different XNAT projects, subjects and imaging sessions. Modifications to the development environment were made to allow developers to test new code more easily against a live XNAT instance. Major new developments focused on the creation and storage of regions-of-interest (ROIs) and included: ROI creation and editing tools for both contour- and mask-based regions; a "smart CT" paintbrush tool; the integration of NVIDIA's Artificial Intelligence Assisted Annotation (AIAA); the ability to view surface meshes, fractional segmentation maps and image overlays; and a rapid image reader tool aimed at radiologists. We have incorporated the OHIF microscopy extension and, in parallel, introduced support for microscopy session types within XNAT for the first time. Results: Integration of the OHIF Viewer within XNAT has been highly successful and numerous additional and enhanced tools have been created in a programme started in 2017 that is still ongoing. The software has been downloaded more than 3700 times during the course of the development work reported here, demonstrating the impact of the work. Conclusions: The OHIF open-source, zero-footprint web viewer has been incorporated into the XNAT platform and is now used at many institutions worldwide. Further innovations are envisaged in the near future.
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Affiliation(s)
- Simon J. Doran
- Division of Radiotherapy and Imaging, Institute of Cancer Research, 15 Cotswold Rd, London SM2 5NG, UK;
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
| | - Mohammad Al Sa’d
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
- Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College, London SW7 2AZ, UK
| | - James A. Petts
- Ovela Solutions Ltd., 20-22 Wenlock Road, London N1 7GU, UK;
| | - James Darcy
- Division of Radiotherapy and Imaging, Institute of Cancer Research, 15 Cotswold Rd, London SM2 5NG, UK;
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
| | - Kate Alpert
- Flywheel LLC, 1015 Glenwood Ave, Suite 300, Minneapolis, MN 55405, USA; (K.A.); (D.M.)
| | - Woonchan Cho
- Neuroimaging Informatics Analysis Center, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA;
| | - Lorena Escudero Sanchez
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
- Department of Radiology, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, UK
- Cancer Research UK Cambridge Centre, University of Cambridge Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Sachidanand Alle
- NVIDIA, 2788 San Tomas Expressway, Santa Clara, CA 95051, USA; (S.A.); (A.E.H.); (B.G.)
| | - Ahmed El Harouni
- NVIDIA, 2788 San Tomas Expressway, Santa Clara, CA 95051, USA; (S.A.); (A.E.H.); (B.G.)
| | - Brad Genereaux
- NVIDIA, 2788 San Tomas Expressway, Santa Clara, CA 95051, USA; (S.A.); (A.E.H.); (B.G.)
| | - Erik Ziegler
- Open Health Imaging Foundation, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; (E.Z.); (G.J.H.)
- Radical Imaging LLC, 188 Annie Moore Rd, Bolton, MA 01740-1140, USA
| | - Gordon J. Harris
- Open Health Imaging Foundation, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; (E.Z.); (G.J.H.)
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Eric O. Aboagye
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
- Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College, London SW7 2AZ, UK
| | - Evis Sala
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
- Department of Radiology, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, UK
- Cancer Research UK Cambridge Centre, University of Cambridge Li Ka Shing Centre, Robinson Way, Cambridge CB2 0RE, UK
| | - Dow-Mu Koh
- CRUK National Cancer Imaging Translational Accelerator, UK; (M.A.S.); (L.E.S.); (E.O.A.); (E.S.); (D.-M.K.)
- Department of Radiology, Royal Marsden Hospital, Downs Rd, Sutton SM2 5PT, UK
| | - Dan Marcus
- Flywheel LLC, 1015 Glenwood Ave, Suite 300, Minneapolis, MN 55405, USA; (K.A.); (D.M.)
- Neuroimaging Informatics Analysis Center, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA;
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Patel V, Li CH, Rye V, Liu CSJ, Lerner A, Acharya J, Rajamohan AG. A Comparison of WebRTC and Conventional Videoconferencing for Synchronized Remote Medical Image Presentation. J Digit Imaging 2021; 35:68-76. [PMID: 34935095 PMCID: PMC8691158 DOI: 10.1007/s10278-021-00544-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/18/2021] [Accepted: 11/11/2021] [Indexed: 10/26/2022] Open
Abstract
DICOM viewers must fulfill roles beyond primary diagnostic interpretation, including serving as presentation tools in teaching and multidisciplinary conferences, thereby enabling multiple individuals to review images collaboratively in real time. When in-person gathering is not possible, a variety of solutions have been deployed to maintain the ability for spatially separated users to view medical images simultaneously. These approaches differ in their backend architectures, utilization of application-specific optimizations, and ultimately in their end user satisfaction. In this work, we systematically compare the performance of conventional screensharing using a videoconferencing application with that of a custom, synchronized DICOM viewer linked using Web Real Time Communications (WebRTC) technology. We find superior performance for the WebRTC method with regard to image quality and latency across a range of simulated adverse network conditions, and we show how increasing the number of conference participants differentially affects the bandwidth requirements of the two viewing solutions. In addition, we compare these two approaches in a real-world teaching scenario and gather the feedback of trainee and faculty radiologists, who we found to favor the WebRTC method for its decreased latency, improved image quality, ease of setup, and overall experience. Ultimately, our results demonstrate the value of application-specific solutions for the remote synchronized viewing of medical imaging, which, given the recent increase in reliance on remote collaboration, may constitute a significant consideration for future enterprise viewer procurement decisions.
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Affiliation(s)
- Vishal Patel
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 2025 Zonal Ave, Los Angeles, CA, 90033, USA.
| | - Charles H Li
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Van Rye
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Chia-Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
| | - Anandh G Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, 2nd Floor, Los Angeles, CA, 90033, USA
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