PACS through web compatible with DICOM standard and WADO service: advantages and implementation

DICOM Integration Libraries for Medical Image Interoperability: A Technical Review

Medical images support diagnostic care and research in medicine. The acquisition and availability of medical images in digital form can facilitate quick diagnosis, ease of access, continuity of care, analysis and contribute to modern medical research. Digital Imaging and Communications in Medicine (DICOM) is a universal standard that promises standardized representation and exchange of medical images and related information from various radiological and waveform sources. DICOM software development kits or tools or libraries make it easier to implement DICOM standard in healthcare applications. There are several such API libraries available from different providers that promise DICOM integration. In this paper, we explore available DICOM API libraries and conduct a comparative study between a set of selected libraries on the four major criteria (DICOM features, technical aspects, the robustness of the library, and the level of user support available). The aim is to provide a complete picture of options available that can help in finding a best-fit open-source DICOM standard integration API library for developing standardized and interoperable healthcare applications.

An Enhanced Device-Transparent Real-Time Teleconsultation Environment for Radiologists

This paper describes a novel web-based platform promoting real-time advanced teleconsultation services on medical imaging. Principles of heterogeneous workflow management systems and state-of-the-art technologies such as the microservices architectural pattern, peer-to-peer networking, and the single-page application concept are combined to build a scalable and extensible platform to aid collaboration among geographically distributed healthcare professionals. The real-time communication capabilities are based on the webRTC protocol to enable direct communication among clients. This paper discusses the conceptual and technical details of the system, emphasizing on its innovative elements.

A Survey of DICOM Viewer Software to Integrate Clinical Research and Medical Imaging

The digital imaging and communications in medicine (DICOM) protocol is the leading standard for image data management in healthcare. Imaging biomarkers and image-based surrogate endpoints in clinical trials and medical registries require DICOM viewer software with advanced functionality for visualization and interfaces for integration. In this paper, a comprehensive evaluation of 28 DICOM viewers is performed. The evaluation criteria are obtained from application scenarios in clinical research rather than patient care. They include (i) platform, (ii) interface, (iii) support, (iv) two-dimensional (2D), and (v) three-dimensional (3D) viewing. On the average, 4.48 and 1.43 of overall 8 2D and 5 3D image viewing criteria are satisfied, respectively. Suitable DICOM interfaces for central viewing in hospitals are provided by GingkoCADx, MIPAV, and OsiriX Lite. The viewers ImageJ, MicroView, MIPAV, and OsiriX Lite offer all included 3D-rendering features for advanced viewing. Interfaces needed for decentral viewing in web-based systems are offered by Oviyam, Weasis, and Xero. Focusing on open source components, MIPAV is the best candidate for 3D imaging as well as DICOM communication. Weasis is superior for workflow optimization in clinical trials. Our evaluation shows that advanced visualization and suitable interfaces can also be found in the open source field and not only in commercial products.

SmartWADO: an Extensible WADO Middleware for Regional Medical Image Sharing

Medical image sharing is an important problem in modern radiology, with wide applications in Internet and mobile devices. Some important features need to be added and optimized to medical image sharing. In this paper, we present an extensible Web Access to DICOM Persistent Objects (WADO) middleware based on image cache and real-time Web monitor technology for regional medical image sharing. We first develop the extension method of WADO standard and workflow of extended WADO service. Then, we design a medical image cache method to improve the performance of medical image on-demand transmission. Using the real-time monitor can discover the performance bottlenecks and optimized critical points. The experimental results show that the middleware effectively delivers medical images and reports to Web clients over the Internet, regardless of the platform used for access. It can be deployed in one hospital to provide WADO service to medical workers and also can be applied to regional picture archiving and communication systems (PACS) to transmit medical images and reports to Internet users in a way that is transparent to end-user applications.

DICOM for Clinical Research: PACS-Integrated Electronic Data Capture in Multi-Center Trials

Providing surrogate endpoints in clinical trials, medical imaging has become increasingly important in human-centered research. Nowadays, electronic data capture systems (EDCS) are used but binary image data is integrated insufficiently. There exists no structured way, neither to manage digital imaging and communications in medicine (DICOM) data in EDCS nor to interconnect EDCS with picture archiving and communication systems (PACS). Manual detours in the trial workflow yield errors, delays, and costs. In this paper, requirements for a DICOM-based system interconnection of EDCS and research PACS are analysed. Several workflow architectures are compared. Optimized for multi-center trials, we propose an entirely web-based solution integrating EDCS, PACS, and DICOM viewer, which has been implemented using the open source projects OpenClinica, DCM4CHEE, and Weasis, respectively. The EDCS forms the primary access point. EDCS to PACS interchange is integrated seamlessly on the data and the context levels. DICOM data is viewed directly from the electronic case report form (eCRF), while PACS-based management is hidden from the user. Data privacy is ensured by automatic de-identification and re-labelling with study identifiers. Our concept is evaluated on a variety of 13 DICOM modalities and transfer syntaxes. We have implemented the system in an ongoing investigator-initiated trial (IIT), where five centers have recruited 24 patients so far, performing decentralized computed tomography (CT) screening. Using our system, the chief radiologist is reading DICOM data directly from the eCRF. Errors and workflow processing time are reduced. Furthermore, an imaging database is built that may support future research.

Real-time medical collaboration services over the web

The gradual shift in modern medical practice, from working alone clinical doctors to MDTs (Multi-Disciplinary Teams), raises the need of online real-time collaboration among geographically distributed medical personnel. The paper presents a Web-based platform, featuring an efficient medical data management and exchange, for hosting real-time collaborative services. The presented work leverages state-of-the-art features of the web (technologies and APIs) to support client-side medical data processing. Moreover, to address the typical bandwidth bottleneck and known scalability issues of centralized data sharing, an indirect RPC (Remote Process Call) scheme is introduced through object synchronization over the WebRTC paradigm.

Data Standards in Tele-radiology

Data standards play an important role to provide interoperability among different system. As other applications of telemedicine, the tele-radiology needs these standards to work properly. In this article, we conducted a review to introduce some data standards about tele-radiology. By searching PUBMED and Google Scholar database, we find more relevant articles about data standards in tele-radiology. Three categories of standards identified, including data interchange, document and terminology standards. Data interchange standards, including those which facilitate the understanding of the format of a massage between systems, such as DICOM and HL7. Document standards, including those which facilitate the contents of a massage, such as DICOM SR and HL7 CDA. And terminology standards, including those which facilitate the understanding of concepts of the domain. Since, the harmonization between different standards are important to meet interoperability, so the more effort is needed to conduct harmonization between tele-radiology standards and other domain.

Leveraging Internet technologies with DICOM WADO

The digital imaging and communications in medicine (DICOM) 3.0 standard was first officially ratified by the national electrical manufacturers association in 1993. The success of the DICOM open standard cannot be overstated in its ability to enable an explosion of innovation in the best of breed picture archiving and communication systems (PACS) industry. At the heart of the success of allowing interoperability between disparate systems have been three fundamental DICOM operations: C-MOVE, C-FIND, and C-STORE. DICOM C-MOVE oversees the transfer of DICOM Objects between two systems using C-STORE. DICOM C-FIND negotiates the ability to discover DICOM objects on another node. This paper will discuss the efforts within the DICOM standard to adapt this core functionality to Internet standards. These newer DICOM standards look to address the next generation of PACS challenges including highly distributed mobile acquisition systems and viewing platforms.

Managing biomedical image metadata for search and retrieval of similar images

Radiology images are generally disconnected from the metadata describing their contents, such as imaging observations ("semantic" metadata), which are usually described in text reports that are not directly linked to the images. We developed a system, the Biomedical Image Metadata Manager (BIMM) to (1) address the problem of managing biomedical image metadata and (2) facilitate the retrieval of similar images using semantic feature metadata. Our approach allows radiologists, researchers, and students to take advantage of the vast and growing repositories of medical image data by explicitly linking images to their associated metadata in a relational database that is globally accessible through a Web application. BIMM receives input in the form of standard-based metadata files using Web service and parses and stores the metadata in a relational database allowing efficient data query and maintenance capabilities. Upon querying BIMM for images, 2D regions of interest (ROIs) stored as metadata are automatically rendered onto preview images included in search results. The system's "match observations" function retrieves images with similar ROIs based on specific semantic features describing imaging observation characteristics (IOCs). We demonstrate that the system, using IOCs alone, can accurately retrieve images with diagnoses matching the query images, and we evaluate its performance on a set of annotated liver lesion images. BIMM has several potential applications, e.g., computer-aided detection and diagnosis, content-based image retrieval, automating medical analysis protocols, and gathering population statistics like disease prevalences. The system provides a framework for decision support systems, potentially improving their diagnostic accuracy and selection of appropriate therapies.

A RESTful image gateway for multiple medical image repositories

Mobile technologies are increasingly important components in telemedicine systems and are becoming powerful decision support tools. Universal access to data may already be achieved by resorting to the latest generation of tablet devices and smartphones. However, the protocols employed for communicating with image repositories are not suited to exchange data with mobile devices. In this paper, we present an extensible approach to solving the problem of querying and delivering data in a format that is suitable for the bandwidth and graphic capacities of mobile devices. We describe a three-tiered component-based gateway that acts as an intermediary between medical applications and a number of Picture Archiving and Communication Systems (PACS). The interface with the gateway is accomplished using Hypertext Transfer Protocol (HTTP) requests following a Representational State Transfer (REST) methodology, which relieves developers from dealing with complex medical imaging protocols and allows the processing of data on the server side.

WADA service: an extension of DICOM WADO service

The Web Access to Digital Imaging and Communication in Medicine (DICOM) Persistent Objects (WADO) service is standardized as the Web extension to DICOM. This paper analyzes the operational specifications of the WADO service and extends its access capability to the whole DICOM hierarchy (patient, study, series, and object). The proposed Web Access to DICOM Archives (WADA) service, as opposed to WADO, also includes an extrainternal query mechanism and support of medical reports submission. A pilot implementation of WADA as software components and their integration into a three-tier architecture are also presented. Advanced security mechanisms are augmented to ensure communication encryption, user identification, and access restriction to data according to user roles. The proposed service is a simple approach, and can be embedded in any system managing medical images and reports. WADA can also be integrated into the Cross-Enterprise Document Sharing-Imaging (XDS-I) standard, which is considered to be the most likely future standard for medical imaging exchange.