RC626B MIRC Teaching Files:
Integration in Practice
Adam E. Flanders, MD
Thomas Jefferson University Hospital Philadelphia, Pennsylvania
Disclaimer
Vice-chair of the MIRC Committee for
the RSNA.
Outline
TF basics and principles
Features of a great teaching file
Personal versus community solutions
Free versus subscription models
RSNA – Medical Imaging Resource
Center
Obstacles to TF creation
What is a Teaching File?
An organized repository of clinical images
and documentation.
Used primarily to supplement learning
process for trainees.
Source material for lectures, publications.
Film library model
Shelves of cases (film jackets)
Organized by anatomy, disease, ACR codes.
Vehicle for notoriety.
What are the Qualities of a “Great” Radiology Teaching File
High quality Images
Comprehensive supplemental Information:
path reports, path images, discussion etc. Organization
Indexed and searchable
Fresh content.
Easily accessed from anywhere.
Easy to navigate.
Secure
Problems with Film-Based TF
Limited access.
Typically, a lot of work to
submit a case.
Difficult to solicit “voluntary” contributions.
Difficult to keep
organized.
Missing or misfiled cases or films.
Need a librarian/policeman Securing files = limited
access. Searching file is
problematic. Inconvenient to use for
decision support. Difficult to update/
maintain – keeping material current.
Digitizing Analog Images
Digital Camera on PACS or Viewbox Laborious but effective!
Personal Image Storage Solutions
Basic Requirements for a Real TF
Stand-alone repository.
Key images (not entire studies)
Annotations
Clinical metadata / teaching
points
Discoverable / Searchable
Common TF Authoring Workflow
Save some images.
Save some metadata.
Package and store images and
metadata in TF.
Augment case at a later time.
Minimal Effort Personal TF
Solutions
Personal Digital Teaching Files
Since advent of PACS, radiologists haveamassed “personal” collections of digital images.
Not unlike private film TF collections.
Solutions include simple directory hierarchy on
user PC.
“Image tagging”
Generally used by a single user.
Image collections are limited in scope.
Difficult to “enhance” content.
Content is not readily sharable.
Where to Put Your Images? - Personal DTF
Copy images into folders labeled appropriately. Nested file structure Need to open content in another application for use. Not very versatile
Google - Picasa
Courtesy R. Gorniak, MDGoogle - Gmail
myRSNA - myFiles
A free service provided by RSNA.
Individual storage of files
Native viewers for many format image
format types including DICOM, Powerpoint, video etc.
Ability to tag content, organize and
search.
Components of a Modern DTF
Fileserver Database Webserver Fileserver Database Webserver EthernetHome Built Example
Assembled a simple system to log cases from PACS using a commercial database solution (FileMaker Pro).
Has a built in database manager, fileserver and webserver in one program.
Customization with a mix of proprietary programming language and open languages like Javascript.
Has run continuously on a vintage PC (Windows 2000) for eight years.
Has over 12,000 Neuroradiology/ENT cases indexed in database.
What Are Your Options?
There’s free stuff
There’s subscription
services.
You can build your own.
There’s software you can
MIRC Teaching File Software Suite
Set of software tools that allow you to
create, index, search and display teaching materials.
Repository for this content.
Ability to selectively share this material
in a consistent manner within your institution on your local intranet or
worldwide on the internet.
MIRC factoids
An RSNA sponsored initiative.
Software toolkit that can be used for creation of
teaching repositories and clinical trials databases.
Built on open-source principles.
No proprietary technology.
Uses available standards DICOM, XML, HTTP, JSP, Java
Software is free-of-charge, no licensing.
Software designed to operate on most common
operating systems incl. Windows, Apple OSX and Linux.
PACS vendor neutral.
MIRC Features
Individualized file storage
Multiple document “templates”
Multiple methods to author content
Multiple methods to display content
Web-based DICOM viewer.
Web-based editor.
DICOM receiver (DICOM SCP)
DICOM anonymizer
Administrative control of viewing, editing, deletion.
Scalable and expandable from one author/PC to
hundreds.
Easy to install & configure.
Many more!!!!!
MIRC ZIP Service
MIRC has a methodto automatically convert your “tired” collection into dynamic MIRC webpages. It will convert a nested directory of images annotated with diagnoses and publish
automatically to your MIRC site.
Great way to get
started with MIRC!
Scalability of MIRC
MIRC has the unique ability to scale from
one computer / one user to many computers / many users.
Potential configurations include:
One MIRC repository for one or more users.
Multiple MIRC repositories in one or many institutions.
Software enables development of
cooperative libraries.
Each library is individually administered yet portions can be made accessible to all.
MIRC Software Supports Many
Storage Formats.
Images: DICOM, GIF, JPEG, PNG
Hyperlinks to other web content.
Virtually any content that is
displayable in a web browser.
Pointers to other files for
downloading.
Display support for other types in
Key MIRC Server Components
Storage Service (Warehouse for material)
A cooperating information library.
Index: the library’s card catalog.
Server: the library’s shelves.
Responds to MIRCquery using the
MIRCqueryresponse schema.
Query Service (“Google-like” search portal)
An entry point into the MIRC community for a user on the Internet.
Creates queries using MIRCquery schema.
MIRC TF Configuration Scenarios
Private Mode
Departmental Mode
Division Mode
Worldwide Mode
Variations
BIG MIRC MIRC TF Scenarios Departmental Mode Multiple users or divisions contribute to a single departmental MIRC server. All users have
controlled access.
All can view public cases.
Only owners can modify data.
Private cases are
supported.
One server to
manage for all content. Easier to administer. Neuro MSK Mammo User MIRC TF Scenarios Worldwide Mode Multiple MIRC sites (“MIRClets”) expose content to the Internet. This public content is accessible to other computers that can perform a query of MIRC content.
Internet
How do you access content through MIRC?
MIRC Query
A search is initiated through the MIRC query page.
MIRC query page is a portal or point-of-entry to search & access MIRC content.
Key Concepts:
All MIRC sites “host” a
query page that can access local content.
All MIRC query pages
can list other public MIRC sites.
From the query page, a
user can search one or more public MIRC sites for content.
You don’t need to be a
MIRC site to perform a MIRC query.
MIRC Query
Query Local MIRC MIRC Query The Internet MIRC Query MIRC Query MIRC Query MIRC QueryHow Does the MIRC Query System Work?
ependymoma
The MIRC Authoring Process
MIRC Case Authoring Process
Collect your images. Send your images to the MIRC file
service.
Login to MIRC author service.
Create a new case using a template
Fill in textual content in fields.
Select appropriate images from the
MIRC file service to include with case.
Case is published
Storing Images in MIRC
MIRC software was designed to utilize
common features available by most PACS vendors to export images.
DICOM SCU/SCP (i.e. DICOM export)
Saving images locally to PACS desktop or folder (subdirectory)
Images are uploaded to the MIRC file service
in one of three ways:
Storing Images in MIRC
3 Methods
DICOM export
Upload single image
Upload multiple files (using ZIP archive) myRSNA file share. PACS DICOM Export Single Image ZIP File
MIRC File Service
Container for images.
Two File Storage Areas
Public
Private
Can Transfer Files Between Public
and Private Repositories. Delete, Add or Update files to the
File Service.
Store or utilize myFiles in myRSNA
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) • Copy to/from myFile/myRSNA
New Features in 2009 MIRC T35
Latest MIRC Version T35
• New thumbnail query result page. • Auto-indexing of RadLex terms • New File Cabinet• Drag-and-drop functionality • Conferencing
• Interaction with myRSNA – myFiles service
• Exploit the sharing, tagging and social networking capabilities of myFiles
Authoring to myRSNA
MIRC TF Installation at TJU
Two MIRC servers currently installed.
One departmental (private) server behind university firewall (2003 Server)
One Neuroradiology (public) server residing on the public DMZ of the firewall (2000 Server).
Uses
Primarily Teaching Files
Repository for clinical research data.
Public Neuroradiology Server
Resides on the public internet. Contains interesting Neuroradiology/ENT cases.
Is listed with the RSNA portal.
Contains a subset of our proprietary DTF.
Does not contain the majority of our DTF.
Uses:
PR device for the division.
Provides opportunity for former fellows to “give back” to the division.
Consultation cases are reviewed in weekly case conference.
“Home Grown” Neuroradiology DTF Linked to PACS
Export Function to Public MIRC
Internet Public Neuroradiology MIRC Server firewall Public User Selected Neuro/ENT Cases Are
Pushed Out to Public NeuroRadiology MIRC Server
Using Custom Script Cases on NeuroRadiology/ENT
MIRC Server are Available for Public Access Registered Author Registered Authors (former fellows & staff)
Can Contribute to the Public NeuroRadiology/ENT MIRC Server
How is the Public Site Used?
Public Teaching File Repository for
Neuroradiology/ENT Cases.
Repository for consult cases from prior
fellows and colleagues.
Marketing tool for the TJUH NeuroRad
fellowship.
Central image server for multi-institutional
SCI pharma imaging data.
Private Departmental MIRC Server
Departmental MIRC Server
Serves multiple functions.
Heterogeneous case mix (> 12,000 cases)
Largest proportion MSK (>8300 cases).
Over four thousand Neuro/ENT cases from
“home-grown” server are indexed on server with links back to DTF (index card). Provides support for four clinical research
databases.
“Feeds” to Departmental MIRC Server
Teaching Cases Exported from PACS Teaching Cases Exported from Other DTF using ZIP Service Neuro DTF Index Image Storage
Departmental MIRC Server
HAGL
Users of Departmental Server
Medical students
Residents
Fellows
Rad Faculty
Trainees & staff from clinical
services
Researchers
Uses of Dept MIRC Teaching File
Decision Support
Source of images for
presentations.
Case Conferences
Pre-boards warmup
Compliance with
the authoring
process.
The Authoring Problem
Lessons Learned
The software will not build the
collection for you… Only people will!
The only way to build a great
collection is to encourage multi-user contribution and to build a community
that promotes knowledge sharing.
Even with the best of intentions, it is
Lessons Learned
One or more champions to lead the
process.
Support from leadership.
Authoring must be part of the training
process – learning portfolio.
TF should be incorporated into regular
department activities and curricula. Employ reminders, contests etc.
Make it fun!
Obstacles
The “ownership” issue…
Community property or personal
property?
Collecting images and a
diagnosis are a good start, but is
not enough.
Need librarians that will create
complete documentation of cases.
Keys to Success
Shame people into cooperating!
Make the process fun!
Incorporate your DTF into a regular case
conference.
Concept of a case “aggregator” – all good
material goes into one basket for all to use. Have a periodic Unknown of the Month, Day
or Week.
Encourage trainees to submit answers.
Tie a prize or reward into most correct cases or most submissions.
Ask staff/fellows to select favorite cases for
residents to review from collection.
Confession
Everything is not perfect at home….. Even in a controlled environment in my own
division, compliance with authoring is far from 100%.
Staff tend to pass the buck to busy trainees who “forget” to author at the end of the day.
Variable definition of a valuable case.
Lack of appreciation of “the classics”.
A generalized “fear” to save a case without pathologic proof.
○ “What if I’m wrong????”
TF Holy Grail
Create TF submissions at point-of-care.
A push-button solution.
Ease of use direct from the PACS stations
during clinical readout.
Facilitates the greatest level of compliance
with TF submission.
Submit to TF
Why Aren’t We There Yet??
PACS systems essentially do the same thing; why isn’t there a uniform solution for TF authoring??
The cold, hard truth about TF
The majority of PACS vendors still do not
completely embrace teaching file authoring as a required feature on their systems.
Each offer workarounds with limited functionality.
TF solutions exploit features common to all
PACS.
Ability to save images locally
Export DICOM
+/- web browser support.
A truly integrated solution is pending.
Making Authoring Easy……
IHE has come to the rescue with the TeachingFile and Clinical Trial Export profile.
Profile defines a schema to bundle and export teaching files to a MIRC repository.
A loose standard or “DICOM for TF”
This profile brings us closer to integrating PACS
workflow with TF.
Some PACS vendors are supporting this profile.
Even fewer vendors are actually selling systems with this as a feature.
Summary
Multiple options for personal teaching files.
Community teaching file options continue to
grow with expansion of social networking.
Internal community based teaching files require
IT support for success.
MIRC Teaching File Software Suite offers a viable, robust and scalable system for creating comprehensive DTF collections.
True teaching file functionality is not available
on all PACS systems today.
Software itself will not build a great collection:
People/Cooperation/Community are key!
MIRC Information & Support
Check out the MIRC section on the
RSNA.org website! Support tools:
MIRC Wiki: http://mircwiki.rsna.org