How to Set Up a System for Teaching Files and Clinical Trials

Medical Imaging Resource Center

MIRC InfoRad Courses

How to Set Up a System for Teaching Files and Clinical Trials

How to Author MIRC Teaching Files

MIRC Case Studies: Using MIRC for Education and Research

Web Classroom Sessions

MIRC Objective

Support the production, storage, indexing and distribution of medical imaging resources:

– Teaching files– Scientific & technical documentation– Research images & datasets– Clinical trials data

MIRC Concepts

The key concepts:– MIRC is a community of cooperating libraries

on the Internet.– The libraries cooperate by supporting a

common query mechanism.– The query mechanism allows users to find

information wherever it is stored.

MIRC Information Formats

Images: DICOM, GIF, JPEG, PNG

Anything that is displayable by a web browser

Hyperlinks to other web content

Pointers to files for downloading

The MIRC Community

InternetInternet

ServerServer

IndexMIRC Sites

ServerServer

Index

RSNA

User

ServerServerIndexMIRC Storage Service:- Document Authoring- Document Storage- Document Indexing- Web Server

MIRC Query Service:- Access to the community

The RSNA MIRC Software

Query Service

Storage Service

- Storage Service - XML Server

- Submit Service - Author Service

- DICOM Service - Admin Service

File ServicePrivate and public file cabinets

Query Service

Standard query form31 defined query fields:

Free text Clinical content

Document attributes Image attributes

Document content Patient attributes

Links to Storage Service Functions

Queries a single site, selected sites, or the entire community

Query Service

Query Service

Two display formats for query results:Standard query results

Title (hyperlink)

Author

Abstract

Case NavigatorRandom or ordered

Known and unknown presentations

Standard Query Results

The Case Navigator

Intended for teaching file cases

Storage Service

Stores and indexes documents

A single MIRC site can have multiple Storage Services for different purposes

– Teaching files for each department/specialty

– Individual services for each clinical trial

XML Server

Serves documents to users on the web

Transforms XML files to other formats

Multiple display formats (page, tab, mstf)

Exports documents and datasets to users

XML Server

Provides access control for:– read, update, export

Restricts access for:– owners, users, roles (user groups), public

Supports private (owner-only) sections of otherwise public documents

Display Formats

Page

Tab

MSTF

Submit Service

Allows users to upload MIRC documents to a storage service

– Supports connections from client-side authoring tools

– Supports uploading documents via a browser– Accepts uploads in the format exported by

the XML Server

Author Service

Allows users to create MIRC documents directly on the Storage Service

Supports multiple templates to allow for the creation of different kinds of documents

Links to the File Service for inserting links to images and other documents

What goes in a teaching file case?

Whatever you want:History Differential Diagnosis

Findings Discussion

Diagnosis Quizzes

References

Images, drawings, videos, audios, …

Admin Service

Allows administrators to manage a Storage Service through a browser

– Control the documents on the Storage Service– Adjudicate the input queue for non-publishers– Configure the Storage Service and DICOM

Service– Control and monitor the DICOM Service– Manage users and roles

File Service

Each authenticated user has a private file cabinet for storage of files of any kind

One public file cabinet for the site

Public file cabinet receives DICOM objects from PACS, modalities, workstations

– Separate anonymizer

Author Service connection

The File Service

Demonstration

XMLServerXMLServer

OS FileOS FileSystemSystem

SubmitSubmitServiceService

InputInputQueueQueue

StorageStorageServiceService

MIRCMIRCIndexIndex

AdminAdminServiceService

HTTPHTTPExportExport

HTTPHTTPImportImport

AuthorAuthorServiceService

FileFileServiceService

DICOMDICOMExportExport

DICOMDICOMImportImport

Ob

jec

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roc

es

so

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bje

ct

Pro

ce

ss

or

MIRCMIRCAnonymizerAnonymizer

MIRCMIRCAnonymizerAnonymizer

DICOMDICOMImportImport

QueryQueryServiceService

DatabaseDatabaseExportExport

The Components of a MIRC Site

DICOM Service

Receives DICOM objects from PACS, workstations, modalities, …Automatic document generation

– Images grouped into documents by study– Template-driven– Automatic JPEG generation from DICOM– Programmable anonymization (de-

identification and re-identification)

DICOM Service

Automatic trial patient ID generationConnection to other DICOM Services for clinical trials

– Support for encrypted communications (SSL)

DICOM import / DICOM exportHTTP(S) import / HTTP(S) exportDatabase export

Database Interface

Links to an externally developed database

Provides classes for interrogating:– DICOM objects– Metadata files:

• XML• ZIP (with manifest)

Anonymization for DICOM and XML objects

FCDICOM

FCDICOM

FCDICOM

PIDICOM

PI

DICOM

MIRC Clinical Trial Configuration

MIRC FieldCenter Application:- Image reception- Anonymization- Transmission to PI

MIRC Site:- Image reception- Image Storage- Transfer to PACS and/or workstations

Firewalls

InternetHTTPHTTPS

Database

HTTP

HTTP

DICOM

Lessons from Field Centers

IT departments are overworked.

Network configuration can be a problem.

– Firewalls, proxy servers, VPNs

Running a MIRC site at a Field Center just for image acquisition is overkill.

Therefore…

The FieldCenter Application

Runs at the image acquisition site

Receives images and metadata files via the DICOM and HTTP(S) protocols

Anonymizes images and metadata files

Transmits to the PI MIRC site via HTTP(S)

Automatically links to the PI MIRC site for remapping tables and software updates

Anonymization

Removal of Protected Health Information (PHI)

Remapping of PHI to trial-specific identifiers

Central vs. distributed remapping tables are an issue in a multi-site trial

Metadata anonymization may also be required in some trials

The FieldCenter Application

The FieldCenter Application

The FieldCenter Application

The FieldCenter Application

The FieldCenter Application

The FieldCenter Application

The FieldCenter Application

The RSNA MIRC Software

Available on the RSNA MIRC site (mirc.rsna.org)– Click the Downloads link in the header

The RSNA MIRC Software

Runs on Mac, Windows, LinuxThree components:

Java / Tomcat / MIRC

All components are freeMIRC Users Group meetings:

11/28 1:30 - 3:3012/1 12:30 - 2:30

Questions/Answers & Help

RSNA Forums:– http://forums.rsna.org

– User Comments, Questions and Answers– RSNA MIRC Software Announcements– MIRC Implementers’ Corner– MIRC Technical Review Committee

Subscribe on the Forums site