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Transcript of Le logiciel libre au service de l'imagerie médicale par Sébastien Jodogne | Liege Creative,...
Vendredi 21 mars
Le logiciel libre au service de l'imagerie médicale
Sébastien JODOGNE, Medical Imaging Engineer, ULg - CHU, Department of Medical Physics
Dans le cadre du festival ImagéSanté
Avec le soutien de :
IntroductionOrthanc
Free and Open-Source Software
Le logiciel libre au service de l’imagerie medicale
Sebastien Jodogne
21 mars 2014
1 / 43
IntroductionOrthanc
Free and Open-Source Software
Who Am I?
PhD in Computer Science (ULg, 2006):
Software engineering.Computer vision = machine learning + image processing.High-performance computing.Theoretical computer science.
Professional experience in private companies:
CCTV – Closed circuit television (Euresys, Secosys),Machine vision (Euresys, Jomago),Broadcasting (EVS).
Since 2011: Medical imaging engineer at the CHU of Liege(Department of medical physics).
2 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Imaging Flows for Radiology
Hospital Information System
Radiology Information System
Picture Archiving &Communication System (PACS)
+
3 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
RIS/PACS Manufacturers
4 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
RIS/PACS Manufacturers
4 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Radiotherapy
What is Radiotherapy?
“The medical use of ionizing radiation, generally as partof cancer treatment, to control or kill malignant cells.”
CHU of Liege
≈ 2600 new cases per year.
First radiotherapy department in Belgium (6 linacs).
5 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Radiotherapy Manufacturers
6 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
The Evolution of Radiotherapy
Surgical Strike
Main Problem
How to identify the target? ⇒ Medical Imaging
7 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
The Evolution of Radiotherapy
Surgical Strike
Main Problem
How to identify the target? ⇒ Medical Imaging
7 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Multimodal Medical Imaging for Radiotherapy
CT + MRI + PET-CT
8 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Imaging Flows for External Radiotherapy
Simulation CT
MRI
PET-CT Nuclear medicine
Contouring Ballistics
Treatment
CyberKnife
Many imaging flows, everything is done with DICOM!
9 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Imaging Flows for External Radiotherapy
Simulation CT
MRI
PET-CT Nuclear medicine
Contouring Ballistics
Treatment
CyberKnife
Many imaging flows, everything is done with DICOM! 9 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
What Is DICOM?
1 File Format:
One image slice + Patient metadata
2 Network Protocol — Early example of Web services:
Send local images,
Search remote images,
Retrieve remote images.
10 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
What Is DICOM?
1 File Format:
One image slice + Patient metadata
2 Network Protocol — Early example of Web services:
Send local images,
Search remote images,
Retrieve remote images.
10 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
What Is DICOM?
1 File Format:
One image slice + Patient metadata
2 Network Protocol — Early example of Web services:
Send local images,
Search remote images,
Retrieve remote images.
10 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
What’s the Matter with DICOM?
Part of the Solution
De-facto standard in medical imaging.
Mature (30 years old).
Supported by any medical device.
Part of the Problem
Large and complex (over 4000 pages).
Old format (redundant with XML, JPEG, PNG. . . ),
Custom network protocol (redundant with SOAP, REST. . . ).
Huge number of files (e.g. 3D images split slice-by-slice)⇒ Redundancies between DICOM files.
Not developer-friendly (complex parsing).
11 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
What’s the Matter with DICOM?
Part of the Solution
De-facto standard in medical imaging.
Mature (30 years old).
Supported by any medical device.
Part of the Problem
Large and complex (over 4000 pages).
Old format (redundant with XML, JPEG, PNG. . . ),
Custom network protocol (redundant with SOAP, REST. . . ).
Huge number of files (e.g. 3D images split slice-by-slice)⇒ Redundancies between DICOM files.
Not developer-friendly (complex parsing).
11 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (1/4)
Data from a single patient:
No uniform convention to organize this data.
How to exchange this data between computers?
How to easily access the embedded medical information?
12 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (1/4)
Wish #1
Transparent, automated indexing of DICOM files.
Work on low-end desktop computer.
Create ZIP files of a patient.
13 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (2/4)
Radiotherapy systems
Another hospital
No DVD reader?!
14 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (2/4)
Radiotherapy systems
Another hospital
No DVD reader?!
14 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (2/4)
Wish #2
Read CD/DVD with DICOM images with any computer.
Upload the images to various DICOM stores.
15 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (3/4)
Nuclear medicine
Radiotherapy
CT + PET + Contours
Removed each day!
16 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (3/4)
Nuclear medicine
Radiotherapy
CT + PET + Contours
Removed each day!
16 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (3/4)
Nuclear medicine
Radiotherapy
CT + PET + Contours
Removed each day!
16 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (3/4)
Wish #3
Deploy decentralized, task-centric DICOM buffers.
Browse their content from anywhere in the hospital to:1 Quickly re-transmit images.2 Connect to viewers or specialized analysis tools.
Nuclear Medicine
DICOM Buffer
Radiotherapy
(1) Re-transmit
(2) View/analyze
17 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (4/4)
CBCT
DICOM
Study server
SFTP
Script
Automated anonymization/forwarding for public clinical studies?
18 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Real-World Software Problems in Hospitals (4/4)
Wish #4
React to the incoming of DICOM images.
Drive low-level DICOM tasks (e.g. anonymization) byhigh-level requirements.
Focus on network administrators (scripting).
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1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Summary: The Medical Context
1 Explosion of the number and volume of medical images.
2 Data management and exchange of images are problematic.3 Many manufacturers are involved:
Proprietary, costly, closed software.Limited interoperability.
4 Imaging workflow is to be automated (cf. anonymization).
5 Low-end, locked computers.
Summary: The Software Expectations
Need for automated image indexing.
Need for intuitive, ubiquitous interface (Web browsers).
Need for DICOM scripting.
Need for free, open product (customizable).
Need for lightweight software (1 installation for 1 flow).
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IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Summary: The Medical Context
1 Explosion of the number and volume of medical images.
2 Data management and exchange of images are problematic.3 Many manufacturers are involved:
Proprietary, costly, closed software.Limited interoperability.
4 Imaging workflow is to be automated (cf. anonymization).
5 Low-end, locked computers.
Summary: The Software Expectations
Need for automated image indexing.
Need for intuitive, ubiquitous interface (Web browsers).
Need for DICOM scripting.
Need for free, open product (customizable).
Need for lightweight software (1 installation for 1 flow).20 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Main Free Software for DICOM
DICOM Toolkits
DCMTK (format, protocol),
GDCM (format, client-only).
Limitations
Close-to-metal: sysadmins?
No indexing.
No Web interface.
PACS Engines
Dcm4che,
ClearCanvas,
ConQuest.
Limitations
Heavyweight, complex.
Not for low-end computers.
Still need a DICOM parser.
Conclusion
Hospitals need another free tool!
21 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Main Free Software for DICOM
DICOM Toolkits
DCMTK (format, protocol),
GDCM (format, client-only).
Limitations
Close-to-metal: sysadmins?
No indexing.
No Web interface.
PACS Engines
Dcm4che,
ClearCanvas,
ConQuest.
Limitations
Heavyweight, complex.
Not for low-end computers.
Still need a DICOM parser.
Conclusion
Hospitals need another free tool!
21 / 43
IntroductionOrthanc
Free and Open-Source Software
Radiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
Main Free Software for DICOM
DICOM Toolkits
DCMTK (format, protocol),
GDCM (format, client-only).
Limitations
Close-to-metal: sysadmins?
No indexing.
No Web interface.
PACS Engines
Dcm4che,
ClearCanvas,
ConQuest.
Limitations
Heavyweight, complex.
Not for low-end computers.
Still need a DICOM parser.
Conclusion
Hospitals need another free tool!
21 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
22 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
22 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Philosophy
1 Compromise between a DICOM toolkit and a PACS.
2 Lightweight DICOM store (runs on low-end computers).
3 Cross-platform (Windows, Linux, Mac OS).
4 Immediate to deploy (standalone, no external database).
5 Simple Web interface to explore the content of the store⇒ Connect from anywhere in the hospital.
6 DICOM to modern formats and protocols (PNG, JSON, HTTP).
7 Open-source and developed inside the CHU of Liege.
23 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Web Interface in Action
Features
“Patient → Study →Series → Instance”transparent indexing.
Preview 2D images.
Inspect DICOM tags.
Send to remotemodalities.
Download ZIP files.
Anonymize.
Demo
24 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Web Interface in Action
Features
“Patient → Study →Series → Instance”transparent indexing.
Preview 2D images.
Inspect DICOM tags.
Send to remotemodalities.
Download ZIP files.
Anonymize.
Demo
24 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Web Interface in Action
Features
“Patient → Study →Series → Instance”transparent indexing.
Preview 2D images.
Inspect DICOM tags.
Send to remotemodalities.
Download ZIP files.
Anonymize.
Demo
24 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Web Interface in Action
Features
“Patient → Study →Series → Instance”transparent indexing.
Preview 2D images.
Inspect DICOM tags.
Send to remotemodalities.
Download ZIP files.
Anonymize.
Demo
24 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Scripting Orthanc
Orthanc features a powerful scripting language (REST API).
Software administrators can automate imaging flows:1 Watch the arrival of new DICOM images,2 Check the value of some DICOM tags,3 React accordingly (forward, anonymize. . . ).
Orthanc can be embedded into third-party systems for theorganization of medical images (replacement to storescp).
25 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Python Sample — Autorouting to the PACS
current = 0while True:
# Wait for new events in Orthanc (event polling loop)r = DoGet(’http://localhost:8042/changes’, { ’since’ : current })
# React when a new instance is receivedfor change in r[’Changes’]:
if change[’ChangeType’] == ’NewInstance’:
# Send the new instance to the PACSinstanceId = str(change[’ID’])DoPost(’http://localhost:8042/modalities/pacs/store’, instanceId)
# Remove the instance from OrthancDoDelete(’http://localhost:8042/instances/%s’ % instanceId)
current = r[’Last’]time.sleep(1)
26 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Current Applications of Orthanc
DICOM buffer for transmission errors:
Nuclear Medicine dept. → Radiotherapy dept.,Treatment Planning System → Treatment machines,
Autorouting and filtering to third-party DICOM servers.
Anonymization platform for clinical research with firms.
Collect in-room images for radiotherapy research.
Automated quality control of PET-CT scanners.
Automated quantification of focal fibrosis on cardiac MRI.
Import of CD/DVD from other hospitals (for modalities notintegrated with the PACS).
Mini-PACS on desktop computers⇒ medical and image processing research.
27 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Orthanc is not a PACS, but a Complement to a PACS
Missing Features
Interfacing with RIS and HIS, worklists.
Tools for radiologists (viewer, reporting).
Long-term, legal archiving.
Scalability.
Distinctive Features
Lightweight (many instances in an hospital).
Easy configuration.
Scriptable.
Open-source for better compatibility between vendors.
Bridge from DICOM to Web 2.0 (JSON/REST/AJAX).
28 / 43
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Worldwide Usage
17,000 visits to the Web site (≈ 36% of new visitors).
29 / 43
2014-03-13
IntroductionOrthanc
Free and Open-Source Software
PhilosophyOrthanc in ActionCurrent Usage
Downloads
3,900 downloads (≈ 12 per day) as of 2014-03-13.
Part of Linux (Debian Med and Fedora Medical).
30 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
31 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
31 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Proprietary Software
Most often paying.
Black box: What is it made of?
Duplication, modification and/or usage is limited.32 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.
33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.
33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.
33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.
33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.
33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is Free and Open-Source Software (FOSS)?
Free Software
1 Freedom to use the source code.
2 Freedom to inspect the source code.
3 Freedom to modify the source code.
4 Freedom to distribute the sources or binaries (possibly paying).
⊂ “Open-source software”: freedom to use and inspect.33 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is the Advantage of Free Software?
“I’m often asked todescribe the ’advantages’ offree software. But the word’advantages’ is too weak whenit comes to freedom.”
[Richard Stallman,for the 30th birthday of GNU project]
⇓
Philosophical point of view:“Librisme” (FR).
34 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
What is the Advantage of Free Software?
“I’m often asked todescribe the ’advantages’ offree software. But the word’advantages’ is too weak whenit comes to freedom.”
[Richard Stallman,for the 30th birthday of GNU project]
⇓
Philosophical point of view:“Librisme” (FR).
34 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
35 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
36 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
A Pragmatic Perspective to FOSS
Technology: Backbone applications (e.g. Orthanc).Feedback/contributions from a large community.Independent code review (e.g. Karen Sandler).
Ethics: Collaborative sharing of tools and knowledge.Avoid piracy (e.g. in education).
Society: ↘ “Fracture numerique” (e.g. XP end-of-life).Developing countries.
Economics: Building boxes to boost private companies.Generate local activities of services.
Sustainability: Software can be maintained after bankruptcy.Code can be adapted for new uses (fork).
Strategy: Security and technological independence (Snowden). 37 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
Economics of FOSS (1/3)
World
79% of smartphones use Linux (Android).
96% of supercomputers use Linux (weather, finance. . . ).
Worldwide infrastructure of Google, Facebook, Twitter. . .
38 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
Economics of FOSS (2/3)
France (Conseil National du Logiciel Libre, 2012)
Market size: 2,5 billions of euros.
300 companies.
30000 employees.
30% of annual growth.
5/6 software developers use or have used FOSS.
Thanks FOSS, creating a proprietary software costs 10 timesless than in 2002 ⇒ boost of competitiveness.
39 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
Economics of FOSS (3/3)
Wallonia and Brussels
150 towns use FOSS for their Web site and theiradministration (through IMIO).
OpenERP S.A. is the “promising company” of 2013 (≈ 100employees).
Robert Viseur (CETIC) maintains a list of companies active inopen-source.
FOSDEM annual conference (ULB).
CIRB promotes FOSS for Brussels region.
Many (all?) software companies internally use FOSS.
40 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
The Special Case of Medical Software
Improve interoperability between vendors (backbone).
Open an ecosystem that is trusted by the major players, byuncoupling proprietary systems (cf. David vs. Goliath).
Enhance the technological independence of hospitals.
Code review to improve the security and quality of healthcare.
Allow the patient to deal with her personal data at home.
Improve healthcare in developing countries.
Reference implementation for standard formats and protocols.Give a consistent interpretation of badly specified file formats,such as DICOM-RT (radiotherapy and nuclear medicine).
FOSS as building blocks of commercial software for medicalimaging: DCMTK, GDCM, ITK/VTK, Python. . .
Examples of complete medical applications: GNUmed, GNUHealth (Jamaica), OsiriX, 3DSlicer. . .
41 / 43
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
Orthanc was Nominated at Zenobe Award 2013
FOSS Acknowledged as a Vector of Social Innovation
Innovative product.
Social need: Healthcare and biomedical research.
Not enough satisfied by the market.
Open, collaborative and sustainable approach to software.42 / 43
1 IntroductionRadiology and RadiotherapyProblems with DICOM in HospitalsThe Need for Another Free Tool
2 OrthancPhilosophyOrthanc in ActionCurrent Usage
3 Free and Open-Source SoftwareDefinitionPractical, Economic Benefits of FOSSSummary
IntroductionOrthanc
Free and Open-Source Software
DefinitionPractical, Economic Benefits of FOSSSummary
Summary
http://www.orthanc-server.com/
Open-source, Web-based DICOM store.
Lightweight, scriptable, versatile.
Comes from real-world, clinical needs.
Availability: Linux, Windows, Mac OS.
FOSS can help the medical sectorfor better interoperability and healthcare quality.
Publications: ISBI 2013, ESTRO 2013, 2 @ BHPA 2013.43 / 43
Appendix
44 / 43
Code Statistics
45 / 43
[Ohloh]
Software Architecture
Major Components
DCMTK (for DICOM format and protocol).
Mongoose (for embedded HTTP server).
jQuery Mobile (for the Web interface).
Boost, JsonCpp and libpng.
Orthanc Server (C++)
DCMTK(DICOM protocol)
SQLite (indexing)
DICOM C-StoreDICOM C-FindDICOM C-Move
REST services
Orthanc Explorer(Javascript/HTML5)
Web browsers
zLib (compression)
Filesystem
Mongoose (HTTP server)
46 / 43
Focus on Code Quality in Orthanc
Daily challenged with large volumes of real-world images.
Continuous Integration Server.
Unit testing.
Integration tests through REST API.
Valgrind.
Trello for project management (roadmap).
FAQ, issue tracking and discussion group available.
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Compatibility between FOSS Licenses
Orthanc is GPLv3.
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