Teaching File Creation with Teaching File Creation with MIRCMIRC

Adam E. Flanders, MDThomas Jefferson University HospitalPhiladelphia, Pennsylvania

Using MIRC for Using MIRC for Departmental Teaching Departmental Teaching Files Files

Segment ObjectivesSegment Objectives

Features of a digital teaching Features of a digital teaching file.file.

The MIRC solutionThe MIRC solution MIRC authoring.MIRC authoring.

What is a Teaching File?What is a Teaching File?

An organized repository of clinical An organized repository of clinical images and documentation.images and documentation.

Used primarily to supplement learning Used primarily to supplement learning process for trainees.process for trainees.

Source material for lectures, Source material for lectures, publications.publications.

Film library modelFilm library model Shelves of cases (film jackets)Shelves of cases (film jackets) Organized by anatomy, disease, ACR codes.Organized by anatomy, disease, ACR codes.

What are the Qualities of a What are the Qualities of a “Great” Radiology Teaching “Great” Radiology Teaching

FileFile High quality ImagesHigh quality Images Comprehensive supplemental Comprehensive supplemental

Information:Information: path reports, path images, discussion etc.path reports, path images, discussion etc.

OrganizationOrganization Indexed and searchableIndexed and searchable Fresh content.Fresh content. Easily accessed from anywhere.Easily accessed from anywhere. Easy to navigate.Easy to navigate. SecureSecure

Problems with Film-Problems with Film-Based TFBased TF Limited access.Limited access.

Typically, a lot of work to Typically, a lot of work to submit a case.submit a case. Difficult to solicit Difficult to solicit

“voluntary” contributions.“voluntary” contributions. Difficult to keep Difficult to keep

organized.organized. Missing or misfiled cases Missing or misfiled cases

or films.or films. Need a librarian/policemanNeed a librarian/policeman Securing files = limited Securing files = limited

access.access. Searching file is Searching file is

problematic.problematic. Inconvenient to use for Inconvenient to use for

decision support.decision support. Difficult to Difficult to

update/maintain – update/maintain – keeping material keeping material current.current.

Analog to Digital Analog to Digital TransformationTransformation

Inexpensive digital cameras / Inexpensive digital cameras / scanners.scanners.

Retirement of hard copy Retirement of hard copy (film)(film)

Proliferation of PACS.Proliferation of PACS. Proliferation of workstations.Proliferation of workstations.

Digitizing Analog ImagesDigitizing Analog Images

Digitizing Analog ImagesDigitizing Analog Images

Digital Camera on PACS or ViewboxLaborious but effective!

Personal Image Personal Image Storage Storage

SolutionsSolutions

Digitized Images: Big Step Digitized Images: Big Step Forward!Forward!

AdvantagesAdvantages Lightweight and reusableLightweight and reusable No deterioration, loss, resistant to theft.No deterioration, loss, resistant to theft. ModifiableModifiable Easy to adjust, crop, contrast, brightnessEasy to adjust, crop, contrast, brightness Easy to add annotation.Easy to add annotation.

ProblemsProblems Access remained limited.Access remained limited. Organization!Organization! Large collections, difficult to find images Large collections, difficult to find images

without meticulous labeling methodswithout meticulous labeling methods Sharing material?Sharing material?

Where to Put Your Images? - Personal Where to Put Your Images? - Personal DTFDTF

Copy images Copy images into folders into folders labeled labeled appropriately.appropriately.

Nested file Nested file structurestructure

Need to open Need to open content in content in another another application for application for use.use.

Not very Not very versatileversatile

Personal Teaching FilesPersonal Teaching Files Thousands of radiologists have amassed Thousands of radiologists have amassed

“personal” collections of images.“personal” collections of images. Solutions include cases on email, upload Solutions include cases on email, upload

of cases to free digital photo services (ie of cases to free digital photo services (ie Google, Flikr, Picassa, Shutterfly etc.)Google, Flikr, Picassa, Shutterfly etc.)

Generally used by a single user.Generally used by a single user. Accessible from a single computerAccessible from a single computer Image collections are limited in scope.Image collections are limited in scope. Difficult to enhance content.Difficult to enhance content. Not readily sharableNot readily sharable

Personal DTF Organization Personal DTF Organization with Picassawith Picassa

The Next PhaseThe Next Phase Web browser is the most appropriate vehicle for Web browser is the most appropriate vehicle for

delivery of educational content.delivery of educational content. Browsers are designed to display written and Browsers are designed to display written and

visual content efficiently.visual content efficiently. Including multimedia.Including multimedia. Early DTF contained “static” web pages.Early DTF contained “static” web pages.

Laborious to produce.Laborious to produce. Time consuming to update and index.Time consuming to update and index.

Modern DTF coupled to a database generates Modern DTF coupled to a database generates content dynamically (“on-the-fly”).content dynamically (“on-the-fly”). Easier to modifyEasier to modify More conducive to search mechanismsMore conducive to search mechanisms

Components of a Modern Components of a Modern DTFDTF

FileserverFileserver DatabaseDatabase WebserveWebserve

rr

Fileserver

Database

Webserver

Ethernet

What Do People Want?What Do People Want?

Radiologists want a simple method Radiologists want a simple method to create teaching materials from to create teaching materials from their existing PACS systems.their existing PACS systems.

Ease of useEase of use Time efficientTime efficient Simple to accessSimple to access Scalable in terms of size & Scalable in terms of size &

complexity.complexity.

What Is Available NOW?What Is Available NOW?

Commercial turnkey systems available Commercial turnkey systems available for a price which will provide:for a price which will provide: Method to save images & data from PACS.Method to save images & data from PACS. Storage local or off-site for your casesStorage local or off-site for your cases Web server to display casesWeb server to display cases

Organizational repositories (e.g. ACR Organizational repositories (e.g. ACR Case-In-Point, Aunt Minnie, MyPACS Case-In-Point, Aunt Minnie, MyPACS etc.)etc.)

You can develop your own…You can develop your own… Or there is MIRC!!!!Or there is MIRC!!!!

What Does The MIRC What Does The MIRC Software Suite Do For Me?Software Suite Do For Me?Medical Imaging Resource Center

Da’ AnswerDa’ Answer

Set of software tools that allow you to Set of software tools that allow you to create, index, search and display create, index, search and display teaching materials.teaching materials.

Repository for educational content.Repository for educational content. Including peer review content (via RSNA).Including peer review content (via RSNA).

Ability to selectively share this material Ability to selectively share this material in a consistent manner within your in a consistent manner within your institution on your local intranet or institution on your local intranet or worldwide on the internet.worldwide on the internet.

MIRC factoidsMIRC factoids An RSNA sponsored initiative.An RSNA sponsored initiative. Software toolkit that can be used for creation of Software toolkit that can be used for creation of

teaching repositories and clinical trials databases.teaching repositories and clinical trials databases. Built on open-source principles.Built on open-source principles. No proprietary technology.No proprietary technology.

Uses available standards DICOM, XML, HTTP, JSP, JavaUses available standards DICOM, XML, HTTP, JSP, Java Software is free-of-charge, no licensing.Software is free-of-charge, no licensing. Software designed to operate on most common Software designed to operate on most common

operating systems incl. Windows, Apple OSX and operating systems incl. Windows, Apple OSX and Linux.Linux.

PACS vendor neutral.PACS vendor neutral.

MIRC ComponentsMIRC Components

Web serverWeb server File serverFile server Self updating indexSelf updating index Powerful administrative Powerful administrative

functionsfunctions

MIRC FeaturesMIRC Features Individualized file storageIndividualized file storage Multiple document “templates”Multiple document “templates” Multiple methods to author contentMultiple methods to author content Multiple methods to display contentMultiple methods to display content Web-based DICOM viewer.Web-based DICOM viewer. Web-based editor.Web-based editor. DICOM receiver (DICOM SCP)DICOM receiver (DICOM SCP) DICOM anonymizerDICOM anonymizer Administrative control of viewing, editing, deletion.Administrative control of viewing, editing, deletion. Scalable and expandable from one author/PC to Scalable and expandable from one author/PC to

hundreds.hundreds. Easy to install & configure.Easy to install & configure. Many more…Many more…

Scalability of MIRCScalability of MIRC MIRC has the unique ability to scale from MIRC has the unique ability to scale from

one computer / one user to many one computer / one user to many computers / many users.computers / many users.

Potential configurations include:Potential configurations include: One MIRC repository for one or more users.One MIRC repository for one or more users. Multiple MIRC repositories in one or many Multiple MIRC repositories in one or many

institutions.institutions. Software enables development of Software enables development of

cooperative libraries.cooperative libraries. Each library is individually administered yet Each library is individually administered yet

portions can be made accessible to all.portions can be made accessible to all.

MIRC supports all MIRC supports all information storage information storage

formats.formats. Images: DICOM, GIF, JPEG, Images: DICOM, GIF, JPEG,

PNGPNG Hyperlinks to other web Hyperlinks to other web

content.content. Virtually any content that is Virtually any content that is

displayable in a web browser.displayable in a web browser. Pointers to other files for Pointers to other files for

downloading.downloading. Display support for other types Display support for other types

in the future…in the future…

MIRC TF Configuration MIRC TF Configuration ScenariosScenarios

Private ModePrivate Mode Departmental Departmental

ModeMode Division ModeDivision Mode Worldwide ModeWorldwide Mode VariationsVariations

MIRC TF ScenariosMIRC TF ScenariosPrivate (selfish) ModePrivate (selfish) Mode

My Stuff

Single-user Single-user contributorcontributor

Single-user Single-user accessaccess

No sharing No sharing of contentof content

MIRC TF ScenariosMIRC TF ScenariosDivisional / Semi-Private ModeDivisional / Semi-Private Mode

Each division or key Each division or key individual maintains a individual maintains a server.server.

Division is responsible Division is responsible for maintaining their for maintaining their content.content.

All or a portion of All or a portion of content can be made content can be made public.public.

Any individual can Any individual can access public records access public records on other MIRC on other MIRC servers within servers within institution.institution.

Much more difficult to Much more difficult to administer.administer.

MIRC TF ScenariosMIRC TF ScenariosDepartmental ModeDepartmental Mode Multiple users or Multiple users or

divisions contribute divisions contribute to a single to a single departmental MIRC departmental MIRC server.server.

All users have All users have controlled access.controlled access.

All can view public All can view public cases.cases.

Only owners can Only owners can modify data.modify data.

Private cases are Private cases are supported.supported.

One server to One server to manage for all manage for all content.content.

Easier to administer.Easier to administer.

BIG MIRC

NeuroNeuro NMNM ChestChest

CTCT Body Body MRMR

MammMammoo

CVIRCVIR MSKMSK PrivatePrivate

Neuro

MSK

Mammo

User

MIRC TF ScenariosMIRC TF ScenariosWorldwide ModeWorldwide Mode

Multiple MIRC Multiple MIRC sites sites (“MIRClets”) (“MIRClets”) expose content expose content to the Internet.to the Internet.

This public This public content is content is accessible to accessible to other computers other computers that can perform that can perform a query of MIRC a query of MIRC content.content.

Internet

The MIRC Authoring The MIRC Authoring ProcessProcess

Four Ways to AuthorFour Ways to Author

Basic authoring tool.Basic authoring tool. Advanced authoring tool.Advanced authoring tool. Submit ServiceSubmit Service ZIP ServiceZIP Service

Three Kinds of AuthoringThree Kinds of Authoring

Point-of-care Point-of-care BookmarkingBookmarking

RetrospectiveRetrospectiveCombinationCombination

Getting Images to MIRCGetting Images to MIRC

Storing Images in MIRCStoring Images in MIRC MIRC software was designed to MIRC software was designed to

utilize common features available by utilize common features available by most PACS vendors to export most PACS vendors to export images.images. DICOM SCU/SCP (i.e. DICOM export)DICOM SCU/SCP (i.e. DICOM export) Saving images locally to PACS desktop Saving images locally to PACS desktop

or folder (subdirectory)or folder (subdirectory) Images are uploaded to the Images are uploaded to the MIRC MIRC

file service file service in one of three ways:in one of three ways:

Storing Images in MIRCStoring Images in MIRC 3 Methods3 Methods

DICOM DICOM exportexport

Upload Upload single imagesingle image

Upload Upload multiple files multiple files (using ZIP (using ZIP archive)archive)

PACSPACS

DICOM Export

Single ImageSingle Image

ZIP File

MIRC File ServiceMIRC File Service Container for images.Container for images. Two File Storage AreasTwo File Storage Areas

PublicPublic PrivatePrivate

Can Transfer Files Between Can Transfer Files Between Public and Private Public and Private Repositories.Repositories.

Delete, Add or Update files to Delete, Add or Update files to the File Service.the File Service.

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)

From DICOM From DICOM SCP or SCP or copied from copied from personal file personal file cabinetscabinets

Files in the Files in the shared file shared file cabinet are cabinet are available to available to all users.all users.

Select one or Select one or more images.more images.

Copy to Copy to personal file personal file cabinet.cabinet.

Begin Begin submission submission process.process.

ZIP ServiceZIP Service

Method to convert an existing Method to convert an existing teaching file system to MIRC from a teaching file system to MIRC from a conventional teaching file hierarchy.conventional teaching file hierarchy.

This will bulk convert all your images This will bulk convert all your images that are in folders in a hierarchical that are in folders in a hierarchical structure to MIRC.structure to MIRC.

Supplement information as needed.Supplement information as needed. Is a great way to get started with Is a great way to get started with

MIRC!MIRC!

TCE ServiceTCE Service The TCE service is an implementation from The TCE service is an implementation from

the Teaching Files and Clinical Trials the Teaching Files and Clinical Trials Export Integration Profile from IHE.Export Integration Profile from IHE.

Brings point-of-care authoring to all PACs Brings point-of-care authoring to all PACs users.users.

Enables one to author teaching file cases Enables one to author teaching file cases directly from PACS.directly from PACS. Select key images.Select key images. Add pre-defined text elements.Add pre-defined text elements. Submit directly to your MIRC service.Submit directly to your MIRC service.

This closes the loop for efficient authoring.This closes the loop for efficient authoring.

TCE ServiceTCE Service

Four PACS vendors support and have Four PACS vendors support and have working demonstrations of the TCE working demonstrations of the TCE export profile at RSNA 2006 & 2007.export profile at RSNA 2006 & 2007. AgfaAgfa FujiFuji GEGE Vital ImagesVital Images

Come see the demonstration in LLC Come see the demonstration in LLC and in technical exhibits area on a and in technical exhibits area on a real real PACS system.PACS system.

Powerpoint ToolPowerpoint Tool

There is a handy (free) Powerpoint add-in There is a handy (free) Powerpoint add-in which will take an entire presentation and which will take an entire presentation and convert each slide to a MIRC TF convert each slide to a MIRC TF document.document.

Many people use Powerpoint as their Many people use Powerpoint as their teaching file repository; this is another teaching file repository; this is another way to convert to MIRC.way to convert to MIRC.

Add-in has been revised, is easy to use Add-in has been revised, is easy to use and install.and install.

Available on the MIRC Wiki.Available on the MIRC Wiki.

MIRC WikiMIRC Wiki

All of the MIRC documentation has All of the MIRC documentation has been uploaded to a new Wiki site been uploaded to a new Wiki site which is easy to navigate and which is easy to navigate and search.search.

All docs and downloads available All docs and downloads available there.there.

Explore the MIRC Explore the MIRC SoftwareSoftware

Tasks for TodayTasks for Today

Logon to Local RSNA MIRC site.Logon to Local RSNA MIRC site. Explore the image Explore the image file cabinetfile cabinet.. Perform a Perform a basic authoring basic authoring with a few with a few

images and text.images and text. Edit our case with the Edit our case with the advanced advanced

authoring toolauthoring tool.. Add annotations, captions, text.Add annotations, captions, text. Preview our case.Preview our case. Publish.Publish. Query our cases on the RSNA server.Query our cases on the RSNA server.

To BeginTo Begin

Double click on the MIRC icon on Double click on the MIRC icon on your desktop to launch your your desktop to launch your browser on the MIRC serverbrowser on the MIRC server

MIRC Front PageMIRC Front Page

Let’s Look AroundLet’s Look Around

Let’s Look AroundLet’s Look Around

Authoring Sequence for Authoring Sequence for TodayToday LoginLogin

Explore the File CabinetExplore the File Cabinet Copy images to personal cabinetCopy images to personal cabinet Add, delete, copyAdd, delete, copy

Basic AuthoringBasic Authoring Launch Basic authoring page.Launch Basic authoring page. Upload one or more images from Upload one or more images from

directory.directory. Edit Case on Advanced ToolEdit Case on Advanced Tool

Explore advanced toolExplore advanced tool Add more text.Add more text. Annotate imagesAnnotate images Add imagesAdd images Preview case.Preview case. Publish!!!Publish!!!

Query the site to see the Query the site to see the collective work!!!collective work!!!

Let’s AuthorLet’s Author

Let’s Log in….Let’s Log in….

Username: user + [1 – 20]Username: user + [1 – 20] Password: userPassword: user

Functions to Focus OnFunctions to Focus On

These tools These tools appear once appear once you’re logged on you’re logged on to system.to system.

These are all on These are all on the left side of the left side of the query page.the query page.

ConcentrationsConcentrations Basic authoringBasic authoring Advanced Advanced

authoringauthoring File CabinetFile Cabinet

What Are My Options?What Are My Options? What if you would like to explore the What if you would like to explore the

MIRC software, but don’t want to have to MIRC software, but don’t want to have to set up your own system?set up your own system?

MyMIRCFiles 2008MyMIRCFiles 2008 RSNA is offering to all members an open RSNA is offering to all members an open

MIRC repository to store all of your materials.MIRC repository to store all of your materials. Utilizes the MIRC software.Utilizes the MIRC software.

Any RSNA member can use it for FREE!Any RSNA member can use it for FREE! Gives you an opportunity to “kick-the-Gives you an opportunity to “kick-the-

tires” before you commit to building your tires” before you commit to building your own.own.

What About PACS What About PACS Interfaces?Interfaces?

MIRC software is vendor neutral.MIRC software is vendor neutral. Therefore it tries to adhere to Therefore it tries to adhere to

existing or upcoming standards.existing or upcoming standards. The TCE profile is getting more The TCE profile is getting more

attention from PACS vendors.attention from PACS vendors. This will allow you to send directly This will allow you to send directly

from PACS using key images.from PACS using key images. Obviate the need to open a web Obviate the need to open a web

browser to author cases.browser to author cases.

More InformationMore Information

Check out the MIRC Wiki:Check out the MIRC Wiki: http://mircwiki.rsna.orghttp://mircwiki.rsna.org

Look over your handout & syllabus.Look over your handout & syllabus. A full installation of MIRC software A full installation of MIRC software

with documentation is on the CDs.with documentation is on the CDs.