JiveX and DICOM technique convey image-reading process over the Web

Using original DICOM images would be useful for Internet-based learning texts, yet most available Internet-based radiology case studies use either JPEG or GIF images. Use of JPEG and GIF protocols prevents the coordination of image representation and HTML text.

In work presented at the RSNA meeting in November, German researchers demonstrated a way to remedy this liability using DICOM Grayscale Softcopy Presentation State Storage Class, a technique they say allows the description of visual appearance, such as displayed area, window settings, and annotations.

Thorsten Geisbe, a medical computer science expert, and colleagues at the Institute for Micro Therapy in Bochum, Germany, used Java 1.2 to develop an applet called JiveX that can be integrated in HTML texts and controlled inside the browser using JavaScript. The popular cross-platform World Wide Web scripting language from Netscape Communications can be included in an HTML file by using the tag .

With this method, the JiveX applet is able to display DICOM images and allow viewers to focus on different aspects of the image. One HTML page can contain multiple synchronized viewers, according to Geisbe.

"Especially useful are function keys embedded into the text defining the display of the image in the viewer," he said.

The new DICOM Grayscale Softcopy Presentation State Storage Class facilitates the creation of these educational texts. Annotations, window settings, and zoom values can be set and integrated with an educational text, so that students can either work with the DICOM image or see the presentation state as set by the teacher.

Previously, DICOM had no mechanism that conveyed the actual image-viewing operations that took place. Vendors attempting to communicate this information used proprietary technologies or part of the DICOM overlay.

Softcopy Presentation State service allows referring physicians reviewing an image to automatically see exactly what the radiologist making the diagnosis saw: the same image rotation, magnification, window width and level, and annotation. The feature is also possible for images viewed months later, perhaps as a comparison for a new study or as a teaching aid.

"This feature leads to more interaction of the students with the material than in traditional HTML using GIF images," Geisbe said.

A public domain version of the JiveX program can be found at http://www.microtherapy.de/go/cs.