New device gathers disparate image files under one umbrella

The digital camera may be the imaging modality of choice for many referring clinicians, but, unfortunately for the PACS, digital photographs often lack important contextual data needed for treatment. A new tool designed to merge this type of metadata with the images promises to solve this problem.

"A tremendous amount of infrastructure is required to outfit a hospital with an enterprise-wide PACS that doesn't usually solve imaging problems outside of radiology, such as ophthalmology, dermatology, or pathology," said Steven Uttecht, a researcher at the University of Pittsburgh Medical Center.

Uttecht presented a solution, coauthored by Dr. Paul Chang, UPMC director of radiology informatics, at the RSNA meeting. The SimpleDICOM Wrapper addresses specific imaging needs of clinicians while leveraging infrastructure investment.

The tool supports visible light images for departments outside of radiology. The wrapper is essentially a program that converts JPG or TIF images to DICOM representation for PACS storage.

"The key missing piece to supporting physicians outside of radiology has been to accommodate their modality, which in many cases is a digital camera," Uttecht said.

Contextual information, such as pixel size or the location of the image on a homunculus for dermatology photos, is often missing from these digital images. To address this problem, the SimpleDICOM Wrapper was designed to meld metadata and images together to create a DICOM file.

Digital cameras generate images in many formats, but so far no way of outputting a DICOM file directly from the camera has surfaced from manufacturers, including major medical and photography players. There are solutions that treat digital cameras as legacy modalities, but these tend to cost more than the camera itself.

"We created an authoring tool to combine the input of contextual information along with the images to help create a study which would be automatically sent to PACS," Uttecht said.

The ability to send images immediately from departments outside of radiology to the PACS is an important one. In the age of HIPAA, privacy concerns abound, and the faster physicians can store images, the better. The viewer, which includes a miniPACS, completes the cycle of processing in situations when the images are not to be stored or accessible on the main PACS, allowing access only to specific individuals directly associated with the studies.

"This prevents browsing by curious users," Uttecht said.

Although not a big concern with radiology images, many of the images on this system are photographs of people, perhaps nude, that patients would want only their doctor to see and absolutely no one else, including other physicians, he said.

Currently, one of the few downsides is the amount of human interaction needed to author digital photos into DICOM format.

"Although every attempt has been made to maximize workflow through minimal manual entry, there are still a certain number of steps that must be performed for each image," Uttecht said.

The other challenge is how to define these studies within a RIS or HIS so that patient information can be validated against orders. There is no scheduler or modality work list for this type of modality, tools relied on to minimize errors and maximize workflow within radiology, he said.