Open source ideal encourages innovation in radiology IT

Multinational corporations may be sewing up the modality market, but when it comes to radiological software, a more community-oriented approach to product development is holding its own in Europe.

Multinational corporations may be sewing up the modality market, but when it comes to radiological software, a more community-oriented approach to product development is holding its own in Europe.

The Open Source Initiative flies directly in the face of commercial R&D, where products are developed behind closed doors and intellectual property is jealously guarded. Open source software is freely available to anyone who wants to use it. Not only that, users are encouraged to scrutinize the software's basic building blocks, its "source code," and suggest modifications to improve performance or remove bugs. Products can thus evolve rapidly on the basis of widespread testing and immediate user feedback.

The open source movement is driving advances throughout the entire radiology IT field. Market leaders are more eager to innovate if they see a host of independent teams hard on their heels, said Claudio Saccavini, a researcher in the department of medical and diagnostic sciences and special therapies at Padova University in Italy.

Radiology researchers at Padova are working with nine other radiology departments to create simple open source software. Their goal is to develop a product that implements a number of "actors," as defined by the Integrating the Healthcare Enterprise initiative. IHE actors are essentially black boxes that transact information during workflow processes. Actors already developed under this particular project, known as MARiS, include an ADT (admit-discharge-transfer system), an order filler, an audit record repository, and an image manager.

"It is very important that the project is based on modules that are IHE actors," Saccavini said. "All the software is completely engineered around IHE transactions, so the result is not an application like a RIS or PACS but a merger of IHE components."

The team is using Open Source PHP and Apache products to develop software for its MARiS project. The Web-based application should be compatible with any operating platform, database, or hardware. It can be downloaded from the project Web site ( or used online.

"The problem is, what is the business model for an Open Source project? We need a community approach, but the users must be involved in project development," Saccavini said. "Everyone who downloads the software must increase its performance."

Users should be regarded as stakeholders during this development process and offered a say in the project's future direction, he said.

Researchers at the University of Pisa in Italy are also taking advantage of open source software in their innovation, an online database that stores images from colon examinations. The Web-based application is built on a MySql server database, using an Apache Web server. It also contains a Java-based DICOM server so that CT images can be received directly in DICOM format. Endoluminal views of the colon are created using proprietary software and are sent to the database as DICOM secondary captures.

The database is divided into two parts: One section stores conventional colonoscopy views, and the other stores CT colonography images. The Web-based interface permits radiologists and gastroenterologists to submit new cases to the appropriate part of the database and to analyze existing data.

The package will form a valuable teaching and research resource and facilitate dialogue between radiologists and their clinical colleagues, said Andrea Bertini, an engineer in the University of Pisa's diagnostic and interventional radiology department. It could also be used to store data from multiple institutions in Italy if a proposed national study of the efficacy of CT colonography gets under way, he said.

"At the moment we are developing a new section of the application that will help evaluate the accuracy of virtual colonoscopy by comparing virtual colonoscopy diagnoses with those from fiber-optic colonoscopy," he said.