System offers one-click DICOM teaching file harvest

Teaching files are necessary in radiology education. But digital teaching file functionality has not been a high priority for PACS vendors, and currently no way exists to export DICOM images from PACS in desktop publishing format.

One academic solution has surfaced at the University of Utah (Radiographics 2006;26(6):1877-1885). The radiology department there has developed a system called RadICS (Radiology Interesting Case Server). The vendor-neutral teaching file system offers a means by which interesting cases can automatically be plucked from PACS without requiring the usual modification of PACS configuration.

"Harvesting medical images from PACS for education, research, and publication is not a simple or intuitive process," said Dr. Aaron W. Kamauu, a biomedical informaticist at the University of Utah.

Even though some PACS vendors claim compliance with the Integrating the Healthcare Enterprise's Teaching File and Clinical Trial Export (TCE) profile, the necessary components will not become available in commercial products for some time, Kamauu said.

Kamauu said RadICS has three important advantages:

• vendor neutrality

• automatic window and level calculation for MR images

• real-time window and level optimization of region of interest

As interesting cases are encountered at the workstation, radiologists use PACS to push studies to RadICS. This step does not require the physician to change or log in to a different application. As images are transferred and automatically processed by the RadICS server, radiologists can continue with clinical tasks.

RadICS can receive medical images in DICOM format from any DICOM-compliant PACS. With its built-in TCE Receiver, RadICS can also receive medical images from any TCE-compliant Export Selector/Manager.

When receiving raw MR images from PACS, RadICS automatically calculates the most appropriate window and level settings for their conversion from DICOM to JPEG, a common desktop publishing format. After an interesting case is created, the author can optimize the images by adjusting window and level settings and cropping the image in real-time, Kamauu said.

"This is important for better display of educational regions of interest," he said.

Although RadICS currently provides a suitable solution for acquiring teaching file images from PACS, Kamauu stressed the importance of the IHE TCE profile.

"Widespread compliance with the TCE profile by PACS vendors will provide radiologists a method for harvesting key images from PACS into a digital teaching file, including MIRC (Medical Image Resource Center), without disruption in clinical workflow," he said.