Teaching file system uses e-mail to promote knowledge sharing

In an effort to streamline the distribution of radiological knowledge among medical institutions, Northwestern University Medical Center has integrated the RSNA's Medical Imaging Resource Center (MIRC)-compliant teaching files into its busy PACS environment. Opting for a low-maintenance model, Northwestern went with e-mail as a tool for developing its teaching files.

"We elected to implement an e-mail-based solution because this provides the ability for multiple images to be extracted from the system at one time," said Pattanasak Mongkolwat, Ph.D., a research associate professor of radiology at Northwestern.

Most PACS aren't designed with teaching file creation in mind, leaving it to radiology departments to devise ways to distribute cases. By working with MIRC, which links a community of image libraries for education, research, and clinical practice, radiology departments can gain access to teaching files from other medical centers and provide access to their own rich case repositories.

"Integrating our teaching file system with MIRC is the best way to disseminate and exchange radiological cases/knowledge within medical communities," Mongkolwat said.

The Northwestern teaching file system integrates with its PACS so radiologists can create teaching files with little interruption to the course of normal radiology workflow. Interesting cases can be e-mailed securely and with de-identified images from either the PACS or the radiologists' personal computer to the teaching file system.

Once teaching cases are composed on PACS workstations, they are sent to the department e-mail server for parsing to extract relevant textual information. Images are also extracted and stashed in a unique case-related folder.

Following parsing, a confirmation e-mail is returned to the case author containing the URL of the unfinished case. Cases can then be edited and managed using a Web interface designed to maximize usability and minimize system navigation, Mongkolwat said.

"One section, for instance, allows the author to add or edit text which was autopopulated from the original e-mail sent from the PACS workstation," he said.

Another section offers image management tools: assigning order to images, entering image descriptions, uploading new images, deleting images, and assigning modality types. The header of each page enhances navigation of the entire teaching file system via links to personal teaching file subfolders as well as to department teaching files.

The system contains a mechanism for controlling access to the teaching files. Upon completion of a teaching case, authors determine the viewing audience by indicating whether the case is "private," "public," "department," or "MIRC."