DICOM Standard Research Articles

To evaluate the cortical bone thickness for ideal placement of infrazygomatic crest (IZC) and mandibular buccal shelf (MCS) bone screws in patients with different facial pattern using cone-beam computed tomography (CBCT)

This study aimed to measure the cortical bone thickness at different anatomical sites of InfraZygomatic Crest and Mandibular Buccal Shelf region for the ideal placement of IZC and MBS screws respectively in patients with different facial patterns using CBCT.Total participants were divided into 3 groups- GROUP A: horizontal growth pattern (FMA <22°); GROUP B: average growth pattern (FMA 22°-28°); GROUP C: vertical growth pattern(FMA >28°). Sixty CBCT images were taken into consideration. They were converted into standard DICOM format. Bone thickness were measured in the InfraZygomatic Crest (IZC) of the maxilla and in the Mandibular Buccal Shelf (MBS) region of the mandible using the Kodak CareStream CS 9300 Software.The results indicate that there was a highly statistical significant difference seen in the overall cortical bone thickness of IZC and MBS at various anatomical sites. The highest mean thickness was found to be at the MB70◦ maxillary 1st molar and distal root of the mandibular 1st molar. There was no difference in the bone thickness at the IZC region and at the MBS region seen between the horizontal and vertical facial patterns whereas the average facial patterns show the highest mean thickness but was not statistically significantThe study conducted on the Indian population yielded results demonstrating the possibly appropriate position for the IZC bonescrews and MBS bonescrews suggested that placing the IZC bonescrews at the mesiobuccal root of the maxillary 1st molar at an angulation of 70◦ and the MBS bonescrews at the distal root of the mandibular 1st molar at 11mm from the cementoenamel junction irrespective of the facial patterns could provide positive results.

Development Of Web-Based Teleradiology Application To Enhance The Quality Of Radiology Services

The development of digital radiology technology improves the quality of medical services, but challenges in image distribution and interpretation encourage the use of teleradiology. The development of web-based teleradiology applications is a cost-effective solution with the ability to integrate patient data and DICOM image display to improve the efficiency of radiology interpretation. This has the potential to improve the quality of radiology services by accelerating the diagnostic process and reducing the physical accessibility limitations of radiologists.This study aims to develop a web-based application as a solution to radiographic image delivery and PACS weaknesses, and test its effectiveness in improving the quality of radiology services. The research method used is the research and development (R&D) method, which aims to produce and test new products. The results of this study show that the development of a web-based teleradiology application provides an appropriate solution to the constraints of the reader's presence at the image capture site, while maintaining image quality according to DICOM standards. The application allows easy use of various devices, data exchange between medical professionals, and secure data storage. In Addition, it reduces the waiting time in the delivery and reading of radiographic images by radiologists. Compared to older methods, such as delivery via email or Whatsapp, this web application shows improved quality and accuracy of radiographic image reading.

MaRGE: A graphical environment for MaRCoS

The open-source console MaRCoS, which stands for “Magnetic Resonance Control System”, combines hardware, firmware and software elements for integral control of Magnetic Resonance Imaging (MRI) scanners. Previous developments have focused on making the system robust and reliable, rather than on users, who have been somewhat overlooked. This work describes a Graphical User Interface (GUI) designed for intuitive control of MaRCoS, as well as compatibility with clinical environments. The GUI is based on an arrangement of tabs and a renewed Application Program Interface (API). Compared to the previous versions, the MaRGE package (“MaRCoS Graphical Environment”) includes new functionalities such as the possibility to export images to standard DICOM formats, create and manage clinical protocols, or display and process image reconstructions, among other features conceived to simplify the operation of MRI scanners. All prototypes in our facilities are commanded by MaRCoS and operated with the new GUI. Here we report on its performance on an experimental 0.2 T scanner designed for hard-tissue, as well as a 72 mT portable scanner presently installed in the radiology department of a large hospital. The possibility to customize, adapt and streamline processes has substantially improved our workflows and overall experience.

DICOM Standard and Its Application in Radioinformatics

The DICOM standard is the emerging standard in the field of medical informatics. It defines the standard network interface and data model makes the medical image equipment manufacturers on the standard network equipment interconnection, simplify the development of various types of medical image, promote open unrelated to the factory of medical digital image transmission and exchange, prompting the image archiving and communication system of PACS (Picture Archiving and Communication Systems) and the combination of various hospital information system HIS (Hospital Information Systems). Radiation therapy departments in many hospitals have purchased more than one manufacturer of radiotherapy planning systems, and treatment information has to be communicated using DICOM standards. The use of DICOM in radiotherapy is called DICOM RT. At home, doctors are not fully aware of its importance and researchers do not. This paper mainly discusses the implementation and application of DICOM and protocol in precision radiotherapy system. The main contents include: (1) DICOM RT defines a total of seven information objects, which play a pivotal role in the information exchange of radiotherapy system. Discuss the content of DICOM RT; discuss the development of radiotherapy technology at home and abroad. (2) At present, DICOM standard has been widely used in the field of medical informatics, but no authority can provide DICOM compatibility verification of imaging equipment or DICOM application system, which still has many difficulties in system interconnection, that is, the research and implementation of DICOM test method. (3) The application of DICOM in PACS system. (4) Impaired compression study without visual loss in medical images based on DICOM standard.

IODeep: An IOD for the introduction of deep learning in the DICOM standard

Background and objectiveIn recent years, Artificial Intelligence (AI) and in particular Deep Neural Networks (DNN) became a relevant research topic in biomedical image segmentation due to the availability of more and more data sets along with the establishment of well known competitions. Despite the popularity of DNN based segmentation on the research side, these techniques are almost unused in the daily clinical practice even if they could support effectively the physician during the diagnostic process. Apart from the issues related to the explainability of the predictions of a neural model, such systems are not integrated in the diagnostic workflow, and a standardization of their use is needed to achieve this goal. MethodsThis paper presents IODeep a new DICOM Information Object Definition (IOD) aimed at storing both the weights and the architecture of a DNN already trained on a particular image dataset that is labeled as regards the acquisition modality, the anatomical region, and the disease under investigation. ResultsThe IOD architecture is presented along with a DNN selection algorithm from the PACS server based on the labels outlined above, and a simple PACS viewer purposely designed for demonstrating the effectiveness of the DICOM integration, while no modifications are required on the PACS server side. Also a service based architecture in support of the entire workflow has been implemented. ConclusionIODeep ensures full integration of a trained AI model in a DICOM infrastructure, and it is also enables a scenario where a trained model can be either fine-tuned with hospital data or trained in a federated learning scheme shared by different hospitals. In this way AI models can be tailored to the real data produced by a Radiology ward thus improving the physician decision making process.Source code is freely available at https://github.com/CHILab1/IODeep.git.

Combined Radiotherapy Using a Method for Biologically Informed IMRT Planning

Radiotherapy (RT) regimens routinely employ multiple courses that vary by delivery modality and/or fractionation schedule as part of initial or follow up treatment. The combination of RTs ideally should consider the biological effect of the total composite dose distribution. Biological effect can be quantified by biological effective dose (BED) which is a function of the RT modality, dose fractionation, and tissue radiosensitivity. This work describes a method of optimizing a follow up intensity modulated RT (IMRT) plan that considers BED from prior RT. Required inputs for this method are the desired composite BED objectives (BEDref) for target volume(s) and organs at risk (OARs). First, the physical dose in each CT voxel from prior RT (Dprior) is converted to BED (BEDprior). The difference between BEDref and BEDprior gives the optimal BED distribution for the follow up IMRT plan (BEDIMRT). Next, the optimal physical dose (DIMRT) corresponding to BEDIMRT is calculated for each voxel as a function of the number of IMRT fractions (nIMRT). Commercial IMRT treatment planning systems require optimization objectives to be specified for contoured structures, not individual voxels, so a workaround is proposed: 1) for each structure, BEDref is converted to physical dose (Dopti) as a function of nIMRT, and 2) for each voxel, the difference of Dopti and DIMRT is calculated. The result is a "base dose distribution" (Dbase) that is used with standard inverse optimization tools to optimize an IMRT plan so that the sum of Dbase and the IMRT dose approaches Dopti for each voxel. This method was implemented using a custom software workflow to calculate Dbase as a function of Dprior and input BEDref values. Validation was performed by comparing the workflow output with hand calculated Dbase values at randomly selected points within clinically significant regions. Satisfactory agreement was considered to be within 5%. Feasibility of the method was demonstrated using an RT trial protocol for glioblastoma multiforme that combines permanent low dose rate brachytherapy (BT) using collagen tiles embedded with 131Cs seeds and follow-up IMRT (20 fractions). The Dbase distribution was obtained from the software as a function of the BT dose and BEDref for one patient model. Comparison of Dbase values from the software and hand calculated values resulted in agreement within 5% for 22/25 points and within 10% for 3/25 points. Discrepancies >5% (max 9.4%) were attributed to data precision resolution effects inherent in the DICOM standard. The resulting IMRT plan was deemed clinically acceptable and the composite dose distribution achieved dosimetric objectives for all target and OARs. A method for optimizing a follow up IMRT plan that considers dose from prior RT to produce a desired composite BED distribution was derived and proof of concept was successfully demonstrated. Further validation of this method with additional patients and multimodality RT protocols will be performed.

Open RT Structures: A Solution for TG-263 Accessibility

BackgroundConsistency of nomenclature within radiation oncology is increasingly important as big data efforts and data sharing become more feasible. Automation of radiation oncology workflows depends on standardized contour nomenclature which enables toxicity and outcomes research, while also reducing medical errors and facilitating quality improvement activities. Recommendations for standardized nomenclature have been published in the American Association of Physicists in Medicine (AAPM) report from Task Group 263. Transitioning to TG-263 requires creation and management of structure template libraries and retraining of staff, which can be a considerable burden on clinical resources. Our aim is to develop a program that allows users to create TG-263 compliant structure templates in English, Spanish, or French to facilitate data sharing. Methods53 pre-made structure templates were arranged by treated organ based on an American Society for Radiation Oncology (ASTRO) consensus paper. Templates were further customized with common target structures, relevant OARs (e.g., Spleen for anatomically relevant sites such as gastroesophageal junction or stomach), sub-site specific templates (e.g. partial breast, whole breast, intact prostate, postoperative prostate, etc.) and brachytherapy templates. An informal consensus on OAR and target coloration was also achieved, though color selections are fully customizable within the program. ResultsThe resulting program is usable on any Windows system and generates template files in practice-specific DICOM or XML formats, extracting standardized structure nomenclature from an online database maintained by members of the TG-263U1 Task Group which ensures continuous access to up-to-date templates. ConclusionsWe have developed a tool to easily create and name DICOM-RT structures sets that are TG-263-compliant for all planning systems utilizing the DICOM standard. The program and source code are publicly available via GitHub, encouraging feedback from community users for improvement and guide further development.

THE LINEAR LENGTH OF MODERN POPULATION'S YOUNG PEOPLE HANDS PHALANGES ACCORDING TO X-RAY OSTEOMETRY AND THEIR CORRELATIONS

More than a sufficient number of works are devoted to X-ray studies of the bones of the hand, its phalanges, and only a few works are devoted to the issues of the relationship of their parameters in the context of the general patterns of organization of the structural elements of the autopodia. The data of these studies do not create a unified idea of the correlation patterns of the metric parameters of the bones that form the human hand skeleton, while the study of this issue is of great theoretical and practical importance. The purpose of the study is the establish of the variability of X-ray steometric indicators of the length of the phalanxes of boys aged 17-21 and girls aged 16-20. The material of the study was 146 radiographs of the right and left hands of boys and girls obtained for diagnostic purposes when applying for trauma care. X-rays of both hands of patients with scanning also of the wrist joints were performed under conventional radiation protection conditions on a mobile X-ray unit MobileDaRt (Shimadzu, Japan). The distance from the X-ray source to the object of study corresponded to the generally accepted recommendations in X-ray osteometry. The images were automatically saved in the computer memory in the standard DICOM format. It was established that the average values of the radiographic linear lengths of the phalanges of the fingers and the overall average in boys were statistically significantly higher than those in girls. Finger-wise comparison of indicators between two sex-different populations also showed their highly significant differences in all phalanges without exception. Among the studied osteometric parameters, according to the results obtained, the smallest variability is inherent in the length of the proximal phalanges in girls. The general image established using the method of indirect X-ray osteometry of the I–V fingers phalanges length correlation values, showed their differences with the few data of other authors. It was concluded that the analysis of the limits of anatomical variability, due not only to various external and internal factors, but also methodological approaches and their comparison are of no less scientific importance than the analysis of the influence of only the different conditions and biological characteristics of the analyzed populations.

BT05 Community and Locality Imaging Centres: innovation in the skin cancer care pathway

Abstract Timely management of patients referred with suspected skin cancer remains challenging due to demand that exceeds the capacity of dermatology departments. Encouraging the attachment of images and key metadata along with referrals from primary care helps promote enhanced clinical referral triage. We describe the process of establishing Community and Locality Imaging Centres (CLICs) that seek not only to promote efficient triage, but also to establish a national pipeline of anonymized images, with linked Digital Imaging and Communications in Medicine (DICOM®) data, to assess the potential for future use of artificial intelligence (AI) algorithms in clinical practice. General practitioners (GPs) can request a CLIC appointment at the time of referral, removing the time pressure and potential technical barriers associated with photography and image attachment. Each centre follows the same standardized image capture and hardware operating procedure, ensuring that high-quality, in-focus digital images are consistently acquired. The CLIC appointments take an average of 15 min, during which a suitably trained healthcare professional obtains written patient consent and, using a National Health Service-approved mobile phone with a dermatoscope attachment, takes paired macroscopic and dermoscopic views of each lesion. Relevant metadata, in line with the recently agreed DICOM standards for dermatology, are recorded for individual lesions, enhancing the utility of each photograph. Paired images and metadata are regularly archived to a secure medical image management system and are linked with the referral, allowing dermatologists to perform enhanced clinical triage and communicate one of the following outcomes directly to the referring GP: routine dermatology appointment, urgent dermatology appointment, direct to biopsy or benign lesion–reassurance and discharge. This process aims to streamline the primary care referral pathway and promote immediate benefits to patient care by reducing unnecessary travel for face-to-face outpatient appointments. The establishment of CLICs in Scotland supports referral optimization by providing an efficient, convenient option for GPs and patients to obtain high-quality clinical photography. This model allows for flexible integration into local services: hospital-based with medical photographers, intermediate secondary care-led centres or community-based primary care hubs. Suspected skin cancer referrals can be efficiently triaged by dermatologists when paired with macroscopic and dermoscopic images and relevant patient metadata compliant with DICOM standards. The same images and metadata, once anonymized, can be securely transferred to a nationwide database for deep learning AI algorithm development. Validated AI programs, with the aim of being deployed at the primary care level, inform opportunities for further enhancement of the referral pathway.

BT07 Creation of a skin lesion image pipeline: key steps in developing a mobile application with DICOM® fields and metadata

Abstract A key issue facing artificial intelligence (AI) for dermatology is the lack of standardization around capture, transfer and storage of skin images and clinical data. To assist systematic capture of clinical data, we developed a nationally agreed proposed minimum dataset, based on Digital Imaging and Communications in Medicine (DICOM®) standards. Subsequently, we collaborated with an established image management system (IMS) supplier, Waba [supported by grants from our local National Health Service (NHS) innovation department], to incorporate these fields into a dermatology-specific mobile application (app), facilitating real-time capture and data transfer. We describe our steps in developing this app. The app integrates with the national Patient Administration System (SCI Store), allowing retrieval of real-time patient demographics linked to hospital or Community Health Index number. Each care episode captures a standardized dataset, including lesion views, clinical information and consent level. On episode completion, datasets are securely transferred to the IMS via WiFi or GPRS signal, following a fully auditable pathway. The IMS is a web-based app developed on a Microsoft Structured Query Language server, which allows authenticated users to access our trust’s centralized repository of nonradiological images. Adherence to industry-standard data storage format, patient safety reporting and specific access rights ensure compliance with Caldicott recommendations and data protection standards. For AI research, we are exploring conversion of datasets into DICOM format. Close collaboration between software developers and end users, including clinical photography, dermatology and general practice, was essential for app design. We worked on design architecture through fortnightly technical meetings, scheduled to progress development in months 1–8. Installation and functionality testing was performed in months 9 and 10, followed by comprehensive user testing in months 10–12. Live app test-of-change rollout was performed in months 13–16, with continued usability refinement during this period. To develop a standardized minimum dataset, we conducted a consensus exercise with the British Association of Dermatology AI working group. Based on DICOM standards, a comprehensive international standard for medical imaging, this could improve the quality, availability and interoperability of data for AI development. In summary, we have developed an app to standardize the capture, transmission and storage of skin lesion images and associated metadata. By collaborating with an industry partner with NHS experience, iterative user-led design and national engagement for standard-setting, we believe this is a useful step toward a national UK skin database for training and validating AI systems. Future work is planned to evaluate the output of this data pipeline.

Morphometric MRI analysis of lumbar spine intervertebral foramen

The article presents morphometric MRI-analysis of the lumbar intervertebral foramen for anatomical study of the size of Kambin safety triangle and the vulnerability of the exiting spinal nerve during transforaminal interventions. 200 discs were studied in 50 patients after transforaminal endoscopic intervention. Standard DICOM image viewing program for MRI in T1 WI and T2 WI modes was used for the measurement. The most distant location of the exiting spinal nerve from the intervertebral disc was observed at the level of L5S1 vertebrae (9.82 mm, 0.95CI (9,53 10,10), p<0.05). The narrowest safety triangle turned out to be at the level of L2‑L5 vertebrae, where the distance did not differ statistically (1.97–2.28 mm, p> 0.05). A similar pattern was revealed for the distance between the exiting root and the intervertebral joint. The greatest angle between the exiting spinal nerve and the disc plane was found at the level of L5S1 (134.68 °, 0.95CI (132.39 136.97), p<0.001). The angle was close to a straight one at the other levels. The exiting root located dorsal to the disc plane at the cranial levels (L2L3, L3L4) in all cases, in contrast to L5S1 level, where it always located ventrally. Thus, the greatest narrowness of the Kambin safety triangle was revealed in the intervertebral foramen of the cranial lumbar segments (L2L3, L3L4). Transforaminal interventions require special attention to the exiting spinal nerve at these levels, and possibly additional bone resection to widen the foramen.

Accuracy of markerless registration methods of DICOM and STL files used for computerized surgical guides in mandibles with metal restorations: An in vitro study

Statement of problemDigital imaging and communications in medicine (DICOM) files together with surface scans must be accurately registered in virtual implant planning software programs to match real-life dimensions and ensure correct plan transfer through computer-aided manufactured surgical guides. PurposeThe purpose of this in vitro study was to evaluate the accuracy of 3 different registration methods of DICOM data with and without metal restorations and a metal artifact reduction (MAR) tool for surface scans. Material and methodsThirteen dentate mandibles were assigned to each group of this study (n=39). Baseplate wax was adapted to the bone surfaces of each mandible, and 5 radiopaque markers were attached. A desktop scanner was used to obtain control scans. The groups of metal-free mandibles (MFM) and mandibles with metal restorations (MRM) were scanned to obtain DICOM data without a MAR tool. Additional DICOM data for the MRM were obtained with the MAR tool (MRM-MAR). Point-based registration (PBR), best-fit registration (BFR), and automatic registration (AR) were used to align standard tessellation language (STL) and DICOM data, and 3 data sets were exported. Radiographic markers on each data set were compared with those on the control scan, and positional deviations were calculated and statistically evaluated with 1-way ANOVA followed by multiple pairwise comparisons, independent samples t test, and 2-way ANOVA (α=.05). ResultsWithin each group, PBR had the lowest deviation values with statistical significance in the MFM and the MRM-MAR groups (P<.001). AR showed failure in the MRM and the MRM-MAR groups. Statistically significant differences were found on comparing the average deviations among the 3 groups for PBR only (P<.001). No association was found between deviation values and the presence or absence of metal restoration, while a positive association was found with the type of registration method (P<.001). ConclusionsPBR had the highest accuracy level compared with AR and BFR methods. An increase in the number of calculations resulted in more deviation values. The MAR tool had a positive effect on PBR in mandibles with metal restorations.

Karawun: a software package for assisting evaluation of advances in multimodal imaging for neurosurgical planning and intraoperative neuronavigation

PurposeThe neuroimaging research community—which includes a broad range of scientific, medical, statistical, and engineering disciplines—has developed many tools to advance our knowledge of brain structure, function, development, aging, and disease. Past research efforts have clearly shaped clinical practice. However, translation of new methodologies into clinical practice is challenging. Anything that can reduce these barriers has the potential to improve the rate at which research outcomes can contribute to clinical practice.In this article, we introduce Karawun, a file format conversion tool, that has become a key part of our work in translating advances in diffusion imaging acquisition and analysis into neurosurgical practice at our institution.MethodsKarawun links analysis workflows created using open-source neuroimaging software, to Brainlab (Brainlab AG, Munich, Germany), a commercially available surgical planning and navigation suite. Karawun achieves this using DICOM standards supporting representation of 3D structures, including tractography streamlines, and thus offers far more than traditional screenshot or color overlay approaches.ResultsWe show that neurosurgical planning data, created from multimodal imaging data using analysis methods implemented in open-source research software, can be imported into Brainlab. The datasets can be manipulated as if they were created by Brainlab, including 3D visualizations of white matter tracts and other objects.ConclusionClinicians can explore and interact with the results of research neuroimaging pipelines using familiar tools within their standard clinical workflow, understand the impact of the new methods on their practice and provide feedback to methods developers. This capability has been important to the translation of advanced analysis techniques into practice at our institution.

33218 Advantages of standardization of dermoscopic imaging by leveraging the DICOM standard

With the rise of digital dermoscopy, databases of dermoscopic images of cutaneous conditions are growing every day. However, the lack of standardization yields numerous problems, such as incompatible databases, and missing information. Even more troublesome is the lack of standardization in color rendering of dermoscopic images, resulting in significant color variability between images captured with different systems. Such color variability may negatively influence confidence and quality of diagnosis and reliability of automated image analysis algorithms.

HL7 Functionalities in RIS/PACS/HIS System Integration

Availability of data is a leading factor for the development of society. Science and technology improvement contributed to modernization of information transmission and availability systems. All areas of life are covered, including health. As a basic field for social stability, it was necessary to determine precisely the organization of every individual step in communication into any healthcare institution. Considering diversity and the amount of data, the development of unique transmission standards faced all sorts of problems. However, with the emergence of HL7 and DICOM standards, data became properly structured, thus successfully avoiding obstacles to general availability. When enrolling a patient, demographic data stay permanently recorded in the information system for medical planning and testing with the identification of obtained results. Workflows within individual departments and financial management of healthcare institutions also belong to the options of HL7 standard participating in setting basic conditions for everyday work. Enrolling all clinical data in formulated form contributes to assistance in the diagnostic and therapeutic process, and it presents key data for medical research. Software platform of complete health data integration is a fundamental precondition for the use of artificial intelligence within individual workflow for every clinical department and institution. Furthermore, integration allowed the patient access to primary medical data to establish quality and efficient cooperation. The final aim of this work is to present primary information exchange process through the HL7 standard because of overall improvement in the quality of work within healthcare institutions.

DICOMization of Proprietary Files Obtained from Confocal, Whole-Slide, and FIB-SEM Microscope Scanners.

The evolution of biomedical imaging technology is allowing the digitization of hundreds of glass slides at once. There are multiple microscope scanners available in the market including low-cost solutions that can serve small centers. Moreover, new technology is being researched to acquire images and new modalities are appearing in the market such as electron microscopy. This reality offers new diagnostics tools to clinical practice but emphasizes also the lack of multivendor system’s interoperability. Without the adoption of standard data formats and communications methods, it will be impossible to build this industry through the installation of vendor-neutral archives and the establishment of telepathology services in the cloud. The DICOM protocol is a feasible solution to the aforementioned problem because it already provides an interface for visible light and whole slide microscope imaging modalities. While some scanners currently have DICOM interfaces, the vast majority of manufacturers continue to use proprietary solutions. This article proposes an automated DICOMization pipeline that can efficiently transform distinct proprietary microscope images from CLSM, FIB-SEM, and WSI scanners into standard DICOM with their biological information maintained within their metadata. The system feasibility and performance were evaluated with fifteen distinct proprietary modalities, including stacked WSI samples. The results demonstrated that the proposed methodology is accurate and can be used in production. The normalized objects were stored through the standard communications in the Dicoogle open-source archive.

Dicoogle Open Source: The Establishment of a New Paradigm in Medical Imaging.

The rapid and continuous growth of data volume and its heterogeneity has become one of the most noticeable trends in healthcare, namely in medical imaging. This evolution led to the deployment of specialized information systems supported by the DICOM standard that enables the interoperability of distinct components, including imaging modalities, repositories, and visualization workstations. However, the complexity of these ecosystems leads to challenging learning curves and makes it time-consuming to mock and apply new ideas. Dicoogle is an extensible medical imaging archive server that emerges as a tool to overcome those challenges. Its extensible architecture allows the fast development of new advanced features or extends existent ones. It is currently a fundamental enabling technology in collaborative and telehealthcare environments, including research projects, screening programs, and teleradiology services. The framework is supported by a Learning Pack that includes a description of the web programmatic interface, a software development kit, documentation, and implementation samples. This article gives an in-depth view of the Dicoogle ecosystem, state-of-the-art contributions, and community impact. It starts by presenting an overview of its architectural concept, highlights some of the most representative research backed up by Dicoogle, some remarks obtained from its use in teaching, and worldwide usage statistics of the software. Finally, the positioning of Dicoogle in the medical imaging software field is discussed through comparison with other well-known solutions.

Optimal fluoroscopic viewing angles for stenting of the coronary aorto-ostial lesions.

BackgroundLong-term results after stenting aorto-coronary ostial lesions (AOL) are worse than those achieved in non-ostial locations. AOL interventions still pose a substantial challenge for interventional cardiologists. The aim of the study was to determine the optimal fluoroscopic viewing angles of the left and right coronary ostia, based on multislice computed tomography (MSCT) data.MethodsCardiac MSCT exams of 30 patients with clinical suspicion of coronary artery disease were analyzed. En face angles of both coronary ostia, as well as their optimal projection curves, were determined by 2 independent observers in a standard Dicom viewer, without any additional, specialized software add-ons, using a systematic, step-by-step approach. Spatial relations between the ostial plane and the aorta were also assessed.ResultsThe average en face angle of the left coronary ostium was RAO 23°, CAU 45°; for the right coronary ostium RAO 18°, CRA 5°. The mean inter-observer differences for the en face angles of the left and right coronary arteries were 5° and 7°, respectively.ConclusionsMultislice computed tomography data provide precise spatial information on the orientation of the coronary ostia and their relation to the aortic root. Their utilization for determining the patient-specific viewing angle may substantially facilitate percutaneous coronary interventions in AOL.

A DICOM dataset for evaluation of medical image de-identification

We developed a DICOM dataset that can be used to evaluate the performance of de-identification algorithms. DICOM objects (a total of 1,693 CT, MRI, PET, and digital X-ray images) were selected from datasets published in the Cancer Imaging Archive (TCIA). Synthetic Protected Health Information (PHI) was generated and inserted into selected DICOM Attributes to mimic typical clinical imaging exams. The DICOM Standard and TCIA curation audit logs guided the insertion of synthetic PHI into standard and non-standard DICOM data elements. A TCIA curation team tested the utility of the evaluation dataset. With this publication, the evaluation dataset (containing synthetic PHI) and de-identified evaluation dataset (the result of TCIA curation) are released on TCIA in advance of a competition, sponsored by the National Cancer Institute (NCI), for algorithmic de-identification of medical image datasets. The competition will use a much larger evaluation dataset constructed in the same manner. This paper describes the creation of the evaluation datasets and guidelines for their use.

A novel binary operator for designing medical and natural image cryptosystems

Image cryptosystems aim to secure the transmission of images in the presence of adversaries in the network. For ensuring confidentiality, images are encrypted to form unintelligible cipher images, the algorithms of which are much different from those for text data. Most image cryptosystems follow confusion–diffusion or complex architectures, which involves permutation and substitution of pixel values. Often these are done using chaotic maps and involve binary operations such as bitwise XOR, addition–subtraction, DNA operations, etc., each of which has certain limitations. Most of the cryptosystems for medical images proposed in the literature encrypt 8-bit compressed versions of the images rather than the standard 16-bit DICOM version, which results in loss of information. This paper presents a novel binary operation that can be used for all types of image cryptosystems — from DICOM medical to natural images using both conventional and DNA approaches. The use of this operation has been tested on a proposed DNA-based cryptosystem, which has novel steps for encryption to overcome the drawbacks of some existing ones. The cryptosystem has been tested on several images of varying pixel depth and dimensions, and the results obtained meet the standards of a secured image encryption system.