Over the last decade, a huge number of medical visual data are widely used for diagnose, treatment, and follow-up. Retrieving needed medical image(s) from a huge number of images is one of the most widely used features in medical information systems, especially in medical image search engines. Indexing as part of search engines (or information retrieval systems), increases the speed (efficiency) of search and the information retrieval process. In this paper, a multidimensional indexing technique for medical images is presented that can improve effectiveness and efficiency of medical image search engines. The structure of the proposed multi-dimensional indexing technique and its main operations (i.e., creation, insertion, deletion and search) is designed and evaluated. In order to create this multidimensional index, the "vertical fragmentation" approach (which is usually applied for distributed database design) is used to determine the each of dimensions; roughly speaking, dimensions are different aspects of the medical images for a/some information need (e.g., image type and format, type of disorder, etc.). Accordingly, data structure of the proposed multidimensional indexing technique (which is named "Diamond") is formed by using the vertical fragmentation of medical image attributes (to differentiate the dimensions), and then using agglomerative hierarchical clustering to build up the hierarchy in each dimension. The proposed multi-dimensional indexing technique is implemented using the open-source search engine Lucene and compared with the built-in indexing technique available in the Lucene search engine, and also with the Terrier Platform (available for the benchmarking of information retrieval systems). In this evaluation, efficiency and effectiveness measures of the proposed multidimensional indexing technique (Diamond) are evaluated experimentally, beside the analysis of the designed data structure and its operations. For the experimental evaluation data set, images from Tabriz Behbood Hospital and a subset of TCIA images were used. Experimental evaluation results show that Diamond, the proposed multidimensional indexing technique improves both efficiency and effectiveness for a medical image search engine.
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