how best to create, standardize, and promote data models ...how best to create, standardize, and...
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How Best to Create, Standardize, and Promote Data Models for Dermatology in the Mobile Era?
David Clunie ([email protected])Pixelmed Publishing, LLC.
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Background & Disclosuresl Owner, PixelMed Publishing, LLCl Radiologist
l Independent Consultant – GE, Carestream, MDDX/Bioclinica, Hologic, Lunit
l Editor of DICOM Standard (NEMA contract)l Formerly co-chair DICOM Standards Committeel Formerly co-chair IHE Radiology Technical
Committee
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Overview
l Modality typesl Interoperability – how and why?l Metadatal Enterprise scalability & securityl Mobility differencesl Data types – more than imagesl Barriers to interoperability
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Range of modalities +/- mobilityl Digital cameras – hand-held
• DSLRs – tethered, wireless (WiFi, Bluetooth), memory card
• mobile phones/tablets
l Dermoscopy/Epiluminescence Microscopy (ELM)• standalone or addition to mobile phone
l Total Body Photography (TBP)• manual following template
• semi- or fully automated
l Reflective Confocal Microscopy (RCM)
l Optical Coherence Tomography (OCT)
l Dermatopathology• microscope attached camera or mobile phone
• Whole Slide Imaging (WSI)
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Interoperability
“the ability of two or more systems or components to exchange information
and to use the information that has been exchanged”
IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. 1990
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l layers: technology, data, human, institutional
l consumer empowerment
l privacy, securityl competition,
homogeneity, innovation
l efficiencies, complexity
l by designl over timel architectures
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Radiology Interoperability
Modality
ArchiveModality
Modality
Modality
PACS +/- RIS
Manager
Workstations
Standard Boundary
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Radiology Interoperability
Modality
ArchiveModality
Modality
Modality
PACS +/- RIS
Manager
Workstations
Standard Boundary 1993 – 25 years!
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Dermatology – Black Box
Proprietary Interfaces
Camera
Camera
Camera
Camera
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Dermatology – Black Box
Camera
Camera
Camera
Camera
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Proprietary black box issuesl interface to EMR?l share with other sites?l persist/represent/query the metadata?l persist/represent/query the annotations?l apply 3rd party tools & analysis?l migrate at end-of-life?l deal with vendor failure?l handle security/single sign on/access control?l handle business continuity/disaster recovery?l …
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Information Wants to be Free
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Standard Camera Interface
Archive
PACS +/- Database, Departmental IS, EMR …
Manager
Workstations
Standard Boundary
Camera
Camera
Camera
Camera
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Capture, Viewing, Analysis
Archive
Manager
Standard Boundary Standard Boundary
Workstations
Analysis Systems
Camera
Camera
Camera
Camera
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Deconstructed Enterprise PACS
Archive
Manager
Standard Boundary Standard Boundary
Modality
Modality Workstations
Analysis Systems
Slide Scanner
Camera
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http://medium.com/digital-trends-index/its-the-metadata-stupid-12a4fc121e45#.4zhwdz5y0
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Types of Metadatal Identifying
• patient, order/request, encounter/visitl Clinical
• reason for study, anatomic locationl Descriptive
• device and settings• kind of image• pixel physical size (calibration against known size object)
l Encoding related• compression• color management
l …
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Patient Metadata
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Anatomic Metadata (CP 1764)26
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Anatomic Metadata (CP 1764)
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Anatomic Metadata (CP 1764)
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EXIF Metadata (CP 1736)
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Color Management Metadatal DICOM’s goal is only color consistency
• i.e., all displays show same thing everywhere• display as the image creator intended• relies on ICC profiles encoded in DICOM file
l Out of scope: province of image creator• color calibration – how to create right profile• color normalization
l Multi-spectral image storage• theoretically possible in DICOM but no experience • define spectral characteristics of channels
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No ICC Profile Applied With ICC Profile Applied
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Metadata for Specific Modalitiesl Total Body Photography
• ? new object required or re-use existing VL Photographic• how to encode stitched image +/ references to source images• re-use example of wide-field retinal photography?
l Dermoscopy-specific metadata• more specific optical path information• re-use ophthalmology, pathology attributes
l Optical Coherence Tomography (OCT)• new object required• re-use ophthalmology, cardiovascular OCT attributes
l Reflective Confocal Microscopy (RCM)• new object and attributes required
l In the interim• use extended VL Photographic, Secondary Capture objects, etc.
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Device connectivity optionsl Physical
• removable media (memory card)• tethered (Ethernet or USB cable)• wireless (WiFi, Bluetooth)
l Logical• command and control• data (image) transfer
l Application• metadata pre- or after-load• demographics, etc.• device firmware or loadable “app”
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Wrapping a camera device
Camera
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Wrapping a camera device
Camera
Proprietary Interface
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Wrapping a camera device
Camera
Proprietary Interface
Interface Application
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Wrapping a camera device
Camera
Standard Boundary
Proprietary Interface
Interface Application
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Wrapping a camera device
Camera
Standard Boundary
Proprietary Interface
Interface Application
Standard Infrastructure
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Camera wrapper application
PACS
DICOM
C-STORE
Wrapper provides user interface to populate metadata
Wrapper
Proprietary
Interface
Camera
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IS Integration for Metadata
PACSIS
DICOM
C-STORE
Wrapper
DICOM MWL, HL7 QBP
Camera
Proprietary
Interface
Wrapper re-uses IS-supplied metadata
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DICOM Camera with MWL
PACS
DICOM
C-STORE
IS
DICOM
MWL
Standard Images and HL7/DICOM IS Integration
Broker
HL7
OML/QBPCamera
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DICOM in the era of mobilityl Traditional DICOM payloads/protocols
• designed for local area networks – do work on WAN, WiFi
• dedicated protocols (i.e., not HTTP) – need toolkit/library
• services
• send (C-STORE)
• retrieve (C-MOVE, C-GET)
• query (C-FIND)
• modality worklist (C-FIND)
• …
• binary tag-value pair encoding
• security features rarely used (other than TLS)
• huge installed base of archives, viewers, tools
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DICOM in the era of mobilityl DICOMweb payloads/protocols
• designed for browser, mobile devices, JavaScript• http access to “RESTful” resources
• URLs for study/series/instance/frame/metadata
• services• send (STOW-RS)• retrieve (WADO-RS)• query (QIDO-RS)
• JSON and XML metadata encoding• ordinary image/jpeg payload (if compressed)• web security: https, OAUTH2, JWT etc.• relatively new but rapidly growing, esp. EMR, VNA
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DICOMweb – easy to capturel Consider phone app developer’s task
• has a JPEG from the camera API
• has an identifier from the barcode API
• wants to send to DICOM PACS
• knows nothing about DICOM
l Minimal documentation describes• URL to which can send JSON header + image/jpeg
• JSON template to insert identifier into
l Standard DICOMweb server does the rest• server “fills in the blanks”
• uses supplied identifier to look up & insert demographics
• uses JPEG header to populate required pixel data module
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IHE Web Image Capture (WIC)
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Security & Privacy Concerns
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PACS Access Controll Deployment
• historically, many radiology deployments unrestricted
• many contemporary PACS/VNA do provide per user or role
based access control, separate databases/folders/facilities
• needs reliable authentication
l Interface
• proprietary user interface easily secured
• traditional DICOM interface can be but is rarely secured
• newer DICOMweb more easily secured (SSO with EMR)
l Restrict (filter) triggered by DICOM attributes
• device source, modality, specialty, department, etc.
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https://onepacshelp.com/display/V12/Managing+Case+Access
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Annotation Representation
Contour – 2D Coordinates (SR) Rasterized Bitmap (SEG)
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DICOM Segmentation Objects
l Not just for 3D cross-sectional images• i.e., photographs, 2D projection images too• 1:1 correspondence to original pixel matrix
l Multiple planes• different segmentation properties• can be overlapping (i.e., not a label map)
l Single bit or fractional• fractional can be occupancy or probability
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DICOM Structured Reports (SR)l Spatial coordinates
• 2D image relative referencing original imagel Can also reference segmentationsl Other coded/structured content
• measurements (e.g., size)• other quantitative values (e.g., texture features)• qualitative (categorical) assessments (e.g., malignant)
l Temporal information• describe change over time
l Lesion tracking• human-readable and unique identifiers
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Encoding Lesion Matching
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DICOM Tracking ID/UID
In both DICOM Structured Reports and Segmentation Objects
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DICOM 3D and Surface Scansl Surface Segmentationl Surface Scan Meshl Surface Scan Point Cloud
l Rigid and Deformable Registration (field not spline)l Spatial Fiducials
l Encapsulated STL (3D Manufacturing)l Encapsulated OBJ, etc., (work in progress)
? of interest for TBP +/- stereophotogrammetry
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DICOM & Camera RAW imagesl From DSLRs and mobile devices (phones)l Proprietary formats
• format is dependent on maker, model, versionl Adobe Digital Negative (DNG)
• TIFF-like structure• +/- embedded original RAW file
l DICOM possibilities• existing Raw Data object
• intended for proprietary CT/MR/PET raw data• standard composite context + private (image) payload• storage & regurgitate from PACS – proprietary viewer
• new Encapsulated DNG object?• +/- EXIF DICOM attributes
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Store & Regurgitate
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Interoperability
“the ability of two or more systems or components to exchange information
and to use the information that has been exchanged”
IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. 1990
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Barriers to Interoperabilityl ≈ barriers to adoption of DICOM in dermatologyl Lack of customer demand
• education about feasibility and opportunitiesl Cost of interoperability features
• economies of scale• cost of failure (loss of data, security breach)
l Missing dermatology features (in products/standard)• best of breed mix of generic infrastructure & specific tools• extend standard
l Need to address security & privacy• choose solutions with appropriate segregation/controls
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“we will add your biological and technological distinctiveness to our own”
“your culture will adapt to service us”
“resistance is futile”