Practical Material

Introduction

 
Real image based practical material stands for an anonymized version of real life examinations whereby one can learn the practical skills and understand the methods of digital imaging. The image material is in the electronic archive, which is owned and maintained by Semmelweis University Faculty of Medicine Department of Radiology and Oncotherapy. (Images are archived in a DICOM). The practical DICOM images are accessible through eRAD ImageMedical PracticeBuilder1-2-3 a Web based tele-radiologic solutions software (supported on Windows). When given all the necessary authorizations to access the practical material, and all the necessary software and hardware requirements are met, one can access the material independently from the geographic locations, thus the basic skills of digital diagnostic image evaluation can be obtained. Another goal of the practical material is to provide experience for non medical experts in the field of natural sciences who use, develop or research diagnostic imaging and would like to gain experience in their imaging modality of interest. It is important to note that the practical material not only contains human examinations, but also has mathematical, physical (anatomical) phantom examinations for the more reliable identification of the imaging contents. Further parts of this chapter outline the system requirements and the knowhow of the system. Some English knowledge is necessary for eRAD ImageMedical PracticeBuilder1-2-3 software system application because it is available only in English.

System requirements

 
The presented list could be considered as a recommendation, any higher capacity hardware system will work better, while less developed hardware systems might not be able to perform operations or need much more time to execute the tasks. The recommended hardware configuration on the client’s side:

Desktop or laptop:

 

• Min 2GHz Dual-Core CPU
• 2 GByte memory
• 0.5 GByte graphical memory (NVIDIA recommended)

 

Display capabilities:

 
Image Resolution: At least 1680*1050 screen resolutions is necessary or users having 4:3 display ratio the recommended resolution is 1280*1024. Of course it does not mean that any other display resolution is not supported, but it will be less convenient to use. In most cases (i.e.: CT uses several hundreds of 512*512 pixel images) high resolution and large numbers of image presentation needs to be supported.

As a general rule it could be noted that displays should support landscape arrangement in a vertical 1024 pixels or better.

Network connection:

 
Any network adapter supporting 10/100Mbit, or 10/100/1000Mbit TCP/IP network protocol. 10Mbit band-width connection is a minimum requirement for communication speed form the service provider side.

In case of a mobile internet connection, HSDPA 3G service is necessary and one should pay attention to the data limit since the usual monthly 2 GByte or 4GByte limits can be easily exceeded (even the more expensive 8 or 16GB limits can be reached).

Basic operation systems:

 
eRAD Image Medical PracticeBuilder1-2-3 tele-radiological software system traditionally used to work only under Windows operational system (Explorer engine). Very soon Linux and Mac bases system will be available also. Our institute works with this system since 2001 and all the development have been achieved from clinical point of view exclusively Windows environment has been applied. Our comprehensive support is only limited to Windows environment because of the practical reason that the institutional client computers are all Windows based. The non-Windows based clients support will be solved individually.

Windows requirements:

 
PracticeBuilder1-2-3 operates with all 32bite and 64bite operational system (except Windows XP). In case of Windows XP, no experiences are available concerning the 64bite version, therefore, its use is not recommended. In case of a 32bit version, installation of SP3 (Service Pack 3) is recommended, but SP2 is necessary. Everything works with Windows Vista and Windows 7 perfectly.

How to acquire login account

 
Physically, the tele-radiological system operates on Semmelweis University Faculty of Medicine Department of Radiology and Oncotherapy, where an appropriate sized mass storage device and server is in service continuously (24hours) by secure way. The educational material is available (logically only) after a login with a special identification which can be acquired from the professionals possessing with system administration authorities listed here:

Béla Kári PhD Research Associate SU FoM Department of Radiology and Oncotherapy Department of Nuclear Medicine Head of Division of Image Archiving and Processing

e_mail: kari.bela@med.semmelweis-univ.hu Tel: +36-1-210-0300/52247 Mob: +36-20-380-0804 Mob: +36-70-337-8162

István Somogyi IT specialist, System administrator SU FoM Department of Radiology and Oncotherapy Division of Image Archiving and Processing

e_mail: somogyi.istvan@med.semmelweis-univ.hu Tel:+36-1-210-0300/53223 Mob: +36-20-825-8801

Dávid Légrády PhD Associate professor BME Institute of Nuclear Techniques

e_mail: legrady@reak.bme.hu Tel: +36-1-463-1254 Mob.: +36-30-460-6270

 
Following acquiring the appropriate login authorization, one of the following (Windows operated) browsers must be activated:

• Windows Internet Explorer (7,8,9)
• Netscape Navigator 9.0.0.6
• Mozilla Firefox 6.0.1 or newer

 
(These browsers are being used in the past years, and only these operations are guaranteed concerning the use of PracticeBuilder while using Windows operating systems.)

Following the activation of any browser the next line should be entered (see figure 1)::
http://sote-rad.eradimagemedical.net

 
Following the correct type in the eRAD server address a window shown on Figure 2. appears where the previously acquired username or User ID (received for login authorization purpose) and the related password, a secure login code, must be entered with small but no capital letters.

 
Following type in of the correct identifiers, click on the „Sign On” button and the window shown on Figure 3. appears after login.

 
Once the patient list automatically opens, the „Download Viewer” function, which is available in the superior menu marked by red arrow on Figure 3, must be activated at first login. Namely, the latest version of the PracticeBuilder1-2-3 will be downloaded and installed after this activation in the workstation of the present client (please note that it is fortunate if the given computer operates based on a system administration right, since the installation may accompany with less difficulties). Installation process is easy and automatic; the only possible arising question can be the location of download in case of the presence of more partitions. Following the completion of installation process, images of examinations and image processing possibilities will be available. After the successful installation, click on the icon marked by blue arrow on the actual patient list and the images of the present patient will open for further processing purposes. If the images of the selected patient are available for further processing purposes, the following window appears on the screen as shown on Figure 4.

 
It is not definitely necessary that the image series (eg., CT) appear always in the same layout. Therefore, the layout can be set by the users themselves according to their user right belonging to organs. In order to achieve more details after your initial setup and delve into several problematical issues or topics deeper, please consult with your assigned group leader how to solve the revealed questions based on the available tools. Online consultation is also obtainable. Accordingly, controversies related to several fields can be explored in detail by self-education and based on instructions acquired by consultation through real examinations with non-risk way. Henceforward, methods will be demonstrated according to several functions how the digital image processing of various modalities can be acquired. Returning to Figure 4. you can observe that a slice of a CT image, e.g., is displayed in the maximal magnification in accordance with the available screen resolution, as well as all the available slices of the particular series can be screened all along one by one slices by scrolling the mouse. Besides the magnified image, a small zone with miniaturized image (thumbnail) (or images, depending on the quantity of performed image series of a certain patient) can be observed. The miniaturized images can be allocated to the image field by the „drag & drop” operation of the mouse in order to perform more detailed analysis and further evaluation. These functions will be demonstrated by some examples henceforth. Look at the Figure 5.

 
The results of a morphologic CT and a functional cerebral SPECT examination of the same patient (but performed in two different centers) are evaluated here simultaneously. One of the first initial tasks is the designing and the personal customization (personalization) of the screen layout (as shown on Figure 5.) adapting to the type of examination and our evaluation method. Designing of the screen layout can be found in the top row of the screen as so-called „pull down” menu (see Figure 6.) or as icons located along the margin of the screen (marked by green arrows on Figure 5.).

 
As shown on Figure 6., „layout manager” (Figure 7.) is available from the „pull down” menu by function key F6, or by mouse in order to design the screen allocation.

 
The chosen layout can be seen immediately in the miniatures of „Layout manager” (thumbnail). Besides the appropriate set-up of screen layout, optimal set-up of image quality (contrast, brightness) parameters is also essential, which plays a key role in point of the determination of correct diagnosis. In order to achieve it by mouse on the chosen image series, keep the left mouse button pressed while a pointer of a small light bulb appears instead of the small arrow. While moving the mouse, the contrast and brightness will be changed simultaneously. It can be also tracked from the position of sliders located in the upper control button line – Window, Level sliders (indicated by light blue and orange arrows on Figure 7). The contrast and the brightness is adjustable by shoving the above mentioned sliders or by typing in numbers in the window located next to the sliders, indicating the same effect and result. Accordingly, the optimal contrast brightness can be adjusted by three different approaches. The optimal brightness and contrast can be saved according to user and the type of examination, which can be displayed from this list later (Figure 8.):

 
Image processing tools represented by the icons can be also studied by directing the mouse pointer to the icon, while the operation related to the icon appears in a small appearing window (Figure 9.).

 
Accordingly, the available image manipulation tools can be studied independently, and their effects can be investigated and checked interactively.

Additional more complicated 3D post-processing tools are also available in the system, such as fusion possibilities of image results of multimodality imaging systems (SPECT-CT, PET-CT), and 3D displays of these. In addition, multi-planar reconstruction and display of CT and MR images are essential in the everyday practice. Obviously, all these operations can be fulfilled independently of geographical area in case of appropriate Internet band-width. Finally, the multi-planar reconstruction will be demonstrated as a post-processing operation. The accessibility and feasibility of the multi-planar reconstruction post-processing tool is shown on Figure 10.

 
The following figure 11. demonstrates a completed result of MPR operation.

 
This brief review will be hopefully enough to develop the practical skills with the acquired authorization and anonymized image material. The access/forbidding of different authorization levels and the related operational tools in addition their operational mechanism is the part of the practical material, which can be obtained strictly only by the supervision of a well trained leader (certain system configuration procedures are emerged already here). Obviously, tele-education and telecommunication is also adoptable upon these terms and conditions.

The practical material based database

 
In the following part we would like to tell some words regarding the compiled image database and the related use. According to the easy selection aspects, names of patients stored in the anonymized database and measured results (phantom) start with *Demo character line in all cases. Following this demo character line, some kind of indication indicates the characteristics of the anonymized examination in the name.

A report belongs to each anonymized examination which contains a brief explanation and instruction concerning the examination (eg., what kind of processing is required with the given series. See Figure 12.).

 
„Reporting” function can be activated for an examination as shown on Figure 13.

 
Finally, let’s see how to realign the patient database according to pre-arranged criteria. See Figure 14.

 
If a icon can be observed on the top of a column, it indicates that the patient data order can be realigned based on given terms according to parameters characterizing the certain column, and determinating various criteria only those patient who met them will appear in the list.

Clicking on the icon of any column, a window appears where the searching, chosing, grading criteria can be added according to the column (see Figure 15.).

 
Those patient examinations which met the criteria on Figure 16. (examinations performed before 12 January 2003) appear in the list.

 
Entirely analogous criteria can be used for patient name, image modality, etc. It can be also observed from the visualized filtered list, that the patient list can be also adjusted according to the number of patients shown on one page (e.g. 20). The automatic refreshing time of the patient list can be also determined (e.g. 5min). „Page” line indicates how many pages are necessary for visualizing the selected patient list (e.g. 1).

With this information, the review describing the use of practical material has been finished. Exploration of additional details can be attained by self usage or advices and instructions of practiced leaders. In case of any arising technical questions in the course of system use please contact the authorization providing professionals via email or phone indicated above.

 
Collection of image material: All the authors (both medical and technical aspects) contributed and hopefully they will contribute in the future too for the imaging material collection. The collection procedure can be considered like a continuous task providing even more wide range of studies, examples for the practical education tasks.

Following external partners support the continuous operation of the system providing the real anonymized images:

• Képdoktor Ltd.
• MDO.HU Ltd.
• Medimat. Ltd.
• Mediso Ltd.

 
Technical and/or professional work in order to manage the demo human studies for practical education:

• János Gyebnár MD.
• Csaba Korom MD.

 
Translation to English:

• Ádám Tárnoki MD.
• Dávid Tárnoki MD.

 

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