RADIOLOGY INFORMATION SYSTEM · FUTURIS 1

IBERIS SOFTWARE2

The FutuRIS system is intended to be used at diagnostic and clinical departments that schedule their daily activi-ties around diagnostics results. It is a hardware-software package for storing, processing and viewing radiological images acquired from digital or analog devices. The system is built on the client-server architecture, where clinicians’ and diagnosticians’ workstations operate as clients, and one or more powerful computers function as the server that accumulate and safely store data, ensuring round-the-clock access from the workstations.

Unlike a classic Radiology Information System, FutuRIS is developed so that its modules can work remotely over the HTTP protocol. For instance, a workstation can download images from a server located at another hospital. Images can be collected from all DICOM-compliant devices and sto-red in a remote location. On a larger scale, the system sup-ports data exchange between hospitals.

The system is comprised of two logically independent parts connected with each other via simple interfaces. One part deals strictly with images and does not interact with the database. It could be broken into two sub-parts:

•Image Studio – a fully functional workstation for viewing and processing images

•Service – a server application for interacting with DICOM-compliant devices.

The other part is the RIS database that collects all radiolo-gical data and stores the links to image and audio (doctor’s comments) files. It is also divided into two sub-parts:

•RIS Explorer – a user interface of the RIS database•RIS Service – a server application enabling clients and

other services to interact with the RIS database.

This ability to be safely broken up into constituents allows one to modify the RIS database or even use external data-bases without affecting Image Studio and DICOM Service: they will reliably operate without regard to the database structure.

Image and audio files are stored separately from the data-base; the latter just stores referrals to the former. The data can be reached via:

•Regular access to a local or network disk•Special Storage Service.

What isFUTURIS?

>

RADIOLOGY INFORMATION SYSTEM · FUTURIS 3

Image StudioImage Studio is built on the popular medical imaging pac-kage LeadTools utilizing its following powerful features:

•Fast and high-quality image visualization•Image processing•Import and export of DICOM files•Networking of DICOM images.

The user interface of Image Studio is based on the Win-dows Presentation Foundation technology, allowing distri-butors to freely change its design. Besides that, the inter-face is expandable, which means that one can easily add extra modules (plug-ins) to the original package. The main features of Image Studio, grouped by functionality, are lis-ted below.

ImagePresentation

•The user can view frames on one or more monitors con-nected to her workstation. One of the monitors (usually, with the lowest specs) can be assigned to show the da-tabase (Database Explorer).

•Each monitor displays image windows, the thumbnails panel, the tab bar and the tool bar.

•The panel and bars can either auto-hide or be pinned to the screen, enabling the user to balance between con-trols accessibility and image size.

•The thumbnails panel is also tabbed. Each tab corres-ponds to a particular study (patient, modality).

•For each modality and study description, the user can set up hanging protocols that will specify:•Display mode: stack or tiled•Screen layout (viewing windows)•Viewing windows layout (boxes)•Image-to-box placement according to DICOM attribute

tags •Relevant priors.

•The hanging protocols can apply automatically or be selected manually by the user allowing her to brush through dozens of sequences in a short time.

•The automatic display mode allows the user to place and scroll frames through either all monitors or a se-parate monitor or a set of monitors, thereby enabling simultaneous viewing of different studies on different monitors or sets of monitors that will work indepen-dently in this mode.

•The animation mode enables the user to play a tempo-ral or spatial sequence forward or backward. More than one playback can run at the same time.

Overlay

•Images can be covered with DICOM overlay of the color chosen by the user.

•Various text data, regarding images, patients and stu-dies, including modality-specific information stored in DICOM attribute tags, are displayed in the corners of a frame window.

•Text styles can be changed by different formatting methods. Formatting allows the user to simulate the text formats used by medical devices in Image Studio.

•The user can pop up the table with the values of all of the DICOM attributes. This feature will help a medical equipment engineer to analyze special technical tags.

•The arrow and annotation tools allow the user to leave notes in places-of-interest on images.

•The user can enable the display of intersection lines bet-ween selected frames and a certain frame to view the

spatial relationships between tomographic sequences or a sequence and a localizer.

•The user can toggle on the rulers on the frame borders.

IBERIS SOFTWARE4

Editing

•The user can mark key frames in image series and later load just them, skipping unimportant in-between fra-mes.

•Copying to the clipboard enables quick export of images into other applications.

•The user can create new series or even new studies using frames from other series or merging series and shuffling frames in any imaginable way.

•By clicking Delete after selecting a frame or a range, the user can get rid of unwanted frames or video clips.

•Area cropping allows the user to remove edges and con-centrate on important parts of an image. Cropping can apply to all frames in a sequence (pipe cropping). Diffe-rent types of crop areas (including freehand shapes) are supported.

•The user can stitch adjacent scans into an image of a patient’s full body.

•Filters allow the user to:•Reduce noise•Increase sharpness•Enhance edges.

GeometricTransformations

•Geometric transformations can be applied to one or more selected frames.

•A geometric transformation includes an arbitrary num-ber of the following operations:•Stepwise image resizing•Zooming of a selected area in an image•Smooth image resizing by a mouse drag•Smooth dragging of an image with the mouse•90-degree rotation•Vertical and horizontal image flipping.

•Geometric transformations can be applied to all frames in a sequence either manually or in automatic mode.

•The user can equalize the scales across multiple images using the Match Scale command.

GrayscaleTransformations

•Grayscale transformations can be applied to one or more frames.

•By setting up the window center and width the user can select the intensity ranges.

•Two types of non-linear intensity mapping functions can be used:•Exponential•Logarithmic.

•Inversion can be added to the above transformations.•A grayscale transformation can be saved under a speci-

fic name as a preset for future use.•Grayscale transformations can be applied to all frames

in a sequence either manually or in automatic mode.

RADIOLOGY INFORMATION SYSTEM · FUTURIS 5

MeasurementsandAnnotations

•Length measurements can be done on the following graphic primitives:•A segment•A polyline•A curve.

•Additionally, pixel intensity values can be measured along straight lines (e.g. distances and lengths).

•Area measurements are performed within the following graphic primitives: •A rectangle•An ellipsis•A polyline•A curve.

•Area measurements can be accompanied by the fo-llowing statistical measurements of the pixel intensity within a primitive:•Mean intensity •Intensity variance•Min and max intensity values•A histogram.

•Angles are measured between two segments.•Special tools allow users to perform specific medical

measurements, e.g. limb difference and vertebral displa-cement.

•Volume measurements are performed within ellipsoids

of revolution.•Users can annotate images with text and draw arrows

pointing at places-of-interest.•Peripheral and unwanted areas of images can be filled

in with selectable colors. The user can also specify the shape of the fill-in area: from rectangular to freehand.

•Metric calibration of an image allows the user to cal-culate the pixel size by drawing a segment of a known length.

•The pixel intensity beneath the pointer and its x and y coordinates are always displayed in a special box on the screen.

ImportandExport

•Import and export of standard image files (jpg, gif, png, bmp, avi), as well as DICOM files, are supported.

•The preview mode allows the user select image files to be loaded from a Windows folder or DICOM directory.

•Exported files can be directly burned on a CD/DVD.•By requesting a list of DICOM images, patients, and

studies over the network the user can get access to di-fferent DICOM storages and select which image files to load. Information can be filtered by the following para-meters:•Patient’s name•Patient’s year of birth•Patient’s ID•Image modality•Study description•Accession number

•Study date•Study ID.

•The user can send DICOM files over the network to other workstations.

PrintingandScanning

•Regular and DICOM printers are supported.•Images can be printed with all overlays (measurements

and annotations).•The user can save expendable materials (paper and film)

by using the preview mode.•All types of office scanners, VIDAR medical scanners

and DICOM scanners are supported.

IBERIS SOFTWARE6

AnalogVideoRecording

•Analog PAL/NTSC video (ultrasound, X-ray) can be captu-red by any grabber compatible with Windows.

•Analog non-standard video (CT, MRI, angiography, X-ray) is captured with specialized medical grabbers manufac-tured by Foresight and Matrox.

•Automatic adjustment of Foresight boards to analog standards allows the user to seamlessly attune the

board to the current standard.•Pedals, buttons, and a remote control panel (optional

devices) facilitate image recording and viewing.•The user can synchronize the system with an X-ray unit,

which solves the problem of reacting to X-ray on/off switching (by activating/deactivating the video window) and ensures correct recording of pulse X-ray scans.

3DMode

This mode is used for viewing 3D images. The mode is cha-racterized by the following features:

•Orthogonal viewing: displays the original images, their intersections, and cross-sections perpendicular to them

•Each of the three orthogonal sections has a cross-hair 3D cursor formed by the lines that are the projections of the other two sections on this section; by moving the cursor with the mouse, the user can manually position the orthogonal sections in space

•By viewing an arbitrarily positioned oblique section and manipulating its intersections with the orthogonal sec-tions, the user can quickly position it in space

•Pipe cropping perpendicular to an orthogonal or oblique section allows the user to get rid of the edges or, contra-riwise, make a hole in the image; different types of pipe cross-section crop areas (including freehand shapes) are supported

•Viewing an image as a 3D picture, while being able to rotate, zoom and cut it by orthogonal or oblique planes, dramatically improves the experience of working with images, raising it to a much higher level – the 3D level.

High-quality 3D viewing is demanding as to the computing resources of the workstation. It calls for a powerful compu-ter or even a computing server.

AngiographyMode

This mode employs the viewing methods specific for an-giography:

•Mask subtraction (a mask is an image without contrast solution) allows the user to remove background structu-res, leaving only the contrast solution visible

•Mask shift removes background structures if the image has shifted with respect to the mask

•Mask subtraction accumulation (in all the sequence) re-veals the full picture of the flowing of the contrast solu-tion in time and space.

RADIOLOGY INFORMATION SYSTEM · FUTURIS 7

RIS ExplorerBeing the user interface of the RIS database, this compo-nent of FutuRIS significantly depends on the users’ requi-rements and thus should comply with the guidelines and regulations adopted by the hospital. For starters, we install a basic version of RIS Explorer that complies with the mini-mum requirements for a RIS database.

The basic version incorporates the following features:

•By editing dictionaries, an administrator can set up the informational structure of the hospital:•Departments•Rooms•Groups of users•Users•DICOM sources.

•Patient search looks up a patient by the following para-meters:•Patient’s name•Patient’s year of birth•Patient’s ID•Image modality•Study place•Study description•Study status•Accession number•Study date•Study ID.

•The appointment schedule allocates orders and studies for different exam rooms. Order lists can be acquired from a third-party server under the DICOM modality worklist protocol.

•Examination logs keep the history of studies, including all specific data (in addition to the parameters mentio-ned above):•Patient’s DOB and sex•Study time•Examining doctor’s or/and technician’s name(s)•Referring physician’s name

•Report in text, RTF or WPF FlowDocument format, the latter includes free text, static text, interface controls (checkboxes, combo boxes, etc.), and images

•Audio report in WAV format.

•The user should “sign off” a study to allow access for coworkers.

•Images can be directly exported to a DICOM directory without loading them into Image Studio. The user can burn the DICOM directory on a CD/DVD. Moreover, stu-dies can be sent to DICOM devices and other worksta-tions over the network.

•Staff members are identified by passwords or Windows logons.

•Rights are assigned to individuals or groups of users ac-cording to their authorization level, which means that certain operations with database objects can be either forbidden or allowed for certain users or groups of users.

•Statistical reports, deployed on the Microsoft Reporting Server, provide statistical snapshots of the RIS databa-se. Results can be presented in various formats (text, charts, graphs, etc.) in RIS Explorer or a web browser. The deployment of reports on the server and use of standard Microsoft technologies allow distributors and advanced users to modify existing reports and create new ones.

The user interface of RIS Explorer is based on the Windows Presentation Foundation technology, allowing distributors to freely change its design.

In the course of exploitation of the RIS, RIS Explorer can be adapted to the hospital’s needs (even by re-writing the en-tire component from scratch). We provide some software components to facilitate the work of third-parties called upon to adapt RIS Explorer, and shorten and cheapen the terms of their involvement.

IBERIS SOFTWARE8

Server

DICOMService

The service’s task is to support the whole range of DICOM network protocols for seamless integration with medical devices and other PACSes. Its simple user interface allows the user to quickly configure the way FutuRIS interacts with the outer world and adapt the system to the changes in the environment in the future.

The DICOM service can do the following:

•Receive images from DICOM devices and other worksta-tions and store them as DICOM files

•Create a list of images, patients and studies by a filtered request, allowing every workstation (from almost any manufacturer) to view the data stored in the RIS data-base

•Create a list of orders by a filtered request, allowing a DICOM device (or a workstation) to view the list of the patients scheduled for this device.

The DICOM Service is based on the medical imaging packa-ge LeadTools (the same package as used in Image Studio).

RISService

This service is integrated with the DICOM Service. It can perform the following tasks:

•Move DICOM files from the DICOM Service into a long-term storage that stores them as tree-like structures: by year, month, and day

•Create objects in the RIS database corresponding to the DICOM files moved in the previous step

•Create a list of images, patients, studies and orders upon request from the DICOM Service.

Database

The following platforms can be used for managing a RIS database.

•Microsoft SQL Server 2008. An optimal price/quality ra-tio, easy-to-use administration tools, its ability to repli-cate and encrypt data and easy integration with other Microsoft server products make this platform an ideal solution for medium and small hospitals. Furthermore, with the implementation of the cluster technology to improve performance and reliability, SQL Server will even satisfy the requirements of a larger hospital. Microsoft Reporting Server 2008, fully integratable with Microsoft SQL Server 2008, is used to generate statistical reports.

•Oracle 10g. By all standards, this platform is comparable to Microsoft SQL Server, to say the least, and can be a powerful and reliable solution for large hospitals. But its only drawback – complicated administration (requi-res highly qualified server administrators) – makes RIS maintenance pretty costly.

StorageService

Taking into account that image and audio files are stored separately from the database and comprise 99 percent of the data volume, it is important to safely store these huge piles of information.

The Storage Service is dedicated to provide universal ac-cess to various data storages from other FutuRIS compo-nents. The service was developed to ensure quick and se-cure access for hundreds (thousands, in case of a powerful server) of clients. Different access levels are deployed:

•High-speed access to the server’s hard drives or a RAID array, several to dozens of terabytes capacity storage, formed of regular disks mounted in a RAID array; the cost of such storages is minimal due to low costs of disks and a RAID rack

•LAN-speed access to network storages (NASes), ranging from several to dozens of terabytes each; the use of NASes increases storage safety, enabling data backup within the hospital.

The user-friendly interface of the service enables an admi-nistrator to set up policies for data transfer from one level to the other by configuring certain parameters (e.g., maxi-mum first-level storage period).

The network interface of the service is based on the Win-dows Communication Foundation technology, which allows administrators to fine-tune the parameters of its in-teraction with the DICOM Service, viz. protocol, encryption, and reliability of delivery.

RADIOLOGY INFORMATION SYSTEM · FUTURIS 9

DeploymentDeployment of FutuRIS can be performed in two ways.

Intranet-basedDeployment

In case of an intranet-based deployment, the system provi-des access to radiological information only for LAN users. The DICOM Service and RIS Service are installed on the server. The DICOM files acquired from DICOM-compliant de-vices are transferred from the former to the latter. The Sto-rage Service provides access to the files for Image Studio and RIS Explorer installed on every client.

Internet-basedDeployment

When employed by the system, the Internet can be used to carry out the following three tasks:

•Provide access for remote users to the RIS database•Collect image files from DICOM devices•Enable data exchange between databases.

Under the Internet-based deployment, the data are trans-ferred over the HTTP protocol, with the options of encryp-tion and enhanced reliability of delivery.

AccessofRemoteUserstotheRISDatabase

To provide remote access, Image Studio and RIS Explorer are published on a Web-server as XBAP applications and operate within a remote client’s web browser (in fact, they implicitly install themselves on client computers). The Sto-rage Service provides access to the files.

XBAP applications do not differ from locally installed ones; so, remote users enjoy the same GUI in terms of sophisti-cation and design as local users do.

Remote access is not restricted to the hospital’s person-

nel only; workers at other hospitals, patients, even guests, can be granted rights by the authorization system allowing them to access certain parts of the database:

•A physician at another hospital may have access to the information on patients and studies opened for external viewing

•A patient may have access to her personal data•A guest user will be able to access demos to get acquain-

ted with the system.

IBERIS SOFTWARE10

Collection of Image Files from Remote DICOMDevices

To collect images from remote DICOM devices, one needs to divide the DICOM Service and RIS Service between di-fferent LANs. The former is installed on a remote network for data collection, and the latter will operate on the RIS server.

DataExchangebetweenDatabases

Data exchange between databases is performed by inte-raction between special telemedical services running at di-fferent locations (hospitals). If FutuRIS is to be integrated into an existing regional telemedical system (which is often the case), we will develop a Web service designed to:

•Receive information on patients and orders from the re-gional system

•Send back study results (e.g., reports) and images.

RADIOLOGY INFORMATION SYSTEM · FUTURIS 11

TechHeim | RIS Software Provider

B-10F Geumgang Penterium IT Tower, 333-7, Sangdeawon-Dong, Jungwon-Gu462-120 Seongnam-Si, Gyeonggi-Do, Republic of Korea

Tel: +82 31 730 0020Web: www.techheim.com

NapierHealthcareSolutions | HIS Software Provider

5 Shenton Way, #18-10/11, UIC Building 068808 Singapore

Tel: +65 6222 4505Web: www.napierhealthcare.com

Lariviere | Medical Equipment Provider

Teerhof 48 28199 Bremen, Germany

Tel: +49 421 430660Web: www.lariviere.de

Medotrade | HIS Software Provider

Vavilova 69/75, office 1101 117335 Moscow, Russia

Tel: +7 495 792 3574Web: www.medotrade.ru

Strategic Partners

IBERIS SOFTWARE12

Iberis Software S.L.Av. de la Argentina 132, office 219

33213 Gijon, Asturias, SpainTel: +34 984 030 851Fax: +34 985 308 228

Web: www.iberisoft.com Email: info@iberisoft.com

May, 2013