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A Simple Method of Capturing PACS and Other Radiographic Images for Digital Teaching Files or Other Image Repositories

¹ All authors: Department of Radiology, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.

Received August 6, 2001; accepted after revision September 25, 2001.

 
Address correspondence to M. J. Halsted.

Abstract

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OBJECTIVE. We sought to develop an easy-to-use method of capturing and storing radiographic images.

CONCLUSION. The method that we developed can capture any digital image—including an image from a picture archiving and communication system (PACS)—using widely available, inexpensive software. Our method is easy to learn, simple to use, and inexpensive to implement. It is adaptable in a wide range of networking environments and can capture and store images rapidly for a variety of uses. It can be used without interfering with clinical workflow at the PACS workstation.

Introduction

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Radiologists have long been plagued by the lack of a simple system of capturing and storing interesting images. The tedium of using light boxes, tripods, cameras, and darkrooms to collect images illustrating good examples of various diseases has been responsible for the loss of many such images. Copied films are expensive to create, bulky to organize and store, and heavy to move. The advent of picture archiving and communication system (PACS) has brought tremendous speed and flexibility to film display. Unfortunately, many radiologists have been disappointed to find that most PACS systems fail to offer an efficient means of capturing images for use outside the clinical PACS environment [1]. PACS licensing issues generally prevent radiology departments from attempting to incorporate image-capture software into the proprietary primary code of their PACS systems. As a result, many radiologists must undertake separate, time-consuming steps to capture Digital Imaging and COmmunications in Medicine (DICOM) or other proprietary images from their PACS, download them to a removable medium, and then convert these images to more usable formats.

We have implemented a system that operates in the background on our departmental PCs and PACS workstations and allows the efficient capture and transfer of images from the PACS system to a stand-alone server. Users capture images "on the fly" from PACS workstations, without interrupting workflow, and the system saves the images to a server. The user can later annotate, file, organize, store, retrieve, and display the images without tying up PACS resources. Our system renders the issue of ensuring compatibility with DICOM unnecessary because we based our system on screen capturing rather than on the direct pulling of DICOM images from a PACS server [2].

Our system eliminates workflow conflicts by removing copied images from the PACS environment and immediately transferring them to another server. By separating the nonclinical image server from the PACS server, we protect the clinical performance of the PACS system. The availability of the PACS workstations is maximized, and the traffic on the PACS network is minimized. Our system also enhances access to the images because any computer on the network—not just the PACS workstations—can be used to manipulate and view the copied images.

Materials and Methods

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Any digital images on any network PC can be copied to the image server and can then be used in our digital teaching file, in lectures, or in publications. The images can be incorporated into presentation software such as PowerPoint (Microsoft, Redmond, WA) or saved on compact disks for instructional review or presentation outside our institution.

Our system is quick, easy to use, simple to install, and easy to maintain. Its operation is so intuitive that users require minimal training. It offers flexible output options: images can be saved to a server, a network hard drive, a local hard drive, a zip disk, a floppy disk, or even an e-mail attachment. Images can be viewed on any PC or Macintosh computer (Apple Computer, Cupertino, CA) running readily available software.

To capture images, we use screen-capture software (SnagIt, version 5.0; TechSmith, East Lansing, MI; www.snagit.com ), for which we have purchased a multiple-user license ($200 per 10 licenses). SnagIt has been installed on each of our PACS workstations and launches automatically with the workstation software. It is configured to operate requiring the least user intervention possible. When a desirable image is encountered, the user presses the Print Screen button, which changes the workstation cursor to a selection tool. The user drags the selection box around the desired portion of the image and then views the captured image by releasing the left mouse key to bring up a preview window. The user clicks Finish to approve the image. The program then asks the user to name the file and its destination and defaults to save images on the image repository server, on which each physician has a directory designated for his or her images. Once the user clicks Save, the window disappears, the image is sent to the desired location, and the PACS workstation returns to its normal operating mode. The entire capture process takes between 5 and 10 sec and causes negligible workflow interruption (Figs. 1,2,3). The user can later open the images on the server to organize, file, distribute, and display them. If the user is creating a formal teaching file, the images can be pulled directly from the server with the teaching file software.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Radiograph from PACS screen was captured using SnagIt software (TechSmith, East Lansing, MI). Patient is 10-month-old male infant who presented with cough.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Photograph shows screen of PACS as it displays radiograph of 8-month-old female infant who presented with fever. Operator presses Print Screen key and uses cursor (white box in lower right corner) to outline region of interest. Image was captured with digital camera and hence is of lower quality than that of Figure 1.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —Photograph shows screen as program returns preview of MR image, and operator confirms capture by pressing Finish. Program then prompts operator to specify location for saved image file. File is saved, and PACS workstation screen is restored. Patient was 10-year-old boy with pain in lower extremities.

Although less experienced users can accept default options and easily engage in basic capture with only minor training. SnagIt software allows the interested user many options, including the selection of compression ratios, image storage formats, default storage locations, and capture of scrolling windows as well as text and video options (Fig. 4). It runs on any PC operating Windows 95, 98, Me, NT 4.0, 2000 (Microsoft) or later versions. It can be easily configured to capture images automatically so that the process is extremely quick.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —Photograph shows SnagIt screen (TechSmith, East Lansing, MI) as operator selects input and output options, including compression ratios and file types among others. Operator can also capture text and video (useful for capturing dictation text and sonography or MR imaging cine loops). This image was acquired at PACS workstation using digital camera.

We set up a small workstation—server as an image repository to act as a bridge between the PACS and hospital networks. Images are copied from the PACS workstations and saved on the image repository workstation—server. The image repository server is accessible from any hospital network—connected PC. In addition, users can access the image repository server from outside the hospital by connecting via a Virtual Private Network (VPN, Microsoft), which tunnels connectivity securely across the hospital firewall. Images can then be manipulated, saved, and accessed in digital format.

Configuring the PACS Workstations
The workstations of the PACS system (Path-Speed PACS, version 7.12.2; General Electric Medical Systems, Mount Prospect, IL) that we use at our site run on the Windows NT 4.0 platform. The configuration of each workstation was carried out in two easy steps. The privileges for the NT user log-on had to be changed because, by default, the factory configuration gave users access only to the PACS application. The change was not a big hurdle, although we had to have permission from our PACS vendor to do it. The SnagIt application was then installed and configured as previously described.

Configuring the Image Server
The image workstation—server is a Vectra Pentium III (Hewlett Packard, Palo Alto, CA) 400-MHz computer with a 40-G hard drive running Windows NT 4.0 workstation software. Image storage and retrieval are accomplished by file sharing with the hard drive directory. Two network interface cards are installed to connect the two separate networks (those of the PACS and the hospital) together, allowing access to the images from both networks. Because the server is on the hospital network, the server files are backed up weekly to the hospital network in case of catastrophic failure of the image server's hard drive.

Security
The information services group at our hospital maintains a firewall that protects and controls all intranet access. Both the PACS network and the hospital network are protected by this firewall. Thus, although we have bridged the two networks with our image server, we have not compromised patient confidentiality or image security. To protect patient confidentiality, we do not include patient names or medical record numbers in the regions of images we capture. We also avoid naming unsecured image files with such identifying information.

Authorized users can access the image server on the hospital network only by using our VPN. Privileges and passwords to access the VPN are granted to authorized personnel so that they can view and download images from the computers in their offices or homes. These users can then review images, develop lectures, and build the teaching file from home. In this manner, we control access to the images and to the networks.

System Performance
Our system has been in use in our department for several months. We have used it to transfer approximately 4,000 images. Users include radiology staff, fellows, and residents, as well as radiology technologists and medical students. We have experienced no major problems with the system. We have found that the training required is minimal, on the order of 10 min, and users have been very satisfied with the system.

Limitations and Qualifications
Although we use SnagIt for our system and have direct experience only with this program, many other screen-capture programs are available. We do not endorse any particular software. Some of the alternative programs may work as well as, or better than, SnagIt for a particular application. A partial list of alternative software includes Grabber 2K (rad2K systems, London, England; www.rad2k.com/html/g2k_lite.html ), Screen Capture (Ulead Systems, Taipei, Taiwan; www.ulead.com/ ), ScreenPrint (Software Laboratories, Redmond, WA; www.softwarelabs.com/tsl4/3-screenprint.htm ), and ViaNet Image Capture Software (Datacard Group, Minnetonka, MN; www.datacard.com/products/software/identity/vianet_capture.shtm ).

None of the above applications can be used to copy images from Macintosh or UNIX (The Open Group, Menlo Park, CA) platforms. Users of such platforms may be able to adapt other image-capture software for use with their systems. Of course, copied images can be viewed using any platform.

Most PACS vendors do not support, and may not even allow installation of, third-party software such as SnagIt on PACS workstations. Such installations may void warranties for those workstations or perhaps even for the entire system. Users are advised to check with their vendors before proceeding with installation.

Discussion

Top Abstract Introduction Materials and Methods Discussion References

 
We developed a simple method by which interesting images can be captured from almost any PC and sent to a server or other storage medium for later review and use. One of the greatest advantages of our system is its flexibility: it can be run on most types of PACS workstations and is inexpensive enough ($20 per installation) that it can be distributed throughout the department so that every PACS workstation and PC can run the software. Although some departments have a system for capturing their PACS images, these systems often require an expensive license or complicated installation. They may require that images be loaded only from a specialized, designated workstation. Such bottlenecks can reduce the usefulness of the system.

Our system gives image-capture capability to every practicing radiologist and eliminates the need to leave the workstation or break the flow of work to capture interesting images, thereby vastly increasing the usefulness of the system. Using our system to capture images for our digital teaching file, we avoid the tedium of importing images.

We hope to increase the compliance of our residents, fellows, and staff in contributing to the teaching file. Our system enhances the ability of staff and fellows to collect images for lectures and publications quickly and easily. The digital format of the captured images makes them much easier to manipulate, organize, search, retrieve, store, and transport than they were when we relied on conventional film copies and photographic slides. Finally, using our system to copy digital radiographic images directly allows us to avoid photographic problems, such as poor lighting, camera motion, and improper exposure settings, thereby enhancing the quality of images used in our teaching file, lectures, and publications.

References

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1. Maldjian JA, Listerud J. Automated teaching file and slide database for digital images. AJR 2000;175:1249 -1251[Abstract/Free Full Text]
2. Bidgood WD Jr, Horii SC. Introduction to the ACRNEMA DICOM standard. RadioGraphics 1992;12:345 -355[Abstract]

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