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Technical Innovation |
1 All authors: Division of Nuclear Medicine, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.
Received August 9, 2006;
accepted after revision December 6, 2006.
Financial support for software development was provided by Beth Israel
Deaconess Medical Center.
Abstract
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CONCLUSION. A shareware nuclear medicine PACS software package including a display for fused PET/CT studies has been developed, extensively clinically tested, and is freely available on the Internet.
Keywords: digital imaging • nuclear medicine • PACS • PET • teleradiology
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Our nuclear medicine PACS has been heavily influenced by daily attending and resident physician contact with the programmer. In particular, it has been designed to have intuitive functions that constantly changing groups of residents can quickly assimilate with ease. Typically, there is no training for the residents. Within just a few minutes, they are interpreting studies from the database, varying gray scale, and creating cines. Gradually, as they use the system, they try out the different functions seen on the icons and toolbar. There have been many discussions with the programmer as we have sought to make our system user friendly. This has greatly complicated the programming tasks involved in making each function intuitive and simple.
The software is programmed in C++. The programs are purely client based with a small footprint and communicate with generic Microsoft Windows–based file and database servers. The client computers are inexpensive off-the-shelf desktop computers running Microsoft Windows XP with 1–2 GB of memory and a single hard drive with a capacity of at least 100 GB. Servers can be scaled appropriately to accommodate the number of users. Actual limits are not known, but widely available products such as server hardware, Microsoft Windows–based servers, and Microsoft SQL Server database should easily accommodate any modern radiology department. The speed of access and number of simultaneous users will depend on the server used for the database, the amount of computer memory, and the processor speed of the client. However, using an XQL database and standard purchase PCs, the waiting time for a study in our department is less than 500 milliseconds for general nuclear medicine studies and 15 seconds for a full PET/CT study.
Validation of our processing programs has been done by comparing our results with those obtained with our Trionix Research Laboratory, Siemens Medical Solutions, Philips Medical Systems, and GE Healthcare processing programs. Although each of these vendor processing programs provides somewhat divergent results, all of our processing programs result in values that diverge less than 4% from those obtained using one of these other processing programs.
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The major OpenPACS functions are listed in Appendix 1. Zoom and cine functions are included for multiple studies separately and simultaneously. Gray-scale adjustments and addition of annotations, text, arrows, and measurements are also included. Multiple regions of interest can be drawn and total and average counts calculated. These data can be saved on the database with the study. Frames within and between studies can be moved, copied, deleted, or combined either as a group or individually and frame sizes can be changed. Frames can be rotated or mirrored as well. Studies can be printed on plain paper or written to a CD. Different color tables can be applied (Fig. 1). The screen layout can be modified to accommodate different resolutions or multiple monitors.
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PET/CTview
PET/CT studies in DICOM format can be written to the OpenPACS database and
then interpreted from the OpenPACS database using the PET/CTview display
program. Studies can also be accessed from multiple databases or computer
directories. For studies not on one of the OpenPACS databases, the user is
able to define the drives and directories where studies are stored. Studies
can be saved as DICOM files, individual slices as JPEG files, or
maximum-intensity-projection (MIP) cines as AVI files.
The PET/CTview program displays, side by side, the PET study, either attenuation corrected or uncorrected, the corresponding CT study, and the fused studies. The fused studies can be displayed using a choice of several color tables. Instead of the fused study, the user can display an MIP image. Linked cursors on all three images can be used to precisely localize sites of high radiopharmaceutical uptake. PET, CT, and fused slices can be presented in a linked format in transaxial, sagittal, and coronal planes.
Transaxial slices from two studies performed on different dates can be easily compared, with one set of PET, CT, and fused slices above and the second set below. These slice sets can be linked so that they scroll together. To accurately compare slices, there is a provision to adjust the offset on the two sets of slices so that even though the patient is scanned in a different position, each set presents comparable slices during the scrolling (Fig. 2). Brightness and contrast, cine functions, and scrolling in transverse and sagittal planes are all under mouse control. Alternatively, up and down arrows can be used for rapid scrolling. The page up and page down functions advance by 10 slices and the home immediately function goes to the first or last slice in the series. Images can be panned and zoomed to better delineate foci of interest. Preset CT windows can be user set, or the user can use the mouse to adjust the gray scale separately on either the PET or CT slices. Maximum standardized uptake value (SUV) and Hounsfield units are displayed when the cursor points to a site of interest. The size of the region of interest defining the site of interest for these measurements can be varied. Options are provided for the intensity of the CT or PET data on the fused images as is a facility to continuously change the relative intensity from only CT, to 50/50% PET/CT, to only PET. Respiratory gating parameters and MIP speed are user adjustable. Measurements, pointers, and text annotation can be applied to the images and saved with the study.
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Users
The OpenPACS program has been in daily use at our institution since 2001.
The PET/CT-view program began functioning in daily clinical use in 2004. We
have three or four residents and one fellow newly rotating monthly through our
nuclear medicine division. When these software programs were initially
introduced, the trainees were told that they were free to use either this
software or the camera vendors' software. After 3 months, all residents and
fellows were using PET/CTview and OpenPACS. This was partly because the
residents and fellow had a direct impact on the program development. When a
request for a change was made, the change was usually made overnight. As each
new group of residents appears each month, no instruction is given to them as
to the use of these programs because a great deal of effort was made to make
the programs intuitive to the user. More than 100 requests for a download of
these shareware programs have been received since a poster and oral
presentation of this shareware at the annual meeting of the Society of Nuclear
Medicine in June 2006 [7,
8].
Shareware
We are making both OpenPACS and PET/CTview software available as shareware.
The Internet download site for the nuclear medicine PACS shareware is
http://bidmc.harvard.edu/default.asp?leaf_id=13580.
There are two programs included in the download. OpenPACS consists of a full-function nuclear medicine PACS with the ability to import DICOM, Interfile, Picker, and Trionix file formats. A Microsoft Access database is included with instructions in the help file for setting up the database. The second program, which can also use the Open-PACS database, is a PET/CT display program that can display fused PET and CT images, MIP cines, and slice-to-slice comparison with slice linking of two comparison PET/CT studies. The operating systems currently used are Windows XP, 2000, and 2003 professional server. Source code is available for users to modify these programs for their own special requirements.
Sample nuclear medicine studies, including a PET/CT study, can also be downloaded, viewed, and stored in the database, using the OpenPACS program.
Although there are extensive help functions to assist in setting up and operating all of the different options and functions of both programs, further help can be obtained by e-mail at: ilan_tal{at}gmail.com or by Skype telephony between 2:00 am and 10:00 am Eastern standard time, Sunday through Thursday at "Ilanyonatal." The Skype telephony program can be downloaded without charge from the Skype Website.
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionAPPENDIX 1: Functions and...References |
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Because we have our own nuclear medicine PACS, we can add our workstation PACS software on PCs throughout the medical center without the large expense and administrative work of purchasing expensive commercially offered workstations. We can load the display program on a laptop and display studies at conferences. We are now making our nuclear medicine PACS software, which runs on the Microsoft Windows XP operating system, available as shareware for the use of the nuclear medicine community.
Nuclear medicine software that is sold in the United States has to have U.S. Food and Drug Administration (FDA) approval. However, OpenPACS and PET/CTview are being offered as free shareware, and therefore do not require FDA approval (personal communication, Burke E, Center for Devices and Radiological Health, U.S. Food and Drug Administration). Thus, each department using this software is responsible for verifying that the software results meet the department's clinical criteria.
APPENDIX 1: Functions and Tools Available on OpenPACS
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionAPPENDIX 1: Functions and...References |
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Print study
Read database
Read pending study from a list
Read DICOM study
Read Interfile
Read proprietary vendor study
Delete database study
Delete pending study
Write study to database
View patient information
Set CT window and baseline presets
Set zoom factors
Set color tables
Measure lesions
Add text annotations and arrows
Move, copy, delete, add, rotate, and mirror frames
Change frame size
Apply filters
Change color table
Add and annotate teaching study
Radionuclide ventriculogram analysis
Gastric emptying analysis
Quantitative lung perfusion and ventilation analysis
Set dialog font
Set location of one or more databases and backup
Set location of studies on the database and backup
Set location of one or more pending study lists
Set screen layout and pixel dimensions
Set text color, size, and font
Zoom and pan
Cines and zoom cines
Multiple cines
Vary cine speed Vary window and baseline
Mouse change window and baseline
Quality control reporting
Teaching study with comments, history, and annotations
Set up multiple databases and pending lists
Options to control display parameters
Renal analysis
Cardiac perfusion analysis
Make regions of interest (ROIs) and graph counts
Acknowledgments
We acknowledge the many Beth Israel Deaconess Medical Center radiology
residents, the Harvard Joint Program in Nuclear Medicine fellows, and the
technologists on the staff of the Beth Israel Deaconess Medical Center who
have contributed over many years to the development and success of the
Open-PACS and PET/CTview programs. Their contribution on a daily basis has
immeasurably enhanced the ease of use and functionality of these programs. We
also acknowledge the support offered by the chair of the department of
radiology of the Beth Israel Deaconess Medical Center, Herbert Kressel and the
administrator of the department, Allen Reedy.
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