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Editorial |
1 From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 1080-B Main, Philadelphia, PA 19107 (A.E.F.). Received June 15, 2006; revision requested June 26 and received July 6; accepted July 6. Address correspondence to the author (e-mail: adam.flanders{at}jefferson.edu).
In last year’s version of this editorial, my predecessor and "amateur philosopher" Dr David Avrin wisely observed that "The year 2005 will be remembered as a watershed in medical informatics" (1). It is clear today that his prediction was extremely accurate, based on the developments that have taken us into 2006. There is a wealth of exciting innovations and collaborations that have relevance for all radiologists, clinicians, and even patients. Many of these initiatives will impact our clinical practices in one way or another, as some of these efforts represent a technical response to the needs of radiologists. Others are focused on national initiatives related to improving access to clinical information, reducing medical errors and unnecessary duplication of imaging studies, and augmenting patient access to novel therapies. Some of these projects represent the culmination of key development efforts that are familiar to readers of RadioGraphics, such as RadLex (Radiology Lexicon), IHE (Integrating the Healthcare Enterprise), and MIRC (Medical Imaging Resource Center). Other projects represent completely new collaborative forays that underscore the impact of medical imaging in cancer research. We are pleased to report that most of these efforts will be showcased at the 2006 RSNA Annual Meeting.
One of the biggest changes taking place that will provide a richer experience for meeting attendees at RSNA 2006 is the complete redesign of the old infoRAD–Education Exhibits space in the East Building (Lakeside Center) of McCormick Place. This area has been renamed the Lakeside Learning Center (LLC) to emphasize the new integrated learning environment to be featured this year. The new floor plan is configured around a wheel or spoke arrangement, which will provide a more inviting, friendlier space for attendees to access informatics and education exhibits with increased capacity for face-to-face collaboration and small informal presentations.
A new half-day series of informatics lectures are being offered through a consortium of representatives from RSNA and SIIM (Society for Imaging Informatics in Medicine, formerly SCAR [Society of Computer Applications in Radiology]). These co-branded informatics courses are targeted to practicing radiologists who are not informatics specialists.
In 2006, the RSNA-sponsored RadLex project has made major strides, which will culminate with the release of version 1.0 of the entire lexicon in conjunction with the 2006 RSNA Annual Meeting. Under the leadership of Curt Langlotz, MD, PhD, six additional subcommittees (covering musculoskeletal, neuroradiology/head and neck, abdominal, pediatrics, and cardiovascular imaging) were formed to compile domain-specific terminology in each of the key areas to supplement the existing thoracic imaging lexicon. An additional technical subcommittee is creating what has come to be known as "the playbook," a catalog of terms that describe all of the procedures and protocols performed in radiology departments (eg, MR imaging pulse sequences). The RadLex playbook will provide a language for the consistent ordering, "protocoling," performing, reporting, billing, and indexing of radiology procedures.
Currently, nearly 100 volunteer radiologists participate in the RadLex project, which covers all major subspecialties and represents over 26 separate subspecialty organizations, both nationally and internationally. Moreover, collaborative relationships have been forged between the RSNA and other groups conducting related terminology efforts: the College of American Pathologists (SNOMED [Systematized Nomenclature of Medicine]), the National Library of Medicine (UMLS [Unified Medical Language System]), and the National Cancer Institute (caBIG; see below). Over 10,000 distinct radiology concepts have been considered thus far. As the successor of the American College of Radiology’s Index for Radiological Diagnoses, RadLex will eventually serve as the single source for radiology-specific concepts and terms and will fill gaps where existing terminologies are lacking. Specific applications for RadLex include cataloging and annotation of teaching and decision-support materials, markup of clinical research data sets, and clinical reporting. Moreover, since RadLex will exist as a software tool rather than a static document, it will be periodically updated with new terms and can be cross-referenced to other existing vocabularies to provide a richer knowledge base. In addition to providing an unambiguous method for human-to-human communication, RadLex will also provide a common framework for machine-to-machine communications at the software level. RadLex terms will be available for public commentary during the fall, and RSNA meeting attendees will have the opportunity to "kick the tires" by using a RadLex term browser that can be used in conjunction with RSNA’s Teaching File Software Suite (see below). In addition, several RadLex-oriented presentations are planned for the annual meeting, including one intended for clinical users of RadLex and another intended for developers of software that may incorporate RadLex terms.
Considerable progress has also been made in the Teaching File Software Suite and Clinical Trials Tools of the MIRC. The current release of the software suite (T29) is built around a more robust version of the Java runtime (Sun Microsystems, Santa Clara, Calif) and Tomcat servlet (Apache Software Foundation, Forest Hill, Md) technology. The latest version of the Teaching File Software Suite offers a multifunctional authoring tool, which includes the ability to overlay annotations and labels on stored images and a fully functional DICOM (Digital Imaging and Communications in Medicine) viewer that supports basic image adjustments such as window and level, rotation, and inversion. Version T29 also sports a new "case-of-the-day" feature. Another powerful feature is a new file compression or "ZIP" service, which will automatically build a MIRC-compatible teaching file from an existing standard hierarchy of files. For those who have amassed a large collection of digital images on their personal computers, this program provides an automatic way to Web-enable your content and to improve accessibility and search capabilities without the need to manually rewrite your content. The MIRC Clinical Trials Tools have been co-developed with the National Cancer Institute and are currently being used successfully in more than a half dozen national clinical trials to provide easy, secure shared imaging access for multi-institutional trials. Installing the free, open-source MIRC software suite is easier than ever before, with improved online documentation, easy-to-follow instructions, and substantial support through the growing network of MIRC users linked through the MIRC forum. At RSNA 2006, complete software suite installation CDs will be available at the MIRC kiosk and at the MIRC tutorial classrooms; the program is also available for free Internet download from the MIRC Web site (mirc.rsna.org). Future implementations will support embedded video, offer customized authoring templates, and allow users to run entire teaching conferences directly through the software suite. Since the RadLex software is designed to integrate with the MIRC Teaching File Software Suite, the RadLex terminology can be incorporated into teaching or clinical trials materials authored through MIRC.
For a number of years, users have been asking PACS (picture archiving and communication system) vendors to create a mechanism whereby a user can rapidly generate teaching materials while working at the PACS workstation or at the point of service. Many ad hoc methods (displayed in past infoRAD exhibits) have been employed by users as well as by third-party vendors to assist in the submission process; however, there is no universally agreed method for exporting clinical images from a PACS to a teaching repository. In an effort to standardize the process for PACS manufacturers, the IHE Radiology Technical Committee authored a new integration supplement entitled the Teaching File and Clinical Trial Export (TCE) profile. This profile defines a means for selecting relevant images, notes, and reports; describes a mechanism for entering additional information; and outlines a method for transferring these data to a receiving device. At least two commercial PACS vendors will showcase their implementation of the TCE integration profile in their products at RSNA 2006 and use the MIRC Teaching File Software Suite as the designated repository. This demonstration will be the first for this long-awaited functionality in action.
Another featured IHE implementation at RSNA 2006 is XDS-I (Cross-enterprise Document Sharing for Imaging). This profile describes the first standards-based means of sharing medical data (specifically, imaging data) between institutions with disparate information systems (eg, radiology information systems, PACS, or hospital information systems). XDS-I introduces several "actors" (registry, repository, imaging document source, and consumer) that—depending on how they are combined—can support either a distributed model of information sharing (in which images and reports remain at each site but can be found by means of a central index of pointers) or a centralized model (in which images and reports are pooled into a single archive spanning the community). A new crop of XDS-I compliant applications is poised to enable radiologists and clinicians to use the XDS collection of standards to find and retrieve images and reports belonging to a common patient but that are physically scattered among different, even competing medical facilities. At RSNA 2006, participating vendors and institutions will demonstrate how XDS-I can be used to extract medical data for a single patient from multiple locations without the need for similar information systems and to display this information as a consolidated geographic medical record. XDS-I represents the first credible method for building a standards-based backbone for health information exchanges being launched by regional health information organizations (RHIOs). Although regional exchanges are a prerequisite to a future national health information network, the use of XDS-I to build regional exchanges today can be expected to deliver significant improvements in the quality of healthcare while minimizing duplication of resources and reducing errors by providing a full complement of historical patient information at the point of care. Just one exciting potential application of XDS-I is the promise of accessing relevant prior imaging studies from other institutions directly on one’s native PACS workstation.
Another entirely new demonstration area featured this year in the Lakeside Learning Center will showcase the activities of the In Vivo Imaging (IVI) Workspace of the Cancer Bioinformatics Grid (caBIG). This National Cancer Institute initiative is designed to leverage the connectivity of the World Wide Web for the sharing and consolidation of research tools and data for the prevention and treatment of various forms of cancer. The ultimate goal of this ambitious project is to provide universal access for researchers, patients, and physicians to the latest resources in cancer treatment and to lower patient barriers to participation in national clinical trials. The caBIG infrastructure is built on open standards and a grid architecture (caGRID) that allow the sharing of data and services between participants. The new IVI Workspace (under the leadership of Eliot Siegel, MD) was created specifically to identify and standardize methods to optimize the information obtained from clinical and small animal imaging, including molecular imaging. The IVI Workspace also defines four special interest groups that are focused on key developmental efforts: software, standards and interoperability, vocabulary and common data elements, and architecture-testbed environment. A central focus of the IVI Work-space is to provide interoperability between the grid technology defined by caBIG and existing standards and vocabularies such as DICOM and HL7 (Health Level 7) and to define new areas for which informational models are sparse. A cooperative developmental effort between RSNA and caBIG has been initiated to share and harmonize complementary endeavors in the MIRC Clinical Trials Tools and the RadLex vocabulary efforts. A large exhibit area is planned for the caBIG-IVI Workspace, which will feature a series of lectures devoted to the activities of the workspace and technical challenges. It will also have a demonstration area that will feature several workspace projects, including an open-source prototype research workstation on which users will see how distributed clinical trial image data sets can be shared, viewed, examined, and analyzed with available shared tool sets.
In addition to featuring articles based on the best informatics exhibits, RadioGraphics and its readers should look forward to seeing several comprehensive review articles that will provide more detailed updates regarding the significance of many of the aforementioned initiatives in RadLex, XDS-I, RHIOs, and caBIG. Invited reviews on informatics topics of interest to the general radiologist will also appear periodically to interest more people in this growing field. Finally, for those individuals planning to attend RSNA 2006, a trip to the new Lakeside Learning Center will undoubtedly be an enriching experience—don’t miss it!
Reference
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