SIIM 2012 Scientific Poster – CAPTCHA Challenge-Response System To Assess Monitor Performance

Eliot Siegel

Eliot Siegel, M.D.

Editor’s Note:  At events like SIIM 2012 attendees must juggle learning sessions, networking activities and exhibits. Hopefully you had time to tour the scientific posters displayed throughout the meeting space that feature the innovative research being done in the field of imaging informatics. If you missed the poster presentations, Dr. Eliot Siegel , Professor and Vice Chair at the University of Maryland School of Medicine, Department of Diagnostic Radiology, as well as Chief of Radiology and Nuclear Medicine for the Veterans Affairs Maryland Healthcare System, shares an overview of his team’s poster on testing monitor performance.

Repurposing a Traditional CAPTCHA Challenge-Response System

to Assess Monitor Performance Metrics Including Contrast and Spatial Resolution

Jigar B. Patel, MD1; Stephen J. Siegel, BS2; Joseph J. Chen3, MD; Eliot L. Siegel, MD1,3

Baltimore Veteran Affairs Medical Center, Baltimore, Maryland1

University of Maryland Baltimore County, Baltimore, Maryland2

University of Maryland School of Medicine, Baltimore, Maryland3

The most frequently asked question over the years, and this SIIM 2012 was no exception, has been about the use of “off the shelf” in comparison to “medical grade” monitors.  There has been a substantial trend to cut costs not only outside the radiology department but also within the radiology department and utilize these much less expensive “off the shelf” monitors.

The compelling argument for the “off the shelf monitors,” of course, is that they can result in major cost savings, especially in a medium to large healthcare facility.  The strong argument for “medical grade” monitors is the image consistency, ability to more easily calibrate using the DICOM grayscale presentation function, higher luminance, and easier monitor testing which could provide documentation in the event of a medicolegal challenge.

The difference between the best “off the shelf” and medical grade monitors is probably relatively small, but there are no diagnostic imaging consumer reports and manufactures of the “off the shelf” monitors can vary significantly as vendors change manufacturer or other components.

We presented a poster that describes a rapid and easy way to test any type of monitor and this has allowed us to see surprising variability in the monitors that we use in our own department, whether they are medical grade or “off the shelf.”  The solution is based on a challenge test that can be given to a user to determine whether he/she can use a PACS workstation or, alternatively, could be used to report to a PACS administrator that the monitor is not meeting a given standard for display.

Rather than using the SMPTE (Society of Motion Picture and Television Engineers) pattern that we are all familiar with (below) we used a challenge similar to the CAPTCHA challenge that is meant to distinguish a human from a computer in order to get access to data or programs on web sites.

Users are presented with a six letter word that is written in almost black on a black background and almost white on a white background as well as a six letter word written in a small font.  The PACS administrator can determine for various types of users (e.g. Radiologists, technologists, clinicians), locations, or monitor types what percentage of deviation the black writing is from the black background (e.g. The SMPTE pattern uses 5%), the percentage difference of the almost white on white background, and the size of the font.

So when a user first signs onto the system, the user is asked to read and type in the three 6-letter words corresponding to the black, white, and small font challenges. The administrator gets the results of this challenge test which could be used to block use of the workstation or more likely to audit and identify sub-optimal monitors.

We have found the tool to be very sensitive to small differences between monitors and it has been surprising how much of a difference it can make to look at a monitor from above in comparison to below or from the side in being able to pass these three tests.

This could be a very useful test for many purposes but especially to alert users as to the performance of a monitor which can vary considerably depending on whether or not it has “warmed up” or on the angle in which the images are reviewed.

SIIM 2012 Hot Topics – Vendor Neutral Archiving and Imaging Sharing

The proliferation of hospital consolidations as well as facility integration projects supporting HIE and ACO efforts made vendor neutral archiving and image access for referring physicians and patients hot topics at last week’s SIIM conference.

Enterprise Archiving

The discussion at SIIM went beyond the primary need to consolidate islands of storage. Healthcare providers’ needs have evolved. Next-generation archives need to support a wide range of architectures from departmental and multi-site to regional and national medical archive projects, and they must:

  • Collect data beyond imaging exams. Labs, pathology data, video files and JPEG images must combine to create a cohesive patient portfolio.
  • Connect existing platforms to present a single patient worklist without migrating existing archives.
  • Balance the clinical need for information over time and the desire to achieve the lowest storage costs possible with user-defined rules.
  • Provide the patient’s clinical record via the Web or existing EMR/HIS virtually anytime, anywhere – no mater where images and data originate or are stored.

Carestream’s Jeff Fleming highlights the interest in new approaches to enterprise archiving and Carestream’s experience with VNA:

An April 2012 InMedica research report recently highlighted Carestream’s position as the number two player (by study volume) in vendor neutral archiving with more than 2 petabytes of managed data and 80 million studies managed at 10 data centers.

Image Sharing

The vendor neutral archive plays a critical role in the future of image sharing. Ubiquitous image exchange, particularly when you extend beyond the radiology point of view to referring physicians and patients, requires a true VNA foundation and a zero-footprint viewer that can be embedded into EMR systems to become a reality.

Carestream’s Neville Skudowitz presented at SIIM 2012 on Carestream’s approach to commercial products for image sharing:

This vendor session launched a pointed Q&A session about the importance of vendor support for standards and protocols such as HL7, DICOM, non-DICOM, IHE (including XDS, XDS-i) and WADO.

What hot issues or technology caught your attention at SIIM 2012? 

SIIM 2012 Session Recap: A Look Inside Vendor Strategy for Mobile Medical Imaging Applications

SIIM’s Innovation Theatre was standing room only yesterday during the “Medical Imaging? There’s an App for That!” presentation.  The session was moderated by David S. Hirschorn, MD, Director of Radiology Informatics at Staten Island University Hospital, whose passion for mobile devices and its impact on the future of radiology guided the overview of how vendors are addressing mobile needs.

Dr. Hirschorn’s panel introduction focused on how the different use cases for mobile radiology and the lack of control over operating system, device and environment are resulting in very distinct mobile solutions:

Carestream Digital Medical Solutions President Diana Nole presented on the strategy behind our approach with the agnostic CARESTREAM Vue Motion, which was driven by mobile access for the broader physician and  patient community.

Vue Motion is built in HTML 5, which means it is a web-based viewer that can be accessed from tablets without installing additional software. There are no storage or technology requirements for users’ mobile devices, PCs or workstations. It can also be embedded in a HIS or EMR portal to allow clinicians and referring physicians to quickly and easily view patient data and radiology images with a single log-in from anywhere.

You can view Diana Nole’s entire SIIM presentation below: also offers a great summary of the entire session live from the show.

Dr. Hirschon is a member of Carestream’s advisory board.

Top 10 Imaging Informatics Blog Posts on Everything Rad

Erica Carnevale

Erica Carnevale, Digital Media Manager, Carestream

Today kicks off the 2012 Society for Imaging Informatics in Medicine (SIIM) Annual Meeting. Radiology and health IT administrators and practitioners are convening in Orlando under the timely theme of “Strategic Innovation Through Enterprise Image Management.” Diagnostic imaging trends are converging—an explosion of big data, system consolidation and scarce IT resources is erupting at the same time as the emphasis on accountable care and value-based purchasing—making innovation in enterprise image management crucial to the transformation of healthcare.

What innovations, best practices and enterprise image management solutions will SIIM veterans and newbies (like me) be on the hunt for this week? The educational program is packed with sessions like:

These topics come as no surprise to me, as they mirror our top 10 most popular imaging IT posts on Everything Rad (in no particular order):

  1. Don’t Fear Migrating PACS Data from the Cloud
  2. Stage 2 and the Health Affairs IT Study Debate
  3. Inside IT Strategies – Moving Radiology Workflows to the Cloud
  4. What Are You Spending on Image Management?
  5. Consumerized Healthcare: HIEs Will Only Succeed with Patient Access to Imaging Data
  6. Cloud Security in the Medical Imaging Environment
  7. Radiology Workflow, Data Transmission and Storage in the Age of Meaningful Use
  8. Reviews the CARESTREAM Vue Motion Medical Image Viewer
  9. Loire Region Cloud Project Draws Attention
  10. Q&A with Intel’s Chief Architect of Healthcare

SIIM LogoSo if you’re at the show waiting for the opening general session, these posts are a great primer for the themes that will guide us in the next few days. If you’re not in Orlando, stay tuned to Everything Rad for more coverage from SIIM 2012.

Come armed with questions to booth #505 for our imaging IT experts or ask for me to share your best practices or image management opinion on Everything Rad.

Not at the show? That’s what the comment section is for. Leave your questions or opinion below – we look forward to the discussion!

Radiologist Adoption of Structured Reporting Requires Streamlined Integration and Native Tools

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Improved referring physician satisfaction combined with demand for more complete clinical information and decision support resources in radiology reports is driving interest in structured report formats – something long championed by RSNA and ACR.

Best practices for the acceptance of structured reporting have focused on involving clinicians in developing user-defined templates. Collaborating on the ordering of observations, standard vocabulary, imaging techniques and  comparisons—all advised in a recent AuntMinnie article—ensures the physician reading the report can mine the data they need more efficiently.

But an important piece of the standardized reporting puzzle that cannot be overlooked is the radiologist workflow. Structured reporting cannot slow radiologist turn-around time because reporting delays can impede the diagnostic process and compromise standards of care.

Incorporating structured reports into radiology workflow requires an approach that removes error-prone, manual entry, and automates the pre-population of clinical context such as exam measurements or DICOM metadata. Key images and analyses performed (e.g. vessel, calcium scoring, stenosis, aneurysm) must be embedded directly into reports and the radiologist must also be able to quickly review their voice dictation, self-edit and sign-off. And the final report must ingrate back into the HIS or EMR to accelerate delivery to the entire care team—across town or around the world.

The workflow challenge of structured reporting is magnified in multi-site or multi-system environments – specifically for providers of teleradiology services — where radiologists must master multiple interfaces and systems. To succeed, these radiologists need single sign-on to a consistent GUI, a toolset with the native application (RIS or PACS) and access to dictation or voice recognition with user privilege. With the right reporting system and formats, turnaround time can be slashed from days or weeks to just hours.

Renaissance Imaging Medical Associates (RIMA), a provider of specialized diagnostic imaging services, accelerated its report cycle time for hospitals with Carestream Vue Reporting. RIMA’s team of 40 radiologists covers all the modalities in diagnostic imaging and reports on more than 500,000 exams each year. Dr. Andrew Deutsch, President of RIMA and a member of Carestream’s advisory board, recently gave us an overview of how integrated and structured reporting drives RIMA’s business and referrer satisfaction.

Interested in learning more about structured reporting and native voice recognition, and attending the SIIM conference this week in Orlando? Come see me in booth #505

SIIM Panel Preview: Medical Imaging? There’s an App for That!

Diana Nole, Carestream Health

Diana L. Nole, President, Digital Medical Solutions, Carestream

Our mobile devices are communications command centers – both for business and for personal use. So it’s no surprise that mobile applications are entering the healthcare space.

A discussion that explores new mobile apps for medical imaging is the topic for a presentation entitled “Medical Imaging? There’s an App for That!” at the 2012 Society for Imaging Informatics in Medicine (SIIM) conference and exhibit. The session will be held Thursday, June 7, from 2:45–3:45 pm at the Exhibit Hall Innovation Theater at the Orlando World Center Marriott, Orlando, Fla. The moderator is nationally recognized researcher and speaker David S. Hirschorn, MD, Director of Radiology Informatics at Staten Island University Hospital.

This discussion is likely to touch on several key topics including:

  • Vue MotionHow zero footprint imaging viewers and other applications can streamline access while preventing the need for physicians to download—and log into— multiple applications.
  • Security measures that will be required for a mobile environment; and
  • Plans for patient access to medical images and data in the future and how/if mobile devices will be supported.

What is your facility’s biggest challenge to providing mobile access to imaging data?

If you already deliver mobile access to images/reports, has this improved physician satisfaction?  

Visit Carestream at SIIM 2012 in Booth #505.