PACS infrastructure supporting e-learning

Abstract

Digital imaging is becoming predominant in radiology. This has implications for teaching support, because conventional film-based concepts are now obsolete. The IHE Teaching File and Clinical Study Export (TCE) profile provides an excellent platform to enhance PACS infrastructure with educational functionality. This can be supplemented with dedicated e-learning tools.

Introduction

The introduction of digital information technology has influenced the medical community in many fields. Support of teaching, continuous medical education and reference repositories are some of these, almost summarised as e-learning. Many solutions have been developed by individual radiologists, by commercial companies or by scientific organisations, e.g. universities or radiological societies. The European Society of Radiology (ESR) offers different tools with various functionalities. E.g. there are EPOS and ePACS, which are available during the annual meeting on-site, providing electronic access to posters (EPOS) or high-quality educational material in specific areas (e.g. cardiac imaging or chest imaging) with the complete study as DICOM-series in a reporting workstation (ePACS). Other tools are accessible online via internet for downloading presentation from ECR (eDISP) or for presenting scientific papers (EuroRAD). EuroRAD is an electronic platform for presenting radiological cases which have been reviewed by a scientific committee comparable with journals. Nearly 3500 papers are online in 2010.

The teaching file is a vital tool in medical education and the support of teaching and research is a continuous challenge in every radiology department. In former times with film-based departments, very often there were extensive film collections with copies of relevant studies. Many radiological departments and medical centres have built up extensive collections using different categorisation systems (e.g. ACR codes).

Today, most of the radiological imaging is digital and PACS is used for reporting, image distribution and archiving. With such an infrastructure, conventional case collections are obsolete and PACS has to provide a functionality to build digital teaching files. Different developments of digital case collections are to be observed in the meantime [1], [2]; partly there are also commercial offers based on stand-alone solutions or web-based services. Digital teaching files enable broader dissemination of the content both within and outside of the specific institution and can be used as a federated collection with common query mechanism.

Different needs stand in the focus of a digital case collection:

• Support in the education of students.

• Continuing education of residents.

• Reference data bank for rare cases and differential diagnoses.

• Continuing medical education of board certified radiologists.

Based on these requirements not only the quality of the pure content of the cases, but rather also the possibilities of the presentation and management of the cases are crucial. This means standardised categorisation and key words to allow an efficient search for cases on certain subjects to the user. In particular for residents and the students it is of interest to have a presentation mode in which only the images with some necessary clinical information are shown and findings and diagnoses will be hidden. With such an approach the reality in reporting cases could be simulated, so that the student or residents can check their diagnostic abilities. Such functionality is important for acceptance in daily use by students or residents.

While the authoring of teaching files access to imaging studies, typically based in the PACS, and clinical information in RIS or HIS is necessary, identifying relevant cases while reporting and sending the selected images or series with some additional information to a teaching file is a more effective workflow than using other methods with delayed authoring.

Typically inside of teaching file systems there should be no or limited access to information containing patient's identity. For distribution outside it is always necessary to de-identify the cases. These requirements have to be encountered in the workflow too.

Clinical trials have needs similar to teaching files, in that images and related information need to be selected for export to other systems, and other organisations in the case of multi-centre trials. During export, images may need to be de-identified and trial-specific identifiers inserted in accordance with local or national policy and the rules of the trial protocol [3].

Beyond this, digital case collections are also the basis for the advanced e-learning solutions which should be integrated very interactively and efficiently into everyday work [4]. Today, an open-source based solution by RSNA called MIRC (medical image resource centre) is used by many radiological departments. MIRC provides numerous functions and can be used as an independent case collection, but also on a co-operative platform for several institutions.

Indeed, there are still many PACS solutions not supporting such a function or additional non-integrated systems are used for teaching files.

The improvement of the integration of teaching files has been addressed by IHE (Integrating the Healthcare Enterprise) in 2005 with the publication of the profile TCE (Teaching File and Clinical Trial Export) [3]. An infrastructure using this TCE profile permits the integration of PACS and teaching files using standard DICOM services.

In the following an overview of the IHE profile, the integration of PACS and teaching files, the use of MIRC and the integration with learning management systems (LMS) will be given