The Role of Open Source Software in Radiology

Eliot Siegel, M.D.Professor and Vice Chairman University of

Maryland School of MedicineDept. Diagnostic Radiology

Chief Imaging VA Maryland Healthcare System

“Open Source” Software in Radiology

• Many freeware projects in Radiology

– Best known include Osiris, NIH Image, eFilm before they were acquired and became a commercial product, and others

• Very limited number of Open Source Projects

Open Source Programs

• VISTA

• Raynux

• CDMedic

• MIRC

VISTA: Veterans Administration (Dept. Veterans Affairs) Information System Technology

• VistA is a fully integrated, hospital-wide information system

• Currently made available to the general public under the Freedom of Information Act (FOIA)

• The source code is available to the general public under the FOIA but it is not a traditional open source project

• One part of VistA is VistA Rad which is a multi-media PACS that includes a full featured Radiology PACS

• VISTA “open source within VA Community” best EMR available

• SAIC fascinating example of commercialization of this “open source software” sold to DoD despite being free– Commercial version has fallen far behind “open

source” version and requires separate purchase/contract with every modification

• VistA has been ported to a completely open source stack of Linux and GT.M Mumps

• Previously, VistA was only available on a proprietary platform of Microsoft Windows and Mumps

VISTA

• WorldVistA is a non-profit organization incorporated in California with the mission of furthering the cause of affordable health care information technology worldwide

• Acts as coordination point for work on VistA done outside the VA, to ensure that all such software changes are available under an appropriate open-source license, and to feed bug fixes and enhancements back to the VA for consideration for inclusion in the VA's VistA

• Their stated goal is to “help establish for VistA the virtuous spiral of open source by bringing together a critical mass of developers and users”...

Raynux Project

• The project goal is to “realize a wide radiologic software laboratory which is completely free and Open Source, without any commercial limitation”

• RIS software (ESO) and image & report distribution software developed at The University of Padova, Dept. of Medical & Diagnostic Sciences and Special Therapies

• Based on Linux Server with Interbase 6.0 as database engine and a DICOM server application developed starting from OFFIS library (Oldenburg Germany)

CD Medic: PACS and Image Tools

CDMedic

• Intended Audience: Education, Healthcare Industry, Science/Research

License: GNU General Public License (GPL)

Natural Language: English, Spanish

Operating System: Linux

Programming Language: Perl, Unix Shell

BolinOS IntRad

• Multimedia authoring platform and Web operating system for Internet radiology.

• Project, undertaken in the radiology department at Geneva University Hospitals in Geneva, Switzerland, utilized an Apache Web server, pre-hypertext processor (PHP), and MySQL database open-source code as its application base

Medical Imaging Resource Center

MIRC Key Concepts

• Libraries cooperate by supporting a common query mechanism.

• The Query mechanism allows users to find information anywhere in the community

• MIRC supports all information storage formats

MIRC Libraries

• MIRC libraries can archive a wide variety of text, images, and multimedia information– Teaching files– Research data and reference image

repositories• Collections of disease specific

radiographs• Normal variants• Functional brain MR data sets• Clinical trials images and related data

– Journal articles– PowerPoint– Presentations in all formats

MIRC Components

• Query Service

The entry point into the MIRC community for a user on the Internet.

Accessed with standard browsers.

MIRC Components

• Storage Service: a cooperating information library. Can be a web archive or a database indexed to respond to a MIRC query

• Index: the library’s card catalog. Each storage service implements its own.

• Server: the library’s shelves. The place where the content of a MIRC site is stored and retrieved.

MIRC Components

InternetInternet

ServerServer

Index

ServerServer

IndexMIRC site B

ServerServer

Index

QueryService

MIRC site CServerServer

Index

RSNA site

User

MIRC site A

MIRC Query Service:

http://mirc.rsna.org

• The user fills in a query form:

Search for “Hemangioma”

• InteractEd 2 matches• MedPix 13 matches• MyPacs.net 26 matches• Indiana U. 6 matches• National Neuroscience 1 match• Institute Singapore• Casimage Teaching File 7 matches• Mallinckrodt 6 matches• 61 Matches with Early MIRC Sites

• Total Query Time: 3.7 seconds

MIRC Teaching File Display:

How to Participate?

• Use MIRC to perform searches for images and information

• Be an author• Set up a MIRC site:

– Connect your existing Teaching File system– Build your own Teaching File system:

• Use the RSNA MIRC Site implementation• Use someone else’s• Come up with your own and make it

MIRC compatible

MIRCat – MIRC Authoring Tool

• An editor of text and images that uses the MIRC document format.

• Facilitates creation of content for MIRC sites

• An open source component available to be extended.

MIRCat – MIRC Authoring Tool

• MIRCat can be used to create many kinds documents:– Teaching files– Index cards– Articles– And much more…

• Based on customizable templates.• Users can create their own look for a

MIRC document

MIRC Authoring Tool

• Document Editor

MIRC Authoring Tool

• Image Palette

MIRC Authoring Tool

• Image Editor

RadLex

RSNA RadLex: What Is It?

A lexicon for uniform indexing and retrieval of radiology information resources

A common vocabulary to improve medical communication

MIRC Open Source

• One of the development requirements for MIRC was to make it:

– multi-platform

– open source

• Both the MIRC application and Tomcat itself are written in Java and have been run on all the popular platforms

MIRC Open Source

• RSNA is looking into possibility of releasing all the MIRC software as an open source project, perhaps through SourceForge

• The plan would be to have a project manager who would moderate the project and attempt to guide developers in a common direction

• The moderator would review submissions to the project and make recommendations to the committee on whether to accept or reject them.

Software Used on a MIRC Site

• Java– Available from Sun for free– Not open source.

• Tomcat is an open source project of the Apache Jakarta project

• Multipart Form Library (cos.jar) is an interesting open source project– Written by Jason Hunter as part of a book– The MIRC project distributes the executable library

under the terms of the license– The terms for commercial license are:

Terms for Multipart Form Library

• "Permission is granted to use the com.oreilly.servlet.* packages in the development of any non-commercial project

• For this use you are granted a non-exclusive, non-transferable limited license at no cost

• For a commercial project, permission is granted to use the com.oreilly.servlet.* packages provided that every person on the development team for that project owns a copy of the book Java Servlet Programming (O'Reilly) in its most recent edition

• The most recent edition is currently the 2nd Edition, available at Amazon.com

RSNA and Open Source

• RSNA currently looking into implications of releasing MIRC software into the open source community and associated intellectual property issues

• Will continue to develop software and make it freely available on mirc.rsna.org

Need More Information?

• Go to http://mirc.rsna.org• The “Documentation” link guides you to all the software,

installation instructions, and documentation for setting up a MIRC site and creating content

• RSNA Forums:– http://forums.rsna.org– User Comments, Questions and Answers– RSNA MIRC Software Announcements– MIRC Implementers’ Corner– MIRC Technical Review Committee

• Subscribe on the Forums site

Other Courses This Week

• How to Author MIRC Teaching File How to Author MIRC Teaching File DocumentsDocuments

• How to Set Up a Personal Teaching File How to Set Up a Personal Teaching File SystemSystem

• Inside the RSNA MIRC SoftwareInside the RSNA MIRC Software