Ruby DICOMPerry Horwich, MD1 , Christoffer Lervåg2, Jeff Miller3

1Guthrie Health, Sayre, PA 2Helse Møre og Romsdal HF, Norway 3Center for Biomedical Informatics, Children's Hospital of Philadelphia, PA

References

Example Application

Current Uses

1. Informatics in Radiology: Use of CouchDB for Document-based Storage of DICOM Objects, Rascovsky, Delgado, Sanz, Calvo & Castrillón, RadioGraphics, 2012; 32: 913–927

2. Adaptive radiotherapy based on contrast enhanced cone beam CT imaging Søvik, Rødal, Skogmo, Lervåg, Eilertsen & Malinen, Acta Oncologica, 2010; 49: 972–977

3. Evaluation of adaptive radiotherapy of bladder cancer by image-based tumour control probability modeling, Wright, Muren, Høyer & Malinen, Acta Oncologica, 2010; 49: 1045–1051

4. Conversion of Eclipse RTDose Pixel Data to facilitate further simulations in IDL., Kalpathy-Cramer & Fuller, AMIA 2010 Annual Symposium

IntroductionPROBLEM: For radiologists, generating and maintaining a list of clinical cases can be both time consuming and technically challenging.

CONSIDERATIONS: The radiologist may work at multiple computers, may use differing operating systems, may use differing vendor applications, and may work in separate and distant locations.

SOLUTION: Allow the radiologist to maintain a list of cases in a text file on a shared network drive (Figure 5). Use one line of text to represent each case. Using Ruby and Rails, allow for the import, parsing, and editing of the text file. Individual cases may be entered via the Rails application interface as well.

FUNCTIONALITY: When the user is editing or authoring a case with the Rails application, check to see if the radiologist has included a medical record number or accession number. If so, automatically open a DICOM viewer that displays the corresponding series and images (Figure 8). Allow the radiologist to save key images with the case for later display.

RESULT: A shortened cycle for case identification and image association. The resultant case, containing both text and key images, can be reviewed with a web browser.

ADVANTAGES: The process is vendor neutral. Having followed agile development principles, this base application can be adapted to other uses.

Written by Christoffer Lervåg and publicly posted five years ago, Ruby DICOM represents a mature cross-platform Ruby language library that facilitates the handling of DICOM files and network communication. The library manages the reading, editing and writing of DICOM files as well as querying, retrieving and sending of files to and from DICOM nodes (Figures 1-2).

By combining Ruby DICOM with other open source packages, such as NArray or RMagick, one may perform both image processing and display (Figure 3).

When combined with Rails, the Ruby DICOM gem integrates successfully with the Rails web-application framework and includes everything needed to create database-backed web applications utilizing the Model-View-Controller (MVC) development pattern. This presentation includes an example of a Rails application that demonstrates this particular approach.

Ruby DICOM has been an integral component in academic publications.1-4 Ruby DICOM is open source and has drawn nine additional coding contributors since its public release. The work is further supported by a community of more than 40 active discussion group members. You can find additional information at http://dicom.rubyforge.org

The author’s personal case list has grown by over a thousand cases in the past 24 months. Currently this method is useful for tracking:

• Interesting cases for teaching• Consults with associated history and clinical correlation• Cases for follow-up to be reviewed with future surgical,

future clinical, or future imaging exam correlation.• Quality improvement cases

Figure 6: Account validation allows the application to be selectively used by different users. A user with no account may view publicly published case material.

Figure 7: Case data may be searched.

Figure 8: When editing or authoring a specific case, the user is automatically presented with a javascript DICOM viewer displaying the exam images. Images of interest may be selected by the user and associated with the case being authored.

RUBY

CT abd/pel pt had acute diverticulitis and came back with acute appendicitis 132117 3816145cr chest cxr nml shoulder with lung mass teaching case 3815168mr knee equivical osteochondral injury and displaced fragment on .22T hope to see a f/u at 1.5T 3819643CT arthrogram nice example osteochondral injury 3821462MR shoulder thorax includes entire scapula normal nice imaging 3820930MR knee illiotibial band friction syndrome 3821781MR thigh probable pyomyositis with osteomyelitis rapid change on serial CR in femoral cortex 3825457 400904CT abd/pel missed SMA aneyrysm 3826653CR shoulder nice example of hydroxyappetite deposition 3584240cr hip nice example of polyethelene wear and particulate disease hardware loosening 3825650cr leg nice example of "subtle" toddlers fracture with follow-up images showing callus formation 1242423cr forearm soft tissue mass f/u mri 3828160 mri 3832813 f/u clinicalMR knee acl rupture with posterior lateral corner injury LCL sprain nice example 3830023mr forefoot nice example of tibial sesimoiditis 3830957

Figure 5: Use a text file to track cases of interest.

Open SourceThe example application presented makes use of more than 60 open source software libraries, mostly through the use of ruby gems. Studycentric, the open source javascript DICOM viewer used here, was written by Jeff Miller at The Center for Biomedical Informatics, Children’s Hospital of Philadelphia.

Figure 3: Example Ruby code that loads a DICOM object and saves the image data as a PNG file.

require 'dicom'require 'RMagick'

dcm = DICOM::DObject.read("myFile.dcm")image = dcm.imageimage.write("dicom.png")

require 'dicom'

a = DICOM::Anonymizer.newa.anonymize("c:/dicom")Figure 4: Example Ruby code that anonymizes files in a target directory. It’s this easy. Or, if you prefer, many options can be utilized as seen in this tutorial: http://dicom.rubyforge.org/tutorial2.html

File Handling

require 'dicom'

server = DICOM::DServer.new(104, :host_ae => "RUBY_SERVER")

Figure 1: An example method for starting a DICOM server on the local host at port 104 with an AE of RUBY_SERVER. It really is just this simple. If you like, you can make use of many server options including custom file handlers, transaction logging, and more.

require 'dicom'

node = DICOM::DClient.new(remote_server_ip, 104)node.move_study("LOCAL_DICOM_SERVER", '0010,0020' => pat_id, '0020,000D' => study_uid)Figure 2: Example Ruby code that performs a DICOM Move, transferring a study identified with study_uid from a remote DICOM server at remote_server_ip to local DICOM storage named LOCAL_DICOM_SERVER.

Networking