The Laboratory for Clinical and Experimental Image Processing (LKEB) at the Medical Centre of the University of Leiden is actively supporting the specific mission of the Euromed project to enable doctors at remote locations to access advanced medical imaging analysis software, available at various specialised centres in Europe. Responsible project leader at Leiden, Rob van der Geest, is working on the establishment of a protocol, allowing the local doctor to receive and even control the result of the image analysis over the internet in graphical format. The elements needed to fulfil the required data transfer are a network connection and protocol, known as the generally available X-Windows System; a powerful software package, like for instance MASS; a DICOM-PACS archival system, and a special WWW-page. The correct implementation of all these ingredients produces the desired time- and-money-saving connectivity.
Since the Euromed project has defined the World Wide Web as the common interface between the medical world, the local doctor should be capable to use the image analysis software package simply by manipulating his WWW-browser, without having to invest in specialised hardware. As an end-user, he is able to access images from a DICOM (Digital Imaging and Communications in Medicine) PACS (Picture Archival Computer System), situated at a given hospital. The hospital workstation in turn, is permanently connected to the local PACS system as well as other PACS systems via the internet. The MASS image analysis software is also running on this workstation and can send its display to any internet server.
Researcher Rob van der Geest sets out the following scenario. The doctor, working at a remote location, discovers that the cardiovascular MR images that he needs, are to be found in the PACS archival system of a certain hospital. He either chooses to view these images by pressing the view button on his WWW-browser or to perform a quantitative analysis of the concerned images. In the second case, he activates the MASS application by pressing the MASS icon on the same WWW-page. Automatically, the location or IP-address of the doctor's PC is being tracked and the images start loading from the PACS system. The doctor now can interact with the MASS application.
The MASS software package has been developed at LKEB in Leiden and permits quantitative analysis of Magnetic Resonance Imaging (MRI) studies of the heart. Ten to twelve slices of the heart are acquired in sixteen to twenty phases within the cardiac cycle, a process which generates high resolution images. The four-dimensional data set, obtained during the MRI examination, provides decisive information about the existence of abnormalities in the function of the left or right ventricle of the heart by executing semi-automated contour detection of the ventricle's inner and outer boundaries. As a result, a large set of quantitative parameters is being derived and incorporated in the software package in order to facilitate the doctor's choice for proper treatment of the patient.
By means of a DICOM connection, MR images can be transmitted between two hospital sites. From the moment the MASS icon on the WWW-page of a local PC has been pressed down, the send-image application of the first hospital is activated to transmit the required data to a known node at the second hospital, where the receive-image application is running continuously to automatically store any received image at this local site. Simultaneously, the MASS software loads in the requested images while an X-windows session is being established between the second hospital and the local doctor. Since no image transfer is required between hospital and doctor, the necessary bandwidth here can easily be limited. Researcher Rob van der Geest currently is finalising the scenario with some of the work still in progress. If you wish to learn more about the fascinating world of image processing, a visit to the LKEB site really is indispensable.