1	Using the MIRC DICOM Service for Clinical Trials to Automatically Create Teaching File Cases from PACS A. Gentili MD , C.B. Chung MD, T. H. Hughes MD VA San Diego HealthCare System, CA UCSD Medical Center, San Diego, CA
2	Introduction Teaching files are present in most Radiology departments. Radiologists have always collected interesting cases for teaching purposes or for use in presentations and publications. In the past these teaching file were made of copied films, in the recent past with the advent of PACS teaching file are becoming digital. Several systems have been used to distribute these images over the internet.
3	MIRC Server In the past few years, the Radiological Society of North America (RSNA) initiated the Medical Imaging Resource Center (MIRC) project to facilitate sharing of medical information through the imaging community. Documents conforming to the MIRCdocument schema can be easily index and shared over the Internet. RSNA has developed the software necessary to implement a MIRC server capable of indexing and distributing XML documents conforming to the MIRCdocument schema. This software is open source and can be downloaded free of charge from RSNA.
4	The MIRC Web Server
5	Software Installation The MIRC software is written in Java and run under Windows, Mac OS X, or Linux, it requires that the Java 2 SDK 1.4 and Tomcat 4.1 are present on the system where the MIRC Site Software is being installed. The MIRC software includes several components among witch an authoring service and a MIRC DICOM Service for Clinical Trials. After installation, the MIRC DICOM service is configured to accept images from PACS (a DICOM Store AE Title and port is assigned to the MIRC Storage service). The Anonymizer for MIRC Clinical Trial Services is configured to eliminate protected patient informations, but to retain certain data such as: clinical history, imaging modality, organ system, and study comments.
6	template.xml modification After installing the MIRC server software and configuring the clinical trial service, we modified the template.xml file that controls the automatic creation of MIRC documents by the clinical trial service to create teaching file cases directly from PACS.
7	Modified template.xml (1/2) <?xml version="1.0" encoding="iso-8859-1" ?> - <MIRCdocument display="mstf" background="dark"> - <title name="title"> <g0008e0060 desc="Modality" /> Study </title> - <alternative-title name="alternative-title"> <g0008e0060 desc="Modality" /> Study </alternative-title> <keywords name="keywords" /> - <author> - <name> <g0008e0080 desc="Institution Name" /> </name> </author> - <abstract> <text name="abstract-p" rows="4" /> Reason for Study: <g0032e1030 desc="Reason for Study" /> <g0010e21B0 desc="Additional Patient History" /> - <p> <g0032e4000 desc="Study Comments" /> </p> </abstract> <alternative-abstract name="alternative-abstract-p" rows="4"> - <p> <g0032e1030 desc="Reason for Study" /> </p> - <p> <g0010e21B0 desc="Additional Patient History" /> </p> </alternative-abstract> - <section heading="History"> - <history name="history-p" rows="5"> - <p> <g0010e21B0 desc="Additional Patient History" /> </p> </history> </section>
8	Modified template.xml (2/2) <section heading="Findings"> <findings name="findings-p" rows="5" /> </section> - <section heading="Diagnosis"> - <diagnosis name="diagnosis-p" rows="10"> - <p> <g0032e4000 desc="Study Comments" /> </p> </diagnosis> </section> - <section heading="Discussion"> <discussion name="discussion-p" rows="10" /> </section> - <image-section image-pane-width="600"> <insert-megasave width="600" /> </image-section> <references name="refs-ref" rows="5" /> - <anatomy name="anatomy"> <g0018e0015 desc="Body Part Examined" /> </anatomy> <pathology name="pathology" /> <code coding-system="ACR" name="code" /> <category name="category">Musculoskeletal</category> <level name="level" /> - <section heading="Demographic Data"> <g0010e1010 desc="Patient's Age" /> <g0010e0040 desc="Patient's Sex" /> <g0008e0060 desc="Modality" /> <g0018e0015 desc="Body Part Examined" /> </section> - <image-section heading="Images"> <insert-megasave width="512" /> </image-section> - <section heading="not visible" visible="no"> - <patient> - <pt-sex> <g0010e0040 desc="Patient's Sex" /> </pt-sex> </patient> - <modality> <g0008e0060 desc="Modality" /> </modality> - <anatomy> <g0018e0015 desc="Body Part Examined" /> </anatomy> </section> <document-type>Radiologic Teaching File</document-type> - <authorization> <owner>admin</owner> <read name="read" /> <update name="update">ss-author ss-admin</update> <export name="export" /> </authorization> </MIRCdocument>
9	Teaching File Creation While reading a case on PACS, the Radiologist select the images for the teaching file case, write the diagnosis in the “Study Comments” box, usually used for wet readings, and transmit the case to the MIRC server directly from PACS. The MIRC server automatically fills the modified teaching file template using the data in the DICOM header (patient age, patient sex, clinical history, diagnosis, imaging modality, organ system) and creates a simple teaching file. If desired, this teaching file case can be edited at a later time using the Authoring Service.
10	Teaching File Workflow
11	At PACS Workstation
12	Select Images
13	Enter Diagnosis
14	Transmit to MIRC Server
15	Teaching File Workflow
16	A Teaching File is Automatically Created
17	Abstract
18	Patient’s Demographics
19	Clinical History
20	Diagnosis
21	If desired the case can be edited using the MIRC Authoring Service
22	Conclusion The advantage of using the clinical trial service over the authoring service is the need for minimal user intervention, as data already present in the DICOM heading can be automatically inserted into teaching file cases. Since the configuration of the MIRC server to automatically create teaching file cases, the number of teaching file cases submitted to our section MIRC server has significantly increased from one a month to one a day.
23	References Radiological Society of North America: RSNA Medical Imaging Resource Center. Available at http://mirc.rsna.org. Accessed May 10th, 2005 Radiological Society of North America: The MIRC Source Release Theory of Operation. Available at http://mirc.rsna.org/mircstorage/documents/mircsiterelease/TheMIRCSourceRelease.doc. Accessed November 10th, 2005. Radiological Society of North America Medical Imaging Resource Center. How to Configure the MIRC DICOM Service for Clinical Trials. http://mirc.rsna.org/mircstorage/documents/documentation/HowToConfigureTheDICOMServiceForClinicalTrials.doc. Accessed November 10th, 2005.
24	template.xml will be available after RSNA at http://gentili.net