The MICCAI conference 2009

Earlier this week, IXICO was exhibiting at the MICCAI conference in London. This is an international conference to do with the analysis of medical images – with lots of really mathematical stuff presented by computer scientists and engineers. MICCAI stands for Medical Image Computing and Computer Assisted Interventions, so as well as analysis of images, it also has presentations on robotics. The people presenting at the MICCAI meeting are trying to invent new ways of using images to diagnose disease, plan treatment, monitor treatment progress or even control robotic surgery. If you get your work accepted at MICCAI you are doing very well, as less than 10% of work submitted is accepted for a talk.

MICCAI this year was in London, and two of IXICO’s founders – Dave Hawkes and Daniel Rueckert – were involved in organizing it. One of IXICO’s software developers – Sergiy Milko– was also presenting his work.

The people coming to MICCAI all use medical images in their research, and so all have to deal with the problem of moving around these images, collecting them from scanners, ensuring patient privacy rules are obeyed, and sharing the images with colleagues. All too often, the medical images used in this sort of research are not very well looked after – and get lost or mis-placed. If you don’t know what sort of patient the images are collected from, then they become useless for almost all types of research.

That is one reason we decided that MICCAI would be a good place to show everyone Trial Wire - http://www.mytrialwire.com/ – our free tool to share, de-identify and organize your DICOM medical images, and also show people Trial Tracker – our latest product that provides a web-based image management system for comprehensive management of all imaging data from acquisition to analysis. You can get more information on Trial Tracker here www.ixico.com/newproducts/trialtracker

And I nearly forgot – a real highlight of MICCAI was the conference dinner. It was held in the Science Museum. London’s science museum contains fascinating material, from old steam engines to Apollo lander to CT scanners. On the computing side, it contains really ancient computer gizmos - Baggage’s mechanical computer from 150 years go, or the computer memory developed 50 years ago for the Manchester computer). You couldn’t do much image analysis on those systems: modern scanners can generate 1Gbyte of data per patient!

So it was among all these fascinating exhibits that the MICCAI banquet was held – with stilt walkers, jugglers, and a disco. Quite an event!
To find out more about MICCAI go to http://www.miccai.org/

Drifting in the Cloud

‘Cloud computing’ is a buzzword that caught my attention this week. It seems everything that was once firmly grounded – books, music, high street shops and even medical records – are drifting into the ‘cloud’. In a nutshell, this buzz concept means that users do not need to install or maintain any software themselves – all they’ll need is a computer and browser. They will harness the internet as a vast computing resource and connect to them and use them as needed.

Without realizing it, you may be a cloud user already. Facebook, Twitter, Email, YouTube, iTunes all allow electronic information to be stored and processed on computers in the ‘cloud’ and then delivered to you where and when you need it. In the healthcare industry, the web-based personal health records (PHR) is set to revolutionise communication between patients and physicians as both will be able to pull up medical records from the web.

Will pharma companies that run the clinical trials, which only tentatively shifted from ancient paper records to electronic data capture (EDC) and clinical trial management (CTM), embrace the Cloud? We are not sure.

Pharma giant Ely Lilly and Co uses Amazon’s Elastic Compute Cloud (EC2) for its R&D research. They have been ‘able to launch a 64 bit machine cluster computer working on bioinformatics sequence information, complete the work, and shut it down in 20 minutes’ and it only cost ‘$6.40’ (Dave Powers – Ely Lilly Associate Information consultant).

As pharmas seek to reduce time and cost of drug development, the demand for fully integrated, end-to-end clinical solutions will increase. Clinical cloud computing would not only enable a wide range of clinical applications to be tapped from anywhere but also allow for greater access to real-time information and enhanced collaboration between CROs and sponsors.

In relation to medical imaging, it is regrettable that many clinical sites still rely on CDs or specialised equipment to transfer DICOM images. Trial Wire was launched by IXICO as part of its effort to foster the adoption of a simple, web-based image transfer tool. Evidently, a complete cloud based image management is not available, even though its benefits are clear: reduce operational time, real-time access to trial images anywhere in the world, data sharing, enhanced collaboration, and accelerated error correction.

However, all this may just be wishful thinking. Let’s hope that pharmaceutical companies are prepared to drift into the clouds.

Trial Wire – Organizing DICOM Images in a Disorderly World

IXICO recently made available for free a tool called Trial Wire. This is a tool that is routinely used by us in-house to transfer medical image files between clinical trial sites and IXICO servers. Nearly all medical imaging scanners in hospitals can store and transfer image files as a series of slices, or cross sections, using the industry-standard DICOM format. DICOM stands for digital imaging and communications in medicine. It was adopted by the medical imaging community to allow for ease of communication and data transfer, independent of the manufacturer or type of scanner involved. You can think of DICOM as the medical imaging field’s equivalent of a .pdf file.

The DICOM format is designed for communication of image data between scanners, imaging workstations, and hospital image archive (known as Picture Archival and Communication Systems or PACS). But for research studies and clinical trials, handling of DICOM data can be painful!
Among several clever features of Trial Wire, one that is sometimes overlooked is its ability to organize DICOM files into series of sub-directories. This seemingly trivial feature is in fact very complicated for most DICOM data users.

The problem lies with the imaging systems and equipment that are made by the likes of GE, Siemens, and Philips. When a patient is given an MR or CT scan, say, the imaging system can transmit the images to a computer in either a random or systematic fashion. Although the images are still fully DICOM compliant, the manufacturers do not have a standard way of organizing the data. This can result in several image slices being stored in dozens of sub-directories in what to many users can be a very confusing fashion. To manually structure the images is tedious and time-consuming.

Trial Wire uses an algorithm that is able to specifically tackle this problem. When a directory is specified, Trial Wire searches that particular directory and any sub-directory for any DICOM data. It then automatically imposes a directory structure into one of the three options set by the user:

1. Subject/Study/Series
   In this structure, the data is organized first by subject (which can be de-identified by Trial Wire) then by study name and then by image series. This allows for easy review in a trial-centric manner, meaning that someone interested in retrieving the data can now easily search by subject, study, or series. This approach will generally appeal most to those conducting clinical trials.
2. Flat directory
   In this structure, all the files are copied into one target collection. They are also all renamed to have a unique 8-character filename and a DICOMDIR file is created to describe them. This approach will most often be used by those who want to maintain large volumes of data that can be further organized later according to changing needs.
3. Mirror the original structure
   The original directory structure will be kept. This also means that any name on the files (which may contain personal information) is kept. This approach will most likely be used in a clinical setting where patient data is a necessary part of communication between physicians, such as conferring physicians within a hospital centre.

The organizing feature offered by Trial Wire gives the option to structure its files the way our experts do it here at IXICO or preserve the original structure. This provides the maximum flexibility for end users to organize DICOM data for storage or transfer. And a key benefit is that data from different scanners can all be stored together in a coherent structure to allow for easier sharing and analysis of the data.