I recently had an article explaining how I wrote a small app that integrates with Conquest and Clearcanvas which allows radiologist to work off a common work list. I have been actively developing the system and managed to make some nice progress. Our Radiologists are currently using the system to load balance Tele-Radiology cases from our remote branches.

The system is effectively allowing 3 doctors to share cases that where previously reported by only 1. This has been a huge hit as we are currently short staffed with 2 radiologists off sick. The workload is now easily handled by the 3 doctors in-between their normal work. This has saved our practice from hiring a temp radiologist to fill in the gap.

I have managed to improve the system to a stage were we have following features:

1.) LOCKING OF STUDIES BEING VIEWED BY ANOTHER RADIOLOGIST

Studies that are locked appear in the list with a little lock and are slightly greyed out. If a radiologist tries to open the image they are given an error message.

2.) ABILITY TO MARK CASES AS REPORTED

Once a case is marked as reported it falls off the main list and can be found if a user select the show reported filter. Reported cases are shown with a little green tick.

3.) ABILITY TO SEARCH FOR STUDIES (BASED ON PATIENT ID)

There is a basic search facility for finding patients based on their patient ID.

4.) DISPLAY SERIES INFORMATION

The series information is displayed once a study is selected.

5.) COLOUR HIGHLIGHTING OF STUDIES BASED ON TIME WAITING

Cases that have been waiting for longer than 30min are shown in yellow and those waiting for longer are shown in red.

6.) STATISTICS

I created a small stats web page that uses Google charting API to display information about the number of cases for the day, number of cases per day for each branch and number of cases reported by which doctors workstation.

SOME OF THE PROBLEMS I HAVE ENCOUNTERED:

One of the main problems I have encountered in the system is that the units sending the CR cases from the remote branches seem to send the study one image at a time to my conquest server. When conquest accepts the image and stores it in the database it is immediately displayed on the work list. This is a problem because there is no way I can figure out to display the total number of images in a study / series before it has all been received by the conquest server and some of the CR units appear to send the images out of sequence to the server. I have attempted to change the dicom association level, but this has had little effect. The solution that I came up to for this problem is to display the series information to the doctor and sort it by series number. The radiographers annotate on the first image in the series how many images are being sent. The radiologist can then look at the series information and the series number and determine when all the images have arrived.

HOW TO DO IT YOURSELF

This system is not rocket science. All you need to do is the following to get a system like this up and running:

* Forward all cases to a conquest server and get it to auto-forward cases to clearcanvas workstations you want to report from. * Modify the conquest dicomstudies table to have 4 new fields. (bool is_reported, bool is_locked, text locked_by, text reported_b) * Create an application that can connect to the mysql database and pull the study information out. * Integrate with clearcanvas using the API. * And that is about it. It takes a bit of tweaking, but if I can do it then almost any half decent programmer can.

I was surfing Digg and came across a link to this image of kermit the frogs x-ray, lol!

Image Credit: http://www.walyou.com/blog/2010/05/05/x-ray-of-kermit-the-frog/

The puppet x-ray I would really like to see is that of Agmed the dead terrorist.

Image Credit: http://www.blingcheese.com/image/code/145/silence+i+kill+you.htm

I have managed to integrate ClearCanvas into one of my applications. (Please note this is not a product that I intend on releasing, but I thought it may interest some of you out there who are looking at making a similar solution) I was tasked with sharing the workload for our TeleRadiology workstation (GE Centricity RA600 Workstation). The solution I came up with does the following:

Ge Centricty Workstation forwards all cases to a Conquest server. I wrote a C# application that then queries the Conquest database and displays a list of patients. I added 2 new fields to the conquest studies database table ‘study_reported’ & ‘study_locked’, both are type TINYINT(1) with a default value of 0; The conquest server is set to forward all cases to the relevant ClearCanvas workstations. When the user double clicks on a case the application opens the study in ClearCanvas and set the study_locked field in the database to 1 to prevent other users from accessing the same study. The doctor is then presented with a small dialog window that is set to be the topmost window which allows him/her to set the study status to reported or unreported. When they click on these buttons the study_reported status is updated in the database, the study_locked flag is also set to 0 and the application closes the ClearCanvas study.

This application should allow our doctors to share some of the workload between two or more workstations and prevent them from double reporting cases.

Some early screenshots of my hack and slash solution:

The basic worklist page showing normal, locked and reported cases.

Update Study Status dialog showing on top of clearcanvas.

Below is some code taken from the ClearCanvas developers site to perform some of the integration:

OPEN A NEW INSTANCE OF CLEARCANVAS WORKSTATION:

public static void StartViewer() { const string processName = "ClearCanvas.Desktop.Executable"; const string viewerProcessPath = @"C:\Program Files\ClearCanvas\ClearCanvas Workstation";

Process[] viewerProcesses = Process.GetProcessesByName(processName); if (viewerProcesses == null || viewerProcesses.Length == 0) { string executable = Path.Combine(viewerProcessPath, processName) + ".exe";

ProcessStartInfo startInfo = new ProcessStartInfo(executable, ""); startInfo.WorkingDirectory = viewerProcessPath; Process viewerProcess = Process.Start(startInfo); if (viewerProcess == null) MessageBox.Show("Failed to start the viewer process."); } }

OPEN THE A STUDY IN CLEARCANVAS:

private void openStudy(string uid) { // check if the study is opened by someone else if (!isStudyLocked(uid)) // function to check if the study is locked or not { // lock the study so no one else opens it if (lockStudy(uid)) // function to set the study as locked { // open the study in ClearCanvas BasicHttpBinding binding = new BasicHttpBinding(); EndpointAddress endpoint = new EndpointAddress("http://127.0.0.1:51124/ClearCanvas/ImageViewer/Automation?wsdl"); client = new ViewerAutomationServiceClient(binding, endpoint);

try { client.Open(); OpenStudiesRequest request = new OpenStudiesRequest(); request.ActivateIfAlreadyOpen = true; List studiesToOpen = new List();

OpenStudyInfo info = new OpenStudyInfo(uid); studiesToOpen.Add(info); request.StudiesToOpen = studiesToOpen; client.OpenStudies(request); client.Close();

this.Visible = false; // hide the main window Study_Dialog sd = new Study_Dialog(uid); // show the study dialog window sd.ShowDialog(); closeOpenViewerWindows(uid); // once the study dialog window is open close the study window in ClearCanvas this.Visible = true; // show the main form again unlockStudy(uid); // unlock the study in the database updateStudyReportedStatus(uid, studyDialogResult); // update the reported status of the study with the variable set by the study dialog window. } catch (Exception ex) { client.Abort(); MessageBox.Show(ex.Message); unlockStudy(uid); }

// StudyDialog sd = new StudyDialog(); // sd.ShowDialog(); } } else { // error the study is opened by someone else MessageBox.Show("Study is locked by another user!"); } }

CLOSE THE OPEN STUDY WINDOWS IN CLEARCANVAS:

public void closeOpenViewerWindows(string uid) { BasicHttpBinding binding = new BasicHttpBinding(); EndpointAddress endpoint = new EndpointAddress("http://127.0.0.1:51124/ClearCanvas/ImageViewer/Automation?wsdl"); client = new ViewerAutomationServiceClient(binding, endpoint);

try { client.Open(); GetActiveViewersResult result = client.GetActiveViewers(); foreach (Viewer viewer in result.ActiveViewers) { CloseViewerRequest cclose = new CloseViewerRequest(); cclose.Viewer = viewer; cclose.Viewer.PrimaryStudyInstanceUid = uid; client.CloseViewer(cclose); } client.Close(); } catch (Exception) { client.Abort(); throw; } }

Clearcanvas has released version 2 of it product suite (Workstation, RIS & Server).

Story: http://www.clearcanvas.ca/dnn/Home/News/tabid/196/EntryId/72/ClearCanvas-RIS-PACS-2-0-now-available.aspx

Emailing JPG images using ClearCanvas external application feature and a bat script.

As per my last post here is a way to email JPG images. I can only get it to do single images at the moment. I have not managed to devise a way to convert and attach multiple images yet. (My bat scripting is a bit rusty)

This is how I did it:

Requirements

* ClearCanvas 2.0 Beta or higher (With External Applications feature) * Blat Command line emailer - http://www.blat.net/ * dcmj2pnm.exe from DCMTK - http://dicom.offis.de/dcmtk Steps:

1.) Create folder C:\test\ (Or what ever you want to call it, just update accordingly). Add the dcmj2pnm.exe file to this folder.

2.) Create Bat Script in the folder created above with the following in it:

(Please change the directories, email addresses and server names accordingly)

@ECHO OFF

:PROMPT cls echo ClearCanvas Email Script echo. echo Please enter recipient email address: set /p email= :CONVERT cls echo ClearCanvas Email Script echo. echo Converting Images to JPG dcmj2pnm.exe +oj +Wm --scale-x-size 1024 %1 C:\test\%2_.jpg :SEND cls echo ClearCanvas Email Script echo. echo Sending Email Message blat.exe -server servername -f user@domain.com -to %email% -subject "Images - %3" -sensitivity 1 -body "Images Attached" -html -attach "C:\test\%2_.jpg" :END pause

3.) Setup the external application as per image below:

There is room for improvement in the script such as error checking etc. But for now it is a nice simple JPG email system a right click away!

Hope this is useful to someone out there.

I managed to get ClearCanvas to pull reports from our own RIS system using the external applications feature in the new Beta 2.0 version.

Thanks to Jonathan for pointing me to the new ClearCanvas channel on YouTube http://www.youtube.com/clearcanvas.

Our RIS application has a web interface that allows for reports to be accessed using a basic URL. So all I did was point an external application to internet explorer and add the relevant parameters to it.

The $001000020$ tag is for the patient ID, which is what we currently use to identify patient reports. You can pull out any dicom tag using this tool.

I did however find that I was unable to use normal command line shortcuts like %SystemRoot% or %ProgramFiles% shortcuts. But it is not a major train smash.

Below is the video from ClearCanvas that explains how to setup an external application.