Imaging is an extremely powerful and flexible educational and training tool. It can be used to teach students, doctors and other healthcare professionals anatomy and radiology, and can also be used in a wider role in medical training to improve the fundamental understanding of disease. Imaging may be used to educate doctors throughout their medical career from medical student, through training grades, to supporting continuing medical education and revalidation at a consultant level.
We propose the development of an imaging laboratory for education and training that will provide innovative facilities to deliver coordinated training at all these levels. We perceive many current educational needs for imaging within UCLH, UCL and UCL medical school. There are also wider needs that will arise from the training activities of UCLP as part of the MDEC process and we anticipate that an imaging laboratory would support this activity.
A small prototype laboratory could be established beginning with up to 10 viewing stations. This could develop into a much larger facility scaling up on the prototype model. Ultimately this would consist of core educational staff together with a single but flexible imaging IT facility housed within the Trust.
The training needs that could be supported by the Imaging Laboratory (IL) are detailed below:
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a.
Anatomy. Dr Navin Ramachandran is the lead for Anatomy & Imaging teaching at UCL medical school, and has developed a new curriculum spread throughout the medical course, which integrates teaching in the dissection room with clinical imaging. The imaging lab would play a key role in delivering this curriculum, and help to secure the
SIFT funding that the hospital receives for education b.
Medical Training. Imaging could be used more extensively in teaching Medicine to medical students; imaging reflects disease processes and consequently can illustrate disease graphically and memorably.
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2.
The Imaging Laboratory could be used to teach anatomy and radiology and could also be integrated into training in medicine and surgery. Short course formats can be develop to support learning, to rival the Harvard model. Consultants in the
Imaging department are world-renowned experts in their field and aim to play a key role in this project. The imaging laboratory would provide an immersive and interactive environment in which these courses could be optimally delivered. Courses would be developed for a wide range of users including a.
Registrar trainees: i.
Radiologists ii.
Other doctors e.g. anatomy for surgeons, basic image guided interventional skills b.
Reporting radiographers c.
UCLP trainees: i.
Anatomy training for radiologists ii.
Chest ultrasound for physicians iii.
FAST scans for emergency physicians
3.
: The Imaging Laboratory would support modules forming the MSc courses being offered to SpRs by UCLP. a.
Imaging training modules. MSc candidates will develop modules (e.g. on imaging of gynaecological malignant disease) based on validated templates. The training modules would then be available through the IL for other learners. b.
Module in Radiology IT. c.
Research – both scientific and educational. d.
Computed imaging and image processing e.
MR physics for radiologists f.
Molecular imaging g.
Practical MR physics (scanning, work on a sequence, sequence optimization) h.
Contribution to an e-anatomy textbook
4.
: The IL would be used to develop testing systems for formal examinations, testing of learning to allow progression through training (e.g. reporting levels for SpRs), and examination preparation. Dr. Simon Morley has been instrumental in setting up similar systems at The Royal College of Radiologists.
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5.
. The IL could develop a model for radiology quality assurance and this in turn could be used as supporting evidence for revalidation. UCL has been instrumental in setting up the GMC pilot work in this field, and the IL could play a key role in this.
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. The IL would facilitate the development of a free and virtual textbook of anatomy. Contributing to the textbook could form an MSc module.
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: Involvement in the IL could be used as part of a training programme in education and could facilitate the careers of those doctors who would like to be involved in teaching and education. We see that it could contribute to a career pathway as an educator.
The Imaging Laboratory will consist of a subnetwork of computers dedicated to imaging teaching and research, running off the main PACS network. The software is based on the open-source imaging software Osirix, a well-established Mac-based program. Justification for this approach is:
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The use of well-supported open source software reduces the reliance of the trust on expensive proprietary systems.
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Low cost of the initial purchase and subsequent upkeep (significantly lower than current systems).
3.
Dr. Simon Morley, the lead for radiology IT at UCLH, has set up the examination system at The
Royal College of Radiologists, based on Osirix. We aim to use his experience to set up a robust system at UCLH.
4.
The Centre for Medical Imaging at UCL currently uses Osirix for the majority of their research, but in a fashion that does not integrate well with the hospital’s PACS system. Their expertise will be invaluable.
We aim to establish a validated case archive that can be used for training and assessment.
 An outline of the IT system is shown:
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 The database of cases will be stored on Osirix, an open source Picture Archiving and Imaging
System (PACS). o This is a commonly used solution which has the following advantages:
 Free for educational use
 Many plug-ins that are free or at nominal cost to increase functionality
 Familiar to most radiologists, and used by the Royal College of Radiologists for their exams (system set up by Dr. Simon Morley)
 Good keywording ability o All cases will be anonymised or pseudo-anonymised o All cases will be categorized (using the internationally accepted RadLex system) to allow easy retrieval and grouping
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 Cases will be stored on an educational server (see diagram above) o These may then be sent out to the iMac nodes in a synchronized manner. This may be particularly useful to send out the same group of cases to each node for a student assessment exercise. o Any iMac node may retrieve individual cases from the archive on the server. This may be useful when a user is trying to find example cases (e.g. for publication) o Groups of cases could be sent to portable iPads for distance learning from cases. Access will be limited as these cases can be taken off-site.
 The process of sending cases to the archive is outlined in the diagram.
 Educational fellows and nominated registrars would be charged with processing cases for the archive. o Any registrar or consultant can nominate cases – these would be reviewed at the Friday interesting cases meeting o When a case is deemed suitable for archiving, it is transmitted to “DICOM Cleaner” and a
Soliton message sent to the nominated educational registrar. o The educational registrar would regularly check for messages and process the cases for archiving.
 Students on SSC modules and MSc students would also be charged with collecting cases.
 All cases are to be pseudo-anonymised o True patient details stored on a central secure database hosted on the education server, with access limited to agreed individuals. o Pseudoanonymisation allows for situations when:
 Patients ask for all images to be removed
 Unexpected findings discovered on images o New unique identifier given to each case. All identifiers to be removed from actual images (e.g. on ultrasound and DLP CT images) – protocol will state which modalities have patient data burned into image rather than just the metadata, and will therefore need “deeper cleaning”.
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 Random sampling of cases form the archive will audit that anonymisation is happening correctly.
 Caldecott guardian sign-off shall be sought re information governance.
 GMC guidelines state that consent is not necessary if anonymised o However, we would try to get consent whenever feasible and record this within the
Osirix database.
 This would include consent for digital use including the internet.
The reporting room in the new Macmillan Cancer Centre has the potential to serve a dual function as a reporting facility and a small teaching space – this could be used to pilot the project. The use of this room has been given provisional support by Dr Charles House, DCD Imaging.
The development of the IL will require resources by way of time and hard/software. Although some of the activity could be supported in an ad hoc manner in the first year with pump priming, ultimately sustainable funding would be necessary.
Staff:
 Fellow – half time to run and support the database, develop training courses
 Consultant lead – c. 4 sessions pw. Possibly split Medical School/UCLH post.
 SpR involvement through MSc or as part of training scheme
 Administrator P/T initially moving to FT
Funding support for IT :
 Potential sources include: o UCLH (including special trustees, chairman’s awards and educational funds) o UCL (including MSc funding) o HEA & JISC funding
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A demonstration of the training model can be organized to show the versatility and wide applications of this model.
Navin Ramachandran
Simon Morley
Margaret Hall-Craggs
October 2012
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