Case Study: Medical Imaging; From Toolbox to Product to Platform by Gerrit Muller University of South-Eastern Norway-NISE e-mail: gaudisite@gmail.com www.gaudisite.nl Abstract Medical Imaging was an early large scale Object Oriented product. Originally intended to become a re-useable set of toolboxes, it evolved in a family of medical workstations and servers. This article describes the evolution from different viewpoints, to serve as background material for a number of case studies of the Gaudí project. MR "MPR" Distribution This article or presentation is written as part of the Gaudí project. The Gaudí project philosophy is to improve by obtaining frequent feedback. Frequent feedback is pursued by an open creation process. This document is published as intermediate or nearly mature version to get feedback. Further distribution is allowed as long as the document remains complete and unchanged. September 6, 2020 status: preliminary draft version: 0.4 Printer Reading Room CT URF RAD RAD Radiologist at other hospital teaching Radiology department Operating theatre Radiologist somewhere in the hospital Office Vascular RAD Radiologist at home Recepti on CT Referring Physician Referring Physician trauma room Conference room IT infrastructure in basement Philips Medical Systems, schematic organization Philips Medical Systems US Non X-ray modalities MR CT Conventional X-ray Cardio Vascular Medical Imaging Common X-ray Components Case Study: Medical Imaging; From Toolbox to Product to Platform 2 Gerrit Muller version: 0.4 September 6, 2020 PMSorganization URF Surgery Generic drivers of Radiology Departments Image quality Diagnosis Relaxed patient ease of use automation patient accessibility patient handling patient entry, exit Department Efficiency universality integrated information flow minimal film cost up time Safety Compliant with Standards and Regulations minimal evasive Case Study: Medical Imaging; From Toolbox to Product to Platform 3 Gerrit Muller dose reduction version: 0.4 September 6, 2020 RadiologyDrivers Phases of Medical Imaging • 1987-1991 Advanced Development (”Common Viewing”), result: Basic Application plus toolboxes • 1991-1992 Development of 1stproduct: Medical Imaging R/F • 1992-1994 Parallel Development of 2nd product: Medical Imaging CT/MR • 1994-1997 Family Development • 1997-2000 Transformation in re-useable components Case Study: Medical Imaging; From Toolbox to Product to Platform 4 Gerrit Muller version: 0.4 September 6, 2020 HistoricPhasesList Technology innovations by Common Viewing • Standard UNIX based workstation • Full SW implementation, more flexible • Object Oriented design and implementation (Objective-C) • Graphical User Interface, with windows, mouse et cetera • Call back scheduling, fine-grained notification • Data base engine, fast, reliable and robust • Extensive set of toolboxes • Property based configuration • Multiple coordinate spaces Case Study: Medical Imaging; From Toolbox to Product to Platform 5 Gerrit Muller version: 0.4 September 6, 2020 CVinnovations Idealized layers september 1991 Basic Application Image Gfx UI DB SunOS, SunView Standard Sun workstation Case Study: Medical Imaging; From Toolbox to Product to Platform 6 Gerrit Muller version: 0.4 September 6, 2020 MIlayers1991 X-ray rooms from examination to reading around 1990 Examination Room Control Room Examination Room Control Room Case Study: Medical Imaging; From Toolbox to Product to Platform 7 Gerrit Muller Corridor or closet Reading Room version: 0.4 September 6, 2020 XRayRoomsOld X-ray rooms with Medical Imaging applied as printserver Examination Room X ray Control Room source console Corridor or closet printer detector Examination Room Control Room Reading Room light box Case Study: Medical Imaging; From Toolbox to Product to Platform 8 Gerrit Muller version: 0.4 September 6, 2020 XRayRoomsPlusPrintServer Comparison screen copy vs optimized film old: screen copy new: SW formatting 20 to 50% less film needed Case Study: Medical Imaging; From Toolbox to Product to Platform 9 Gerrit Muller version: 0.4 September 6, 2020 MIfilmComparison Idealized layers september 1992 Medical Imaging R/F dev. tools Print service Spool HCU Store SW keys RC driver HC driver DOR driver RC interf HC interf DOR Store Image View Gfx Cluster UI DB PMSnet in NIX SunOS Config Install Start up Standard IPX workstation Desk, cabinets, cables, etc. 3M RC DSI Case Study: Medical Imaging; From Toolbox to Product to Platform 10 Gerrit Muller version: 0.4 September 6, 2020 MIlayers1992 PMSnet out Example Multi Planar Reconstruction oblique slices curved slice Case Study: Medical Imaging; From Toolbox to Product to Platform 11 Gerrit Muller version: 0.4 September 6, 2020 MIexampleMPR Idealized layers june 1994 Medical Imaging CT/MR dev. tools Rad Specialized applications (Dental, etcetera) MR CT remote access customi zation Medical Imaging R/F Spool Specialized applications RF Compose Print Store Image HCU service SW keys Vascular Store MPR Gfx Cardio View UI PCR Export Cluster PMSnet in DB PMSnet out CDSpack RC dials driver HC driver DOR driver HC interf DOR NIX Solaris Config Install RC dials interf Standard IPX or Sparcstation 5 workstation Start up Desk, cabinets, cables, etc. 3M RC dials new HCU MR Case Study: Medical Imaging; From Toolbox to Product to Platform 12 Gerrit Muller CT DSI version: 0.4 September 6, 2020 MIlayers1994 DCAS PCR Example CT/MR department MR Examination room Control room "MPR" room CT Examination room Control room Reading Room Case Study: Medical Imaging; From Toolbox to Product to Platform 13 Gerrit Muller version: 0.4 September 6, 2020 MIdepartmentCTMR Differences between modality images X-ray CT MR image projection slice slice structure single image stack stack or time series or volume or more complex contrast window width window width brightness window level window level resolution 10242 5122 2562 contrast noise ratio 10 bit 12 bit 8 bit absolute acquisition dependent greylevel mapping value Case Study: Medical Imaging; From Toolbox to Product to Platform 14 Gerrit Muller version: 0.4 September 6, 2020 ImageCharacteristics Specification Differences • viewing and print preparation • navigation support • multi-image view • greylevel control • specialized clinical functions • vascular and cardio analysis (X-ray) • dental (CT) • print protocols • information model Case Study: Medical Imaging; From Toolbox to Product to Platform 15 Gerrit Muller version: 0.4 September 6, 2020 ModalitySpecifics Workflow value Medical Imaging Competitive Positioning PACS products Medical Imaging Review GE Siemens workstations Medical Imaging R/F and CT/MR clinical or modality value Case Study: Medical Imaging; From Toolbox to Product to Platform 16 Gerrit Muller version: 0.4 September 6, 2020 MIpositioning Radiology Department MR "MPR" Reading Room CT URF Printer Reception CT Vascular RAD RAD Office RAD teaching Case Study: Medical Imaging; From Toolbox to Product to Platform 17 Gerrit Muller version: 0.4 September 6, 2020 MIradiologyDepartment Vision: Medical Imaging in Healthcare MR "MPR" Printer Reading Room CT URF RAD RAD Radiologist at other hospital teaching Radiology department Operating theatre Radiologist somewhere in the hospital Office Vascular RAD Radiologist at home Recepti on CT Referring Physician Referring Physician trauma room Conference room IT infrastructure in basement Case Study: Medical Imaging; From Toolbox to Product to Platform 18 Gerrit Muller version: 0.4 September 6, 2020 MIhealthcare Idealized layers 1996 Back-ends dev. tools Image Guided Surgery MR CT Spool RF Compose Print Store Image HCU service SW keys Rad CT/MR Specialized applications (Dental, bolus chase, cardio analysis, etcetera) remote access customi zation Review Interfacing RIS, etcetera Vascular Store MPR Gfx XRay Cardio View UI PCR Export Cluster PMSnet in DB PMSnet out CDSpack RC driver HC driver DOR driver RC dials interf HC interf DOR NIX Solaris Config Install Standard Sparcstation 5 workstation Start up Desk, cabinets, cables, etc. 3M RC dials new HCU MR Case Study: Medical Imaging; From Toolbox to Product to Platform 19 Gerrit Muller CT DSI version: 0.4 September 6, 2020 MIlayers1996 DCAS PCR System Level Documents: Root • List of system level document lists • System level requirements, specification and design documents • System aspect documents • Feasibility reports Case Study: Medical Imaging; From Toolbox to Product to Platform 20 Gerrit Muller version: 0.4 September 6, 2020 SystemLevelRootDocument Lists • Cluster, interoperability documents • Functional Specifications X-ray • Functional Specifications CT/MR • Application SW design • System Software design • Hardware documents Case Study: Medical Imaging; From Toolbox to Product to Platform 21 Gerrit Muller version: 0.4 September 6, 2020 SystemLevelDocumentLists Documents • Product Structure • System Engineering requirements • Design overview • Hazard analysis • Verification specification X-ray • Verification specification CT/MR Case Study: Medical Imaging; From Toolbox to Product to Platform 22 Gerrit Muller version: 0.4 September 6, 2020 SystemLevelDocuments Aspect Documents • Cluster design • HW Configuration • CPU resource usage • Disk resource usage • Memory resource usage • Requirements system monitor • Safety • Security • SW process structure • Testability and Service tools • Installation, Configuration and Start-up design • CT/MR image quality • R/F image quality • CT/MR typical load • R/F typical load Case Study: Medical Imaging; From Toolbox to Product to Platform 23 Gerrit Muller version: 0.4 September 6, 2020 SystemLevelAspectDocuments Example Memory Budget budget in MBytes X-ray CT/MR code 14 14 non bulk data 14 18 bulk data 36 88 Unix 13 13 total used 77 133 physical memory 64 128 Case Study: Medical Imaging; From Toolbox to Product to Platform 24 Gerrit Muller version: 0.4 September 6, 2020 MemoryBudget