Faculty of Engineering Biomedical Engineering Department Graduation project 2021 Second Opinion of Radiology Reports Under the supervision of: Prof. Walid Al-Atabany Prepared by: Amany Masoud Mahmoud Amr Mahmoud Ahmed Mohammed Ghanem Aya Ahmed Abdo Israa Karam Sayed Morsi Shrouk Ragab Mohammed ACKNOWLEDGMENT No one who achieves success does so without acknowledging the help of others. The wise and confident acknowledge this help with gratitude. In the accomplishment of this project, we would like to sincerely thank people who guided, concerned, and encouraged us till we reached this successful completion that would not have been possible without them. Firstly, we would like to thank our academic supervisor, Prof. Walid Al-Atabany, for the idea and the endless guidance and support in every step of our project. Finally, we would like to acknowledge with gratitude our families for supporting us till we reached this step. We thank you. Abstract Since the patient’s health and his treatment plan represent a matter of concern, the improper radiology report can lead to unwanted mortal consequences. Such discrepancy and errors can result from the lack of experience of the radiology technician or the radiologist, the overexamining of the area of the interest of scanning, or the misclassification of the radiologist that results in a false report, which leads to destructive results that end up with mortality. According to the latest statistics from the United States of America, radiological report errors represent the 3rd topmost cause that presides the list of devastating mortality causes. Since, around 88% of the radiological reports, unfortunately, are changed or revised from which 400k of American citizens, half of them undergo unnecessary surgeries and the rest received devastating treatment plans. Therefore, there is an urgent need to solve such drawbacks and save the patient’s health. Hence, in this study, we introduce the strategy of a second opinion for radiology report that would be a good decision to relieve the patient from the worries, put him on the correct treatment plan, and decrease the mortality caused by misinterpreting the imaging scan. Because of the current world circumstances caused by the coronavirus, it is advisable to stay away from the crowds. Therefore, it would be better to make the second opinion for radiology reports an online service by designing a website accessed by patients and doctors from anywhere with the access of different scanning centers to provide the patient with a DICOM copy of the scan. Table of Contents Chapter 1 ....................................................................................................................................... 1 Introduction ................................................................................................................................. 1 1.1. Types of medical imaging ................................................................................................ 1 1.1.1. Projectional radiography ........................................................................................... 1 1.1.2. Fluoroscopy............................................................................................................... 2 1.1.3. Magnetic Resonance Imaging ................................................................................... 4 1.2. Motivation ........................................................................................................................ 5 1.3. Book organization ............................................................................................................ 7 Chapter 2 ....................................................................................................................................... 8 Literature review ......................................................................................................................... 8 2.1. Best doctor........................................................................................................................ 8 2.2. Second opinions ............................................................................................................... 9 2.3. XMRI ............................................................................................................................. 10 2.4. Smart radiology opinions ............................................................................................... 11 2.5. DocPanel ........................................................................................................................ 12 Chapter 3 ..................................................................................................................................... 13 Methodology ............................................................................................................................. 13 3.1. Project’s Block-diagram ................................................................................................. 13 3.1.1. Front End ................................................................................................................ 14 3.1.2. Back-end ................................................................................................................. 20 Chapter 4 ..................................................................................................................................... 23 Results ....................................................................................................................................... 23 4.1. Homepage....................................................................................................................... 23 4.2. How to use the website................................................................................................... 24 4.3. Customer’s Opinion field ............................................................................................... 24 4.4. About Us ........................................................................................................................ 25 4.4.1. List of doctors ......................................................................................................... 25 4.4.2. Price list .................................................................................................................. 25 4.4.3. List of scanning centers .......................................................................................... 26 4.5. Sign up............................................................................................................................ 27 4.5.1. Doctor’s sign-up form ............................................................................................. 27 4.5.2. Patient’s sign-up form ............................................................................................. 28 4.5.3. Scanning center sign-up form ................................................................................. 29 4.6. Login form...................................................................................................................... 30 4.7. Accounts ......................................................................................................................... 31 4.7.1. Patient’s account ..................................................................................................... 31 4.7.2. Doctor’s account ..................................................................................................... 33 4.7.3. Scanning center account ......................................................................................... 34 Chapter 5 ..................................................................................................................................... 35 Conclusion and Future Work ........................................................................................................ 35 5.1. Conclusion...................................................................................................................... 35 5.2. Future work .................................................................................................................... 36 References ..................................................................................................................................... 37 List of figures Figure 1.1:Projectional radiography ............................................................................................... 2 Figure 1.2: Fluoroscopy equipment by Siemens Healthineers ....................................................... 3 Figure 1.3: Fluoroscopy showing a dislodged catheter .................................................................. 3 Figure 1.4: Siemens Healthineers MRI Magnetom Sola 1.5T ........................................................ 4 Figure 1.5: MRI brain image .......................................................................................................... 5 Figure 2.1: Best doctor website ...................................................................................................... 8 Figure 2.2: Second opinions website .............................................................................................. 9 Figure 2.3: XMRI website ........................................................................................................... 10 Figure 2.4: Smart radiology opinions website .............................................................................. 11 Figure 2.5: DocPanel registration steps ........................................................................................ 12 Figure 3.1: Project's Block-diagram ............................................................................................. 13 Figure 3.2: HTML 5 Structure ...................................................................................................... 14 Figure 3.3: Head tag structure ....................................................................................................... 16 Figure 3.4: Body tag structure ...................................................................................................... 18 Figure 3.5: CSS properties examples ............................................................................................ 19 Figure 3.6: Hasura Workflow ....................................................................................................... 21 Figure 4.1: Definition of second opinion ...................................................................................... 23 Figure 4.2: Benefit of Second Opinion ......................................................................................... 23 Figure 4.3: Other benefits of second opinion................................................................................ 24 Figure 4.4: How to use the website ............................................................................................... 24 Figure 4.5: Customer's comment .................................................................................................. 24 Figure 4.6: Website's doctors ........................................................................................................ 25 Figure 4.7: List of prices part 1 ..................................................................................................... 25 Figure 4.8: List of prices part 2 ..................................................................................................... 26 Figure 4.9: Website's registered scanning centers ........................................................................ 26 Figure 4.10: Personality specification........................................................................................... 27 Figure 4.11: Doctor's sign-up form part 1..................................................................................... 27 Figure 4.12: Doctor's sign-up form part 2..................................................................................... 28 Figure 4.13: Patient's sign-up form part 1..................................................................................... 28 Figure 4.14: Patient's sign-up form part 2..................................................................................... 29 Figure 4.15: Scanning center's sign-up form part 1 ...................................................................... 29 Figure 4.16: Scanning center's sign-up form part 2 ...................................................................... 30 Figure 4.17: Login form ................................................................................................................ 30 Figure 4.18: Patient's account reports ........................................................................................... 31 Figure 4.19: Uploading scan ......................................................................................................... 31 Figure 4.20: Editing the patient's profile ...................................................................................... 32 Figure 4.21: Patient's Payment for the service .............................................................................. 32 Figure 4.22: Doctor's uploaded second reports ............................................................................. 33 Figure 4.23: Sending the second opinion ...................................................................................... 33 Figure 4.24: Editing the doctor's profile ....................................................................................... 33 Figure 4.25: Uploading the scanning image by the scanning center ............................................ 34 Figure 4.26: Editing the scanning center’s account ...................................................................... 34 Chapter 1 Introduction Medical Imaging is one of the most important methods that is used in the field of healthcare and related to radiology, which is an extremely important branch of medicine as it plays an important role in several medical disciplines; it is the most appropriate and minimally invasive way to diagnose and monitor diseases and injuries. The medical scan is explained by a radiology report written by radiologists. Radiologists are medical doctors who are specialized in the diagnosis and treatment of several diseases in different organs by using different medical imaging techniques. 1.1. Types of medical imaging The field of medical imaging is a wide field of various types where each has a different application in the field of healthcare such as projectional radiography, fluoroscopy, MRI, scintigraphy, positron emission tomography, medical ultrasonography, elastography, tactile imaging, photoacoustic imaging, thermography techniques, and echocardiography. 1.1.1. Projectional radiography Projectional radiography is one of the medical imaging techniques that is also called x-rays and called diagnostic radiography. It is a medical science that is used to take images of the human body structure to make the diagnosis of injury or disease through two-dimensional images by a beam of radiation that goes across the body part and captures the difference in density of the tissues. The projectional radiography image is captured by making an exposure that starts by the x-ray radiation exiting the tube, and it is known by the primary beam that passes through the body. Part of the primary beam is absorbed by the body in a process known as attenuation. Then, the remaining primary beam is called the remnant beam. It is responsible for exposing the areas on the image receptor that receive the most radiation; these areas experience the least attenuation and will be processed as dark areas in the scanned image. 1 Figure 1.1:Projectional radiography 1.1.2. Fluoroscopy Fluoroscopy is a famous medical imaging technique that is used to study moving structures in the body. It uses a continuous x-ray beam that passes through the required body part to be examined. This beam is transmitted to a monitor that looks like a TV so that the motion of this body part can be seen in full detail. It also enables the physicians to look at many systems such as the digestive, urinary, and reproductive systems. It is used in many types of examinations and procedures like barium x-ray, cardiac catheterization, and visualization of joints, lumbar puncture, and many other procedures. It also can be used alone as a diagnostic procedure or in a conjunction with other diagnostic or therapeutic procedures. It is used alone in the barium X-rays to permit the doctor to see the movement of intestines as the barium moves through them and to position the patient for spot imaging. In addition, it is used as a conjunction in cardiac catheterization to enable the surgeon to see the flow of blood in the coronary arteries to detect the presence of arterial blockages. Moreover, it aids the surgeon in intravenous catheter insertion to guide the catheter into the specific location inside the body. It is also used to locate foreign bodies, image-guided anesthetic injections into joints, and in 2 percutaneous vertebroplasty that is a minimally invasive procedure used to treat compression fractures of the vertebrae of the spine. Figure 1.2: Fluoroscopy equipment by Siemens Healthineers Figure 1.3: Fluoroscopy showing a dislodged catheter 3 1.1.3. Magnetic Resonance Imaging Magnetic resonance imaging, also known as MRI, is another well-known medical imaging technique that is used to produce fully detailed three-dimensional anatomical images through a non-invasive procedure. In the healthcare field, it is used to detect different diseases, diagnose them, and monitor their treatment progress. It is used to image the soft tissues of the body such as the brain in which the MRI can differentiate between white matter and grey matter. Its working principle depends on strong magnets to produce a magnetic field that is strong enough to force the body protons to align with that field. These protons are stimulated after applying a radiofrequency current that causes their spinning out of equilibrium and straining against the pull of the magnetic field. Afterward, the radiofrequency field is turned off then the MRI sensors become able to detect the energy released as the stimulated protons start to realign with the magnetic field. Figure 1.4: Siemens Healthineers MRI Magnetom Sola 1.5T 4 Figure 1.5: MRI brain image 1.2. Motivation Sometimes, there is an urgent need for a second opinion for radiology report for several reasons like the radiologist isn’t specialized enough in a particular field of radiology such as brain imaging, so it would be better to seek a second opinion from a radiology subspecialist who gained experience from dealing with several cases and keeping up to date with the latest researches. In addition, sometimes there are important abnormalities that may be overlooked in the first report, so it would be a good decision to seek a second opinion to consider the additional information about the patient’s condition. In some serious cases, the doctor needs to make sure of the first report and its diagnosis and put the right treatment plan for the patient, so he suggests a second opinion for the report from a subspecialist radiologist who is trained enough to see and understand the difficult signs in the images. In addition, sometimes the patient is unsure about the necessity of the decided surgery or does not feel any improvement from the received treatment, which was planned upon the first report, so he seeks a second opinion for the radiology report. Additionally, some symptoms are persisting despite the doctor’s opinion, so a second opinion from a specialist will make it clear for the patient and let him get rid of all of the worries about his health. Decades ago, the second opinion was given to the patient by going to the healthcare facility with his medical imaging scan, and this process may take several days depending 5 on several parameters such as the distance between the patient & the healthcare facility and the availability of the staff at the facility. However, in the technology era and by the presence of the web PACS system in the scanning centers, this process is simplified and facilitated by the website that provides second opinions for radiology reports with its different types without any need of transportation for the patient to the healthcare facility to send the scan and receive the report, and the commuting of the radiologist to the healthcare facility to review the scan; especially in the current world circumstances that limit any crowds in public places. The second opinion is composed of a review of submitted documents & radiological images and evaluation of diagnosis, and all of these are available by uploading the performed scan image, sharing relevant health information such as prior surgeries or previous infections or injuries, and then download your second opinion radiology report to begin your treatment plan. This is done through our website that is characterized by being fast and reliable, as the patient will receive the second report as fast as possible, and increased security, as it will protect the patient from any misdiagnosis or any unnecessary operations. In addition, the website will protect the patient’s data as it is treated confidentially, meaning that it will never be shown to any third party. 6 1.3. Book organization In this book, there are five chapters: Chapter 1: An introduction, an overview of the problem, and the objective to solve the problem. Chapter 2: A literature review about previous techniques and technologies that have been used in providing a second opinion in radiology reports. Chapter 3: The applied methodology explanation and the overall work in the project Chapter 4: The results of the project . Chapter 5: conclusion and future work 7 Chapter 2 Literature review The online service of “Second opinion for radiology reports” is very well known in different countries in Europe and the continents of America, but it is not available in the Arab world. 2.1. Best doctor Best doctor is a website that provides an online second opinion for radiology reports service. It was launched on the 27th of June 2016. It aims to provide the citizens with the best doctors in India through an online platform to get a second opinion for complex cases from well-reputed and highly experienced specialists with low prices. The doctors are chosen according to their educational background, reputation, previous researches, and the previous institutions or healthcare facilities where they worked before. The patient gets a full medical case diagnosis and treatment evaluation by creating an account at first to provide fully detailed information about his medical case, medical history, current and past medications, and treatments. Then, the patient makes his payment to get his second opinion with recommendations and treatment options to share with his physician to get the right care. Figure 2.1: Best doctor website 8 2.2. Second opinions It is an American medical consultation website that provides a second opinion consultation service in all areas of medicine and radiology. The website aims to improve the quality of healthcare and reduce the healthcare costs with the help of a second opinion to obtain a faster correct diagnosis and eliminate unnecessary procedures and surgeries whether it is a medical second opinion or radiology second opinion. The service is available for all of the patients all over the world, not only in the United States, and it can be either a written second opinion report or a phone consultation. The patient uploads his radiology images whatever their type is and the doctors understand them to deliver the results to the patient. Figure 2.2: Second opinions website 9 2.3. XMRI An American scanning center has its own website to provide a second opinion for radiology reports besides providing the primary radiological report. The website is in a partnership with Dicom systems.inc to provide automated cloud-based radiology on demand to automate the process of receiving radiological reports after uploading the images. This technology enables the patient’s devices to be synchronized all the time. The websites’ radiologists are highly experienced, board-certified, and have special expertise in multiple fields such as Cardiac CT with level III certification, Neuroradiology, pediatric radiology, body & breast MRI, and mammography. They also possess Certificates of Added Qualifications. Figure 2.3: XMRI website 10 2.4. Smart radiology opinions It is an Indian website that was established in 2015 as a division of Heidelberg Medical Consultancy & Health tourism. Smart radiology is an online provider for telemedicine, teleradiology, telecardiology through second opinions for different radiology studies. It is characterized by having more than 60 radiologists with an average of 8 years of certification experience. In addition, its working process starts by filling the form by the patient to send the radiology scan to the doctor. Then, the doctor will examine it and send the report back to the patient in a turnaround time starting from 4 hours and 99.5% accuracy. Figure 2.4: Smart radiology opinions website 11 2.5. DocPanel It is an American website that provides a second opinion for radiology reports online service. It aims to provide the patients with an access to a wide range of expert radiologists in different specialties in radiology. To get started with the website’s service, the patient creates an account then starts using the service by uploading the scan in the DICOM format (.dcm), and it is advised to upload the primary report. Then, the patient will add his medical history to inform the specialists and the subspecialists with his medical case and his previous & current treatment. Hence, the patient selects from the website’s radiologists and pays for the service. Figure 2.5: DocPanel registration steps Figure 2.6: Best doctor website 12 Chapter 3 Methodology According to the discussed problem in chapter one and the presence of the latest technology solutions in chapter two, there are hospitals and healthcare establishments that provides a solution to minimize the drawbacks mentioned in the previous statistics In this chapter, we will discuss the used methods to develop a second opinion website that will help in solving this serious problem. 3.1. Project’s Block-diagram Figure 3.1: Project's Block-diagram 13 3.1.1. Front End Front-end web development is also known as client-side development; it is the practice with different tools to create a website or a webpage with which the user can interact directly. The front-end development is challenging the developers by being constantly aware of how the field is developing as the tools and techniques change every now and then. The goal behind designing a website is to guarantee that when the user opens the page, he can read the information easily and understandably. 3.1.1.1. HTML HTML, HyperText Markup Language, is the standard markup language used to create webpages, and it is read and rendered into visible web pages. In addition, it defines the structure of the website’s content in different ways. The HTML file is activated by the tags <!DOCTYPE html> and the opening and closing tags <html> & </html>. In addition, the HTML tag contains the head and body tags that will be discussed in this section. Figure 3.2: HTML 5 Structure 14 Head An HTML element holds every information needed for machine processing and metadata, which is data about the HTML document. Title An HTML element is used to define the page title that is shown in the page tab or the browser’s title bar, and the tags within the element, <title> </title>, are ignored. For more info: https://developer.mozilla.org/en-US/docs/Web/HTML Base The base element specifies the base URL to be used for all relative URLs in an HTML document. For more info: https://developer.mozilla.org/en-US/docs/Web/HTML/Element/base Link The link element identifies the relationship between the current HTML document and any other external source; it is commonly used to link the document with stylesheets containing CSS that will be discussed later. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/link Style The style element has the styling information for the document if it is written within the HTML document. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/style Meta The meta element defines the metadata of the HTML document, which is the information of the HTML document or in other words the webpage. For more info: https://www.w3schools.com/tags/tag_meta.asp 15 Script The script HTML element is used to embed or refer to an executable JavaScript code. It is also used with other languages such as JSON. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/script Figure 3.3: Head tag structure Body The body tag is a description for the document body where it contains all of the contents of the HTML document, such as headers, footers, and many other elements as shown in the figure. For more info: https://www.w3schools.com/tags/tag_body.asp Section The section tag is used to define a section in the HTML document. This tag contains a block of content that needs to be displayed with each other to give the required meaning. For more info: https://www.w3schools.com/tags/tag_section.asp 16 Header This element represents and focuses on the introductory content of the website through heading some elements from <h1> to <h6> where each one of them has different styles. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/header Nav The nav tag is used to represent a section of the website that provides navigation links related to other web pages or another part on the same page. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/nav Footer An HTML element contains the information about the author of the page or the section, the copyright data of the website, or links to related documents which are located at the bottom of the webpage. For more info: https://developer.mozilla.org/en-US/docs/Web/HTML/Element/footer P (Paragraph) The P tag represents the paragraph, which is a block of text separated from other blocks in the webpage. For more info: https://developer.mozilla.org/en-US/docs/Web/HTML/Element/p Div It is a generic element container that does not affect the content of the page until it is styled with some CSS as it is used to group the contents in one style. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/div Span It is a generic element container just like the div element, but the div is a block-level element while span is an inline element. In other words, it is used to group a single element with other elements by using the class attribute. For more info: https://developer.mozilla.org/enUS/docs/Web/HTML/Element/span 17 Figure 3.4: Body tag structure 3.1.1.2. CSS CSS, cascading style sheets, is used to control the shape and the design of the HTML elements displayed on a screen showing the webpage, and it can control several web pages all at once. Previously, the styling of the webpage was through attributes in the HTML document, but now the styling is in a separate CSS file. As shown in the figure, these are some examples of the CSS attributes. For more info: https://www.w3schools.com/css/css_intro.asp Border The CSS border is used to determine the style, width, and color of the HTML element’s border. The border styling is used to specify the shape of the border whether it is dotted, dashed, solid, or any other shape. For more info: https://www.w3schools.com/css/css_border.asp Margin The CSS margin is used to create space around the HTML elements outside any defined borders, and it can be controllable through different values such as auto that lets the browser calculate the margin, and many other values such as length, percentage, and inherit. For more info: https://www.w3schools.com/css/css_margin.asp 18 Padding The CSS padding is used to create space around the HTML elements but inside of the defined borders. In addition, it can be controllable from different positions like top, bottom, right, and left, and from the values length, percentage, and inherit. For more info: https://www.w3schools.com/css/css_padding.asp Figure 3.5: CSS properties examples 3.1.1.3. JavaScript JavaScript is one of the most important components in the field of web development. A programming language enables the developer to introduce features to the web pages such as adding a dropdown menu, changing some elements’ colors upon hovering, and many other dynamic features. For more info: https://www.freecodecamp.org/news/what-isjavascript-definition-of-js/ 3.1.1.4. JQuery It is a fast and feature-rich JavaScript library that is famous for “write less do more” as it binds lots of lines of JavaScript codes to do a single task in a single line to be called whenever it is needed to add effects and animations, and also used to add options in HTML and CSS. For more info: https://www.javatpoint.com/what-is-jquery 19 3.1.1.5. Bootstrap It is a ready CSS library that focuses on simplifying the development of web pages by reducing the size of code, which in turn would reduce the processing time. For more info: https://www.w3schools.com/whatis/whatis_bootstrap.asp 3.1.1.6. React React is a Javascript library used to build a user interface or in other words build the shape of the webpage in an easier process than the HTML and easier process of dynamic content handling. For more info: https://reactjs.org/ 3.1.2. Back-end It is the server-side of the website that is used to store and arrange data, and it is used to verify the workflow on the client-side of the website. In addition, it cannot be seen by the client or interacted with as it contains very sensitive data. The backend is accessed indirectly by the developers through APIs added into the front-end document to connect both sides. It is managed by different methods and programming languages such as node.js, Hasura, GraphQL, Apollo, AWS. 3.1.2.1. Node.js It is an open-source runtime environment and framework that is used to execute JavaScript code on the server client-side. It is characterized by being asynchronous which means that the node.js-based server never waits for an API to be executed. In addition, the node.js applications never buffer any data as they simply output the data in chunks. For more info: https://www.tutorialspoint.com/nodejs/nodejs_introduction.htm 20 3.1.2.2. GraphQL A query language is used to create the API that allows any application and website to access the data and interact with operating systems and external software components. This service is created by defining types and the fields of these types to be used in validation and execution. For more info: https://graphql.org/learn/ 3.1.2.3. Hasura A GraphQL server that gives the developer the instant GraphQL APIs over Postgres ( an open-source database management system). In addition, it provides webhook triggers on database events to make an HTTP request upon triggering actions such as inserting, updating, deleting events. Figure 3.6: Hasura Workflow 21 3.1.2.4. Apollo A management library for JavaScript that allows the developer to manage the local and remote by using GraphQL. It is characterized by declarative data fetching to query and receive data without manually tracking loading states. In addition, it is designed for modern React.js features such as hooks. 22 Chapter 4 Results 4.1. Homepage This is the homepage of our website that opens after the patient, doctor, or scanning center loads the page. On this page, we show the websites’ advantages and list the website’s info in a continuous carousel. Figure 4.1: Definition of second opinion Figure 4.2: Benefit of Second Opinion 23 Figure 4.3: Other benefits of second opinion 4.2. How to use the website Instructions for the patient to let him know how to use the website. Figure 4.4: How to use the website 4.3. Customer’s Opinion field The part where the customer says his comment about the website or asks any question whether it’s related to his medical case or the website. Figure 4.5: Customer's comment 24 4.4. About Us This is the page where the patient will find all of the information about the website such as the website’s radiologists, price list, and the website’s scanning centers. 4.4.1. List of doctors Figure 4.6: Website's doctors 4.4.2. Price list Figure 4.7: List of prices part 1 25 Figure 4.8: List of prices part 2 4.4.3. List of scanning centers Figure 4.9: Website's registered scanning centers 26 4.5. Sign up When the user clicks sign-up, he is redirected to a page asking for his personality whether he is a patient, doctor, or a scanning center. Each of these choices will redirect him to the appropriate sign-up form. Figure 4.10: Personality specification 4.5.1. Doctor’s sign-up form Figure 4.11: Doctor's sign-up form part 1 27 Figure 4.12: Doctor's sign-up form part 2 4.5.2. Patient’s sign-up form Figure 4.13: Patient's sign-up form part 1 28 Figure 4.14: Patient's sign-up form part 2 4.5.3. Scanning center sign-up form Figure 4.15: Scanning center's sign-up form part 1 29 Figure 4.16: Scanning center's sign-up form part 2 4.6. Login form This is the form from which the user will log in to his account and start using the website whether he is a user, doctor, or scanning center. d Figure 4.17: Login form 30 4.7. Accounts 4.7.1. Patient’s account Figure 4.18: Patient's account reports Figure 4.19: Uploading scan 31 Figure 4.21: Patient's Payment for the service Figure 4.20: Editing the patient's profile 32 4.7.2. Doctor’s account Figure 4.22: Doctor's uploaded second reports Figure 4.23: Sending the second opinion Figure 4.24: Editing the doctor's profile 33 4.7.3. Scanning center account Figure 4.25: Uploading the scanning image by the scanning center Figure 4.26: Editing the scanning center’s account 34 Chapter 5 Conclusion and Future Work 5.1. Conclusion Radiology is a very sensitive and important department in medicine; radiologists' reports play a huge role in patient diagnosis and evaluation. While the technology used to create medical images is improving, medical errors can still occur. Most radiologic errors occur due to the under-reading of the radiology exam images, the first radiologist was not a specialist in a particular field of radiology, and the overlooking of some abnormalities during writing the primary report. Hence, second-opinion consultation is widely recommended to improve the accuracy of diagnosis and to improve patient care. In addition, it reduces the chances of misdiagnosis by almost 90% and provides peace of mind, makes you aware of all possible treatment options, and ensures that you have selected the best one. Previously, the patient was resorting to another offline doctor for a second opinion about his medical imaging scan. However, the same problem and errors could happen again, and the patient pays a lot to the doctor for a long time process taken to receive the report. As a result, it has been found that this problem can be providing a second opinion website that contains several expert specialists from which the patient can select at a low cost by using a credit card through a fast and easy process by uploading the medical imaging scan and the primary report and sending them to the doctor who would send back the second opinion to the patient to view it from any place. 35 5.2. Future work 1. Enhance the quality of the website according to the latest technology and the market requirements, and launch it on a good quality website to be an Egyptian online second opinion for radiology reports service accessed by everybody 2. Improve the security of the website by obtaining the SSL certificate, Secure Sockets Layer, to create an encrypted link between a web server and a web browser. 3. 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