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Its distribution is facilitated by an exemption from payment and a simple and localized interface. Surprisingly, these functions were as well appreciated by clinicians cardiologists, neurologists, surgeons, pathologists, and dermatologists as by radiologists Table 1 , and this pointed out the interest of a simple and localized program for clinicians, who do not read studies like radiologists and need a simple, familiar, and localized interface, instead of multiple different ones like those they find on DICOM CDs.
It is certainly more important because image-viewing features are fully available without registration, and people who only use DicomWorks for image viewing may never register. Additionally, an important part of registered users is represented by IT technicians who use DicomWorks for solving image manipulation problems conversions, anonymization or patient data reconciliation in a PACS environment batch DICOM tags modifications. As the Internet is now ubiquitary, even in the lowest-developed countries, and as the program is localized and free and runs on the lowest configurations, we think the repartition of the users could be a representation of digital imaging usage in the world.
We found no reference in the literature about such repartition for comparison. The majority of the users come from countries where digital imaging modalities are widely available. Although logical, this reveals that a lot of features are missing from commercial systems and that there is a need for low-cost viewing systems even in the most developed countries. This illustrates the difference between North America, where interstate teleradiology has been practiced for many years, 13 and the European Union, where this practice is just starting.
Also, even if several European countries have issued guidance on the practice of teleradiology, ethic and legal issues remain difficult to resolve in the European Union, as no common regulation is available on this subject. Only 0. Overall, Table 1 data demonstrate that teleradiology is only developed in places where equipment and medical resources are widely available, and used when people need facilities in addition to a stable routine practice night hawk, image sharing…. International teleradiology is surprisingly more aimed at commercial overseas interpretation in the highest developed countries 13 , 14 than at humanitarian purposes.
Nevertheless, low-cost teleradiology 15 is an interesting solution in emerging countries where physicians work in distant or geographically difficult areas and cannot afford to buy expensive commercial teleradiology systems. These experiences remain rare. We hope this will help teleradiology network administrators to delegate the client part of their network, including the image review, to free applications, and focus their human and economic resources on the security and reliability of communications because patient data are transmitted through the Internet building a robust and secure server, establishing stable, fast, and secured communications through the Internet.
DicomWorks was developed to provide a free solution to the daily image manipulations problems radiologists have to face. The DICOM viewer provides a customizable and nearly professional solution for image interpretation, education, teaching, and research.
Our 5-year experience and the feedback of several thousands of radiologists and clinicians worldwide led us to build an opened platform that can work as a single client interface for reviewing multiple and various image sources, whether local or remote LAN, e-mail servers, FTP servers, DICOM servers. It is part of multiple teleradiology solutions that can focus their human and economic resources on other critical parts of the teleradiology network.
We strongly believe that proprietary teleradiology solutions with dedicated lines and proprietary software will make way for a new generation of teleradiology solutions using secured Internet connections and based on standard DICOM and Integrating the Healthcare Enterprise compliant software. J Digit Imaging.
Published online Feb Philippe A. Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC.
Abstract DicomWorks is freeware software for reading and working on medical images [digital imaging and communication in medicine DICOM ]. Now that the vast majority of radiology institutions or departments have moved to digital, several challenges are revealed: Inside radiology departments, there is a growing need for additional, secondary viewing stations because primary interpretation stations provided with modalities or the PACS are not always available in sufficient number.
Additionally, there is a need for portability: many radiologists wish to review images in their office or on their laptop and prepare presentations at home. In all these cases, additional low-cost DICOM stations are desirable, but rarely included in PACS projects or department equipment plans, as their profitability would be too poor. Outside radiology departments, clinicians have many difficulties reviewing their studies on digital removable media, both because their knowledge of digital imaging is limited DICOM, windowing, etc Client Installation The program 2 is available in 15 languages and can be downloaded from the Internet and installed at no charge.
RESULTS Since its first version in September, , more than , downloads were counted, and since , more than 35, of these users registered the software to unlock special features e-mail, presentation software, and AVI exports. Open in a separate window. Fig 1. Reviewing a Study All sources of images are displayed identically as a hierarchical list of patients, studies, series, and images that can be expanded by double-clicking on their icon Fig.
Fig 2. Exporting to Microsoft PowerPoint Fig. This avoids fastidious image manipulations that otherwise would have been necessary, and required image processing applications: 6 , 7 DICOM-to-JPEG transformation with windowing and zoom, image anonymization for US images, for example , manual importation of images in PowerPoint one by one , manual resizing, manual alignment, new annotations Fig 3.
Plug-in development: A software development kit is available for free. Any developer can quickly create additional modules that DicomWorks automatically recognizes at startup. Plug-ins also allow the export of any selection of images to external applications that need DICOM images on input, such as third-party MPR or 3-dimensional or image data analysis applications.
IT and PACS Administration Tools The software can be a useful tool to troubleshoot some frequent issues when using DICOM images in a PACS environment: Some vendors store dynamic series or repeated CT phases in the same series, whereas some others store them in separate ones eg, images of 18 different slices acquired 15 successive times, or a single series of CT-scanner images including slices at the arterial phase and at the portal phase.
DicomWorks includes simple tools to select groups of images and split a large series in several, with respect to the DICOM standard. Inversely, merging several series in a single one is also possible.
The DICOM tags edition is a very useful tool to insert or delete single or sets of DICOM tags in a study, a series, or an image to force the compatibility with a specific workstation or PACS archive eg, some postprocessing workstations or PACS servers require mandatory tags to import the images, but the information is sometimes written in another tag, with a wrong syntax, or omitted by the source modality.
Teleradiology DicomWorks was installed as a part of various teleradiology solutions in the United States eg, in a network stretching from the Alaskan Arctic to Southern California , in Europe eg, to connect five regional hospitals in Greifswald, Germany , and in multiple low-cost solutions based on e-mail transmissions in Mali, Algeria, Morocco, Chile, Benin, and Cambodia, as detailed in Figure 4.
Rarely necessary in developed countries, this feature is very important in developing countries where DICOM-compatible US devices are still minority. Import and export of DICOM images using regular e-mail accounts is the simplest method to share images with colleagues: DicomWorks can check your account using the POP3 protocol and display the images immediately, leaving other messages on the server. The sending of anonymized and compressed images is also achieved by DicomWorks Fig.
They required a permanent static IP address, a secured virtual private network, and DICOM communication software on both the client and server sides. Fig 4. References 1. Accessed May 22, Accessed May 19, Medical imaging PACS: design and evaluation.
Proc SPIE —, Collins J. Education techniques for lifelong learning: making a PowerPoint presentation. Yam CS. Using PowerPoint to create high-resolution images for journal publications. Escott EJ, Rubinstein D. Displaying radiologic images on personal computers: practical applications and uses. Teleradiology and emerging business models. J Telemed Telecare. Adopting a straightforward approach, the application comes with a user-friendly interface and with well-organized menus. After the application recognizes the file or the archive that contains multiple DICOM images, you are able to view all the contained files and navigate through them with ease.
The right panel displays all the available DICOM files and allows you to move back and forth using the proper navigation buttons that are displayed each time you hover the mouse on the current image. You are able to modify details such as patient name, study description or supposed diagnosis. Another important option that will ease your work is that you can add a new FTP server using the application.
The Export function is very complex since it comes with a built-in wizard that allows you to choose which files you want to export and set their destination file format and location, while keeping the same quality. After that, you can change the picture dimensions and the quality according to your needs, then choose to compress all the selected files in a single ZIP archive and save it to a specific location.
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