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RADIOLOGY INFORMATION SYSTEM · FUTURIS
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The FutuRIS system is intended to be used at diagnostic
and clinical departments that schedule their daily activities around diagnostics results. It is a hardware-software
package for storing, processing and viewing radiological
images acquired from digital or analog devices. The system
is built on the client-server architecture, where clinicians’
and diagnosticians’ workstations operate as clients, and
one or more powerful computers function as the server
that accumulate and safely store data, ensuring round-theclock access from the workstations.
Unlike a classic Radiology Information System, FutuRIS is
developed so that its modules can work remotely over the
HTTP protocol. For instance, a workstation can download
images from a server located at another hospital. Images
can be collected from all DICOM-compliant devices and stored in a remote location. On a larger scale, the system supports data exchange between hospitals.
What is
FUTURIS?
The system is comprised of two logically independent parts
connected with each other via simple interfaces. One part
deals strictly with images and does not interact with the
database. It could be broken into two sub-parts:
• Image Studio – a fully functional workstation for viewing
and processing images
• Service – a server application for interacting with DICOMcompliant devices.
The other part is the RIS database that collects all radiological data and stores the links to image and audio (doctor’s
comments) files. It is also divided into two sub-parts:
• RIS Explorer – a user interface of the RIS database
• RIS Service – a server application enabling clients and
other services to interact with the RIS database.
This ability to be safely broken up into constituents allows
one to modify the RIS database or even use external databases without affecting Image Studio and DICOM Service:
they will reliably operate without regard to the database
structure.
Image and audio files are stored separately from the database; the latter just stores referrals to the former. The data
can be reached via:
• Regular access to a local or network disk
• Special Storage Service.
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Image Studio
Image Studio is built on the popular medical imaging package LeadTools utilizing its following powerful features:
• Fast and high-quality image visualization
• Image processing
• Import and export of DICOM files
• Networking of DICOM images.
The user interface of Image Studio is based on the Windows Presentation Foundation technology, allowing distributors to freely change its design. Besides that, the interface is expandable, which means that one can easily add
extra modules (plug-ins) to the original package. The main
features of Image Studio, grouped by functionality, are listed below.
Image Presentation
• The user can view frames on one or more monitors connected to her workstation. One of the monitors (usually,
with the lowest specs) can be assigned to show the database (Database Explorer).
• Each monitor displays image windows, the thumbnails
panel, the tab bar and the tool bar.
• The panel and bars can either auto-hide or be pinned to
the screen, enabling the user to balance between controls accessibility and image size.
• The thumbnails panel is also tabbed. Each tab corresponds to a particular study (patient, modality).
• For each modality and study description, the user can
set up hanging protocols that will specify:
• Display mode: stack or tiled
• Screen layout (viewing windows)
• Viewing windows layout (boxes)
• Image-to-box placement according to DICOM attribute
tags
• Relevant priors.
• The hanging protocols can apply automatically or be
selected manually by the user allowing her to brush
through dozens of sequences in a short time.
• The automatic display mode allows the user to place
and scroll frames through either all monitors or a separate monitor or a set of monitors, thereby enabling
simultaneous viewing of different studies on different
monitors or sets of monitors that will work independently in this mode.
• The animation mode enables the user to play a temporal or spatial sequence forward or backward. More than
one playback can run at the same time.
Overlay
• Images can be covered with DICOM overlay of the color
chosen by the user.
• Various text data, regarding images, patients and studies, including modality-specific information stored in
DICOM attribute tags, are displayed in the corners of a
frame window.
• Text styles can be changed by different formatting
methods. Formatting allows the user to simulate the
text formats used by medical devices in Image Studio.
• The user can pop up the table with the values of all of
the DICOM attributes. This feature will help a medical
equipment engineer to analyze special technical tags.
• The arrow and annotation tools allow the user to leave
notes in places-of-interest on images.
• The user can enable the display of intersection lines between selected frames and a certain frame to view the
spatial relationships between tomographic sequences
or a sequence and a localizer.
• The user can toggle on the rulers on the frame borders.
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Editing
• The user can mark key frames in image series and later
load just them, skipping unimportant in-between frames.
• Copying to the clipboard enables quick export of images
into other applications.
• The user can create new series or even new studies
using frames from other series or merging series and
shuffling frames in any imaginable way.
• By clicking Delete after selecting a frame or a range, the
user can get rid of unwanted frames or video clips.
• Area cropping allows the user to remove edges and concentrate on important parts of an image. Cropping can
apply to all frames in a sequence (pipe cropping). Different types of crop areas (including freehand shapes) are
supported.
• The user can stitch adjacent scans into an image of a
patient’s full body.
Grayscale Transformations
• Grayscale transformations can be applied to one or
more frames.
• By setting up the window center and width the user can
select the intensity ranges.
• Two types of non-linear intensity mapping functions can
be used:
• Exponential
• Logarithmic.
• Inversion can be added to the above transformations.
• A grayscale transformation can be saved under a specific name as a preset for future use.
• Grayscale transformations can be applied to all frames
in a sequence either manually or in automatic mode.
Geometric Transformations
• Geometric transformations can be applied to one or
more selected frames.
• A geometric transformation includes an arbitrary number of the following operations:
• Stepwise image resizing
• Zooming of a selected area in an image
• Smooth image resizing by a mouse drag
• Smooth dragging of an image with the mouse
• 90-degree rotation
• Vertical and horizontal image flipping.
• Geometric transformations can be applied to all frames
in a sequence either manually or in automatic mode.
• The user can equalize the scales across multiple images
using the Match Scale command.
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• Filters allow the user to:
• Reduce noise
• Increase sharpness
• Enhance edges.
Measurements and Annotations
• Length measurements can be done on the following
graphic primitives:
• A segment
• A polyline
• A curve.
• Additionally, pixel intensity values can be measured
along straight lines (e.g. distances and lengths).
• Area measurements are performed within the following
graphic primitives:
• A rectangle
• An ellipsis
• A polyline
• A curve.
• Area measurements can be accompanied by the following statistical measurements of the pixel intensity
within a primitive:
• Mean intensity
• Intensity variance
• Min and max intensity values
• A histogram.
• Angles are measured between two segments.
• Special tools allow users to perform specific medical
measurements, e.g. limb difference and vertebral displacement.
• Volume measurements are performed within ellipsoids
of revolution.
• Users can annotate images with text and draw arrows
pointing at places-of-interest.
• Peripheral and unwanted areas of images can be filled
in with selectable colors. The user can also specify the
shape of the fill-in area: from rectangular to freehand.
• Metric calibration of an image allows the user to calculate the pixel size by drawing a segment of a known
length.
• The pixel intensity beneath the pointer and its x and y
coordinates are always displayed in a special box on the
screen.
Import and Export
• Import and export of standard image files (jpg, gif, png,
bmp, avi), as well as DICOM files, are supported.
• The preview mode allows the user select image files to
be loaded from a Windows folder or DICOM directory.
• Exported files can be directly burned on a CD/DVD.
• By requesting a list of DICOM images, patients, and
studies over the network the user can get access to different DICOM storages and select which image files to
load. Information can be filtered by the following parameters:
• Patient’s name
• Patient’s year of birth
• Patient’s ID
• Image modality
• Study description
• Accession number
• Study date
• Study ID.
• The user can send DICOM files over the network to other
workstations.
Printing and Scanning
• Regular and DICOM printers are supported.
• Images can be printed with all overlays (measurements
and annotations).
• The user can save expendable materials (paper and film)
by using the preview mode.
• All types of office scanners, VIDAR medical scanners
and DICOM scanners are supported.
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Analog Video Recording
• Analog PAL/NTSC video (ultrasound, X-ray) can be captured by any grabber compatible with Windows.
• Analog non-standard video (CT, MRI, angiography, X-ray)
is captured with specialized medical grabbers manufactured by Foresight and Matrox.
• Automatic adjustment of Foresight boards to analog
standards allows the user to seamlessly attune the
board to the current standard.
• Pedals, buttons, and a remote control panel (optional
devices) facilitate image recording and viewing.
• The user can synchronize the system with an X-ray unit,
which solves the problem of reacting to X-ray on/off
switching (by activating/deactivating the video window)
and ensures correct recording of pulse X-ray scans.
Angiography Mode
This mode employs the viewing methods specific for angiography:
• Mask subtraction (a mask is an image without contrast
solution) allows the user to remove background structures, leaving only the contrast solution visible
• Mask shift removes background structures if the image
has shifted with respect to the mask
• Mask subtraction accumulation (in all the sequence) reveals the full picture of the flowing of the contrast solution in time and space.
3D Mode
This mode is used for viewing 3D images. The mode is characterized by the following features:
• Orthogonal viewing: displays the original images, their
intersections, and cross-sections perpendicular to them
• Each of the three orthogonal sections has a cross-hair
3D cursor formed by the lines that are the projections
of the other two sections on this section; by moving the
cursor with the mouse, the user can manually position
the orthogonal sections in space
• By viewing an arbitrarily positioned oblique section and
manipulating its intersections with the orthogonal sections, the user can quickly position it in space
• Pipe cropping perpendicular to an orthogonal or oblique
section allows the user to get rid of the edges or, contrariwise, make a hole in the image; different types of pipe
cross-section crop areas (including freehand shapes) are
supported
• Viewing an image as a 3D picture, while being able to
rotate, zoom and cut it by orthogonal or oblique planes,
dramatically improves the experience of working with
images, raising it to a much higher level – the 3D level.
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High-quality 3D viewing is demanding as to the computing
resources of the workstation. It calls for a powerful computer or even a computing server.
RIS Explorer
Being the user interface of the RIS database, this component of FutuRIS significantly depends on the users’ requirements and thus should comply with the guidelines and
regulations adopted by the hospital. For starters, we install
a basic version of RIS Explorer that complies with the minimum requirements for a RIS database.
• Report in text, RTF or WPF FlowDocument format, the
latter includes free text, static text, interface controls
(checkboxes, combo boxes, etc.), and images
• Audio report in WAV format.
• The user should “sign off” a study to allow access for
coworkers.
The basic version incorporates the following features:
• By editing dictionaries, an administrator can set up the
informational structure of the hospital:
• Departments
• Rooms
• Groups of users
• Users
• DICOM sources.
• Patient search looks up a patient by the following parameters:
• Patient’s name
• Patient’s year of birth
• Patient’s ID
• Image modality
• Study place
• Study description
• Study status
• Accession number
• Study date
• Study ID.
• The appointment schedule allocates orders and studies
• Images can be directly exported to a DICOM directory
without loading them into Image Studio. The user can
burn the DICOM directory on a CD/DVD. Moreover, studies can be sent to DICOM devices and other workstations over the network.
• Staff members are identified by passwords or Windows
logons.
• Rights are assigned to individuals or groups of users according to their authorization level, which means that
certain operations with database objects can be either
forbidden or allowed for certain users or groups of users.
• Statistical reports, deployed on the Microsoft Reporting
Server, provide statistical snapshots of the RIS database. Results can be presented in various formats (text,
charts, graphs, etc.) in RIS Explorer or a web browser.
The deployment of reports on the server and use of
standard Microsoft technologies allow distributors and
advanced users to modify existing reports and create
new ones.
for different exam rooms. Order lists can be acquired
from a third-party server under the DICOM modality
worklist protocol.
The user interface of RIS Explorer is based on the Windows
Presentation Foundation technology, allowing distributors
to freely change its design.
• Examination logs keep the history of studies, including
In the course of exploitation of the RIS, RIS Explorer can be
adapted to the hospital’s needs (even by re-writing the entire component from scratch). We provide some software
components to facilitate the work of third-parties called
upon to adapt RIS Explorer, and shorten and cheapen the
terms of their involvement.
all specific data (in addition to the parameters mentioned above):
• Patient’s DOB and sex
• Study time
• Examining doctor’s or/and technician’s name(s)
• Referring physician’s name
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Server
DICOM Service
RIS Service
The service’s task is to support the whole range of DICOM
network protocols for seamless integration with medical
devices and other PACSes. Its simple user interface allows
the user to quickly configure the way FutuRIS interacts
with the outer world and adapt the system to the changes
in the environment in the future.
This service is integrated with the DICOM Service. It can
perform the following tasks:
The DICOM service can do the following:
• Receive images from DICOM devices and other worksta-
• Move DICOM files from the DICOM Service into a longterm storage that stores them as tree-like structures: by
year, month, and day
• Create objects in the RIS database corresponding to the
DICOM files moved in the previous step
• Create a list of images, patients, studies and orders
upon request from the DICOM Service.
tions and store them as DICOM files
• Create a list of images, patients and studies by a filtered
request, allowing every workstation (from almost any
manufacturer) to view the data stored in the RIS database
• Create a list of orders by a filtered request, allowing a
DICOM device (or a workstation) to view the list of the
patients scheduled for this device.
The DICOM Service is based on the medical imaging package LeadTools (the same package as used in Image Studio).
Taking into account that image and audio files are stored
separately from the database and comprise 99 percent of
the data volume, it is important to safely store these huge
piles of information.
Database
The Storage Service is dedicated to provide universal access to various data storages from other FutuRIS components. The service was developed to ensure quick and secure access for hundreds (thousands, in case of a powerful
server) of clients. Different access levels are deployed:
The following platforms can be used for managing a RIS
database.
• Microsoft SQL Server 2008. An optimal price/quality ratio, easy-to-use administration tools, its ability to replicate and encrypt data and easy integration with other
Microsoft server products make this platform an ideal
solution for medium and small hospitals. Furthermore,
with the implementation of the cluster technology to
improve performance and reliability, SQL Server will even
satisfy the requirements of a larger hospital. Microsoft
Reporting Server 2008, fully integratable with Microsoft
SQL Server 2008, is used to generate statistical reports.
• Oracle 10g. By all standards, this platform is comparable
to Microsoft SQL Server, to say the least, and can be a
powerful and reliable solution for large hospitals. But
its only drawback – complicated administration (requires highly qualified server administrators) – makes RIS
maintenance pretty costly.
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Storage Service
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• High-speed access to the server’s hard drives or a RAID
array, several to dozens of terabytes capacity storage,
formed of regular disks mounted in a RAID array; the
cost of such storages is minimal due to low costs of
disks and a RAID rack
• LAN-speed access to network storages (NASes), ranging
from several to dozens of terabytes each; the use of
NASes increases storage safety, enabling data backup
within the hospital.
The user-friendly interface of the service enables an administrator to set up policies for data transfer from one level
to the other by configuring certain parameters (e.g., maximum first-level storage period).
The network interface of the service is based on the Windows Communication Foundation technology, which
allows administrators to fine-tune the parameters of its interaction with the DICOM Service, viz. protocol, encryption,
and reliability of delivery.
Deployment
Deployment of FutuRIS can be performed in two ways.
Internet-based Deployment
Intranet-based Deployment
When employed by the system, the Internet can be used to
carry out the following three tasks:
In case of an intranet-based deployment, the system provides access to radiological information only for LAN users.
The DICOM Service and RIS Service are installed on the
server. The DICOM files acquired from DICOM-compliant devices are transferred from the former to the latter. The Storage Service provides access to the files for Image Studio
and RIS Explorer installed on every client.
• Provide access for remote users to the RIS database
• Collect image files from DICOM devices
• Enable data exchange between databases.
Under the Internet-based deployment, the data are transferred over the HTTP protocol, with the options of encryption and enhanced reliability of delivery.
Access of Remote Users to the RIS Database
To provide remote access, Image Studio and RIS Explorer
are published on a Web-server as XBAP applications and
operate within a remote client’s web browser (in fact, they
implicitly install themselves on client computers). The Storage Service provides access to the files.
XBAP applications do not differ from locally installed ones;
so, remote users enjoy the same GUI in terms of sophistication and design as local users do.
nel only; workers at other hospitals, patients, even guests,
can be granted rights by the authorization system allowing
them to access certain parts of the database:
• A physician at another hospital may have access to the
information on patients and studies opened for external
viewing
• A patient may have access to her personal data
• A guest user will be able to access demos to get acquainted with the system.
Remote access is not restricted to the hospital’s person-
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Collection of Image Files from Remote DICOM
Devices
To collect images from remote DICOM devices, one needs
to divide the DICOM Service and RIS Service between different LANs. The former is installed on a remote network
for data collection, and the latter will operate on the RIS
server.
Data Exchange between Databases
Data exchange between databases is performed by interaction between special telemedical services running at different locations (hospitals). If FutuRIS is to be integrated
into an existing regional telemedical system (which is often
the case), we will develop a Web service designed to:
• Receive information on patients and orders from the regional system
• Send back study results (e.g., reports) and images.
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Strategic
Partners
TechHeim | RIS Software Provider
B-10FGeumgangPenteriumITTower,333-7,Sangdeawon-Dong,
Jungwon-Gu
462-120 Seongnam-Si, Gyeonggi-Do, Republic of Korea
Tel: +82 31 730 0020
Web: www.techheim.com
Napier Healthcare Solutions | HIS Software Provider
5 Shenton Way, #18-10/11, UIC Building
068808 Singapore
Tel: +65 6222 4505
Web: www.napierhealthcare.com
Lariviere | Medical Equipment Provider
Teerhof 48
28199 Bremen, Germany
Tel: +49 421 430660
Web: www.lariviere.de
Medotrade | HIS Software Provider
Vavilova 69/75, office 1101
117335 Moscow, Russia
Tel: +7 495 792 3574
Web: www.medotrade.ru
RADIOLOGY INFORMATION SYSTEM · FUTURIS
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Iberis Software S.L.
Av. de la Argentina 132, office 219
33213 Gijon, Asturias, Spain
Tel: +34 984 030 851
Fax: +34 985 308 228
Web: www.iberisoft.com
Email: [email protected]
May, 2013
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