Operating room
Hospitals are facing a problem when managing videos recorded in operating rooms. There are neither specific solutions nor clear strategies on how to capture, store and make videos accessible both from inside and outside the hospital. Is a video another “document” that should be stored in the hospital’s PACS? If so, how can a non-DICOM video file be correctly sent to PACS? How can accurate and meaningful metadata (needed for proper PACS routing and retrieval) be ensured for videos generated by devices of different manufacturers? Could the videos be integrated into the Electronic Patient Record? Could a surgeon manage a video privately and share it with colleagues for research activities through the Internet? The C2C eHealth Company of Spain has been asked to provide a solution for the above-mentioned challenges.
So far hospital departments working with DICOM standards were mainly limited to radiology and cardiology. DICOM is the standard for radiological imaging and PACS use DICOM image metadata (including biomedical parameters, patient name and ID, accession number, birth date, modality, etc.) to properly manage, route and retrieve images. A clinical image without DICOM metadata is useless for diagnostic and therapeutic purposes as it ignores essential patient-specific information.
When a video is recorded in an operating room, the first problem is to capture the video from the device (i.e. endoscope) and convert it to a DICOM format with suitable metadata for PACS management. A major drawback at this point is that part of the DICOM image metadata, specifically the biomedical parameters, is vendor dependent as it is generated by the device itself. At the same time, another part of the metadata, namely the patient information, is obtained from hospital information systems via DICOM worklists. Therefore, interpreting the vendor-dependent DICOM format of images generated by different devices becomes a practically unsurpassable obstacle in a multi-vendor environment. DICOM does not fully specify the biomedical tags stored with images so that manufacturers of medical equipment create DICOM files that differ in the meaning and representation of these tags. Ideally, any PACS should read the metadata of any image, allowing the user to retrieve all images regardless of the originating device. Unfortunately, the differences between vendors’ DICOM implementations make this a very difficult task.
In order to solve this complex compatibility problem, C2C has developed the MIO (Medical Image Organizer) software tool. MIO captures non-DICOM video files generated by any endoscope and converts them to a standard DICOM format with consistent metadata for proper PACS interpretation. Whether S-Video, NTSC, PAL or RGB, all these signals can be captured as static images or video sequences and converted into DICOM format. MIO can be configured to capture video sequences of specific lengths generating DICOM multiframe or MPEG-2 videos. In addition, MIO retrieves patient metadata from any associated information system (HIS, RIS, etc.) via DICOM worklists to properly identify the video with all the appropriate tags. After this, MIO is ready to send the images to any PACS with one click.
Once the video has been converted into the right format, the user can store it according to workflow needs. If the video is to be incorporated into the hospital’s Electronic Patient Record system, the PACS is recommended as storage system. In this case the user stores short video sequences in DICOM multiframe format (since PACS do not usually support MPEG-2 storage). By using MIO the user can send the video to PACS without requiring a previous RIS scheduling. If the video is intended for research, second opinion, or academic activities outside the hospital, a private Web storage system is required. In this scenario the surgeon may want to share the video with other colleagues through the Internet, allowing them to make comments about the surgery technique, etc. To this end, C2C has developed the www.medting.com Web 2.0 platform, which permits the exchange of clinical cases under a social network approach.
Since MIO is totally integrated with Medting, medical images can be uploaded to Medting directly from the imaging device in a matter of seconds. Today, the public version of Medting serves as online global image repository for more than 2,000 clinical cases and 17,000 images and videos of different specialties. Alternatively, healthcare organizations can purchase private customized versions of Medting for corporate use.
By combining MIO and Medting C2C offers a “one click” solution for operating room video management. When the system is on, the doctor presses a foot switch or a wireless mouse to start/stop video recording. The output video is then automatically converted to DICOM and sent to either PACS or Medting depending on the purpose of the application.
For more information about MIO and Medting contact pledesma@medting.com
