Imaging informatics is a subspecialty of Biomedical Informatics. Its genesis began in radiology and they have become the leaders in Imaging Informatics. Many other specialties now use imaging and their role in the field of imaging informatics remains undefined.
Two organizational efforts in the 1980’s made it possible now for any radiologist in the developed world to view radiological images from a computer anywhere from most radiological devices. They are DICOM (Digital Imaging and Communications in Medicine) http://medical.nema.org/ and PACS (picture archiving and communication systems) Picture Archiving and Communication Systems (PACS). Prior to this, it was virtually impossible for anyone to decode images from radiologic imaging devices except for the manufacturers. It was the cooperation of industry and medicine that allowed this successful alliance. In 1983 the DICOM standards committee was formed from these joined forces.
DICOM is a standard for handling, storing, printing and transmitting medical images. It was originally developed by the American College of Radiology (ACR) and the National Electrical Manufacturer’s Association (NEMA). The standards developed were mainly limited to radiology and cardiology, but they are continuously expanding. DICOM allows not only the image but other metadata to be transmitted simultaneously. For example, patient ID and other attributes are also accompanied with the image; information that accompanies the image can never be separated from this image by mistake. There has been near universal level of acceptance amongst medical imaging equipment vendors and healthcare IT organizations of the DICOM standard.
PACS is the interface that allows the DICOM standardized images to be viewed. It is a group of workstations, servers and archives tied to imaging modalities (CT, MRI etc) that acts as a database and processor for these files.
Radiology is an inherently technology driven specialty so it was not unexpected that this specialty quickly saw the need for standardization and coordination. With the explosion of digital images across not only the practice of medicine but in all aspects of society – analog film is becoming almost obsolete. Advances in Imaging Informatics are being tested and applied in other areas of medicine.
With regards to dermatology, the easy availability of digital photography and better resolution has allowed frequent photography of clinical lesions, dermoscopy, and histopathology. There are currently no standards for cataloguing and storing the files. Often, they are haphazardly stored in various physical locations under various file formats in random organizational fashions. This non-standardization is a concern for privacy and security issues and also for patient care. These images, along with relevant information (metadata) needs to retrieved easily. Relevant information should include, but are not limited to: patient name, date of service, diagnosis and location of lesion. Furthermore, for teaching purposes, this provides for a visual teaching tool/database/atlas. With the widespread implementation of electronic health records (EHRs), the clinical workflow and use of digital images embedded into the medical record is also becoming more widespread. It remains to be seen whether dermatology will unite with the DICOM standards and use the PACS system to access the clinical digital images or pave a different path.
Special considerations for Dermatology include
1) Dermatology is a uniquely visual specialty and diagnosis of a medical condition weighs heavily on what is seen on the patient and what is seen histologically should a biopsy be done. Due to its heavy reliance on the physical exam, photos that are taken can be potentially contain sensitive information and be exploited Detection and management of pornography-seeking in an online clinical dermatology atlas.
2) Dermatologists need to access clinical images for patient care AND also for teaching purposes. Because Dermatology is so visually dependent, the clinical images used for patient care are often used to teach dermatology trainees. These teaching files that were typically kodachromes now exist in the digital realm and the distinction between teaching files and patient records become blurred. Frequently accessed teaching databases include Visual Dx http://www.visualdx.com/ and Derm Atlas http://dermatlas.med.jhmi.edu/derm/. There are also commercial ventures that offer software for cataloging images; http://imagestore.md/, http://www.canfieldsci.com/imaging_systems/imaging_software/Mirror_software.html
3) An efficient clinical workflow needs to be developed to move the digital images from the camera device into a secured database. With wireless technology and digital cameras embedded in many mobile devices, it seems only logical that digital images should be captured easily at the patient bedside with the appropriate metadata and sent to a secured database without a third party required. Whether this occurs under the DICOM standard or through the PACS system remains to be determined.
Initiatives and Projects
Submitted by (Julie H. Lin)