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Open-source Viewer
Opens Doors — OsiriX Unlocks Mac Platform to Imaging Meet OsiriX. The first commercialized radiology system for Apple computer systems drew physicians’ attention at RSNA. In medical computing, as everywhere else, it’s hard to escape the fact that the PC rules. Application developers and system vendors tout their compatibility with Microsoft Windows as a vital selling point. But as in every other environment, there’s always been a coterie of knowledgeable, hands-on types willing to step outside that status quo and see what else is offered. In the PACS world, two such pioneers—Antoine Rosset, MD, and Osman Ratib, MD—have created OsiriX, an open-source viewer program developed to run specifically on the Apple Macintosh. At RSNA 2006, PACS makers Meta Fusion and aycan Medical Systems individually announced new products that will support OsiriX. Although each company has taken a different track, both solutions enable users to run a completely PC-free PACS setup or to add the viewer in a mixed Mac-PC environment. Building on Past Performance Their answer was to rewrite the existing freeware and allow the viewer to navigate through the image volumes typical of today’s multidimensional modalities. By incorporating several separate, proven open-source imaging tools into the original program, Rosset and Ratib created a new single, integrated PACS viewer. This application is now OsiriX, which, according to its developers (and a fast-growing body of users worldwide) allows an appropriately configured Mac to support PACS viewer capabilities comparable to most high-end, dedicated, proprietary vendor workstations. OsiriX Features and Functions “OsiriX offers advanced 3-D postprocessing tools, such as volume rendering, multiplanar rendering, maximum intensity projections, surface rendering, or thick slabs,” Rosset says. “OsiriX also offers complete support for 4-D imaging, as required for cardiac CT and image fusion for PET/CT. And finally, we also support 5-D imaging for cardiac PET/CT, so you can see simultaneously the 3-D image of the heart at the different phases of the cycle [4-D], and the corresponding functional images of the PET [5-D].” According to Rosset, the Apple operating system provides various integrated tools that made it relatively easy to modify OsiriX for advanced computing functions in a clinical environment. Because OsiriX supports a plug-in architecture, each user can select functions and expand as needed, including capabilities for remote consulting and teleconferencing via iChat AV; Internet-based file sharing of even very large image sets using iDisk; file anonymizing to remove individual patient demographics from shared image sets; and QuickTime interactive video for 3-D visualizations and 3-D rotations on any combination of axes. Another innovation was adding the Apple iPod for mobile DICOM storage. Says Rosset, “OsiriX will archive and index DICOM files directly on the iPod hard disk without requiring copying them on the computer hard disk.” For radiologists working at different sites, the ease and security this functionality offers for moving very large amounts of imaging data is a distinct benefit. “You can easily take up to 80,000 CT slices with you, allowing you to interpret studies when and where you want,” he says. Mac Advantages In addition, he says, “Apple completely rewrote their operating system with MacOS X, based on a Unix kernel. So the user benefits from the robustness of a Unix system and from a modern, advanced, and fully integrated graphical user interface environment.” And concurrently developing the operating system and hardware presents another big advantage in terms of designing performance enhancements for optimizing the viewer’s capabilities, he adds. For instance, the newest version of OsiriX is specifically crafted to take full advantage of Apple’s current dual-processor design as anticipated clustered processors and processor grids. “With the release of MacOS X Leopard 10.5 [this spring], we will release a true 64-bit version of OsiriX, allowing it to handle an unlimited number of images,” says Rosset. “With the latest generation of multislice CT, it is now fundamental to allow loading and manipulating [of] more than 5,000 images at the same time, for example, to do gated cardiac CT. In comparison, Windows Vista doesn’t support 64-bit as standard. You need to install a specific and limited version, largely limiting its adoption.” Welcome to the Mac World Any Meta Fusion system enables users to select and integrate various viewers and applications, including the growing number that support accelerated spatial and temporal visualization. “What we provide is the PACS, the information system, and all of the infrastructure to implement, access, and use the PACS and information system,” says Hazari. “We can help you build your workstations, and you can install your viewer choice, within limits. “For OsiriX, we’ve provided all the integration needed for daily use workflow in an institution, even for multiple integrated departments, like front desk people, back office people, billing [personnel], radiologists, technologists and radiographers, even transcriptionists.… Basically, you can drop OsiriX into the flow and it becomes part of the RIS, which governs the daily interactions for a radiology practice or imaging department. And it is possible to combine OsiriX with multiple other viewers, so you could deploy a hybrid RIS or a RIS practice management system with a different viewer for each radiologist, including some Mac and some PC workstations.” Keeping costs down while making the most of the newest modalities is important not only for users who may feel shut out of the high-end workstation market but also for people who still believe a Mac setup must inevitably cost more than a similarly functional PC-based system. Meta Fusions’ RSNA exhibit was highly effective in convincing both habitual PC users and Mac aficionados that they have new options, according to Hazari. The demonstration ran OsiriX on the Mac Pro, a high-speed, Intel-based, expandable system. "A radiology practice can build a respectable diagnostic workstation using a Mac Pro, adding some memory, adding two inexpensive graphics cards at under $400 each that will drive four high-pixel-count large displays at full resolution, and installing OsiriX, which is open-source and now available in its first FDA-approved version,” he says. “At least one of the four displays can be a Siemens megapixel display which internally converts to 10-bit data. Although most standard card drivers cater to 8-bit data granularity, and more expensive cards can be used to drive 10 bits, the internal engineering of the display reportedly appears to have been oriented to meeting FDA substantial equivalency requirements for mammography, even in the presence of 8-bit data. Overall, the end-user cost of a Mac workstation that offers capabilities available in more expensive diagnostic workstations can be quite competitive." Hazari expects some radiology practices and imaging centers to enter the Mac world by hybridizing their existing systems. “Maybe bring in one Macintosh workstation, and with that Mac, they also bring in OsiriX with all many features that their other viewers don’t support—maybe they want to do cardiac CT studies, for instance. So the software opens doors in terms of the breadth of diagnostic capabilities, at a very competitive cost.” Open-source In true open-source tradition, aycan plans to offer and support its version of the OsiriX view, in a similar way that software developer Red Hat offered and supported the open source Linux operation system (see box on page 14). But many worry that open-source “means lots of chefs in the kitchen, lots of fingers in the pie,” says Hazari. “You can have not only many different program versions, but many variations of the master code base. If you visualize the master code as a tree, typically you have branches of the software that are customized to do specialized tasks. But when these branches are being remerged or changes are being made in the trunk, you can have issues of incompatibilities, bugs, all kinds of problems, so typically one or more influential developers act as quality controllers for the trunk.” Open-source software’s potential problems, Hazari
points out, can be more than offset by a crucial advantage: “The
software capabilities are limited only by the imagination of the people
involved and, ultimately, how capable the programmers are and how well
they interact,” he says. “OsiriX will be developed according
to how those people prioritize and implement all the features they want
to put in. And that’s novel because often the developers are the
end users.” He adds, “We will continue to adapt OsiriX based on user feedback. For 2007, we will specifically work on more image registration tools, allowing PET/MRI fusion, for example. We will also add more segmentations tools, to extract and display a specific part of a volume—for example, metastases volume or liver segments. And finally, we want to add better support for perfusion sequences, such as breast MRI perfusion or brain CT perfusion imaging.” Ultimately, says Rosset, “we want to create a global community of users that will drive an evolving DICOM viewer … and by developing our own tool, we can quickly adapt it to our real needs, knowing perfectly the workflow of a radiology department and the possibilities and limitations of the imaging modalities.” — J. K. Bucsko is a freelance healthcare and technical writer based in Westville, N.J., and a frequent contributor to Radiology Today. aycan Introduces OsiriX Turnkey Workstation At RSNA 2006, aycan Medical Systems preannounced its OsiriX-based turnkey solution, slated for full commercial release this quarter. The aycan offering will bundle an FDA-approved version of the OsiriX viewer with Apple hardware (including some user-selectable options) plus installation and, “very importantly,” says Director of U.S. Operations Frank Burkhardt, a user manual, product training, and a support hotline. aycan is best recognized in the United States for its DICOM paper printer. In Europe, the company also offers a proprietary PACS. Burkhardt says, “Our entire line of turnkey solutions is geared toward low cost and high value, with a strong emphasis on service and support. With the aycan OsiriX workstation, we’ve added a new solution that fits seamlessly with our product philosophy. “We consider OsiriX a high-value solution,” he continues. “Today’s modalities deliver increasing volumes of data, which require the use of high-end workstations in order to get the maximum out of them. Unfortunately, the prices are showstoppers for many hospitals and imaging sites. But OsiriX helps make the same features and functionalities affordable. And we strongly believe OsiriX will help spread these advanced technologies because it meets radiologists’ exact needs and requirements. Nothing has been developed unnecessarily, which you often find in other software.” Following FDA approval, aycan is prepared to continuously update its OsiriX product to accommodate changes as they occur. “We’ll track features, test them, and take them through the FDA process every six to 12 months to bring out a new version. As it’s an open-source process, you can expect there will probably be developments on a daily basis. We’re working very closely with [Antoine Rosset, MD, a radiologist at the University of Geneva], and we have a very tight relationship with the user community,” says Burkhardt. “And of course, in some cases, if we see a specific requirement from a customer, we program that function into the software ourselves; for instance, a client wanted to use our DICOM print program with OsiriX, so we added it to the 2.6 version which we released at RSNA.” Besides meeting the stringent FDA quality management process and extensive feature and functionality testing, every approved version will also require new documentation and user manuals. The FDA approval applies only to the software aycan bundles with specific Apple hardware and its own user documentation. “That’s a key value that we add,” says Burkhardt, “because people can upload the software today off the Internet, but in a clinical situation, where do I go if I have questions or don’t know how best to use it? Plus, with an FDA-approved [and numbered] version, it’s very clear [which] changes and problems have been reported.” Burkhardt also believes OsiriX will help Macintosh penetration into previously PC-only strongholds. “This is one of the battles we have, that Mac is not really widely spread and is often resisted in IT departments,” he says. “We do find that when there are alternatives to the PC, many people become interested. And there’s absolutely no reason not to have Apple in the medical enterprise. It’s as easy to integrate as any other system. And of course, if you want to use OsiriX, you have to use Mac.” In fact, he adds, while aycan isn’t positioning the product as such, he suspects some very small first-time facilities, especially those without any preexisting software bias, may choose to run the OsiriX workstation as an entry-level PACS. — JKB
http://tech.groups.yahoo.com/group/OsiriX www.opensource.org/licenses/gpl-license.php
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