[MUSIC] We don't say a lot about images in this course, and imaging informatics is huge area. You could imagine giving all the types in the images available, the strong need to kind of figure out what's going on in the body, both the diagnosed, do surgery planning, there is a lot in there. Images are not just of the body, but of pathology specimens, cellular level, gross level, there's tons to do about images. In this little section, all I want to get across is how images are transferred from one place to another before all the fancy stuff is done on them. The standard here is called DICOM, digital imaging communication in medicine. It's an interesting story in that of before DICOM, radiologists and others have spent a lot of money on devices that seemed to be repeats. So again, MRI, got a CT scan, each one includes both their own monitor to view their images, but that sounds kind of nuts, right? because the monitor should be able to see things of any sort. So, they banded together and say we need to have a standard way of transferring and storing images, so that we don't have to pay exorbitant amounts of money for things we don't need. So here's an image, this is an ultrasound image of a heart, and the colored parts of this picture is showing blood flow. You can see there's some red and there's some blue. So red means blood is going in one direction, the blue means it's going in the other direction. I think you would agree with me that one thing you don't want in the heart is blood going in two different directions. And in this case, this is called mitral regurgitation, where blood is going back into the atrium from a ventricle. And I think you can see that the blue is crossing the valve borders. That's a bad thing. But we're not talking about interpretation of the images, that's somebody else's job. We just want to know how do you store it, and how do you transfer it. Now, we use this word modality, and modality is, from my way of thinking, kind of a weird name for the gizonal from which you acquire the image. So there's digital x-ray, there's MRI, there's CT scan, there's ultrasound, there's pet scanning. Any way that radiologists gets images, the gizmos are called the modality. And so DICOM's job is to say, I want to be able to support getting images from any modality, so that if a new modality comes along, we don't have to build things from scratch, or we don't have to build the standard from scratch, I should say. So it's transfer, it's printing, and its storage. On this slide you can see how the environment kind of works. The modality does not have to be digital, it could be analog. And it can be a machine that translates the analog signals to digital data, or it could be a digital device. Analog would be x-ray film, whereas digital would be the digital x-ray, where there's no film involved at all. But in any case the DICOM image is available for those different uses. Now, if you're a patient, you care about this, because if your insurance makes you go five miles away to get your CT scan, and you want to make sure that your doctor gets the CT scan, how do you do that? Well, the CT folks may print the CD for you and put it on a DVD. How do you know that your doctor will be able to read the image off that DVD? And the answer is DICOM. Or today, the image can be sent electronically over network, and again, when your doctors sitting in her exam room pulls up an electronic health record, and sees the image on a pane of that record. There's a lot of DICOM worker in behind the scenes to get that data from that CT scan five miles away to you, or to her. I list these goal mainly because I wanted you to see that the word semantics is used in something that you could think of as as prosaic as sending an image from point A to point B. And semantics here has to do about what are the types of things you intend to accomplish with this transmission, or with the storage. And at the bottom is the notion of conformance to making sure that the people who say they conform to DICOM, really actually conform to DICOM. Remember with HL7, it wasn't so straight forward and we neither whole staff of people to make sure that they get from point A to point B. When you carrying yours on your DVD, you cannot carry an IT guy with you. So you need to know that both the sender and the receiver conform to the DICOM standards. So it's both a network environment, and these are new services like I suggested earlier. And they are taking into account international standards, so it's not just an American thing, your DICOM image can be used and viewed anywhere in the world. Just like the HL7 is the most adopted standard, this also has a very very high level of adoption. It's like you basically can assume that anybody who is in radiology or imaging is using DICOM The purpose of this picture is simply to point out that besides the sending around that I mentioned before, on the one hand the DICOM standards deals with very low level issues. Like what level of Technical network do you have, an ATM switch is a very low level type of a thing to be worrying about about. On the other hand, it also has to deal with the PACS and RIS systems. The PACS, the Picture and Archiving Communication System, is what manages the image for the radiologist. The RIS is where the ordering physician sends in their order, and the radiology suite schedules the patient. And where the radiologist generates the report that then gets read by the ordering physician. So it's on more of the human side, more on the tech side of things. So it's, even right out of the box DICOM rules in a pretty complicated ecology. You don't want to talk about the DICOM image because an image can be part of a set of images which is part of a study, so a CT scan has many images. So what you see here are the list of metadata around the study, which can contain multiple pictures of images. And just like HL7 has multiple volumes for managing and understanding how to deal with it, DICOM also has many volumes. And so, if you're getting into this business, you want to get into it for real. So, I just wanted to give you a flavor of what imaging informatics is about, and in particular DICOM is the standard that you should be familiar with.
