DicomWorks: software for reviewing DICOM studies and promoting low-cost teleradiology

Abstract

DicomWorks is freeware software for reading and working on medical images [digital imaging and communication in medicine (DICOM)]. It was jointly developed by two research laboratories, with the feedback of more than 35,000 registered users throughout the world who provided information to guide its development. We detail their occupations (50% radiologists, 20% engineers, 9% medical physicists, 7% cardiologists, 6% neurologists, and 8% others), geographic origins, and main interests in the software. The viewer's interface is similar to that of a picture archiving and communication system viewing station. It provides basic but efficient tools for opening DICOM images and reviewing and exporting them to teaching files or digital presentations. E-mail, FTP, or DICOM protocols are supported for transmitting images through a local network or the Internet. Thanks to its wide compatibility, a localized (15 languages) and user-friendly interface, and its opened architecture, DicomWorks helps quick development of non proprietary, low-cost image review or teleradiology solutions in developed and emerging countries.

Fig 1

The main import sources and export destinations of DicomWorks. The application can import images from a local hard disk, network hard disk, removable media (DICOMDIR support), e-mail accounts, FTP, or a DICOM network with the help of a third-party DICOM SCP application. Images can be modified and exported to numerous destinations (local hard disk, e-mail, FTP, DICOM archive, or directly in a Microsoft PowerPoint presentation). The plug-ins technology allows conversion and exportation to any other file format or destination.

Fig 2

Screenshot of the main screen of version 1.3.5 with a study opened (axial T2 weighted sequence of a prostate MRI examination). On the left part of the screen, a direct access to favorite directories of DICOM images is possible (blue folder), whereas the current directory is sorted in patients, studies, series, and images. All levels are expandable (such as here at the image level). On the right part of the screen, a maximum of the screen surface is dedicated to the image. Patient and image data are overlaid. A simple toolbar allows easy navigation through the series and images. Window leveling, pan, and zoom are performed using the mouse, and the mouse wheel allows scrolling in the series. Important functions (measures, screen splitting, etc...) are accessible from the toolbar.

Fig 3

Diagram showing the steps to include a selection of images in Microsoft PowerPoint using DicomWorks: (a) Images are selected in DicomWorks and marked in the “Palette” window. A click on the “Export...” button shows the “Export wizard” window (b) where “Microsoft PowerPoint” clearly appears when this application is installed on the machine. After clicking on “next”, images can be cropped or resized and exported automatically to a new presentation (c) or inserted in a new slide of the currently opened presentation (d). Image window levels, zoom, and annotations are preserved. No JPEG transformation is necessary. This procedure avoids fastidious image manipulations (JPEG transformation, resizing, sorting, grouping, alignment).

Fig 4

An example of an international teleradiology solution installed between Africa (Mali, Benin, Morocco, Algeria) and France (Marseille, Lyon, Frejus) using DicomWorks’ built-in e-mail import and export functions: Requesting physicians (1 and 2) and remote experts (3) only need a DicomWorks client application installed on a standard PC connected to the Internet. They all share a single e-mail account on a simple mail transfer protocol/POP e-mail server (here on a dedicated server in Marseille to avoid security issues), but they can also have individual accounts. In the first case, images are imported from non-DICOM modalities (5) and converted to DICOM-compatible files using DicomWorks on station 1. In the second case, images from a CT scanner are native DICOM and easily sent to DicomWorks using a Store-SCP client application on the PC. Communications use regular Internet connections. Any user can upload a message on the e-mail server and specify a recipient (8) using a predefined list (in local preferences file). Cases can also be left available to all physicians (7), so that unanswered cases can be viewed by several experts. Transmitted images are left in DICOM format, but anonymized, compressed using a lossless algorithm, and attached as a single file to the e-mail message. Images are retrieved using DicomWorks’ built-in POP client that filters messages addresses to its specific “USERID” (fixed and encrypted in local preferences), or to “ALL.” Reviewing is performed using DicomWorks viewing tools. A simple “Answer” button is available to send a response (that may contain a reference JPEG image) to the original sender (9).