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Simulation of DICOM traffic in PACS networks using behavior profiles

Conference Paper · June 2015

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Eduardo Pinho Carlos Ferreira

BMD Software University of Aveiro
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interaction concepts that can provide a reliable and accurate user
interface based on currently available gesture-control hardware.
Methods
We developed medical visualization software for an ‘‘off-the-shelf’’
gesture control input device (Leap Motion [1]) with a special focus on
the interactive creation of multi-planar reformation (MPR) and thin-
slab maximum intensity projection (‘‘thin MIP’’) images. Version 2.0
of the device’s software development kit was used, in particular a new
hand detection approach that provides the software developer with
access to a virtual hand model.
The user of our software is presented with a simultaneous display
of three MPR or thin MIP images that are perpendicular to each other.
In addition, a three-dimensional (3D) view is provided that combines
a volume-rendered image of the whole image data set with a 3D
representation of the MPR or thin MIP images.
Multiple interaction modes have been implemented and informally
evaluated with the help of interviews. In a first step, all interaction
modes have been tested by non-medical students. The following four
modes have been judged to work sufficiently accurately and reliably
and have been subsequently presented to radiologists:
(1) Generation of orthogonal MPR or thin MIP images: the x, y and
z positions of the hand with regard to a fixed reference point
define which axial, coronal and sagittal image is shown, resp.
(2) Generation of oblique MPR or thin MIP images: the 3D position
and orientation of the hand palm defines the position and
orientation of an oblique MPR image within the image volume.
The other two MPR or thin MIP images are computed
automatically as perpendicular images.
(3) like (1), but the user has to hold down a key on the keyboard and
then move the hand to change the current axial, coronal or
sagittal image in a relative way
(4) like (2), but the user has to hold down a key on the keyboard and
then move the hand to change the position and orientation of the
oblique MPR or thin MIP image in a relative way
Four clinical cases have been provided for testing: Head MRI
(without pathological findings, used with MPR), chest CT (aortic
dissection, used with MPR and thin MIP), head and neck CT
(calcified atherosclerotic plaque in the carotid arteries, used with thin
MIP), and cardiac 4D CT (ten phases, artificial aortic valve, used with
MPR). Examples of how the software is used can be seen in Fig. 1.
Fig. 1 Examples of how the software is used
Results
Several interaction modes that were rejected in the first testing step
relied on the detection of different gestures, e.g., extending certain
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Int J CARS (2015) 10 (Suppl 1):S1–S312
fingers or a certain amount of fingers. This approach has shown to be
not reliable enough, as too often the gestures were not detected cor-
rectly. Related to this, starting and stopping a certain action (e.g.,
relative change of the position or orientation of an MPR image) with a
certain gesture has shown to be a general problem. Even for the more
robust distinction between a completely extended hand and a fist,
users had problems with properly ending an interaction (e.g., ex-
tended hand: change MPR image, fist: do nothing). This resulted in
unwanted changes of the images. Thus, interaction modes that require
a key to be pressed to start the actual action, have been appreciated
more.
The detection of the position and orientation of the hand worked
best for an extended hand. This was particularly important to reliably
detect the palm’s orientation, as used in the interaction modes (2) and
(4), whereas the detection of the position alone as used in the other
modes was less dependent on an extended hand.
The following advantages of the presented gesture-controlled user
interface as compared to conventional input devices like mouse and
keyboard were stated: (a) more intuitive, ‘‘direct’’ definition of obli-
que images, potentially saving time, (b) potential prevention of strain
injuries when used together with the conventional mouse in an al-
ternating way, (c) faster scrolling through big data sets, (d) potential
use in an intraoperative scenario.
Concerns were raised with regard to fatigue, in particular when
using modes 1 and 2.
Conclusions
The results suggest that the presented gesture-controlled user inter-
face can be useful for 2D and 3D medical image navigation. For
routine tasks in diagnostic radiology like scrolling through stacks of
images, it could be used as an alternative to the conventional mouse.
The same is true for intraoperative image access, where we would
recommend the use of additional foot pedals to reliably start and stop
interactions as opposed to using different hand gestures. For more
advanced imaging tasks (3D) like on-the-fly generation of oblique
MPR or thin MIP images, the presented approach could be a useful
addition to conventional user interfaces, leaving the majority of the
tasks (2D) up to the reliable and accurate computer mouse.
In general, with regard to gesture-controlled user interfaces in
medical imaging we recommend the ‘‘less is more’’ approach, i.e., not
to use every potential feature of hand gesture detection, as with
current ‘‘off-the-shelf’’ technology the hand detection doesn’t work
reliably enough.
References
[1] http://www.leapmotion.com
Simulation of DICOM traffic in PACS networks using behaviour
profiles
E. Pinho1, C. Viana-Ferreira1, C. Costa1
1
IEETA - University of Aveiro, Aveiro, Portugal
Keywords Medical imaging  Picture archiving and communication
systems  Simulation  Big data  Network workflows
Purpose
In a context of ever-increasing requirements of DICOM data sharing
and handling [1], the high privacy and rather strict terms of medical
image disclosure are a strong barrier against the study of such data.
Although medical images may be disclosed for academic purposes, the
analysis of real, large-scale DICOM network traffic is either impos-
sible or very inaccurate with such low amounts of data. In addition,
with the current trend of repository outsourcing to the Cloud, the
development of smart caching and pre-fetching mechanisms is highly
important. Therefore, a simulation process of medical imaging traffic
is quite useful and more feasible than testing in a real environment.
Int J CARS (2015) 10 (Suppl 1):S1–S312
A DICOM traffic generator based on behavior profiles was pre-
viously implemented, in order to dimension solutions to minimize
communication latency [2]. However, the solution itself was not
feature-complete, and requires a new model before being applicable
to more contexts where PACS are involved. In addition, no simulation
performance concerns were presented.
This paper presents a backbone architecture for simulating
DICOM traffic produced by one or more facilities supporting medical
imaging. The key aspects of this simulation are DICOM study meta-
data generation and traffic induction in a simulated network based on
behavior profiles. The main goal of the simulator is to open new
challenges in this area of study and provide scientific and techno-
logical value to future research projects.
Methods
We established a common architecture for the simulator (henceforth
named PACS-BSim), fit for a variety of new contexts, while still
scoped on medical imaging use cases. Figure 1 shows a model dia-
gram highlighting the most relevant parts of a simulation context.
Besides the time intervals in which the simulation will run, the
context is also composed by one system network topology and a
group of consumers. The full simulation process is comprised by the
following phases:
(1) Context creation phase: The simulation environment is built,
including its main components.
(2) Data generation phase: Patients and studies are generated and
stored.
(3) Consumer phase or Traffic generation phase: Consumers are
deployed to the system, generating DICOM traffic according to
their behavior profile.
Data synthesizing is used in the form of DICOM meta-data
generators. The patient generator creates patient records with
properties found in DICOM studies, such as name, birth date and
gender. Afterwards, DICOM studies of these patients are generated
with the study generator. All meta-data is stored in a database, which
contemplates multiple PACS repositories and a variable number of
locations for study storage. The simulator contemplates a network
topology model, so as to provide a more precise environment. The
topology in Fig. 2 exemplifies the use case of outsourcing medical
images to the Cloud [3]. All nodes in the topology hold a network
status generator, which simulates a local or wide area network of
variable bandwidth utilization by inducing artificially generated
delays defined in [2].
Fig. 1 Model diagram highlighting the most relevant parts of a
simulation context
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Fig. 2 Topology of the use case of outsourcing medical images to the
Cloud
We have defined consumers as the active entities responsible for
accessing the repositories using single- and multirepository DICOM
queries, thus producing traffic. The time instants of query requests
and responses and study moves are the main events being registered
in the event log.components.
Each consumer has its own modus operandi, which describes work
tendencies. For instance, a cardiologist may perform revisals of
studies (from several patients) related to images of the heart, whereas
another doctor may iteratively focus on particular patients by scan-
ning their image history. In [2], modality revisal, patient revisal and a
few other behaviors are stated. In this work, we call them major daily
tasks. During the consumer phase, consumers will randomly request
data under their preferences, during their schedule. The consumers’
criteria of what images to retrieve is fully configurable using a re-
striction set mechanism.
The modus operandi of each consumer is enhanced with the in-
jection of behavior mixins, which may induce other particular
operations during the task. This is achieved with a mechanism based
on chains of event listeners. When such an event is triggered, all
mixins mapped to the event are executed in that order.
A simulation is terminated when all consumers reach the end of
their final day of work.
Results
The simulator was implemented in Java 8 and outputs an event log of
the intervening entities’ actions, as well as the lists of generated pa-
tients and studies. The implementation is highly versatile, in which
contexts comprise several parameters that can be tweaked to achieve
many diverse environments and behaviors. End users of the tool can
take the liberty of formulating a suitable simulation context for their
tasks.
Conclusions
This work leaves room for a few other challenges. The matter of
model accuracy, validation and high performance are tightly related,
and can be further discussed for ways to achieve a reliable simulator.
Nevertheless, PACS-BSim’s outputs have already been used for de-
velopment and testing of solutions for PACS, as described in [4].
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References
[1] L. S. Ribeiro, C. Costa, and J. L. Oliveira, ‘‘Current trends in
archiving and transmission of medical images in medical
imaging,’’ 2011. doi:10.5772/27959.
[2] C. Viana-Ferreira and C. Costa, ‘‘DICOM traffic generator based
on behavior profiles,’’ in Biomedical and Health Informatics
(BHI), 2014 IEEE-EMBS International Conference on, Jun.
2014, pp. 93–96. doi:10.1109/BHI.2014.6864312.
[3] L. Silva, C. Costa, and J. L. Oliveira, ‘‘A PACS archive
architecture supported on cloud services,’’ English, International
Journal of Computer Assisted Radiology and Surgery, vol. 7, no.
3, pp. 349–358, 2012, ISSN : 1861–6410. [Online]. doi:
10.1007/s11548-011-0625-x.
[4] C. Viana-Ferreira, S. Matos, and C. Costa, ‘‘Incremental
learning versus batch learning for classification of user’s
behaviour in medical imaging,’’ in HealthInf 2015, 8th Interna-
tional Conference on Health Informatics, 2015, pp. 431–436.
Quo vadis, CARS? first steps towards text-mining-based analysis
of topics in the international journal of computer assisted
radiology and surgery
B.A. Borucki1, L. Bolikowski1
1
University of Warsaw, Interdisciplinary Centre for Mathematical
and Computational Modelling, Warsaw, Poland
Keywords IJCARS  Text mining  Topics  Trends
Purpose
Once in a while in every discipline it is advisable to look around -
look backwards to see the whole picture of the amassed knowledge
and look forward to foresee what is ahead. The International Journal
of Computer Assisted Radiology and Surgery is about to enter its
tenth year and both methods and topics of interest covered by the
Journal are evolving in time. We decided to analyse the contents of
the Journal in the past volumes and look for trends. In this work we
present our approach to retrospective and prospective analysis of
topics based on text mining techniques. We focus on titles and ab-
stracts of the articles published in the Journal and the properties of the
most commonly present phrases each year. Based on the gathered data
we try to extract the trends and analyse the observed (ir)regularities.
Methods
We have queried Springer Metadata API in order to obtain a list of all
the articles published in the Int. J. of Computer Assisted Radiology
and Surgery from year 2006 to 2014. Our queries with a constraint
‘‘issn: 1861–6429’’ resulted in 1126 metadata records, from which we
extracted three fields: title (dc:title), year of publication (prism:pub-
licationDate) and abstract (xhtml:body). The results were
automatically sorted into ‘‘phrases’’, where a phrase is a single word
or a combination of two, three or four words that is repetitive over
several texts. Next the common language phrases (such as ‘‘the’’, ‘‘a’’,
‘‘and’’, ‘‘this work’’, ‘‘were obtained’’ etc.) were automatically re-
moved by comparison with baseline texts (e.g. common phrases in
other journals). Lemmatization was also applied in order to cluster
together various grammatical forms of a phrase (e.g. ‘‘image’’/‘‘im-
ages’’, ‘‘process’’/‘‘processing’’). Additional substantial aggregation
was performed in relation to discipline (e.g. ‘‘MRI’’/‘‘MR’’/‘‘mag-
netic resonance’’, ‘‘CT’’/‘‘computed tomography’’, ‘‘cardiac’’/
‘‘heart’’/‘‘myocardium’’). Manual fine tuning was applied.
Next, we counted the total number of phrase occurrences per year,
total number of phrases per year and calculated relative annual fre-
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Int J CARS (2015) 10 (Suppl 1):S1–S312
quencies of phrases. Additionally the moving average over the period
of three years was calculated for all occurrences and relative fre-
quencies were derived. All frequencies were calculated in
milipercents (0.001 %, or number of occurrences per 100,000) rela-
tive to total number of phrases each year.
Finally, some manually picked most interesting phrases and topics
were selected for additional aggregation and selected topic coverage
within four groups: data dimensionality, imaging modality, human
body parts, and methods and algorithms.
Results
Over 734k phrases were extracted in total from the gathered texts and
limited to over 153k after automatic elimination. The global growth in
total number of phrases each year was observed, starting at 21k in
2006, up to 192k in 2014. Figure 1 shows the gathered results for the
top 50 phrases.
Fig. 1 Results for the top 50 phrases
The most common phrase during all years was the ‘‘image(s)’’
phrase (1797 occurrences), while the top 5 was completed with
phrases ‘‘surgical/surgery’’ (975), ‘‘model(s)’’ (742), ‘‘MRI/
MR/magnetic resonance’’ (726), ‘‘CT/computed tomography’’ (715).
The most general observation from the top 30 phrases is that the
journal mainly covers the topics of 3D CT and MRI automated image
processing techniques, targeted at accuracy and error evaluation and
comparison, using mainly models and algorithms of segmentation and
registration.
Frequency analysis shows that in majority of phrases a periodic
sine-like occurrences characteristics is visible with the period of
2–4 years. Some phrases tend to peak (being very popular) in one
year (e.g. ‘‘technique(s)’’ in 2010, ‘‘error(s)’’ in 2011, ‘‘region(s)’’ in
2012, ‘‘tracking’’ in 2011, ‘‘2D’’ in 2010, ‘‘objective’’ in 2007), it
might be interesting to correlate this data with technical and sci-
entific events preceding the peak. Moving average frequency
analysis gives better observations on trends as it is less sensitive to
local peaks.
The analysis of data dimensionality group (Fig. 2a) led to obser-
vations that frequency of ‘‘2D’’ phrase was consequently decreasing
until 2012, and now is becoming more popular. Frequency of ‘‘3D’’
phrase seems constant, while frequency of ‘‘4D’’ phrase is becoming
slightly more popular recently.