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Procedia Computer Science 138 (2018) 203–208
1877-0509 © 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientific committee of the CENTERIS - International Conference on ENTERprise
Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International Conference on Health and
Social Care Information Systems and Technologies.
10.1016/j.procs.2018.10.029
10.1016/j.procs.2018.10.029
© 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientic committee of the CENTERIS - International Conference on
ENTERprise Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International Conference
on Health and Social Care Information Systems and Technologies.
1877-0509
Available online at www.sciencedirect.com
ScienceDirect
Procedia Computer Science 00 (2018) 000–000
www.elsevier.com/locate/procedia
1877-0509 © 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientific committee of the CENTERIS - International Conference on ENTERprise
Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International Conference on Health and Social
Care Information Systems and Technologies.
CENTERIS - International Conference on ENTERprise Information Systems /
ProjMAN - International Conference on Project MANagement / HCist - International
Conference on Health and Social Care Information Systems and Technologies,
CENTERIS/ProjMAN/HCist 2018
Outcomes from Indexing Initiatives of Medical Imaging DICOM
Metadata Repositories. A Secondary Analysis
Milton Santosa,
*
, Nelson Pacheco Rochab
a University of Aveiro, School of Health Sciences / IEETA, Campus Universitário de Santiago, Agras do Crasto, Edificio 30, 3810-193 Aveiro,
Portugal
b University of Aveiro, Medical Sciences Department / IEETA, Campus Universitário de Santiago, Agras do Crasto, Edificio 30, 3810-193
Aveiro, Portugal
Abstract
To optimize the usage of the enormous amount of data that results from medical imaging studies (e.g. Digital Imaging and
Communication in Medicine – DICOM – metadata), which is relevant to characterize healthcare provision, it is pertinent to
identify the main advantages and challenges related to the indexing of DICOM metadata for secondary analyses. In the study
reported in the present paper, the authors performed a secondary analysis on the results of research studies supported on the
indexing of DICOM metadata from Picture Archiving and Communication Systems (PACS) of different healthcare facilities. The
analysis was made according to two perspectives: i) advantages of indexing and analyzing DICOM metadata from the PACS of
different healthcare facilities; and ii) challenges associated to the indexing and managing of large volumes of DICOM metadata.
The research studies being analyzed revealed the potential for the use of DICOM metadata by aggregating and consolidating
huge amounts of DICOM metadata to characterize healthcare provision.
© 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientific committee of the CENTERIS - International Conference on
ENTERprise Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International
Conference on Health and Social Care Information Systems and Technologies.
Keywords: DICOM metadata, Big data, Medical imaging, PACS.
* Tel.: +351234401558; fax: +351234370089.
E-mail address: mrs@ua.pt
Available online at www.sciencedirect.com
ScienceDirect
Procedia Computer Science 00 (2018) 000–000
www.elsevier.com/locate/procedia
1877-0509 © 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientific committee of the CENTERIS - International Conference on ENTERprise
Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International Conference on Health and Social
Care Information Systems and Technologies.
CENTERIS - International Conference on ENTERprise Information Systems /
ProjMAN - International Conference on Project MANagement / HCist - International
Conference on Health and Social Care Information Systems and Technologies,
CENTERIS/ProjMAN/HCist 2018
Outcomes from Indexing Initiatives of Medical Imaging DICOM
Metadata Repositories. A Secondary Analysis
Milton Santosa,*, Nelson Pacheco Rochab
a University of Aveiro, School of Health Sciences / IEETA, Campus Universitário de Santiago, Agras do Crasto, Edificio 30, 3810-193 Aveiro,
Portugal
b University of Aveiro, Medical Sciences Department / IEETA, Campus Universitário de Santiago, Agras do Crasto, Edificio 30, 3810-193
Aveiro, Portugal
Abstract
To optimize the usage of the enormous amount of data that results from medical imaging studies (e.g. Digital Imaging and
Communication in Medicine – DICOM – metadata), which is relevant to characterize healthcare provision, it is pertinent to
identify the main advantages and challenges related to the indexing of DICOM metadata for secondary analyses. In the study
reported in the present paper, the authors performed a secondary analysis on the results of research studies supported on the
indexing of DICOM metadata from Picture Archiving and Communication Systems (PACS) of different healthcare facilities. The
analysis was made according to two perspectives: i) advantages of indexing and analyzing DICOM metadata from the PACS of
different healthcare facilities; and ii) challenges associated to the indexing and managing of large volumes of DICOM metadata.
The research studies being analyzed revealed the potential for the use of DICOM metadata by aggregating and consolidating
huge amounts of DICOM metadata to characterize healthcare provision.
© 2018 The Authors. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Selection and peer-review under responsibility of the scientific committee of the CENTERIS - International Conference on
ENTERprise Information Systems / ProjMAN - International Conference on Project MANagement / HCist - International
Conference on Health and Social Care Information Systems and Technologies.
Keywords: DICOM metadata, Big data, Medical imaging, PACS.
* Tel.: +351234401558; fax: +351234370089.
E-mail address: mrs@ua.pt
204 Milton Santos et al. / Procedia Computer Science 138 (2018) 203–208
2 Milton Santos et al. / Procedia Computer Science 00 (2018) 000–000
1. Introduction
Currently there are many different information systems in clinical environment, as well as multiple imaging
modalities equipment’s from different manufacturers, that produce huge amounts of data [1].
In medical imaging arena, the Digital Imaging and Communication in Medicine (DICOM) has been used in
multiple scenarios [2,3,4] including Content Base Image Retrieve initiatives [5]. On the other hand, DICOM
metadata stored in medical image repositories can be a valuable source of information for professional practice
characterization and can be used in efficiency metrics for productivity assessment [6], or to provide data for different
initiatives as is the case of the development of medical imaging performance indicators [7,8] or biomedical research
[9].
However, the enormous amount of data, as well as the diversity of informational environments, poses some
difficulties to the access, indexing and usage of DICOM metadata [10,11], which turns relevant the development of
tools and methods for the extraction, processing, delivery and analyses of large volumes of DICOM metadata. In this
scenario, the development of tools like Dicoogle [12] can provide important assets.
The objective of the study reported in this paper was to identify the potentialities and challenges associated to the
indexing and analyses of the information contained in the DICOM header belonging to medical imaging studies,
stored in Picture Archiving and Communication Systems (PACS) of different healthcare facilities. For that the
Dicoogle application was used.
2. Background
The interest in the potential of the tremendous amount of information that is produced on a daily basis in the
hospital environment is not new. The reasons for this interest have been changing over time, much due to a constant
healthcare differentiation. Along with the information from Electronic Health Records (EHR), multidimensional data
from genomic, transcriptomic, proteomic, metabolomic, and microbiomic measurements, but also from medical
imaging modalities has been contributing to the Big Data phenomenon [13].
The management of large volumes of information is useful if good practices are adopted when using new
technologies according to quality standards, associated with interoperable storage strategies and promoting the
adoption of advanced computing solutions for data analyses [14].
Regarding the EHR data, these can be used for different purposes. However, the data extraction from EHR
systems to be used in the scope of clinical and translational research is not a trivial process, which has promoted the
development of multiple strategies and technological solutions over time [15].
Some of these solutions were developed to extract data from medical reports, including unstructured information,
often supported in Natural Language Processing (NLP) [16,17]. The use of NLP has been evident in multiple
scenarios namely in the identification of cases of cancer [18] or within medical imaging departments [19]. In
medical imaging environment, NLP can be useful to identify clinical syndromes and common biomedical concepts
related to the clinical situation under investigation, namely through data capture from free-text radiology reports
[20].
It is also possible the image retrieval based on radiology reports [21] as well as store and retrieve preclinical
molecular imaging data stored in PACS [22].
Also in the scope of collecting information stored in PACS, it is possible to index DICOM metadata from
scattered and unstructured files [23]. In this context, Dicoogle [24] is a software framework that enables developers
and researchers to quickly prototype and deploy new functionality taking advantage of the embedded DICOM
services. It allows the realization of two types of data indexing: a hierarchical content indexing of the DICOM
metadata (patient, study, series, image) and a text content indexing (free text query). The results of the indexing
process are stored in a index file, on which the user can perform queries and extract the DICOM metadata of interest.
The development of new methods for access, extraction and analysis of DICOM metadata [12,25], namely of
DICOM metadata belonging to medical imaging studies stored in multiple PACS [26], can be a complementary
strategy to characterize medical imaging department practices, namely the medical imaging procedures [27].
Milton Santos et al. / Procedia Computer Science 138 (2018) 203–208 205
2 Milton Santos et al. / Procedia Computer Science 00 (2018) 000–000
1. Introduction
Currently there are many different information systems in clinical environment, as well as multiple imaging
modalities equipment’s from different manufacturers, that produce huge amounts of data [1].
In medical imaging arena, the Digital Imaging and Communication in Medicine (DICOM) has been used in
multiple scenarios [2,3,4] including Content Base Image Retrieve initiatives [5]. On the other hand, DICOM
metadata stored in medical image repositories can be a valuable source of information for professional practice
characterization and can be used in efficiency metrics for productivity assessment [6], or to provide data for different
initiatives as is the case of the development of medical imaging performance indicators [7,8] or biomedical research
[9].
However, the enormous amount of data, as well as the diversity of informational environments, poses some
difficulties to the access, indexing and usage of DICOM metadata [10,11], which turns relevant the development of
tools and methods for the extraction, processing, delivery and analyses of large volumes of DICOM metadata. In this
scenario, the development of tools like Dicoogle [12] can provide important assets.
The objective of the study reported in this paper was to identify the potentialities and challenges associated to the
indexing and analyses of the information contained in the DICOM header belonging to medical imaging studies,
stored in Picture Archiving and Communication Systems (PACS) of different healthcare facilities. For that the
Dicoogle application was used.
2. Background
The interest in the potential of the tremendous amount of information that is produced on a daily basis in the
hospital environment is not new. The reasons for this interest have been changing over time, much due to a constant
healthcare differentiation. Along with the information from Electronic Health Records (EHR), multidimensional data
from genomic, transcriptomic, proteomic, metabolomic, and microbiomic measurements, but also from medical
imaging modalities has been contributing to the Big Data phenomenon [13].
The management of large volumes of information is useful if good practices are adopted when using new
technologies according to quality standards, associated with interoperable storage strategies and promoting the
adoption of advanced computing solutions for data analyses [14].
Regarding the EHR data, these can be used for different purposes. However, the data extraction from EHR
systems to be used in the scope of clinical and translational research is not a trivial process, which has promoted the
development of multiple strategies and technological solutions over time [15].
Some of these solutions were developed to extract data from medical reports, including unstructured information,
often supported in Natural Language Processing (NLP) [16,17]. The use of NLP has been evident in multiple
scenarios namely in the identification of cases of cancer [18] or within medical imaging departments [19]. In
medical imaging environment, NLP can be useful to identify clinical syndromes and common biomedical concepts
related to the clinical situation under investigation, namely through data capture from free-text radiology reports
[20].
It is also possible the image retrieval based on radiology reports [21] as well as store and retrieve preclinical
molecular imaging data stored in PACS [22].
Also in the scope of collecting information stored in PACS, it is possible to index DICOM metadata from
scattered and unstructured files [23]. In this context, Dicoogle [24] is a software framework that enables developers
and researchers to quickly prototype and deploy new functionality taking advantage of the embedded DICOM
services. It allows the realization of two types of data indexing: a hierarchical content indexing of the DICOM
metadata (patient, study, series, image) and a text content indexing (free text query). The results of the indexing
process are stored in a index file, on which the user can perform queries and extract the DICOM metadata of interest.
The development of new methods for access, extraction and analysis of DICOM metadata [12,25], namely of
DICOM metadata belonging to medical imaging studies stored in multiple PACS [26], can be a complementary
strategy to characterize medical imaging department practices, namely the medical imaging procedures [27].
Milton Santos et al. / Procedia Computer Science 00 (2018) 000–000 3
3. Materials and Methods
A secondary analysis was performed on the results of a set of research studies supported on the indexing of
DICOM metadata from the PACS of different healthcare facilities, using the Dicoogle application as a DICOM
metadata indexing tool. The analysis was made according to two perspectives: i) advantages of indexing and
analyzing DICOM metadata from PACS; and ii) challenges associated to the indexing and managing of large
volumes of DICOM metadata.
4. Results
Eight research studies reporting the indexing of DICOM metadata from the PACS of four different healthcare
facilities were analyzed [10,11,26,27,28,29,30,31]. The number of healthcare facilities covered by the studies varied
between one [28] and four [11].
The metadata indexing strategies began with the installation of Dicoogle on a personal computer [26,27,28,30] or
on virtual machines belonging to the healthcare facilities [10,11,27,31]. Regarding indexed metadata volume, it
ranged between 250 GB [28] and 34.2 TB [11], which had an impact on indexing time, ranging from 16.5h [28] to
86 days [11].
Some of the studies characterize comparatively the DICOM metadata stored in two PACS [26,30]. Regarding the
amount of data used, the studies were supported in all metadata resulted from the indexing process [10,11,29,26,28],
or in a subset of the initial DICOM metadata sample, which was defined according to the objectives of each study
[28,30,31]. For example, in [31], from an initial sample of 1274927 images, only 26233 images were selected and in
[30], from an initial sample of 69041 patients with 210582 studies and 351248 images, a final sample of 1757
patients was selected and the metadata of 2047 studies and 8087 images were analyzed.
4.1. Advantages Associated to the Indexation and Analysis of DICOM Metadata from PACS
Regarding the possibility of characterizing medical imaging stakeholders and population using DICOM metadata,
it is possible to identify patients and make their characterization by age and gender [27,28,31] in different imaging
modalities [28,30,31] but also to characterize healthcare provision [26,29]. The possibility of identifying different
medical imaging stakeholders can be significant for increasing the effectiveness and efficiency of the procedures.
The exchange of information between doctors and other professionals as well as with the patients presupposes that
they are correctly identified, namely to clarify the clinical situation of triggers the performance of imaging
procedures. On the other hand, the knowledge of the population with studies performed, may be useful for the
identification of the population predisposition to a particular pathology, or clinical situation, according to their age,
gender or clinical history.
Concerning the individual and population exposure characterization, the DICOM metadata indexed from PACS
seems to allow the exposure analysis in multiple scenarios. In a patient-oriented approach, it is possible to
characterize the patient´s radiation exposure history [27] and to identify situations representing inappropriate
exposure [28,30,31]. In fact, knowledge of the history of exposures to ionizing radiation may be useful for the
definition of other strategies that do not involve the enhancement of studies of modalities that do not require ionizing
radiation (e.g., ultrasound or magnetic resonance studies).
In a population-orientation approach, it is possible to characterize population with imaging studies performed in
different modalities [28,26] and to analyze the average number of imaging studies performed on the patients, age
groups and modalities [27,30].Considering the analysis of the material and human resources, it seems to be possible
the identification of the professionals who carry out the imaging studies [29], the identification of the studies carried
out on a specific equipment [26,30], and the identification of the imaging studies carried out on different modalities
and over time [10,26,28,30], making possible the professional practice analysis and being able to contribute to
human and material resources usage optimization. In terms of the analysis of performance and optimization, it seems
possible to identify contributions for the improvement of professional practice, regarding the optimization of
resource utilization [25] [15], procedures [28,30,31] and individual and population radiation protection [27].
206 Milton Santos et al. / Procedia Computer Science 138 (2018) 203–208
4 Milton Santos et al. / Procedia Computer Science 00 (2018) 000–000
On the other hand, the analysis of the DICOM metadata can contribute to a better knowledge of the information
acquisition and storage needs, which can contribute to a better PACS information management, as well as a better
knowledge of all the infrastructure requirements to support the storage of the enormous amount of information
produced by medical imaging modalities in daily practice [10], particularly in the context of modalities such as
computed tomography and magnetic resonance imaging.
4.2. Challenges Associated with Indexing and Managing Large Volumes of Metadata
The use of Dicoogle in a clinical setting does not appear to promote limitations in PACS usage during daily
activity. At two healthcare facilities, the indexing of metadata was achieved without significant constraints, even in
situations where the PACS supplier gave no cooperation [25]. This scenario has demonstrated in a paradigmatic way
the potentialities and advantages of indexing metadata for DICOM data mining initiatives. The possibility of
accessing DICOM metadata without resorting to the equipment and information systems manufacturers, and without
altering the stored data, can be an advantage for the analysis of the metadata stored in different PACS, regardless of
their geographic location.
In addition, the existence of information systems and equipment from multiple manufacturers did not cause
constraints on access and indexing of metadata [28]. Depending on the included research studies, large amounts of
metadata were indexed, from 265 GB [28] to 34.2 TB [11]. As a result of the indexing of PACS with different
dimensions, large index files [10,11], associated with indexing times from 16,5h [28] to 86 to 86 days, were
produced [11]. However, the adoption of efficient storage, merging, and information extraction strategies mitigated
the computational and storage limitations associated with the management of large amounts of data.
In some of the included research studies, it was necessary to merge the information that results from the indexing
of the metadata stored on different disks that are part of the PACS [10,11,26], namely using a spinoff application of
the Dicoogle, which allowed the metadata aggregation and normalization [11].
Regarding the quality of the metadata, they seem to be very dependent on the DICOM attributes available in
different medical imaging modalities [10], as well as their percentage of use [10,28,29]. For example, the number of
DICOM attributes publicly available for the characterization of medical imaging stakeholders (e.g. institution,
manufacturer, or healthcare professionals) can range from 20 in Computed Radiography to ten in the Radio
Fluoroscopy modality [29]. This fact may become limiting to the need for healthcare delivery, namely in the
communication between different stakeholders (e.g., between different physicians and health professionals and
patients) as well as to define the best imaging strategy to clarify the clinical problem to be resolved.
On the other hand, some DICOM attributes although used, have unexpected values, namely related to the Patient
ID and Referring Physician Name DICOM attributes [28,29], or related to the Institution Name DICOM attribute.
Therefore, the DICOM attributes that characterize the patients, or the healthcare professionals have different
completion levels [10,29].
5. Conclusion
The research studies analyzed revealed the potential for the use of DICOM metadata, but also challenges
associated with indexing and managing large volumes of metadata, namely identification of medical imaging
stakeholders, computational needs and information management, quality of DICOM metadata, analyses of individual
and population exposure and the use of human and material resources.
Furthermore, it was possible to adopt efficient mechanisms to acquire and process the DICOM metadata without
impact in the performance of the PACS during daily activities. However, there are constrains in terms of the quality
of the available DICOM metadata.
The possibility of acquiring information on imaging studies carried out on a population, in a way that does not
constrain the provision of health care, can be a valuable asset for the medical imaging practice continuous
improvement. On the other hand, the possibility of DICOM metadata statistical analysis makes its use feasible and
potentially advantageous in multiple scenarios, such as in the definition of patient-centered care strategies, but also
in medical translational and multidimensional research.
Milton Santos et al. / Procedia Computer Science 138 (2018) 203–208 207
Milton Santos et al. / Procedia Computer Science 00 (2018) 000–000 5
The studies included in the analysis reported in this paper, do not provide evidence of use of the indexation of
metadata embedded in DICOM Structured Reports (DICOM SR). This specific question will be object of future
research.
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