5 ms·

That reminded me about story my friend told me some time ago. He's IT specialist in hospital, they were having some problems with x-ray machine with server base

That reminded me about story my friend told me some time ago. He's IT specialist in hospital, they were having some problems with x-ray machine with server based on windows XP and thin clients as viewing stations. Eventually it was replaced with debian based workstations and haven't look back ever since. After this he told me about interesting case with it, there was patient complaining about middle foot pains, on previous setup x-ray photos showed nothing, after switching to debian workstations they were using aeskulap dicom viever (http://aeskulap.nongnu.org/index.html http://aeskulap.nongnu.org/index.html) which had more adjustments for viewing those files, like hue, saturation, color and so on, so after opening those photos with aeskulap and fiddling a bit with parameters it clearly showed that patient has broken bone in foot but in unweighted position it was almost invisible line on black and white default viewer.

deleted 11y ago
[deleted]
dorfsmay 11y ago
I agree that we should be using using open / standard format for data and images, but no general rule can be deducted from the fact that one particular FOSS software was better than a particular proprietary software, and in this particular case it looks like which OS they were running on had nothing to do with the better diagnostic.
- radoslawc 11y ago
  To make it shorter I've omitted part about OS, generally there was something about this XP box that it was resetting connections randomly, then restarting if it couldn't reach some number of workstations, workstations were thin clients, so sometimes data was lost etc. Support was blaming networking, networking guys x-ray machine server and so on. Finding Aeskulap viewer was byproduct of using linux on server and workstations.
irremediable 11y ago
Stuff like this shows the gulf between research and clinical practice. I'm doing a PhD in medical imaging, and we have carte blanche to run whatever we want. We generate a lot of amazing visualisations. But almost all hospitals are stuck running out-of-date software that wasn't even good when it was released.
- phodo 11y ago
  How does a healthcare system or private clinic acquire such software? What is the solution? Are the bottlenecks monetary, political, access?
  - irremediable 11y ago
    Good questions, and I don't claim to fully know the answers. Some such software is released open-source, e.g. NifTK, FSL, MedINRIA. Some is spun out and then sold through vendors as a service, e.g. Siemens, icoMetrix, many others. Why aren't things used more? I'd say the main bottlenecks are monetary, political and cultural. Doctors are often set in their ways, and hospital management staff are risk-averse. Moreover, because of legal liability issues, a lot of this stuff has not been formally approved for clinical use -- so hospitals won't touch it. This is especially true of the open-source software. Getting approved is an expensive and time-consuming process. Service contracts with approved software are expensive, mostly as a result of this. Heck, look at the struggle involved in digital patient records, which is supposedly a simpler problem than imaging. In the UK, we've spent billions on that without getting anything usable. There are uniquely bad political reasons for that, but it's illustrative nonetheless.
johnchristopher 11y ago
So basically doctors were missing fractures because they couldn't fiddle with hue, saturation and colors on the image viewer ? That's fucked up.
- acveilleux 11y ago
  Colors don't apply to X-Ray (if you see color, it's just a gradient with a color scale.) Any half competent clinical DICOM viewer will have a full set of intensity windowing tool. Anything that doesn't should have it's authorization to market revoked (i.e.: FDA 510(k)).

deleted 11y ago

[deleted]

dorfsmay 11y ago

I agree that we should be using using open / standard format for data and images, but no general rule can be deducted from the fact that one particular FOSS software was better than a particular proprietary software, and in this particular case it looks like which OS they were running on had nothing to do with the better diagnostic.

radoslawc 11y ago
To make it shorter I've omitted part about OS, generally there was something about this XP box that it was resetting connections randomly, then restarting if it couldn't reach some number of workstations, workstations were thin clients, so sometimes data was lost etc. Support was blaming networking, networking guys x-ray machine server and so on. Finding Aeskulap viewer was byproduct of using linux on server and workstations.

irremediable 11y ago

Stuff like this shows the gulf between research and clinical practice. I'm doing a PhD in medical imaging, and we have carte blanche to run whatever we want. We generate a lot of amazing visualisations. But almost all hospitals are stuck running out-of-date software that wasn't even good when it was released.

phodo 11y ago
How does a healthcare system or private clinic acquire such software? What is the solution? Are the bottlenecks monetary, political, access?
- irremediable 11y ago
  Good questions, and I don't claim to fully know the answers. Some such software is released open-source, e.g. NifTK, FSL, MedINRIA. Some is spun out and then sold through vendors as a service, e.g. Siemens, icoMetrix, many others. Why aren't things used more? I'd say the main bottlenecks are monetary, political and cultural. Doctors are often set in their ways, and hospital management staff are risk-averse. Moreover, because of legal liability issues, a lot of this stuff has not been formally approved for clinical use -- so hospitals won't touch it. This is especially true of the open-source software. Getting approved is an expensive and time-consuming process. Service contracts with approved software are expensive, mostly as a result of this. Heck, look at the struggle involved in digital patient records, which is supposedly a simpler problem than imaging. In the UK, we've spent billions on that without getting anything usable. There are uniquely bad political reasons for that, but it's illustrative nonetheless.

johnchristopher 11y ago

So basically doctors were missing fractures because they couldn't fiddle with hue, saturation and colors on the image viewer ? That's fucked up.

acveilleux 11y ago
Colors don't apply to X-Ray (if you see color, it's just a gradient with a color scale.) Any half competent clinical DICOM viewer will have a full set of intensity windowing tool. Anything that doesn't should have it's authorization to market revoked (i.e.: FDA 510(k)).