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Open Three (O3) Consortium

Open Source+Open Standard
(IHE)+Open Knowledge (MIRC)

RSNA 2006
Educational exhibit
R Stramare, MD, A Castellini, G Feltrin,
MD, P Inchingolo*, C Saccavini, PhD, G
University of Padova
*University of Trieste
Exhibit Outline

The goal is to realize an open source solution based on

Open Source technology, Open Standard, such as
IHE, and Open Knowledge such us MIRC.

We have developed a solution that is formed by IHE

actors into a four packages: O3-MARiS, that is a RIS
system based on php/Apache/MySQL, O3-DPACS,
that is a PACS based on Jboss/PostgreSQL, O3-
RWS. that is a reporting workstation based on Java,
and O3-FatBrother, that is an Audit Record Repository

Exhibit Outline

It is very important to notice that all the packages can

export/import radiologial data in MIRC format, and an
O3-MIRC site has active since October 2005 in
Padova University

The goal of the Open Three (O3) Consortium is to

promote an Integrated Healthcare Environment for
archiving, transmission, exchange, retrieval and
visualization of data, signals, images and reports, in
which the three dimensions of the Health Policies -
Hospitals, Territory / RHIOs and Home Care / Ambient
Assisting Living (AAL)) are linked together.

Open Source

The basic idea behind open source is very simple:

when programmers can read, redistribute, and modify
the source code for a piece of software, the software
evolves. People improve it, people adapt it, people fix
bugs. And this can happen at a speed that, if one is
used to the slow pace of conventional software
development, seems astonishing.
Some consider it as a philosophy, and others
consider it as a pragmatic methodology.

Creative Commons

The Creative Commons (CC) enables copyright

holders to grant some of their rights to the public while
retaining others through a variety of licensing and
contract schemes including dedication to the public
domain or open content licensing terms. The intention
is to avoid the problems current copyright laws create
for the sharing of information.
The CC is a non-profit organization devoted to
expanding the range of creative work available for
others legally to build upon and share.

Open Standards

Open standards are publicly available and

implementable standards. By allowing anyone to
obtain and implement the standard, they can increase
compatibility between various hardware and software
components, since anyone with the necessary
technical know-how and resources can build products
that work together with those of the other vendors that
base their designs on the standard.

Open Standards: IHE

IHE is an initiative by healthcare professionals and

industry to improve the way computer systems in
healthcare share information.

Systems that support IHE Integration Profiles

communicate better, are easier to implement, and
enable care providers to use information more
effectively. The goal is efficient delivery of optimal
patient care.

Open Knowledge: MIRC

The MIRC project was initiated by the RSNA

Radiology Informatics Committee to construct a
library of medical information, globally accessible to
the imaging community through the Internet. The
project has evolved to support communities of
cooperating libraries, individually managed by
healthcare and educational institutions, whose content
can be accessed by a user as if it were a single

Our Project

We try to insert in a real-world radiology the Open

Source metodology, the Open Standard approach
and the Open Knowledge Management to realize a
simple radiological report workplace in which there

PACS archive


MIRC Server

Dpt. Medical and Diagnostic Sciences Layout


General Hospital Private University Hospital

Padova MIRC Server Padova

Public MIRC

The MARiS-OF is a RIS developed using IHE

architecture. It is based on Apache/PHP server and
the GUI is realized using CSS approach. The
dababase can be MySQL, PostgreSQL or Oracle. All
DICOM and HL7 services are developed using
dcm4chee libraries.
 The website is

MARiS technical architecture

O3-DPACS: the OSS Image Manager

The O3-DPACS open-source DPACS is an image-

data manager/archiver. It’s a Java J2EE (Java 2
Enterprise Edition) Application developed on JBOSS,
an open source application server, but it runs on
nearly every application server as the concept of
platform independence states. It has been realized as
a modular collection of services.
This server is implemented in the Padova General
The website is

O3-DPACS technical architecture

DCM4CHEE: the OSS Image Manager

dcm4chee is an Image Manager/Image Archive

(according to IHE). The application contains the
DICOM, HL7 services and interfaces that are required
to provide storage, retrieval, and workflow to a
healthcare environment. By taking advantage of many
JBoss features , and assuming the role of several IHE
actors for the sake of interoperability, the application
provides many robust and scalable services
This server is implemented in the Padova University
The website is

RWS: the OSS Image Display

This workstation has been developed thinking upon

radiology department needs, with strong feedback
from radiologists. It gives the support for the
integration with the open source RIS (MARIS-OF).
IHE profiles that was be tested at IHE Europe
Connectathon 2006:
SWF Scheduled Workflow
CPI Consistent Presentation of Images
KIN Key Image Notes

The website is

RWS: the OSS Image Display

RSNA MIRC software: the OSS MIRC server

There are several ways for an individual or an

institution to establish a system that can participate in
a MIRC community:
The RSNA MIRC software provides both a query service
and a storage service as well as support for the MIRC-
defined authoring format.
An existing teaching file system can be modified to use
its internal database to provide an index of its documents,
requiring only the construction of the software layer
necessary to respond to a MIRC query.
Some commercial teaching file systems also support the
MIRC query mechanism, allowing them to participate in a
MIRC community.

The website is

MIRC case Workflow

The Modality produces images

and store to PACS server

The resident or junior radiologist

prepare the report

The senior radiologist validate

the report and decide if it is
interesting for MIRC publication

The editorial board of

postgraduated School of
Radiodiagnostic decide if to
publish the case on public MIRC

MIRC case consumer during reporting

The Modality produces images

and store to PACS server

The resident or junior radiologist

retrive image on workstation

He queries MIRC servers to find

similar images or interesting
teaching files

Private MIRC site: simple resident case

Private MIRC site:
example of Resident’s vs Fellow’s Report

Private MIRC site:
example of Resident’s vs Fellow’s Report

Public MIRC site

Public MIRC site: clinical case

Public MIRC site: historical clinical case


The Knowledge Management in Radiodiagnostic

using Open Source + Open Standard + Open
Knowledge are very interesting especially in
University Hospitals, because:
Present and future Residents will benefit of their
historical errors.
Resident’s reading error tracking
Teaching quality control
Training effectiveness.

The flexibility of Open technologies will open new

approaches in Diagnostic Imaging Management, in
particular with the image comparison not only with
previous examinations, but also with “similar” ones