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Now up and running, the Pukka-J solution for image viewing, archiving and distribution is fulfilling a key role within the Trust. At the same time the archiving solution provided to the Royal Sussex County Hospital prepares the Hospital for PACS, with all CT, MRI PET and NM image being stored direct to the Trust’s existing SAN. The Trust will be deploying NPfIT PACS in the very near future and the Pukka-J storage system will be utilised for specialist areas such as Oncology and On-call reporting.

At the Royal Sussex, Pukka-J’s web browser product for teleradiology: Dicom Explorer is used primarily for the distribution and display of medical images (CT, MRI PET and NM), for Radiology, Oncology, A&E, Neurological Services and Renal Medicine Departments. Images can also be shared with other hospitals within the Trust, including the Sussex Cancer Centre and Princess Royal Hospital, Haywards Heath. Pukka-J’s PACSPost allows on-call consultants to pick up images from a secure site immediately, view remotely and provide a 24/7 “on call” reporting service, including emergency reporting on CT and MRI images.

Dr. Graham Dodge, Lead Consultant Radiologist at the Royal Sussex Hospitals says:

We have been particularly pleased with the image distribution facility, how fast it is, and the fact that my radiological colleagues and I can report on a variety of images from anywhere in the hospital. It also allows clinicians to access images from their clinics and offices. Using PACSPost allows us to view on call-scans securely and reliably from our homes.

The Sussex Cancer Centre, situated in the Royal Sussex County Hospital , Brighton, using Pukka-J’s system, is also able to view images from the Agfa PACS at Eastbourne District General Hospital and The Conquest Hospital, Hastings . Next in line, is a link to images from the Ferrania PACS at Worthing and Southlands Hospital , Worthing . The Centre is a key specialist cancer care organisation providing oncology treatment within the Sussex cancer network area. It serves a population of just over one million people, covering an area stretching from Hastings in East Sussex to Worthing in West Sussex . Hospitals within the network include The Royal Sussex County Hospital, Brighton Royal Hospital , Hayward ‘s Heath Hospital , Worthing and Southlands Hospital , Eastbourne DGH and the Conquest Hospital in Hastings . The main function of the Centre is the provision of both radiotherapy and chemotherapy treatment; the fast and easy access to images via the Dicom Exporer is vital for the efficient and timely diagnosis and treatment of patients.

The winner of Pukka-j’s prize draw at the BNMS meeting in Manchester was Elaine Woods, Trainee Clinical Scientist at the Royal Free Hospital. The prize, which was an iPod player, was presented to Elaine by Dez Wright, Software & Applications Physicist at Pukka-j. The winning entry was drawn by Dr. Rak Ganatra, Chairman of the Scientific BNMS Committee and Consultant Radiologist, Nuclear Medicine Physician & PETCT Specialist at Nottingham University Hospitals.

Shown here are Louise Crossley
(Pukka-j Business Development Director)
with Dr. Rak Ganatra making the draw.

Shown here are Dr Dez Wright
(Pukka-j Software & Applications Physicist)
presenting the prize to Elaine Woods.

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Andrew Hoole, Radiotherapy Physics, Addenbrooke’s Hospital

Addenbrooke’s Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, recently took delivery of a Pukka-j Oncology Image Store and online disaster recovery solution. The Pukka-j Oncology Store forms a single central repository, including an online data backup with dedicated workspace for managing, storing and accessing all oncology-related images.
Pukka-j specialises in Healthcare IT and is committed to DICOM, HL7 and IHE industry standards. The Pukka-j Oncology Store is designed as an open system that allows users to retain their choice of equipment supplier.

As a 1,000 bed teaching hospital, Addenbrooke’s is one of the Government’s new biomedical research centres with a world-class research reputation. It supplies acute and specialist services for the local as well as regional population, with the Oncology Centre providing a service to more than 4,000 new patients each year, from East Anglia and beyond. It offers a highly integrated approach to the management of both common and rare cancers, with specialist facilities that include a computerised treatment planning system for use in radiotherapy, which was recently updated to include full 3-D facilities for conformal therapy. This will soon be linked to the computerised radiotherapy equipment to allow high accuracy of verification and recording of radiotherapy (RT) treatment.
Pukka-j has an established track record in the handling of radiotherapy images, and the provision of simple and elegant solutions for this complex area. Its rule-based software facilitates an automated workflow between the modalities and workstations within the Oncology department, being able to handle all RT images, as well as allowing for the intercommunication between multiple-vendor systems.
The Pukka-j system is based on DICOM RT, an extension of DICOM, the industry-wide norm for PACS. DICOM RT has been developed specifically for handling radiotherapy modalities and as such is the standard for integrating the specific imaging systems and modalities employed within RT departments. It includes the provision of the specifications for transferring medical images and related information, while emphasising cross-vendor connectivity through the use of standardised protocols. Developed to suit the particular needs of radiotherapists, DICOM RT includes in its scope RT Image for all normal RT imaging (including simulator images and portal images); RT Plan, which contains the geometric and dosimetric data for courses of external beam treatment or brachytherapy; RT Structure Set, which includes patient-related structures identified from diagnostic data; RT Dose for dose distributions from the planning system and dose matrix, and RT Treatment Record, which records all data from the treatment summary.
The hospital is enthusiastic about the new facility. Andrew Hoole, of the Medical Physics and Clinical Engineering Department at Addenbrooke’s comments:

Pukka-j impressed staff at the hospital, not only when the company presented their initial plans, but also when the working relationship developed. Pukka-j’s ability to work with us in developing a system that is tailored to suit the needs of the Radiotherapy Department, including their response to feedback and actions to help develop the solution reinforced our first impressions. The installation itself went remarkably easily. All of the different modalities in the centre were quickly configured to utilise the server as a central store. We are looking forward to exploiting the additional features of the system to streamline our process.

The online disaster recovery solution that was also provided by Pukka-j will give the Centre a resilient back-up system, using the company’s unique DICOM mirror software. Data is automatically backed-up so that should a failure occur, the mirrored DICOM Server prevents loss of data and workflow.
The Oncology Centre itself serves the western districts of the Eastern Regional Health Authority with the Regional Cancer Centre at Cambridge being linked with cancer units at several hospitals in the region, where many of the Oncology Centre’s consultants and other staff run sessions.
Within the Radiotherapy Department at the Centre a full range of equipment is offered for the treatment of cancer, including five linear accelerators, a dedicated CTR scanner, an orthovoltage unit and two simulators. A full brachytherapy service for sealed and unsealed source treatments, including a medium dose rate selectron for gynaecological treatment and an iodine suite for thyroid conditions is also available. In addition, Radiotherapy Physics, part of the Medical Physics and Clinical Engineering Department at the Hospital, provide the physics support to the Oncology Centre. As well as measurement and calibration to ensure the delivery of accurate doses of radiation within National protocols, they cover a number of specialised areas, such as the production of computerised treatment plans for individual patients

Staff R T1, Murray A D2, Ahearn T S1, Counsell C E3, Taylor K3, Wilson K4, Gemmell H G1. University of Aberdeen and Aberdeen Royal Infirmary; 1Department of Bio-Medical Physics and Bio-Engineering, 2Department of Radiology, 3Department of Medicine and Therapeutics. 4Pukka-J Limited.

The traditional media of information dissemination used by radiopharmaceutical companies and the nuclear medicine community limits the support given to users of fpcit. The distribution of glossy sales brochures and academic publications, although useful, cannot raise competence to the level that only comes with viewing large numbers of images.
We have designed and built a web-based archive that enables users to view a large cross-section of images from a range of sources. Images and clinical data are contained in the site along with interpretations of the data from experienced users. The site contains mining tools that enable users to interrogate the archive. For example, ‘Show me images of those subjects in the archive that have a specific clinical presentation’. Alternatively the site allows users, through software bound into the site, to search for images with specific characteristics, for example uptake, shape and size.

Data mining

Presentation mining
I have a patient with a particular set of presentation characteristics. Show me images of a patient in the database with a similar set of characteristics.
The site has a series of windows that allow users to look at images with a specific presentation characteristic. One of these windows is shown in Figure 1.

Figure 1:
A window from the presentation mining section of fpcit.net.

 
Image mining
I have a set of patient images with a particular appearance. Show me images of patients in the database that look like this.
The site allows users to interrogate the imaging archive base on a number of imaging characteristics. For example show me images that have a caudate to background ratio of X calculated using a particular software approach. Figure 2 shows a particular software approach which comes as part of the Quantispect software and measures the ratio of the striatum to the occipital cortex.

Figure 2: The regions of interest used to quantify the striatum to background ratio.

Semi quantitative techniques such as this do not produce ideal discrimination between Parkinsonian and non Parkinsonian patients. There is also some discrepancy between the visual interpretation and the semi-quantified value. Figure 3 shows a box plot of the visual interpretation and the quantified value.

Figure 3: Plot of semi quantified uptake and visual classification

The site also uses a pattern recognition technique to identify similar images. Image data can be uploaded to the site, processed on-line, and compared to the database. Figure 4 shows how the size and shape are extracted.

Figure 4: Extracting the size and shape from each striatum
NS/EW RATIO

Figure 5: Plot of shape measure and visual classification. The NS/EW ratio is the ratio if the length of the longest to the shortest axis.
SIZE AREA

The relationship between each shape measure and the visual classification is shown in Figure 5. Using a combination of shape and size and a nearest neighbor technique for classification the software had a kappa statistic of 0.91 when compared to an experienced observer.
Although this site is based around fpcit its structures and concept are generic for new imaging radiopharmaceutical techniques. fpcit.net provides a data archive and image processing tools that can aid any new users to ascend the learning curve. It is free, and has a powerful connectivity tools which enables it to be used with data acquired from any system.