The invention comprises a system and method for integrating electronic patient information with an electronic medical image file. In one embodiment, at least one information processor is provided that is operable to communicate over a communication network. A database is provided on the at least one information processor, wherein the database is operable to store electronic patient information representing a plurality of patients, and further to store respective image files representing patient medical examinations. A receiving module is preferably included that receives an image file representing a patient medical examination. The image file is preferably formatted with a respective filename. Also, a converting module is provided that is operable to convert the image file to be associated with at least one tag, wherein the converting module refers to at least the respective filename to associate the image with the tag(s), and further the tag(s) are associated with the image file to associate the medical image record with the electronic patient information for a respective patient. A storage module is further operable to store the converted image to the database. Preferably, the modules operate substantially without human intervention.
The present application is based on and claims priority to U.S. Provisional Patent Application Ser. No. 60/655,331, filed on Feb. 22, 2005 and entitled SYSTEM AND METHOD FOR INTEGRATING ANCILLARY DATA IN DICOM IMAGE FILES, U.S. Provisional Patent Application Ser. No. 60/661,773, filed on Mar. 15, 2005 and entitled SYSTEM AND METHOD FOR INTEGRATING ANCILLARY DATA IN DICOM IMAGE FILES (II)," and U.S. Provisional Patent Application Ser. No. 60/670,326, filed on Apr. 12, 2005 and entitled "SYSTEM AND METHOD FOR INTEGRATING ANCILLARY DATA IN DICOM IMAGE FILES (III)," the entire contents of all of which are hereby incorporated by reference.
The present invention relates, generally, to medical image records, and, more particularly, with providing DICOM image files with medical information received from at least one or more sources.
The Digital Imaging and Communications in Medicine (DICOM) standard was created by the National Electrical Manufacturers Association (NEMA) for improving distribution and access of medical images, such as CT scans, MRI and x-rays. Accordingly, contemporary medical imaging uses the DICOM image format for the transport and storage of medical images. The DICOM image format arose in an attempt to standardize the image format of different machine vendors (i.e., GE, Hitachi, Philips) to promote compatibility such that machines provided by competing vendors could transmit and receive information between them. This original goal for the DICOM format has achieved varying degrees of success.
Over time, the DICOM standard has become the de-facto standard for the format used for medical images that are electronically transferred from one place to another. DICOM files have found particular use in the field of teleradiology. As used herein, the term "teleradiology" refers to, generally, the practice of reading a medical image at a location that is remote from the location where a medical examination was performed, or where the medical image related to the examination was acquired. Typically, the image is electronically transferred to the location where it is eventually read.
Teleradiologists (i.e., physicians who read and/or interpret medical images at a remote location) have encountered a major obstacle regarding images formatted according to the DICOM standard. Accurate interpretations of medical images require that the radiologist be aware of related patient information submitted by the referring physician. For example, a radiologist requires information regarding the patient's medical history, and perhaps information regarding the technologist and/or physician who performed the medical examination. The radiologist (and patient) will also benefit from having the referring physician's address, telephone and fax information readily available in order to communicate urgent findings or for use in secondary data feeds, such as the known Health Level 7 ("HL-7") protocol. As known to those skilled in the art, HL-7 is a standardized data protocol for data transmitted within the healthcare industry. Unfortunately, such information is not typically available and teleradiologists often encounter an obstacle because they cannot interpret patient examinations accurately in a vacuum.
In the prior art, the DICOM image format provides for the entry of brief patient histories, usually by the technologist, and may also provide a patient work-list by the technologist that includes patient history and/or physician information. However, in practice, such information is often not provided or used as intended. This occurs, typically, because technologists who are time-constrained, tend to omit data entry tasks that they perceive as overly time-consuming, and they rationalize that the radiologist who eventually reads and interprets the medical image(s) already has or can gain access easily to the patient's chart should the radiologist require more information than provided in the DICOM file. Unfortunately this assumption is often false, especially in a teleradiology practice, when the patient's chart may be located hundreds or thousands of miles from the location where the teleradiologist actually interprets the medical image and/or examination.
Solutions to problems associated with a teleradiologist requiring more information than is provided in a DICOM file have, for the most part, taken the form of faxing or scanning handwritten clinical data (i.e., paperwork) to the teleradiologist. In the case of scanning, paperwork is typically entered in a flatbed or sheet-fed scanner and the scanned, electronic image(s) of the paperwork is uploaded to a computer, such as to a server configured to receive files via the file transfer protocol ("FTP"). The scanned paperwork can then be transmitted to a remote computer and made available to the teleradiologist.
Unfortunately, such prior art solutions are cumbersome and often untenable, especially in cases involving more than just a few patients. Accordingly, some prior art software vendors providing DICOM files have incorporated some type of image capture software in their software packages that provides for scanning, and electronically integrating the scanned material into the DICOM image file. This prior art software, however, is typically designed for capturing secondary medical images, and not paperwork. Also, such software can be quite cumbersome to use and require many complex steps. Further, technologists who operate medical image software programs vary widely in their abilities to use difficult software. Many are unable to use the software successfully for various reasons, including respective skill levels.
Most teleradiologists agree that an ideal scenario involves the simultaneous viewing of hand-written paper data when medical images are being viewed and interpreted. This is preferred over reviewing paper data, not as a separate task. To date, little has been done to facilitate this goal.
The foregoing illustrates the need for a system and method that automatically generates DICOM files comprised of information provided in non-digital paperwork and patient histories submitted by the patient and referring physician to the radiologist. Further, the invention preferably integrates DICOM files with ancillary information, which may otherwise be absent from an original DICOM image file such as provided by the referring physician name and address.
A system and method is further provided that enables a user to easily select from a list of patients, and that converts files from a first format, such as the Joint Photographic Experts Group ("JPEG") format, to a DICOM format using DICOM tags and data of the selected patient's imaging examination to "marry" this information to the imaging examination. A system and method is further provided that that runs in an automatic mode, without substantial user intervention and without requiring any special equipment such as a flatbed scanner, but rather uses readily available equipment such as a fax machine, to directly integrate patient (e.g., medical) information into the DICOM image examination.
Accordingly, the present invention comprises a system and method for integrating electronic patient information with a medical image file. In one embodiment, at least one information processor is provided that is operable to communicate over a communication network. A database is provided on the at least one information processor, wherein the database is operable to store electronic patient information representing a plurality of patients, and further to store respective image files representing patient medical examinations. Moreover, a receiving module is preferably included that is operable to receive over the communication network an image file representing a patient medical examination. The image file is preferably formatted with a respective filename.
Also, a converting module is provided that is operable to convert the image file by associating the image file with at least one tag, wherein the converting module refers to at least the respective filename to associate the image with the tag(s). The tag(s) are associated with the image file to associate the medical image record with the electronic patient information for a respective patient. A storage module is further operable to store the converted image to the database. Preferably, the modules operate substantially without human intervention.
In alternative embodiments, the receiving module is operable to receive electronic textual information, and an adder module is operable to integrate the electronic textual information with the image file. Also in an alternative embodiment, a fax module is operable to receive a fax cover page that comprises a bar code that is read by the fax module, and used to associate electronic information in pages following the fax cover page with the image file.
In still alternative embodiments, a display module is provided that enables a user to review the image file integrated with the electronic textual information. Further, a graphical user interface is preferably provided that enables a user to supply parameters to the modules, and to invoke the modules.
FIGS. 11A-11F illustrate example display screens and reports that are provided in accordance with an internet, web-based embodiment of the present invention.
The present invention comprises a system and method for incorporating paperwork/handwritten (analog) clinical patient information into digital DICOM image files for interpretation by the radiologist or other physician. In an example embodiment, the present invention comprises a suite of software modules which reads and incorporates paperwork/handwritten (analog) clinical patient information directly integrating them into the DICOM image examination files.
In an example embodiment of the present invention, patient demographic information is output as a separate file after a patient examination file is acquired by a DICOM server. This output file comprised of key available DICOM tags, contains demographic information of the patient along with detailed information regarding the examination itself. A key indexing number, for example, labeled the "Study UID" number, is preferably included among these DICOM tags in the output file. The present invention imports the output file from either a remote FTP site or a local folder, either in an automated fashion, or by user intervention with a GUI. Of course, one skilled in the art will recognize that other methods and locations for transferring and/or receiving electronic files are known, and are envisioned in the present invention. The present invention differs from prior art methods in its ability to utilize the DICOM tags, and in particular, the STUDY UID tag, and to have the analog data become a part of the original DICOM image examination, rather than merely an attachment to it.
Referring to the drawings, in which like reference numerals refer to like elements, FIG. 1 shows an example hardware arrangement in a preferred embodiment of the present invention and referred to generally as system 10. In the embodiment shown in FIG. 1, system 10 comprises at least one information processor 2 configured to operate as an internet web server and/or file transfer protocol server ("FTP") that is operable to access and update a database 8. Information processor 2 preferably accesses communication network 6 and communicates with user terminals 4. Preferably, user terminals 4 and information processor(s) 2 communicate via the known communications protocol, Transmission Control Protocol/Internet Protocol "TCP/IP." In this way, content can be transmitted to and from the devices 2 and 4, and commands can be executed to enable the various functions described herein.
Information processors 2 and user terminals 4 are any devices that are capable of sending and receiving data across communication network 6, e.g., mainframe computers, mini computers, personal computers, laptop computers, a personal digital assistants (PDA) and internet access devices such as Web TV. In addition, information processors 2 and user terminals 4 are preferably equipped with a web browser, such as MICROSOFT INTERNET EXPLORER, NETSCAPE NAVIGATOR, MOZILLA FIRREFOX or the like. Thus, as envisioned herein, information processor 2 and/or user terminals 4 are devices that can communicate over a network and can be operated anywhere, including, for example, moving vehicles.
In a preferred embodiment of the present invention, various kinds input devices and output devices are utilized by system 10. Although many of the devices interface (e.g., connect) with a computer, it is envisioned herein that many of the device can operate without any direct connection to a computer. With reference to FIG. 1, scanner 3, fax machine 7 and voice recognition device 9 are operable to provide data to information processor 2. Further, printer 5 and fax machine 7 are operable to output data. Thus, a plurality of so-called "peripheral" devices are included in system 10 that provide data to and from information processor 2 and user terminal 4.
The nature of the present invention is such that one skilled in the art of writing computer executable code (i.e., software) can implement the described functions using one or more of a combination of popular computer programming languages and developing environments including, but not limited to C, C++, Visual Basic, JAVA, PHP, HTML, XML, ACTIVE SERVER PAGES, JAVA server pages, servlets, MICROSOFT .NET, and a plurality of various web site development applications.
For example, data may be configured in a MICROSOFT EXCEL spreadsheet file, as a comma delimited ASCII text file, as a MICROSOFT SQL SERVER compatible table file (e.g., MS-ACCESS table), or the like. In another embodiment, data may be formatted as an image file (e.g., TIFF, JPG, BMP, GIF, or the like). In yet another embodiment, data may be stored in an ADOBE ACROBAT PDF file. Preferably, one or more data formatting and/or normalization routines are provided that manage data received from one or a plurality of sources. In another example, data are received that are provided in a particular format (e.g., MICROSOFT EXCEL), and programming routines are executed that convert the data to another formatted (e.g., ASCII comma-delimited text).
It is contemplated herein that any suitable operating system can be used on user terminals 4 and information processor 2, for example, DOS, WINDOWS 3.x, WINDOWS 95, WINDOWS 98, WINDOWS NT, WINDOWS 2000, WINDOWS ME, WINDOWS CE, WINDOWS POCKET PC, WINDOWS XP, MAC OS, UNIX, LINUX, PALM OS, POCKET PC or any other suitable operating system. Of course, one skilled in the art will recognize that other software applications are available in accordance with the teachings herein, including, for example, via JAVA, JAVA Script, Action Script, Swish, or the like.
Moreover, a plurality of data file types is envisioned herein. For example, the present invention preferably supports various suitable multi-media file types, including (but not limited to) JPEG, BMP, GIF, TIFF, MPEG, AVI, SWF, RAW or the like (as known to those skilled in the art).
FIG. 2 illustrates the functional elements of user terminal 4 and/or information processor 2 and that include one or more central processing units (CPU) 12 used to execute software code and control the operation of user terminal 4, read-only memory (ROM) 14, random access memory (RAM) 16, one or more network interfaces 18 to transmit and receive data to and from other computing devices across a communication network, storage devices 20 such as a hard disk drive, floppy disk drive, tape drive, CD ROM or DVD for storing program code, databases and application data, one or more input devices 22 such as a keyboard, mouse, track ball, magnetic card reading device, bar code reading device, microphone or the like, and a display 24.
The various components of information processor 2 and/or user terminal 4 need not be physically contained within the same chassis or even located in a single location. For example, storage device 20 may be located at a site which is remote from the remaining elements of information processor 2 or user terminal 4, and may even be connected to CPU 12 across communication network 6 via network interface 18. Information processor 2 preferably includes a memory equipped with sufficient storage to provide the necessary databases, forums, and other community services as well as acting as a web server for communicating hypertext markup language (HTML), FLASH, Action Script, Java, Active Server Pages, Active-X control programs on user terminals 4. Information processors 2 are arranged with components, for example, those shown in FIG. 2, suitable for the expected operating environment of information processor 2. The CPU(s) 12, network interface(s) 18 and memory and storage devices are selected to ensure that capacities are arranged to accommodate expected demand.
As used herein, the term, "module" refers, generally, to one or more discrete components that contribute to the effectiveness of the present invention. Modules can operate or, alternatively, depend upon one or more other modules in order to function.
In an example embodiment, the present invention provides a graphical user interface that includes a drop-down list (or other graphical screen control) of patient names (or other identifiers) for the user to select a patient. After the above-described output file is received, patient information in the output file is extracted and used to populate the drop-down list. The automated version allows a faxed or hand-scanned copy of this paperwork to automatically perform a database lookup for the patient, and automatically associate itself with the DICOM tags for the patient (including the Study UID) and upload itself to become part of the DICOM image examination without user intervention. More specifically, both the manually operated and the automated version of the invention allows an electronic version of the paperwork, for example paperwork that is scanned in a sheet fed or auto-feed scanner, or faxed from a fax machine, to be associated with a particular patient examination, and uploaded to a DICOM server where the imaging examination resides, as part of the imaging examination itself. In other words, the present invention electronically associates and integrates electronic versions of paperwork with one or more medical images. The electronic DICOM file representing the examination is opened by the radiologist (or teleradiologist) or other physician for interpretation, and the clinical patient paperwork displays simultaneously, thereby allowing the viewing of patient information at the same time that the digital medical image(s) are viewed and interpreted.
The present invention preferably includes one or more software modules and/or ancillary software applications. For example, the invention provides a module which auto-uploads data files to a remote DICOM server. Another module functions as a sort of file daemon that monitors one or more locations on a computer system for the existence of a data file. When a data file is discovered, the data are automatically processed and/or uploaded, and converted (if necessary) to the JPEG file format and then processed. For example, a technologist scans paperwork to a Tag Image File Format ("TIFF") file, or faxes paperwork to the file directory, and the modules of the present invention discover the TIFF file, convert it to a JPEG file, and upload it to a server where it is processed for further manipulation, substantially as described herein.
The following discussion regards example software modules, which are represented in the block diagram shown in FIG. 3, and operable in an embodiment of the present invention. The following discussion of example software modules makes reference to example display screens shown in FIGS. 4A-4K. In accordance with a preferred embodiment, many of the screen displays provided by the present invention are formatted as graphical controls, such as textboxes, checkboxes, dropdown lists, pushbuttons, radio buttons or the like. Many of the display screens provided by the present invention are operable as data entry forms, and information provided in the form is preferably stored in database 8. Of course, one skilled in the art will recognize that the example modules and corresponding names are illustrative, and that various other designs, names and modules may be fashioned depending upon a particular embodiment of the present invention.
FIG. 3 is a block diagram illustrating various modules and respective parameters in accordance with an example embodiment of the present invention. It is preferred that the modules illustrated in FIG. 3 operate together as an integrated unit, and incorporate various utilities, described below, for operation. Although the modules are designed to operate together, the modules can be used individually in cases where an integrated interface is not useable for any reason.
Module AUTOSENDIMG 302 determines when an image file, such as a TIFF file or JPEG file, is stored in a specified file folder. When an image file is recognized, module 302 preferably converts it to DICOM format and transmits the formatted file to DICOM Server 2. In a preferred embodiment, module 302 recognizes when the name of the image file employs a particular format, such as PatientName-PatientID-StudyUID (e.g., names of data fields that represent a patient and study), and module 302 preferably uses these data when converting an image file to the DICOM format. Moreover, module 302 preferably references an American Standard Code for Information Interchange ("ASCII") text file (e.g., named "config.txt") in order to retrieve and add information, such as Institution Name, Study Description and Modality.
In accordance with the MICROSOFT WINDOWS operating system, module 302 preferably operates as a background application and is represented by an icon in the toolbar. When the icon is selected, a user interface, substantially as shown in FIG. 4A, is displayed. As shown in FIG. 4A, selecting hide button 402 causes display screen 400 to be removed from view (e.g., referred to in the art as being minimized). Selecting About button 404 displays textual information regarding module 302, and selecting the End button 406 terminates module 302. In addition, parameters are preferably defined by a user and referenced by module 302: Path name 408, IP address 410, Port Number 412, Local Entity Title 414 and DICOM server Entity Title 416. For example, Path name 408 represents a folder that is used by module 302 to determine where an image file that requires conversion to DICOM format is stored. IP Address 410 represents the IP address of the DICOM Server 2 where the image file properly formatted in the DICOM format, is to be transmitted. Port Number 412 represents the port number of the DICOM Server 2. Local Entity Title 414 and Server Entity Title 414 represent the respectively designated names of the local computer system and the remote server 2.
Continuing with reference to FIG. 3, DICOMPush module 304 preferably transmits images formatted as DICOM images from path name 408 to DICOM server 2. Module 304 preferably operates as a background application and is represented by an icon in the toolbar. Once the icon is selected, a user interface, substantially as shown in FIGS. 4B-4D, is provided. FIGS. 4B-4E illustrate example display screens provided by module 304 that correspond to respective tabs for entering, changing and viewing information directed to a patient, study, institution and/or image, as selected in tab section 417. Also illustrated FIGS. 4B-4D is buttons section 419 that includes plurality of buttons for invoking various processes provided by module 304. For example, buttons are provided to enable a user to load a file, perform a query, send a file, setup module 304, review information regarding module 304, and terminate module 304.
FIG. 4B illustrates an example display screen 415 that is presented by module 304 and corresponds to the patient tab from tab section 417. Display screen 415 includes graphical screen controls for data entry regarding a patient, and preferably includes patient name 418, patient ID 420, gender 422 and patient age 424. Thus, users can submit various data regarding a patient via display screen 415.
FIG. 4C illustrates an example display screen 425 that is presented by module 304 and corresponds to the study tab from tab section 417. Display screen 425 includes graphical screen controls for data entry regarding a study, and preferably includes study instance UID 426, Modality 428, Accession Number 430, Study Date 432, Study Time 434 and Study Description 436. In particular, UID 426 represents a unique identifier that is used to reference a particular study. Modality 428 represents a type of equipment used to acquire a medical image of the body. For example, radiography, ultrasound and magnetic resonance imaging are examples for modalities in this context. In the example shown in FIG. 4C, modality 428 is listed as "OT," which represents "other." Study date 432, time 434 and description 436 enable a user to submit various descriptive information regarding the study associated with UID 426.
FIG. 4D illustrates an example display screen 437 that is presented by module 304 and corresponds to the institution tab from tab section 417. Display screen 437 includes graphical screen controls for data entry regarding a respective institution that provided an image corresponding with UID 426. In particular, display screen 437 includes institution name 438, referring physician's name 440, referring physician's address 442, and referring physician's telephone number 444. These data entry fields enable tracking of the institution and referring physician with regard to UID 426.
FIG. 4E illustrates an example display screen 446 that is presented by module 304 and enables a user to provide parameters used by module 304, such as described above with reference to module 302 and FIG. 4A. Display screen 446 is preferably provided when setup button is selected by a user from buttons section 417, and includes data entry controls for submitting corresponding information for Path name 408, IP address 410, Port Number 412, Local Entity Title 414 and DICOM server Entity Title 416.
Referring back to FIG. 3, another module provided in accordance with a preferred embodiment is DICOMTag2Text module 306, which is operable to provide various functionality in accordance with the teachings herein. In one embodiment, module 306 generates tagged data files that are MEDWEB compliant using data provided in an EFILM database. In an alternative embodiment, module 306 generates tagged data files that are MEDWEB compliant using data provided in an CONQUEST database. Alternatively, module 306 generates PDF fax cover pages using data provided in an EFILM database, or generates PDF fax cover pages using data provided in an CONQUEST database. In yet another alternative, module 306 generates tagged data files directly from the user's console that are MEDWEB compliant using data provided in an EFILM database. In yet another embodiment, module 306 generates tagged data files directly from the user's console that are MEDWEB compliant using data provided in an CONQUEST database, or generates PDF fax cover pages directly from the user's console using data provided in an MEDWEB tagged file.
In a preferred embodiment, the present invention provides data in a format for a database accessible by information processor 2, and not particular to CONQUEST or EFILM. By using an internal database that is continually updated via DICOM queries to the DICOM server, the overall process is streamlined by not having to transmit an entire DICOM examination to the CONQUEST or EFILM database in order to produce the PDF fax cover sheets. or HTI text files. Further, by substituting repeated DICOM queries to the target DICOM server, instead of automatically transmitting the entire examination, a significant bandwidth, transmittal time, and storage space savings is produced. The query process 'asks' the target DICOM server if any new studies have arrived. If the results to the query indicates new studies, the relevant DICOM tags are pulled from the new study and added to the internal database. Thereafter, the relevant DICOM tags for the examination are transmitted instead of the entire examination, which may include hundreds of images. The inventor believes this is the most parsimonious approach toward updating the local internal database, and allows use of this single database for all relevant modules.
As used herein, the "console" refers, generally, to a command line, such as invoked from the MICROSOFT WINDOWS command prompt, also known in the industry as a "C prompt." One skilled in the art will recognize that the letter C can be substituted for any other respective drive letter, and that any operating system, such as UNIX, which provides a prompt for command line execution is applicable herein.
In a preferred embodiment, tagged file formats and Acrobat PDF Fax Cover files are provided according to predetermined specifications that correspond with the particular format for the data. For example, one type of query may be provided for EFILM data files, and another type of query may be provided for CONQUEST data files. Preferably, queries are formatted for a database maintained by information processor 2, such as a MICROSOFT ACCESS or other SQL compliant database.
FIG. 4F illustrates an example display screen 448 that is preferably provided by module 306 and provides various configuration settings. As shown in FIG. 4F, ODBC DSN 450 identifies open database connectivity ("ODBC") data source names. ODBC-DSN 450 indicates an alias defined by an ODBC data source administrator. For example, "CONQUESTdb" is typically defined for a CONQUEST database EFILMdb is typically defined for an EFILM Access database. Output dir. 452 identifies a file directory where output files are placed. Freq. (min) 454 represents the frequency in minutes to poll the database for new records.
Continuing with reference to FIG. 4F, Fields 456 and Tags 458 are provided in an editable grid, where Fields 456 represents a database field name, and Tags 458 represents the corresponding tag to be used. In a preferred embodiment, database field names use SQL-like syntaxes. For example, TableName.FieldName. (i.e., Patient.PatientID) indicates the data field PatientID defined in a database table, "Patient." Tasks control panel 460 contains two checkboxes, the first ("Tagged File Output") selects output to tagged files and the second ("PDF Generation") selects output to PDF files. Additionally, save settings button 462, when selected, saves the current settings. Start button 464, when selected, preferably causes information processor 2 to start execution of DICOMTag2Text module 306 using the respective values defined in display screen 448. Stop button 466, when selected, preferably halts execution of DICOMTag2Text module 306. All graphic user interface settings are persistent in disk, such that closing module 306 does not result in the loss of the values. When module 306 executes in the future, the settings are loaded automatically. In addition to graphic screen controls, display screen 448 preferably provides status information, such as displayed in FIG. 4F at the bottom of display screen.
In a preferred embodiment of the present invention, selecting the cross icon in the upper right corner of display screen 448 does not result in termination of the module 306. Instead, selecting the cross icon merely minimizes the window to the toolbar near the clock. In order to close terminate module 306, the user preferably selects (e.g., "right clicks") on the tray icon and a pop-up menu is shown, such as illustrated in FIG. 4G.
FIG. 4G illustrates a MICROSOFT WINDOWS "tray icon" 468 that is preferably selected to control operation of module 306. When a user selects tray icon 468, pop-up menu 470 is preferably presented, enabling the user to select a choice to terminate module 306. Continuing with reference to FIG. 4G, icons 468A, 468B and 468C represent different states of icon 468, which represent the status of module 306. For example, icon 468A indicates that Start button 464 has been selected and module 306 is operating. Icon 468B indicates that Stop button 466 has been selected and that module 306 has stopped. Further, icon 468C indicates that module 306 is currently executing a task.
As noted above, the present invention is operable by executing "console" commands at a command line prompt. The following are example parameters that are meaningful when invoking module 302 via the console. In a preferred embodiment, one parameter is used at a time. In a preferred embodiment, all of the parameters submitted via the graphic user interface, such as illustrated in FIGS. 4A-4K, can be defined and applied while operating module 306 from the console.
FIGS. 4H and 4I illustrate example MICROSOFT WINDOWS display screens for use in configuring a Microsoft ODBC data source. As known to those skilled in the art, a user configures a DSN by selecting the System DSN tab (display screen 472) and adding a name and driver. Thereafter, a new data source is added (display screen 474) by selecting a respective driver. Thus, as known to those skilled in the art, the present invention preferably avails ODBC to provide transmission of data between a plurality of respective data sources.
Referring back to FIG. 3, the present invention further includes DICOMadder module 308 that preferably reads demographic patient information from a data file. FIG. 5 is a flow chart that illustrates steps 500 associated with processing a file in accordance with module 308. At step 502, a data file becomes available to module 308 after a patient examination is acquired by a DICOM server 2. The data file preferably includes information regarding the patient, along with detailed information on the examination itself. Module 308 reads this file either directly from an ftp folder or a local folder. Module 308 then provides a pull down menu for the user containing a patient list (step 504). Any paper that is scanned, for example, via a sheet fed or auto-feed TWAIN scanner, is preferably associated with a particular patient examination by module 308 (step 506). Module 308, thereafter, automatically uploads the data file to the DICOM server as part of the imaging examination (step 508). At step 510, the examination is available for viewing, for example by a radiologist for interpretation, and the clinical patient paperwork displays simultaneously as a separate DICOM series. In this way, the present invention allows for the viewing of patient information at the same time as digital images.
In a preferred embodiment, each feature available via DICOMadder module 308 preferably performs one or more functions related to the task of attaching non-DICOM paperwork/clinical data to a DICOM examination. Some can be run concurrently with each other. Others have special functions such as allowing entry of certain DICOM tags as part of the conversion, or allow e-mail attachments in TIFF/JPEG format to automatically convert itself to DICOM format. Using various combinations of these utilities and applications allows for different hardware and software configurations to carry out the process of adding non-digital patient data directly to specific DICOM image examinations.
One feature associated with DICOMadder module 308 uses JPEG files from a twain scanner, fax transmission, email attachments or JPEG print drivers, and attaches the converted DICOM file to the appropriate DICOM examination. DICOMfaxadder module 310, described below, automatically attaches faxed paperwork to a DICOM examination. Further, a DICOMadder module 308 software library is DICOMtags2txt. This application produces the required patient data file for the DICOMadder and produces the cover sheet for the DICOMfaxadder application. DICOMTag2Text module 306 allows the use of EFILM, CONQUEST DICOM or other database servers to be used to produce demographics and other materials required by DICOMadder module 308 and DICOMfaxadder module 310, in order to make the demographics and materials universally compatible with any commercially available DICOM server.
Other modules (or utilities) provided via DICOMadder module 308 run concurrently, or separately from DICOMadder module 308 and DICOMfaxadder module 310 and DICOMTag2Text module 306. These utilities do ancillary jobs such as auto-uploading data to DICOM server 2, acting as file daemons to monitor folders for new data, and automatically processing or uploading the data for conversion of TIFF or JPEG format scanned files to DICOM files. The utilities also allow the addition of referring physician information (address, phone, fax) to the DICOM examination if this data is lacking, and is meant to be used by administrative personnel to add this information to the DICOM file if it is missing from the original DICOM worklist. Using various custom combinations of these utilities and applications, allows for different hardware and software DICOM server configurations to carry out the process of adding non-digital patient data directly to specific DICOM image examinations.
Thus, DICOMadder module 308 reads certain demographic patient information from a data file. This data file becomes available to the DICOMadder module 308 as soon as a patient examination is acquired by a DICOM server 2. The data file includes information on the patient, along with detailed information on the examination itself. The DICOMadder can read this file either directly from an ftp folder or a local folder. It then provides a pull down menu for the user containing a patient list, and allows papers scanned from a sheet fed or auto-feed TWAIN scanner to be associated with a particular patient examination, and automatically uploaded to the DICOM server as part of the imaging examination. The end result is when the examination is opened by the radiologist for interpretation, the clinical patient paperwork displays simultaneously as a separate DICOM series, allowing the viewing of patient information at the same time as the digital images.
Also referring to FIG. 3, the present invention preferably provides DICOMfaxadder module 310 that enables direct or remote scanning of non-digital paper-based patient data directly into DICOM imaging examinations. In a preferred embodiment, fax server 2 receives fax cover pages that are generated with a barcode. The fax is processed by our software in a similar way as scanned paperwork is processed by the DICOMadder module 310. FIG. 6 is a flow chart illustrated that illustrates steps 600 associated with the workflow in accordance with module 310. At step 602, the facsimile cover page comprising a bar code is produced by ancillary software. The fax cover page containing the bar code is then either automatically uploaded to an FTP server 2 for download by the remote examination site personnel, automatically printed at the examination site via a remote internet printing application, or automatically faxed to the examination site directly. A technologist at the remote examination site then uses the fax cover sheet to transmit corresponding patient paperwork via a simple fax machine to server 2. The end result is that users can fax the patient paperwork directly into the patients DICOM examination. This application obviates the need for paper scanners and capture programs, and greatly simplifies the addition of non-digital handwritten patient information to the DICOM examination.
In accordance with a preferred embodiment, another module, DICOMProxy module 312, is provided that functions in conjunction with a DICOM Storage SCP (Service Class Provider), receives an image via a DICOM communication, modifies the DICOM tags for the examination following various criteria, and then forwards the modified examination to the DICOM Storage SCP. The various criteria for modifying the image comprises matching a DICOM tag, for example "Institution Name," with a list of words. If there is a match, the module modifies one or more DICOM tags, such as "Accession Number" and "Institution Name." Also the matching image may be transmitted to a new destination that corresponds with an IP address and port number that corresponds with the matching word achieving a 'rerouting' of the examination, based upon predefined criteria present in the DICOM tags.
FIG. 4J illustrates an example text file 474 (labeled "dcminfo.txt") that is referenced by DICOMProxy module 312 for supplying parameters to DICOMProxy module 312 in the event that various DICOM tags are not provided in the DICOM image, or need to be changed. As shown in FIG. 4J values are provided for DICOMProxy module 312. In the example text file 474 shown in FIG. 4J, the values are delimited, such as by the "pipe" (|) character. The values in FIG. 4J represent the following: 'CR' is a character string to be matched in the DICOM tag 'institution name', 'Medimaging Tools' is the new institution name to be entered in the institution name tag in the event of a match, '1234' is the prefix for the accession number tag to be added to the accession number field, '127.0.0.1' is the IP address of the DICOM server to forward the examination to following the changes, '4006' is the port number corresponding to the IP address, and 'EFILM' is the title of the DICOM server. Continuing with this example, the last three fields are address info of where to send the examination in the event of a 'CR' match, after the tag transformations are made.
FIG. 4K illustrates an example DICOMProxy module setup display screen 476 that preferably uses values provided by either the DICOM image file or the text file 474 to define parameters used by DICOMProxy module 312. As shown in setup display screen 476, various parameters can be defined, including Port (the DICOM Storage SCP port), IP Address (the IP address of the DICOM Server), Out Port (the Port number of the DICOM Server), Local AET (Entity Title of this application), Remote AET (Entity Title of the DICOM Server), and Key number (a security key provided by the software provider after a valid serial number is transmitted.
Preferably, the present invention comprises various modules, which can run concurrently, or separately from DICOMadder module 308. These ancillary modules do the jobs of auto-uploading to the DICOM server 2, watching folders for new data to be automatically processed or uploaded, and converting TIFF or JPEG format scanned files to DICOM files which can then be processed by the DICOMadder application or one of the other applications in the library, substantially as described herein. Ancillary software also allows the addition of referring physician information (address, phone, and fax) to the DICOM examination if this data is lacking, and is meant to be used by administrative to add this information to the DICOM file if it is missing from the original worklist.
Other ancillary applications in the DICOMadder library produce the patient data file for the DICOMadder module 308 and produces the cover sheet for the DICOMfaxadder module 310. Although some DICOM server produces this file automatically (i.e. MEDWEB), other DICOM servers do not. The present invention preferably provides EFILM and CONQUEST DICOM servers to be used to produce similar demographics, so that DICOMadder module 308 and DICOMfaxadder module 310 can be universally used with any commercially available DICOM server.
Features of DICOMfaxadder module 310 is provided below with reference to FIG. 7 and in reference to an embodiment of the present invention.
FIG. 7 is a flow chart illustrating steps 700 associated with processing a facsimile that is received by Fax server 2. At step 702, a new FAX arrives the Fax server 2. Thereafter, Fax server 2 invokes DICOMFaxAdder module 310 and passes parameters thereto, including, for example, path, folder, base name and barcode. In a preferred embodiment, the barcode is formatted to include PatientUID-PatientID. A checksum process is performed on the bar code that is received to verify that no error has occurred during transmission. In step 708, a determination is made to determine whether an e-mail exists. If so, the process branches to step 710, and an e-mail is preferably sent to a system administrator alerting him/her of the error. Thereafter, the process terminates (step 712). Alternatively, if at step 708, it is determined that no error has occurred, then, at step 714, a query is performed, for example, to an EFILM database to retrieve corresponding study and patient tables. If after a determination in step 716 that no data can be retrieved regarding, for example, the respective PatientUID, the process branches to step 710 and an error e-mail is sent to system admin, and no further processing is done (step 712). Alternatively, if data are returned from the query, then the information retrieved from the database each frame in a corresponding TIFF file, except the first one (representing the FAX cover), is converted into a DICOM image and sent to DICOM Server 2 (step 718).
In a preferred embodiment, DICOMFaxAdder module 308 is a command line (console) application that is called by the fax server 2 application programming interface ("API"). DICOMFaxAdder module 308 is designed to work in tandem with the DICOMTag2Text module 306. Module 308 receives parameters from fax server 2, including, for example, path, folder, patient name, barcode, IP address of the DICOM Server 2, port number of the DICOM Server 2, local Application Entity name, and remote Application Entity name.
Thus, DICOMfaxadder module 308 preferably reads a TIFF file from the respective folder, and subsequently queries an E-FILM database and creates a DICOM archive that preferably sends a fax to DICOM Server 2. The fax preferably has attached the appropriate patient examination as an additional examination series. The workflow is as follows: the specially barcoded cover page is produced by the DICOMtag2text module 306.
Ancillary software also allows the addition of referring physician information (address, phone, fax) to the DICOM file if examination data are lacking, and are meant to be used by ancillary personnel (e.g., secretaries or assistants to the teleradiologist) to add this information. This feature is significant, particularly, for bi-directional HL-7 feeds. The present invention preferably includes a module that uses an HL-7 feed for speech recognition transcription. For example, if a DICOM patient file contains the referring physician address and telephone/fax information, the proper header is substantially automatically produced by a module included with the speech recognition software, and is preferably entered as part of the actual radiology report and automatically faxed to the referring physician.
Other "ancillary" software modules of the present invention perform such functions as producing the required patient output file (described above). The present invention supports a variety of DICOM servers that receive and digitize medical imaging examinations as DICOM files. For example, the present invention allows the use of EFILM, MEDWEB, and CONQUEST DICOM servers to be used to produce similar databases, such that the present invention can be universally used.
Another feature of the present invention (provided via a hardware/software module) includes a patient information facsimile ("fax") module. Preferably, a dedicated fax server is provided which supports the use of a printed barcode on the cover page of a fax. The barcode is derived from the DICOM tag database of the DICOM image examination. The barcode is preferably read and used to automatically name the fax substantially when received, and automatically formats the fax as a named TIFF file and, thereafter, attaches the TIFF file to an encrypted e-mail letter. In an example embodiment, the fax is processed in a similar way as the scanned paperwork (described above).
In an example embodiment of the fax module of the present invention, the workflow is as follows: a barcode cover page is substantially automatically produced by the present invention when an imaging study is received by, for example, the DICOM server. The cover page is then either 1) automatically uploaded to an FTP site for download by the examination site personnel, 2) automatically printed at the examination site, for example, via an internet printing application, or 3) automatically faxed to the examination site directly. The technologist at the examination site then uses this specially encoded cover sheet to send the corresponding patient paperwork via a typical fax machine to a server operating the present invention. In this way, the present invention enables a remote site to fax paperwork directly into the patient's DICOM examination file. By enabling technologists to fax paperwork, the need for paper scanners and capture programs is obviated, and the process of providing non-digital handwritten patient information to the DICOM examination, and ultimately to the interpreting physician, is greatly simplified.
FIG. 8 is an example data entry display screen 800 provided by the present invention. Display screen 800 is used for enabling a user to select a patient, and to convert one or more image (JPEG) files to files in the DICOM format using the data of the selected patient. As described above, paperwork generated during one or more medical examinations is integrated by the present invention when a user selects a patient and opens image file(s) stored on a remote site (e.g., FTP server 2) or stored locally on the user's computer system. For example, data files are stored on an FTP server or on the local file system containing the values of some DICOM attributes ("TAGS"). These values are applied to the created DICOM files.
Continuing with reference to FIG. 8, display screen 800 includes drop-down list 802 that allows a user to select a specific patient. After a patient is selected, information is preferably displayed in section 804 which represents the patient's medical identification number, the modality of the medical image (e.g., CT, x-ray, or MRI) and the date/time the image was generated. When the user is satisfied that the correct patient is selected, the user selects Transfer Syntax 806 to choose a transfer syntax for the created DICOM file(s). As shown in FIG. 8, the transfer syntaxes provided by the present invention include: explicit VR, JPEG lossy, little endian; explicit VR, uncompressed, little endian; and implicit VR, uncompressed, little endian. All of these represent standard DICOM transfer protocols and syntax. In the example shown in FIG. 8, the default selection is the implicit VR syntax. After the user has selected the patient and the transfer syntax, the user preferably opens one or more JPEG files (via file menu) in order to convert the JPEG file to DICOM format using the data of the selected patient as the DICOM tags.
For example, the menu items "File|Open" displays an open file dialog box. The user selects one or multiple (using the CTRL or SHIFT key) JPEG files. After closing the open dialog by clicking on the OK button, the selected JPEG files are converted to the DICOM standard. The data of the selected patient are included in each DICOM file and the DICOM files are stored on the user's computer system, for example, in a directory location named, "c:\CONVERTOUT." In a preferred embodiment, successfully converted JPEG files are automatically deleted, and the user is notified of the success or failure of the operation.
Also, as displayed in FIG. 8, update button 810 can be selected to reload patient data from the FTP server or user's local computer system, depending upon the location where patient information is stored. This feature is useful for updating patient information (e.g., demographics) over time, and to provide DICOM files that contain current patient information.
In a preferred embodiment of the present invention, the user can configure the present invention to identify the locations of data that are used for generating DICOM files, substantially as described herein. The user can configure the present invention by selecting the menu entry choice "Options|Configure" as shown in FIG. 8. After correctly entering the password, the present invention preferably displays the Configuration Dialog screen 900, as shown in FIG. 9.
Institution filtering is used to restrict the retrieval of patient data that comply with institutional information defined by the user. In particular, to configure an Institution Filter, the user preferably enters a character string in the "Institution Name" textbox. As shown in FIG. 9, the user selects radio button controls for "no filtering" (any data file is available), "match whole string" (Institution Name in data file must be equal to entered Institution name), or "match part of string" (Institution Name in data file must contain entered value as substring). In an example embodiment, filtering is case-sensitive. This feature is important to preserve patient confidentiality.
As noted above, the present invention supports patient data that are stored locally, in case the user desires not to connect to an FTP server in order to retrieve patient data. As shown in FIG. 9, in case the checkbox "Read data from FTP server" is not checked, the user is able to navigate or "browse" to a local folder that contains the patient data file(s). This folder will be used for storing and retrieving the data files.
Another option provided in display screen 900 is the ability to change a user's password (e.g., by selecting the change password ("Change") button). A dialog box requires the user to enter an old password once and the new password twice. After confirmation, the new password is active.
After the user is satisfied with the configuration settings provided in display screen 900, the user applies the changes. The user preferably selects the button labeled "OK" to apply the changes of the configuration. Alternatively, the "Cancel" button closes the configuration dialog without modifying the configuration.
Thus, the present invention enables users to retrieve patient information and digital forms of paperwork to provide DICOM files that integrate paperwork with medical image records.
FIG. 10 is an example "thumbnail" view of images comprising patient examination information and medical images in the DICOM format and provided by an example embodiment of the present invention. As shown in FIG. 10, a plurality of neck, spine and brain images are provided along with electronic versions of paperwork. Preferably, a user selects one or more of the images (and/or electronic versions of paperwork) and enlarged versions are provided for improved viewing. In this way, the viewing of hand-written paper data are provided simultaneously when medical images are viewed.
In an effort to improve the flexibility and availability of the present invention, an internet-based embodiment is preferably provided on information processor 2 and available for users establishing a communication session with information processor 2 using standard web browsing software. FIGS. 11A-11F illustrate example display screens and reports that are provided in accordance with an internet, web-based embodiment of the present invention.
FIG. 11A illustrates an internet web-based display screen 1100 of the present invention that enables a user to perform queries for DICOM records (i.e., integrated image files and ancillary information) and records stored on database 8 which may or may not have corresponding integrated DICOM records. Preferably, display screen 1100 is provided to a user who has selected a graphic screen control (i.e., a button) for performing a query. The choices illustrated in screen 1100 include DICOM Query by Study Date, DICOM Query by Patient Name, DataBase Query by Study Date and DataBase Query by Patient Name.
FIG. 11B illustrates an example display screen 1102 that is provided to a user who has selected DICOM Query by Study Date from display screen 1100. The user has the option in display screen 1102 to select a control to generate a fax cover page (formatted with corresponding bar code), and specifies information for the query. For example, and as shown in FIG. 11B, the user identifies in textbox control an institution name 438 and/or the Study Date 432 of interest. In the example web-based embodiment shown FIG. 11B, a so-called "wildcard" character (e.g., "*") can be submitted in the textbox controls to represent any character in the query. In the example shown in FIG. 11B, any institution name ("*") is identified by the user, and the date is any day within the month of November, 2005 ("2000511*"). After the user presses the submit button control, the query is executed on server 2, and the results are displayed (substantially as displayed in FIG. 11C). Alternatively, the user can select the reset button to clear the entries and begin again.
FIG. 11C illustrates an example query result display screen 1104 provided in accordance with the web-based embodiment of the present invention. As shown in FIG. 11C, a series of columns are provided that include the UID 426, institution 438, modality 428, patient name 418 and study date 432. Display screen 1104 further includes a column for enabling a user to create a fax cover sheet, preferably formatted as a hyperlink. This feature enables a user to search for a particular study, and, thereafter, generate a fax cover sheet formatted with a respective bar code for future use.
FIG. 11D illustrates an example display screen 1106 that is provided to a user who has selected DICOM Query by Patient Name from display screen 1100. The user has the option in display screen 1106 query for IP 408, Local Entity Title 414, DICOM server Entity Title 416, Institution Name 438 and Patient Name 418. Upon selecting the submit button, a report, substantially as displayed in FIG. 11C (with data corresponding to the query submitted in FIG. 11D) is provided.
FIG. 11E shows an example display screen 1108 that is provided to a user who has selected a graphical screen control for configuring ("CONFIGURE") the web based application, such as in display screen 1100. In the example display screen 1108 shown in FIG. 11E, a textbox control is provided for an IP address and port number for the fax server 2 for generating fax cover pages. Further a textbox control is provided for an IP address and port number for information processor 2 for automatically transmitting DICOM integrated files. Moreover, a textbox control is provided for the DICOM server 2 IP and port 410/412, and Local Entity Title 414 and DICOM server Entity Title 416. The user preferably selects the save button to ensure the settings are provided in the future.
FIG. 11F shows an example a web-based display screen 1110 that is preferably used for automatically uploading images to DICOM server 2 in accordance with the present invention. Using the setup button, the user can identify a folder to identify a location where image files, such as TIFF files or JPEG files, will be stored. As described above, when an image file is recognized, module 302 preferably converts it to DICOM format and transmits the formatted file to DICOM Server 2. In a preferred embodiment, module 302 recognizes when the name of the image file employs a particular format, such as PatientName-PatientID-StudyUID (e.g., names of data fields that represent a patient and study), and module 302 preferably uses these data when converting an image file to the DICOM format. In accordance with the embodiment shown in FIG. 11F, the user can specify this information using a web-based display screen. Further, the user can identify a specific date (including by using a wildcard character, as described above), and, thereafter, select the log button to review a history of file activity.
Thus, as shown in the example display screens 11A-11F, the present invention provides a convenient and secure internet-based embodiment that is operable using standard web browser software.
A discussion regarding technical details regarding an embodiment of the present invention is now provided to further describe the invention.
The present invention contains an interface as a COM- and Automation-Server (COM refers herein to the known Component Object Model). The interface enables a technical user to remotely control the present invention without the need for an interactive session, substantially as described. For example, one or more computer software programs or scripts can be developed to automate the functions and configuration of the present invention.
More particularly, a user can employ one or more automation functions to define various features of the present invention that are to be performed automatically. The following example lists functions that are provided in an example embodiment of the present invention: SetInputFolder; SetOutputFolder; SetLookupTable; SetErrorFolder; SetTransferSyntax; and ProcessFolder. Other functions not listed herein are envisioned which support other functionality of the present invention, and is or will become apparent to one skilled in the art. A brief description of the above-listed functions is provided below.
The SetInputFolder function enables a user to define an "input" folder or location on a computer system where JPEG files are to be expected and, once retrieved, to be converted to DICOM. In an example embodiment, the following syntax is used: int SetInputFolder(BSTR DirName). As used in an example embodiment, "DirName" indicates the path or the directory where the JPEG files are stored. Preferably, DirName is formatted as an absolute path name. If SetInputFolder succeeds, the computer system preferably returns a value of 0, otherwise an Errorcode is returned (−1), in case the specified folder does not exist.
The SetOutputFolder function enables a user to define an "output" folder or location on a computer system where the converted DICOM files are to be stored. In an example embodiment, the following syntax is used: int SetOutputFolder(BSTR DirName). As used in an example embodiment, DirName indicates the path of the target directory for the DICOM files. Preferably, DirName is formatted as an absolute path name. If SetOutputFolder succeeds, the computer system preferably returns a value of 0, otherwise an Errorcode is returned (−1), in case the folder does not exist.
The SetLookupTable function enables a user to define the path of a lookup table that maps the variable, "siteIDs" to Institution Names. In an example embodiment, the following syntax is used: int SetLookupTable(BSTR FileName). As used in an example embodiment, "FileName" indicates the path where a filename of a lookup table file is stored. If SetLookupTable succeeds, the computer system returns a value of 0, otherwise an Errorcode is returned (−2), in case the file does not exist, or (−3) in case the file could not be parsed.
The SetErrorFolder function enables a user to define an error folder where JPEG files are to be copied, in case no matching data file can be found on an FTP server. In an example embodiment, the following syntax is used: int SetErrorFolder(BSTR DirName). As used in an example embodiment, "DirName" indicates the path of the directory where JPEG files without a match are located. If SetErrorFolder succeeds, the computer system returns a value of 0, otherwise an Errorcode is returned (−1) in case the folder does not exist.
The SetTransferSyntax function enables a user to define which transfer syntax shall be used with the present invention. In an example embodiment, the following syntax is used: int SetTransferSyntax(int Value). As used in an example embodiment, "Value" represents a number that specifies the transfer syntax according the following: Value VR Compression Byte Order—0 explicit JPEG lossy little endian, 1 explicit none little endian, 2 implicit none little endian. On success, the SetTransferSyntax functions causes the computer system to return the value for the TransferSyntax, otherwise an error code is returned (−6), in case the value for the TransferSyntax is out of range.
The ProcessFolder function enables a user to convert JPEG files in the inputfolder to DICOM and to apply the information of the matching data files on the FTP server. In an example embodiment, the following syntax is used: int ProcessFolder( ). If ProcessFolder succeeds, the computer system returns the number of successfully converted files, otherwise an Errorcode is returned (−3) in case no lookup file is available, (−4) in case any of the required folders wasn't defined or doesn't exist, (−5) in case no access to the data files was possible (FTP connection or access failed or no access to file system folder), (−6) in case if no supported TransferSyntax is specified.
Of course, one skilled in the art will recognize that the functions described above illustrate ways to automate tasks and configuration of the present invention. Other functions and techniques will become apparent to one skilled in the art for providing features, such as described herein.
store the second electronic DICOM file in the at least one database.
2. The system of claim 1, wherein the second electronic DICOM file is added to the first electronic DICOM file.
3. The system of claim 1, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to receive electronic textual information that further represents the medical study.
4. The system of claim 3, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to associate the electronic textual information with the at least one image.
5. The system of claim 4, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to associate the at least one image with the electronic textual information by adding the electronic textual information to the at least one image.
6. The system of claim 4, wherein the electronic textual information includes handwritten notes, forms and/or charts.
7. The system of claim 1, further comprising a facsimile receiver that is configured to receive a fax cover page formatted with the barcode, and is further configured to receive electronic textual information that represents the medical study represented by the at least one image.
8. The system of claim 7, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to associate the electronic textual information with the at least one image, wherein the electronic textual information is received by the facsimile receiver.
9. The system of claim 1, further comprising a graphical user interface providing one or more graphical screen controls enabling a user to identify parameters for the at least one computer processor and to cause the at least one computer processor to execute the instructions.
an open database connectivity data source name representing the at least one database.
11. The system of claim 1, further comprising a display that is operable to display the second electronic DICOM file.
12. The system of claim 1, further comprising a reporting module that enables a user to execute a query of the database and that displays a report of the results of the query.
13. The system of claim 12, wherein the query is executed and the report is displayed via a web browser software application over the internet.
14. The system of claim 12, wherein the report is formatted in hypertext markup language, and further wherein the report includes selectable links.
15. The system of claim 14, wherein the selectable links enable the user to generate a fax cover page and/or view the medical image file associated with the at least one tag.
storing by the at least one computer processor the second electronic DICOM file in the at least one database.
17. The method of claim 16, wherein the second electronic DICOM file is added to the first electronic DICOM file.
18. The method of claim 16, wherein the instructions cause the at least one computer processor to operate substantially without human intervention.
19. The method of claim 16, further comprising receiving by the at least one computer processor, via the communication device, textual information that further represents the medical study.
20. The method of claim 19, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to associate the electronic textual information with the at least one image.
21. The method of claim 20, wherein the generating the second electronic DICOM file comprises associating the at least one image with the electronic textual information by adding the electronic textual information to the at least one image.
22. The method of claim 20, wherein the electronic textual information includes handwritten notes, forms and/or charts.
23. The method of claim 16, further comprising receiving by facsimile receiver a fax cover page formatted with the barcode, and receiving electronic textual information that represents the medical study represented by the at least one image.
24. The method of claim 23, wherein the non-transitory processor readable media further stores instructions for causing the at least one computer processor to associate the electronic textual information with the at least one image, wherein the electronic textual information is received by the facsimile receiver.
25. The method of claim 16, further comprising providing a graphical user interface that includes one or more graphical screen controls enabling a user to identify parameters for the step of receiving and/or the step of converting, and/or further to instruct the computer processor to execute at least one of the steps of receiving, converting or storing.
27. The method of claim 16, further comprising displaying the medical image file and the associated electronic textual information.
28. The method of claim 16, further comprising providing an interface to enable a user to execute a query of the database, and displaying a report of the results of the query.
29. The method of claim 28, further comprising providing the interface and displaying the report via a web browser software application over the internet.
30. The method of claim 29, further comprising formatting the report in hypertext markup language, and including includes selectable links in the report.
31. The method of claim 30, wherein the selectable links enable the user to generate facsimiles and/or view the medical image file associated with the at least one tag.
32. The method of claim 16, wherein the second electronic DICOM file includes a DICOM image file.
NL160193B (en) * 1950-06-15 Wavin Bv Apparatus for manufacturing a plastic pipe having transverse waves.


-1854 & 1855: rumors of immense copper deposits along the North Shore & of iron ore at Lake Vermilion sparked a boom in the area.
-1854: the Treaty of La Point was signed at Fond du Lac by which the Grand Portage & Fond du Lac Indians gave up their rights to mineral tracts in the region.
-1870: First Charter; Duluth was booming and regarded itself as a "City of Destiny."
-1871: Col. J. B. Culver was elected the first mayor of Duluth. The canal through Minnesota Point, now bridged by the Aerial Lift Bridge, was dug.
-1873: Jay Cooke's financial failure rocked the area. Banks failed, real estate slumped, and there was no work. The population dwindled from about 5,000 to 1,300.
-March 12, 1877: Duluth held its last council meeting after which it burned up its bonds and lapsed into a "village" status. The more settled parts of were known as the Duluth village for the next 10 years, and the surrounding areas the "district."
-1878: Duluth's prominence begins to return; lumbering, grain began to pour into the port, and the village boundaries had to be expanded.
-1929: Peak year of total net tonnage shipped of 60.39 million -- of this iron made up 50%; the balance was limestone, coal, grain, and misc. products; value exceeded $485 million.
-In 1985, Duluth was second to New York in the United States in total net tonnage, even with only eight months of navigation. The average yearly tonnage was 48 million net.


text:
Wi-Fi Alliance Offers Insight into Wi-Fi 6 GHz
Residential Tech Today
On April 23, the Federal Communications Commission (FCC) made 1200 megahertz of unlicensed spectrum in 6 GHz available for unlicensed Wi-Fi use – paving the way for faster, higher capacity, and lower latency Wi-Fi devices and networks.
According to Wi-Fi Alliance, the Wi-Fi users will quickly benefit from additional capacity, wider channels, and less congested spectrum. Certification for Wi-Fi 6E – the brand name for Wi-Fi 6 devices operating in 6 GHz – will be available in early 2021.
Wi-Fi Alliance has been working to prepare interoperability certification as soon as Wi-Fi 6E devices enter the market so 6 GHz benefits can reach consumers, device manufacturers, and service providers more quickly.
The Wi-Fi industry has coalesced around certification to rapidly deliver the program to market and enable worldwide interoperability of Wi-Fi 6E devices as additional countries make 6 GHz spectrum available.
"By making 6 GHz available for unlicensed use, the FCC has secured the future of Wi-Fi. 6 GHz access is a seminal development for connectivity and provides Wi-Fi more capacity to deliver groundbreaking use cases and to unlock novel new Wi-Fi applications," said Edgar Figueroa, president and CEO, Wi-Fi Alliance. "Today's global climate highlights how important Wi-Fi is in connectivity and productivity, and new Wi-Fi 6E solutions will further increase Wi-Fi's standing."
Wi-Fi 6E will soon provide higher resolution streaming for applications such as video conferencing, lower latency for gaming and industrial IoT, and faster download speeds to provide critical services to enterprise, education, and healthcare markets. Users will also see a new generation of mobile devices, including those that deliver bi-directional video and AR/VR applications.
"We expect initial Wi-Fi 6E products to enter the market this year, with the first Wi-Fi 6E access points available by the fourth quarter of 2020," said Phil Solis, research director at IDC. "We expect Wi-Fi 6E will gain momentum and see rapid 2021 adoption with more chipsets targeting flagship smartphones, PCs, TVs, and even VR devices."
Wi-Fi 6E extends the capabilities of Wi-Fi 6 into 6 GHz, and the additional spectrum addresses Wi-Fi's spectrum shortage by bringing nearly six times the total capacity in both 2.4 and 5 GHz, seven contiguous 160 MHz channels, and less interference from legacy Wi-Fi devices. This translates to multigigabit Wi-Fi speeds and more devices performing optimally on a Wi-Fi network at once. 6 GHz brings more benefits from the latest generation of Wi-Fi, paving the way for faster, higher-performance, and lower latency Wi-Fi devices and networks.
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redpajama_set_name: RedPajamaCommonCrawl


I have a large-ish table (over 10 million rows) - we'll call this table "rowData". I have the following columns; "rowId", "groupId" and "textString". The ID's are both ints and "textString" is a simple varchar. I only have a maximum of 50 groupId's at a time which are stored in another table (possibly not of interest), but the groupID's are NOT sequential (rowId is AUTO_INCREMENT and the PRIMARY KEY).
What I would like to do, is to partition my table on these groupID's. I know what the list of groupIDs are (IE. 2342, 5251, 1591, 5915 etc etc). How would I go about doing this (sample code anyone?) and would I have to add a new partition to my "rowData" table every time I add a new "groupId" to my group table (not discussed in detail here)?


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text:
Kimberly Sanchez
Overall, this year has been crazy and overwhelming for everyone. From being worried about what vaccine to get to concerns about when going on vacation would be safe again. Little by little, returning to our "normal" is becoming a reality; however, does this mean the summer of 2021 will be a new opportunity for normality or will this be the summer of 2020 all over again?
The summer of 2020 was filled with chaos. A new unknown virus causes many deaths amongst people. Stay-at-home orders were required and many of the programs MACES had to offer over the summer were now offered only online.
The summer of 2021 looks hopeful for "normality" this year. "I think the summer of 2021 will be a bit more enjoyable than last year since everything is opening back up and people have been getting vaccinated. Everyone is most likely going to be going out again," Alondra Pompa, a sophomore, said.
Pompa also spoke about the fact that vaccines are rapidly being distributed, as that helped with the diminishment of COVID deaths. Luz Puebla, a mother of four said, "People are going to be desperate this summer and there will be a division between mask-wearing people and non-mask wearing people causing social tension." This social tension could lead to protests and violence among the community.
With that being said, would students still be willing to wear a mask after the mask mandate is removed? "I think that I would only wear masks in crowded places but wherever there aren't too many people I wouldn't. I think as long as the cases of COVID stay low and the majority of people are vaccinated, we shouldn't have to have mandatory masks," Mariana Herrera, a freshman, said. In rebuttal Luke Dornath, a sophomore said, "I think as a society we are ready for the mask mandate to be removed. I'm a believer that if you have gotten your vaccine and show no symptoms, you shouldn't need to wear a mask." According to The LA Times, "California's COVID-19 state of emergency order will remain in place beyond June 15, despite plans to fully reopen the state's economy on that date, Gov. Gavin Newsom said Friday." So, for now, masks should be worn until further notice.
Although this summer may be different compared to last year, we aren't yet back to "normal." It is important to stay safe by continuing to wear masks, social distance, and washing our hands regularly to put an end to Covid-19.
MACES students face the challenge of learning online due to. COVID-19


text:
Canada and the US agree to turn back migrants at border
by: ROB GILLIES, Associated Press
TORONTO (AP) — Canadian Prime Minister Justin Trudeau said Friday that Canada and the United States have reached a reciprocal agreement under which they will now be sending back back migrants who attempt to cross illegally anywhere at the border.
Trudeau called it an exceptional measure that will protect Canadians amid the pandemic. It addresses concerns about the difficulty of screening refugee claimants for the new virus.
Thousands of migrants have fled north to Canada since 2017. There is a longstanding agreement between the United States and Canada that requires those seeking asylum to apply in the first country they arrive in. So, if they crossed from the U.S. at a legal Canadian port of entry, they would be returned and told to apply in the U.S. But if they request asylum on Canadian soil at a location other than an official crossing, the process is allowed to go forward.
In most cases, the refugees are released and allowed to live in Canada, taking advantage of generous social welfare benefits. Now they will be turned back to American authorities under the new agreement.
Many migrants were crossing the border into Quebec from Champlain, N.Y. at Roxham Road, about 30 miles (50 kilometers) south of Montreal.
Trudeau also confirmed that all non-essential travel between Canada and the United States will end at midnight Friday. The two countries announced the measure earlier this week.


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We had the opportunity to meet prof. Benjamin Gidron in occasion of a seminar held in Genova, in October 2015, in the Department of Economics of the University of Genova.
Introducing Professor Gidron is really hard. His curriculum vitae is particularly rich.
He pioneered the study of the Third (Nonprofit) Sector in Israel, founded the Israeli Center for Third sector (ICTS) Research at Ben Gurion University and directed it for 12 years (1997-2009). During this period ICTS was the major source of data, knowledge and insight on the Sector in Israel and in comparative fashion, knowledge that is being used to develop comprehensive government policy towards the Third Sector. He also pioneered in the training of nonprofit organizations managers. He founded (2004) and directed the first Graduate Nonprofit Organizations Management Program in the Faculty of Management.
His speech focused on a real interesting topic -The Changing Relationship between the Business Sector and Society. At the end, we asked him to answer some questions for our Journal, considering that his contribution could be interesting for our readers.
In your research activities, the relationship between business sector and society plays an important role. Will you explain us the reason of this interest?
While I teach in Business Schools – currently the College of Management Academic Studies and before retirement at Ben Gurion University of the Negev, I come from a "social" background – sociology and social work. I see my role in the Business School to show the students the social context in which they operate, which both impacts their activities and is impacted by these activities. This is often difficult because business students are taught to think primarily about the business world, which has a different "language" than the world outside it, both in terms of values and forms of behavior. This was much more difficult about ten years ago; nowadays business students are more open to such ideas. It is important to do this because in the past the state played a central role in steering society, whereas now it is clear that the state is retreating from this role, which leaves a void. The business sector, being large and powerful, is, whether it wants it or not, a key player in society. I am interested in this dynamic relationship (between society and business sector), which can have very positive or very negative consequences.
There is nothing wrong with CSR. It gives business entities a platform to be engaged in society. It usually means that a small portion of the profits of the firm (often very small I may add) go to some social cause outside of the business entity. While it can have many forms, in the final analysis it be seen as a form of philanthropy. It gives the firm an opportunity to look good to the outside world and such activities are often used for marketing purposes. Yet, its very definition relates this activity to the firm's profits, and can very easily be eliminated when there are no profits or profits are low. Furthermore, we have to understand what it can and what it cannot do. It clearly cannot create significant social change: It cannot deal with the major problems of the world – inequalities, environment, health, etc. In all those issues it can at best do some fascinating projects, which will need follow-up and dissemination, for which there are no funds. Also, it cannot (and is not interested) to transform the business sector, so that it has some built-in limitations, for example regarding exorbitant salaries paid to executives, which contribute to inequalities in the world and which indirectly threatens its stability.
Obviously. CSR is better than total disregard by the business sector of society, but painting it in bright colors and exaggerating its potential is false, in my mind. The fact that the EU supports it does not change those truths.
The main point in the social business paradigm is to include social and environmental considerations in the heart of the business activities, in the way it conducts itself. Unlike CSR, where the social activity is taken place outside the business entity – in nonprofit organizations or in the community, in the social business concept the social activity has to be built-in, in the heart of the business activity. The details are not clear yet as it is a new concept and of course different business entities will have different models in introducing social considerations into the business activities. There are of course differences between the developing and the developed world in implementing such a notion. But the main point is to include social considerations in the center of the business planning and activities.
Changes of paradigms indeed represent rare events but they happen, and it indeed takes a long time for them to ripen. We are at the beginning of a process that, if successful, will involve changes on many levels: In policy, consumer behavior, educational practices, etc. Obviously there will be opposition to it, as in all change processes. Yet, as I believe that the business sector is beginning to realize that its own activities and the ways it conducts those are threatening society and the globe, and indirectly – itself, it will have to develop a new paradigm.
In your papers you propose some examples of this new way to support your proposition. Will you tell us which are the most relevant? How do you find them?
Finally, the evolution you propose has lights and shadows. Will you describe them? and what are your personal opinion for the future?
The ideas I try to promote will, in my opinion, help society and the business sector. It will create a more compassionate and creative business sector and will enable society to benefit from its tremendous resources. It has some dangers as well – if we introduce the business sector into social life, even if it considerate and compassionate, we run the danger of commodification of our social life, of creating a society that values only things that are for sale. What this means is that we need to steer this process carefully and involve policy-makers and consult with a diversity of stake-holders. It also involves consumer education. In the final analysis consumers will have to decide which products/services they prefer and how much they are willing to pay in order to help companies to become more "social".
Regarding the future – we have a saying in Hebrew: "Prophecy was given to prophets or to stupid persons". I am clearly not a prophet and I hope I am not stupid, so I will not try to foresee the future. I learned that society develops in ways that are totally unpredictable, because it is influenced by political developments, scientific and technological developments, etc. What this means is that academicians have the duty to promote their ideas, on the basis of their understanding and analyses, which sometimes may look as if they are out of context. If the analysis is correct, such ideas will be adopted, at least partially, by society in a long process of negotiations with many stake-holders. This is how social change is taking place.


text:
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Home > Cocalico > School District examines budget for new year
School District examines budget for new year
By Kimberly Marselas on May 25, 2018
Cocalico School District readied itself for the 2018-19 school year on May 21, making a series of purchasing, hiring, and procedural votes needed to set a new academic year.
In a housekeeping move, the school board voted to make hundreds of thousands of dollars in budgetary transfers. In one, the board tapped about $266,000 in bond revenue from 2014, paying it out to various departments to buy new staff computers in time for summer training. Another $11,600 once expected to be used on pre-K transportation (which was ultimately not provided) was instead used to pay for substitutes, supplies and contracted services connected to the pre-school program, according to Superintendent Ella Musser.
The board also voted unanimously to approve salaries for all of the district's support staff and administrators, including Musser. The superintendent will see her salary jump 5.4 percent, from $140,000 this school year to $147,500 next.
The board also approved or renewed special education agreements to be paid per student in 2018-19; retained its solicitor, auditing firm and tax collector for another year; and appointed board member Richard Brenner to serve another year as treasurer.
Additionally, the board:
Approved a 10-cent hike in student breakfast and lunch prices for next year. Lunch will rise from $2.60 to $2.85 for secondary students and to $2.40 for elementary students. Adults will pay $4.25 for lunch, up .25 from this year. Business Manager Sherri Stull said the 2018-19 increase is based on federal guidance provided as part of the National School Lunch Program.
Agreed to purchase a new set of 30 anatomy and physiology textbooks for the high school at a cost of $7,318 including online materials.
Added a new middle school arts enrichment program for the summer. The cost will be borne by students who participate. Other summer programs, including library hours and band camps, were approved earlier this year by the board.
About Kimberly Marselas
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Q: Angular get remote Image URL in base64 format I have a function that converts a image to base64 and returns the value.
In .ts file:--
async getBase64ImageFromUrl(imageUrl) {
  const proxyurl = "https://cors-anywhere.herokuapp.com/";
  var res = await fetch(proxyurl+imageUrl);
  var blob = await res.blob();

  return new Promise((resolve, reject) => {
    var reader  = new FileReader();
    reader.addEventListener("load", function () {
      // console.log(reader.result); /// getting the base64 image URL here.
      resolve(reader.result);
      return;
    }, false);

    reader.onerror = () => {
      return reject(this);
    };

    reader.readAsDataURL(blob);
  })
}

I wanted to get the value in in the HTML, I know I am doing something wrong

I know I am doing it wrong, wanted to know the right way to do this.

A: It's not Angular specific.
In general, you need to prepend the base64 string with data:image/png;base64 if it was a png image.
<img src="data:[<mediatype>][;base64],<data>" />

Example:

Check these for more info:

*

*Data URIs

*How to display Base64 images in HTML?

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