How to Utilize an Open Source DICOM Viewer and Properly Transmit Diagnostic Images in Your Practice

1. Introduction

The adoption of digital imaging has been swift and recent. The greatest advantage of digital imaging is the ability to manipulate contrast, zoom in on areas of interest, make measurements, and transfer them via the Internet for consultation. However, for optimal benefit, this adoption requires more technical “know how.” As such, the need for image visualization and analysis has extended beyond the light box. Software for digital imaging and communications in medicine (DICOM) image viewing is often expensive, challenging to navigate, and limited in accessibility. Because of this, practitioners often send and receive radiograph, ultrasound, computed tomography, or magnetic resonance as lossy compressed images with .jpg or .jpeg (Joint Photographic Experts Group (JPEG)) file extensions for consultation on cases. However, when a diagnostic image is exported as a JPEG image important metadata and information in the DICOM header that tells the detector system, the radiographic technique, institution obtaining the radiographs, compression levels, and a host of other information is stripped. Most importantly, the information of scale is also stripped, so measuring lesions is not reliable. Furthermore, JPEG images are difficult to manipulate in a way to ensure that the reader is able to properly evaluate the entire image. Therefore, it is important that practitioners realize the advantage of reading and sharing DICOM images.

In order to share DICOM images, practitioners must have access to simple, user-friendly, and free/ affordable DICOM imaging software and easy methods to transfer images to colleagues and specialists. Osirix^a is an open source Mac OSX-based image processing application for DICOM image viewing. It is free and downloadable software from the Internet. This user-friendly software will aid practitioners in not only evaluating their own images such as radiographs and ultrasound, but it will allow them to manipulate, illustrate, and prepare images and even videos for presentations to clients and colleagues. Osirix is specifically designed to navigate and visualize 2D and 3D images while at the same time acting as a DICOM picture archiving and communication system (PACS) workstation (it can also handle 4D and 5D, but that is outside the scope of this discussion). Additionally, this program will easily transmit images via DICOM transfer or export the DICOM images for transfer via free file sharing programs. Learning to use software such as Osirix will improve practitioners’ ability to evaluate medical images, consult with other professionals on cases, and even provide increased understanding of cases to clients. This article aims to provide practitioners with an overview of the many capabilities of Osirix, an open source DICOM imaging software and file-sharing options.¹

2. Materials and Methods

Software

An open source stand-alone application has been developed that serves as a DICOM viewer and PACS. Osirix can be downloaded at www.Osirix-viewer.com to run on the latest version of OsX.. There are alternatives for the Windows users such as Ginkgo CADx,^b however this “how to” will be confined to Osirix and free file-sharing software. There are numerous download options to choose from, including the free 32-bit version, a paid 64-bit version, a paid FDA approved 64-bit version for medical usage, and a paid version for iPad and iPhone users. Unless you are a radiologist or performing advanced imaging studies with very large volume sets, the free 32-bit version should suffice in most scenarios.
 

The Osirix program offers all the basic image manipulation functions of zoom, pan, contrast adjustment, image orientation, and measure, as well as allowing annotation and database organization by client or diagnosis. It also has the ability to hang multiple relevant prior exams. Additional advanced functions that can be performed include multiplanar reconstructions, convolution filters, variable slice thickness adjustments, volume rendering, minimum and maximum intensity projections, and surface rendering.

There are several free file-sharing programs commercially available. Dropbox, Google Drive, and Microsoft Onedrive are the most notable. Only Dropbox will be explored in depth in this “how to.”² A Dropbox account can be created and the software can be downloaded at www.dropbox.com. This is available for Windows, OsX, as well as mobile versions. Dropbox is an installable program or web-based program that syncs images on a personal computer as well as a remote server, also known as the cloud. [...]