Law Technology

The following Guest Post is from William A. Jackson, M.D., a Radiologist with Beaufort Medical Imaging at Beaufort Memorial Hospital:

Why is a physician writing on an attorney?s blog?  First, I have been a Mac user for fourteen years, and this blog is about Mac use.  The inspiration for this particular post came from a discussion with a fellow physician who is currently involved in a medical malpractice case.  He was asked for the medical images involved in the case, which he provided on a CD.  The requesting attorney was unfamiliar with the viewing software on the CD, and he did not realize all of the images were there but needed to be scrolled through.  Accusations were then made that information was deliberately withheld, which had its own set of hearings and unnecessarily increased the cost, time and stress for all involved.  As an impartial party, I saw an opportunity to contribute information that could have prevented this misunderstanding and offer an advantage to fellow Mac users.

Modern digital medical images are stored in DICOM format.  DICOM (Digital Imaging and COmmunications in Medicine) is a standardized format based on a lossless JPEG format that can carry additional medical data about the images.  The data identifies the type of study, patient name and date, much like the metadata tags that people are now applying to their digital photos.  In order to view the DICOM images, you must have a DICOM viewer.  At the hospital (or office) that took the images, they will have PACS (Picture Archiving and Communications System).  These systems can stores thousands of images and allow for viewing of the images at multiple locations.  The images can be printed on conventional film or burned onto a CD or DVD.  Due to cost savings and convenience, the CD/DVD format is preferred.  Most CD/DVD?s will include a copy of a free DICOM viewer; however, most assume that a Windows PC will be used and that Internet Explorer will be the default browser, often with ActiveX turned on.

So what are Mac users to do?  Of course, they can opt to use Boot camp, virtualization or a spare PC, but they can still have problems based on the assumptions already mentioned.  The best option for Mac users is OsiriX.  OsiriX is an open source DICOM viewer for Mac OS X.  It can open CD?s and DVD?s that contain DICOM images.  This allows you to view the images just as a radiologist or other physician would view them on a PACS.  The settings can be adjusted and areas of interest measured if desired.  OsiriX has the capability if working as a 3-D work station which is likely well above the needs of most attorneys.  The most important aspect, I feel, is the ability to view the images in a familiar format.  If you rely on the software included on the CD/DVD, each will have its own user interface.  This means that you must learn multiple ways of doing the same thing, often with contradictory results for the same action on different viewers.  This consistent user interface will make you more efficient at handling the images and less likely to over look some of the images.

OsiriX can allow you to store a copy of the images so you will still have them if the CD/DVD is damaged or lost.  You can make your own discs to distribute to your colleagues or witnesses.  You can store the images on a hard drive, locally or networked.  You can then export the images in a variety of formats.  You can burn CD?s or DVD?s.  You can also export to other drives or iPods.  They can be upload to web servers or iDisks.  Images can be exported in standard JPEG for incorporation into presentations.

As a radiologist, I find OsiriX useful even though I work at a hospital with a good PACS.  OsiriX is better at finding the DICOM images than our PACS, although some of that is due to protective settings on the PACS.  OsiriX opens nearly every disc that comes in.  There is one office that formats the disc in such a way that I have to manually find and load the images, which is fortunately the rare exception.  In fact OsiriX is so powerful, that there have even been a couple of times when it saved the day.  A referring physician wanted the outside images loaded onto our PACS and even with a $150,000 imaging work station designed to import images,  I had to extract the images from the disc, burn a new one using OsiriX, and then we could load the images onto PACS through the work station.  Not bad for free software!

William A. Jackson, M.D.
Beaufort Medical Imaging
Beaufort Memorial Hospital