Le logiciel libre au service de l'imagerie médicale par Sébastien Jodogne | Liege Creative, 21.03.14

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Au cours des vingt dernières années, l'essor puis la démocratisation des nouvelles technologies d'imagerie médicale ont mené à de profondes révolutions dans la prise en charge clinique de nombreuses pathologies, comme le cancer ou l'insuffisance cardiaque. Le volume sans cesse croissant d'images auquel tout hôpital est actuellement confronté n’est pas sans créer des difficultés.
Face à ces besoins impérieux de la collectivité et face au manque d'offres commerciales adaptées, le Département de Physique Médicale du CHU de Liège a décidé de concevoir un produit informatique innovant et de qualité industrielle. Ce logiciel, nommé Orthanc, a la particularité d'être un logiciel libre. Tous les hôpitaux du monde peuvent donc l'utiliser librement, selon une démarche universitaire, collaborative et ouverte.

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Le logiciel libre au service de l'imagerie médicale par Sébastien Jodogne | Liege Creative, 21.03.14

  1. 1. Vendredi 21 mars Le logiciel libre au service de l'imagerie médicale Sébastien JODOGNE, Medical Imaging Engineer, ULg - CHU, Department of Medical Physics Dans le cadre du festival ImagéSanté
  2. 2. Avec le soutien de :
  3. 3. Introduction Orthanc Free and Open-Source Software Le logiciel libre au service de l’imagerie m´edicale S´ebastien Jodogne 21 mars 2014 1 / 43
  4. 4. Introduction Orthanc Free and Open-Source Software Who Am I? PhD in Computer Science (ULg, 2006): Software engineering. Computer vision = machine learning + image processing. High-performance computing. Theoretical computer science. Professional experience in private companies: CCTV – Closed circuit television (Euresys, Secosys), Machine vision (Euresys, Jomago), Broadcasting (EVS). Since 2011: Medical imaging engineer at the CHU of Li`ege (Department of medical physics). 2 / 43
  5. 5. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  6. 6. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  7. 7. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Imaging Flows for Radiology Hospital Information System Radiology Information System Picture Archiving & Communication System (PACS) + 3 / 43
  8. 8. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool RIS/PACS Manufacturers 4 / 43
  9. 9. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool RIS/PACS Manufacturers 4 / 43
  10. 10. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Radiotherapy What is Radiotherapy? “The medical use of ionizing radiation, generally as part of cancer treatment, to control or kill malignant cells.” CHU of Li`ege ≈ 2600 new cases per year. First radiotherapy department in Belgium (6 linacs). 5 / 43
  11. 11. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Radiotherapy Manufacturers 6 / 43
  12. 12. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool The Evolution of Radiotherapy Surgical Strike 7 / 43
  13. 13. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool The Evolution of Radiotherapy Surgical Strike Main Problem How to identify the target? ⇒ Medical Imaging 7 / 43
  14. 14. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Multimodal Medical Imaging for Radiotherapy CT + MRI + PET-CT 8 / 43
  15. 15. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Imaging Flows for External Radiotherapy Simulation CT MRI PET-CT Nuclear medicine Contouring Ballistics Treatment CyberKnife 9 / 43
  16. 16. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Imaging Flows for External Radiotherapy Simulation CT MRI PET-CT Nuclear medicine Contouring Ballistics Treatment CyberKnife Many imaging flows, everything is done with DICOM! 9 / 43
  17. 17. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  18. 18. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool What Is DICOM? 10 / 43
  19. 19. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool What Is DICOM? 1 File Format: One image slice + Patient metadata 10 / 43
  20. 20. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool What Is DICOM? 1 File Format: One image slice + Patient metadata 2 Network Protocol — Early example of Web services: Send local images, Search remote images, Retrieve remote images. 10 / 43
  21. 21. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool What’s the Matter with DICOM? Part of the Solution De-facto standard in medical imaging. Mature (30 years old). Supported by any medical device. 11 / 43
  22. 22. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool What’s the Matter with DICOM? Part of the Solution De-facto standard in medical imaging. Mature (30 years old). Supported by any medical device. Part of the Problem Large and complex (over 4000 pages). Old format (redundant with XML, JPEG, PNG. . . ), Custom network protocol (redundant with SOAP, REST. . . ). Huge number of files (e.g. 3D images split slice-by-slice) ⇒ Redundancies between DICOM files. Not developer-friendly (complex parsing). 11 / 43
  23. 23. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (1/4) Data from a single patient: No uniform convention to organize this data. How to exchange this data between computers? How to easily access the embedded medical information? 12 / 43
  24. 24. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (1/4) Wish #1 Transparent, automated indexing of DICOM files. Work on low-end desktop computer. Create ZIP files of a patient. 13 / 43
  25. 25. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (2/4) Radiotherapy systems Another hospital 14 / 43
  26. 26. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (2/4) Radiotherapy systems No DVD reader?! 14 / 43
  27. 27. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (2/4) Wish #2 Read CD/DVD with DICOM images with any computer. Upload the images to various DICOM stores. 15 / 43
  28. 28. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (3/4) Nuclear medicine Radiotherapy CT + PET + Contours 16 / 43
  29. 29. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (3/4) Nuclear medicine Radiotherapy CT + PET + Contours Removed each day! 16 / 43
  30. 30. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (3/4) Nuclear medicine Radiotherapy CT + PET + Contours Removed each day! 16 / 43
  31. 31. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (3/4) Wish #3 Deploy decentralized, task-centric DICOM buffers. Browse their content from anywhere in the hospital to: 1 Quickly re-transmit images. 2 Connect to viewers or specialized analysis tools. Nuclear Medicine DICOM Buffer Radiotherapy (1) Re-transmit (2) View/analyze 17 / 43
  32. 32. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (4/4) CBCT DICOM Study server SFTP Script Automated anonymization/forwarding for public clinical studies? 18 / 43
  33. 33. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Real-World Software Problems in Hospitals (4/4) Wish #4 React to the incoming of DICOM images. Drive low-level DICOM tasks (e.g. anonymization) by high-level requirements. Focus on network administrators (scripting). 19 / 43
  34. 34. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  35. 35. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Summary: The Medical Context 1 Explosion of the number and volume of medical images. 2 Data management and exchange of images are problematic. 3 Many manufacturers are involved: Proprietary, costly, closed software. Limited interoperability. 4 Imaging workflow is to be automated (cf. anonymization). 5 Low-end, locked computers. 20 / 43
  36. 36. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Summary: The Medical Context 1 Explosion of the number and volume of medical images. 2 Data management and exchange of images are problematic. 3 Many manufacturers are involved: Proprietary, costly, closed software. Limited interoperability. 4 Imaging workflow is to be automated (cf. anonymization). 5 Low-end, locked computers. Summary: The Software Expectations Need for automated image indexing. Need for intuitive, ubiquitous interface (Web browsers). Need for DICOM scripting. Need for free, open product (customizable). Need for lightweight software (1 installation for 1 flow). 20 / 43
  37. 37. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Main Free Software for DICOM DICOM Toolkits DCMTK (format, protocol), GDCM (format, client-only). PACS Engines Dcm4che, ClearCanvas, ConQuest. 21 / 43
  38. 38. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Main Free Software for DICOM DICOM Toolkits DCMTK (format, protocol), GDCM (format, client-only). Limitations Close-to-metal: sysadmins? No indexing. No Web interface. PACS Engines Dcm4che, ClearCanvas, ConQuest. Limitations Heavyweight, complex. Not for low-end computers. Still need a DICOM parser. 21 / 43
  39. 39. Introduction Orthanc Free and Open-Source Software Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool Main Free Software for DICOM DICOM Toolkits DCMTK (format, protocol), GDCM (format, client-only). Limitations Close-to-metal: sysadmins? No indexing. No Web interface. PACS Engines Dcm4che, ClearCanvas, ConQuest. Limitations Heavyweight, complex. Not for low-end computers. Still need a DICOM parser. Conclusion Hospitals need another free tool! 21 / 43
  40. 40. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  41. 41. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  42. 42. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage
  43. 43. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage 22 / 43
  44. 44. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Philosophy 1 Compromise between a DICOM toolkit and a PACS. 2 Lightweight DICOM store (runs on low-end computers). 3 Cross-platform (Windows, Linux, Mac OS). 4 Immediate to deploy (standalone, no external database). 5 Simple Web interface to explore the content of the store ⇒ Connect from anywhere in the hospital. 6 DICOM to modern formats and protocols (PNG, JSON, HTTP). 7 Open-source and developed inside the CHU of Li`ege. 23 / 43
  45. 45. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  46. 46. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Web Interface in Action Features “Patient → Study → Series → Instance” transparent indexing. 24 / 43
  47. 47. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Web Interface in Action Features “Patient → Study → Series → Instance” transparent indexing. Preview 2D images. 24 / 43
  48. 48. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Web Interface in Action Features “Patient → Study → Series → Instance” transparent indexing. Preview 2D images. Inspect DICOM tags. Send to remote modalities. Download ZIP files. Anonymize. 24 / 43
  49. 49. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Web Interface in Action Features “Patient → Study → Series → Instance” transparent indexing. Preview 2D images. Inspect DICOM tags. Send to remote modalities. Download ZIP files. Anonymize. Demo 24 / 43
  50. 50. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Scripting Orthanc Orthanc features a powerful scripting language (REST API). Software administrators can automate imaging flows: 1 Watch the arrival of new DICOM images, 2 Check the value of some DICOM tags, 3 React accordingly (forward, anonymize. . . ). Orthanc can be embedded into third-party systems for the organization of medical images (replacement to storescp). 25 / 43
  51. 51. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Python Sample — Autorouting to the PACS current = 0 while True: # Wait for new events in Orthanc (event polling loop) r = DoGet(’http://localhost:8042/changes’, { ’since’ : current }) # React when a new instance is received for change in r[’Changes’]: if change[’ChangeType’] == ’NewInstance’: # Send the new instance to the PACS instanceId = str(change[’ID’]) DoPost(’http://localhost:8042/modalities/pacs/store’, instanceId) # Remove the instance from Orthanc DoDelete(’http://localhost:8042/instances/%s’ % instanceId) current = r[’Last’] time.sleep(1) 26 / 43
  52. 52. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  53. 53. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Current Applications of Orthanc DICOM buffer for transmission errors: Nuclear Medicine dept. → Radiotherapy dept., Treatment Planning System → Treatment machines, Autorouting and filtering to third-party DICOM servers. Anonymization platform for clinical research with firms. Collect in-room images for radiotherapy research. Automated quality control of PET-CT scanners. Automated quantification of focal fibrosis on cardiac MRI. Import of CD/DVD from other hospitals (for modalities not integrated with the PACS). Mini-PACS on desktop computers ⇒ medical and image processing research. 27 / 43
  54. 54. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Orthanc is not a PACS, but a Complement to a PACS Missing Features Interfacing with RIS and HIS, worklists. Tools for radiologists (viewer, reporting). Long-term, legal archiving. Scalability. Distinctive Features Lightweight (many instances in an hospital). Easy configuration. Scriptable. Open-source for better compatibility between vendors. Bridge from DICOM to Web 2.0 (JSON/REST/AJAX). 28 / 43
  55. 55. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Worldwide Usage 17,000 visits to the Web site (≈ 36% of new visitors). 29 / 43 2014-03-13
  56. 56. Introduction Orthanc Free and Open-Source Software Philosophy Orthanc in Action Current Usage Downloads 3,900 downloads (≈ 12 per day) as of 2014-03-13. Part of Linux (Debian Med and Fedora Medical). 30 / 43
  57. 57. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  58. 58. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  59. 59. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? 31 / 43
  60. 60. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? 31 / 43
  61. 61. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Proprietary Software Most often paying. Black box: What is it made of? Duplication, modification and/or usage is limited. 32 / 43
  62. 62. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 33 / 43
  63. 63. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 1 Freedom to use the source code. 33 / 43
  64. 64. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 1 Freedom to use the source code. 2 Freedom to inspect the source code. 33 / 43
  65. 65. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 1 Freedom to use the source code. 2 Freedom to inspect the source code. 3 Freedom to modify the source code. 33 / 43
  66. 66. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 1 Freedom to use the source code. 2 Freedom to inspect the source code. 3 Freedom to modify the source code. 4 Freedom to distribute the sources or binaries (possibly paying). 33 / 43
  67. 67. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is Free and Open-Source Software (FOSS)? Free Software 1 Freedom to use the source code. 2 Freedom to inspect the source code. 3 Freedom to modify the source code. 4 Freedom to distribute the sources or binaries (possibly paying). ⊂ “Open-source software”: freedom to use and inspect. 33 / 43
  68. 68. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is the Advantage of Free Software? “I’m often asked to describe the ’advantages’ of free software. But the word ’advantages’ is too weak when it comes to freedom.” [Richard Stallman, for the 30th birthday of GNU project] 34 / 43
  69. 69. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary What is the Advantage of Free Software? “I’m often asked to describe the ’advantages’ of free software. But the word ’advantages’ is too weak when it comes to freedom.” [Richard Stallman, for the 30th birthday of GNU project] ⇓ Philosophical point of view: “Librisme” (FR). 34 / 43
  70. 70. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary 35 / 43
  71. 71. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary 36 / 43
  72. 72. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  73. 73. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary A Pragmatic Perspective to FOSS Technology: Backbone applications (e.g. Orthanc). Feedback/contributions from a large community. Independent code review (e.g. Karen Sandler). Ethics: Collaborative sharing of tools and knowledge. Avoid piracy (e.g. in education). Society: “Fracture num´erique” (e.g. XP end-of-life). Developing countries. Economics: Building boxes to boost private companies. Generate local activities of services. Sustainability: Software can be maintained after bankruptcy. Code can be adapted for new uses (fork). Strategy: Security and technological independence (Snowden). 37 / 43
  74. 74. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary Economics of FOSS (1/3) World 79% of smartphones use Linux (Android). 96% of supercomputers use Linux (weather, finance. . . ). Worldwide infrastructure of Google, Facebook, Twitter. . . 38 / 43
  75. 75. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary Economics of FOSS (2/3) France (Conseil National du Logiciel Libre, 2012) Market size: 2,5 billions of euros. 300 companies. 30000 employees. 30% of annual growth. 5/6 software developers use or have used FOSS. Thanks FOSS, creating a proprietary software costs 10 times less than in 2002 ⇒ boost of competitiveness. 39 / 43
  76. 76. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary Economics of FOSS (3/3) Wallonia and Brussels 150 towns use FOSS for their Web site and their administration (through IMIO). OpenERP S.A. is the “promising company” of 2013 (≈ 100 employees). Robert Viseur (CETIC) maintains a list of companies active in open-source. FOSDEM annual conference (ULB). CIRB promotes FOSS for Brussels region. Many (all?) software companies internally use FOSS. 40 / 43
  77. 77. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary The Special Case of Medical Software Improve interoperability between vendors (backbone). Open an ecosystem that is trusted by the major players, by uncoupling proprietary systems (cf. David vs. Goliath). Enhance the technological independence of hospitals. Code review to improve the security and quality of healthcare. Allow the patient to deal with her personal data at home. Improve healthcare in developing countries. Reference implementation for standard formats and protocols. Give a consistent interpretation of badly specified file formats, such as DICOM-RT (radiotherapy and nuclear medicine). FOSS as building blocks of commercial software for medical imaging: DCMTK, GDCM, ITK/VTK, Python. . . Examples of complete medical applications: GNUmed, GNU Health (Jamaica), OsiriX, 3DSlicer. . . 41 / 43
  78. 78. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary Orthanc was Nominated at Z´enobe Award 2013 FOSS Acknowledged as a Vector of Social Innovation Innovative product. Social need: Healthcare and biomedical research. Not enough satisfied by the market. Open, collaborative and sustainable approach to software. 42 / 43
  79. 79. 1 Introduction Radiology and Radiotherapy Problems with DICOM in Hospitals The Need for Another Free Tool 2 Orthanc Philosophy Orthanc in Action Current Usage 3 Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary
  80. 80. Introduction Orthanc Free and Open-Source Software Definition Practical, Economic Benefits of FOSS Summary Summary http://www.orthanc-server.com/ Open-source, Web-based DICOM store. Lightweight, scriptable, versatile. Comes from real-world, clinical needs. Availability: Linux, Windows, Mac OS. FOSS can help the medical sector for better interoperability and healthcare quality. Publications: ISBI 2013, ESTRO 2013, 2 @ BHPA 2013. 43 / 43
  81. 81. Appendix 44 / 43
  82. 82. Code Statistics 45 / 43 [Ohloh]
  83. 83. Software Architecture Major Components DCMTK (for DICOM format and protocol). Mongoose (for embedded HTTP server). jQuery Mobile (for the Web interface). Boost, JsonCpp and libpng. Orthanc Server (C++) DCMTK (DICOM protocol) SQLite (indexing) DICOM C-Store DICOM C-Find DICOM C-Move REST services Orthanc Explorer (Javascript/HTML5) Web browsers zLib (compression) Filesystem Mongoose (HTTP server) 46 / 43
  84. 84. Focus on Code Quality in Orthanc Daily challenged with large volumes of real-world images. Continuous Integration Server. Unit testing. Integration tests through REST API. Valgrind. Trello for project management (roadmap). FAQ, issue tracking and discussion group available. 47 / 43
  85. 85. Compatibility between FOSS Licenses Orthanc is GPLv3. 48 / 43

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