TELEHEMATOLOGY
ICT Solution of a Shared Digital Image Repository
Daniel Schwarz
Institute of Biostatistics and Analyses, Masaryk University, Kamenice 3, Brno, Czech Republic
Miroslav Penka
Department of Internal Hematooncology, Masaryk University, Brno, Czech Republic
Ladislav Dusek, Petr Brabec
Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
Keywords: Telehematology, Image Consultation, Web Based Learning.
Abstract: Telehematology is one of educational projects at the Faculty of Medicine of Masaryk University. The
project has two various parts: the clinical part allows physicians to remotely consult their indefinite findings
and the educational part brings new possibilities for contact tuition as well as for effective distant learning in
a wide range of medical specialties. In this paper, the project is described mainly from the technical point of
view. The design and implementation of the shared digital image repository are explained here.
1 INTRODUCTION
Hematology is the branch of medicine that is
concerned with blood and its disorders. A subset of
telemedicine services including digital transmission
of visual information in hematology is usually
referred to as telehematology (Beolchi, 2003).
Recent developments in digital photography
together with the expanding use of the Internet have
brought many new applications of image
documentation, particularly in anatomical pathology
(Leong and Leong, 2004) or in dermatopathology
(Feit et al., 2005). First telehematology
investigations were focused mainly on utilizing
intrahospital networks and supporting clinical
decision making (Mitsuhashi et al., 2000). Very
specific hematologic issues are addressed in (Luethi
et al., 2004), where the diagnostic accuracy in
telehematology via email and in telehematology via
real-time conference techniques was studied.
The goal of this paper is to describe the ICT
solution of the Telehematology project at Masaryk
University. The project has been initiated in
cooperation with several hematooncology centres in
the Czech Republic in 2006 with a long-term plan to
support medical students’ access to digital
microscopy images and to the documentation of
diagnostics and treatment of serious diseases of the
blood and the blood-forming organs.
2 ICT IN TELEHEMATOLOGY
Our Telehematology project consists of a clinical
part and an educational part. It allows physicians to
remotely consult their indefinite findings with the
use of a shared digital image repository. The
discussions as well as the images and their text
descriptions are anonymous with a respect to patient
information protection. In the educational part, it is
available for contact tuition as well as for effective
distant learning in a wide range of medical
specialties.
2.1 Telehematology Workstations
Telehematology workstation is meant to be a site
equipped with a laboratory microscope fitted with a
digital camera which communicates through USB or
Firewire interface with an ordinary personal compu-
168
Schwarz D., Penka M., Dusek L. and Brabec P. (2008).
TELEHEMATOLOGY - ICT Solution of a Shared Digital Image Repository.
In Proceedings of the First International Conference on Health Informatics, pages 168-171
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Figure 1: The simplified scheme of the shared image repository in the Telehematology project. Only the most important
objects, their selected relations and properties are displayed.
ter (PC) connected to the Internet. The digital
camera is usually attached to a trinocular head of the
microscope with the use of a "c" mount video
coupler. The communication between the camera
and PC is controlled by a local software program
which is usually supplied together with the camera.
It is recommended to use also an additional piece of
local software for advanced image editing. In order
to send the captured images into the central
repository and organize them in the image
collection, a common internet browser is sufficient.
A typical setup of a telehematology workstation
involved in the Telehematology project includes a
laboratory microscope Olympus BX41
(planachromat 10× and 20× objectives and a fluotar
100× objective), digital video camera Artcam
300 MI (3 Mpx, up to 46 fps, USB), optical coupler
U-TV0.5X, PC control unit (Windows XP), software
QuickPhotoMicro and freely distributed image
editor GIMP.
2.2 Shared Image Repository
Despite the existence of various proprietary systems
for digital image documentation and sharing, our
original software has been developed, in order to
avoid over-reliance on technology by a single
provider.
The shared digital image repository in our
Telehematology project is implemented in the form
of web-based application, what allows participation
of any interested hematology site equipped with a
telehematology workstation. The main components
of the repository are shown in its simplified scheme
in figure 1.
The image collection is organized in a
tree-hierarchic structure. Particular tree branches
represent either personal folders in the image
consultation mode or diagnoses in the educational
image atlas mode. In the latter case the WHO
taxonomy of blood disorders is used. The
tree-hierarchic structure is realized by the block code
which is well-known in the field of communication
techniques. It allows for arbitrarily deep branching.
The term “study” refers to a set of images
captured from one case. Studies represent visual
information about particular diagnoses of particular
patients. Besides the images, each study contains a
text description about the case. The number of
images associated to a study is unrestricted. Each
image is identified by its file name, text description
and also by a single-choice parameter with a
TELEHEMATOLOGY - ICT Solution of a Shared Digital Image Repository
169

following list of values: peripheral blood, bone
marrow, cerebrospinal fluid, tumour print. In
addition, a set of keywords selected from a
predefined thesaurus may be added to each image
object in order to allow advanced searching
capabilities in the repository. Adding keywords from
the thesaurus is implemented in the form of an
interactive prompter which looks up a list of
possible words compared to a searching phrase. The
prompter is implemented with the use of AJAX
technique to avoid extensive page reloading.
The images are stored in the repository in several
versions: 1) the original file, 2) a copy with the
original resolution converted to the JPEG format,
3) a converted copy resampled to VGA resolution
(640×480), 4) a watermarked copy in VGA
resolution and 5) a thumbnail resampled to 75 px
along its longer side. All the image operations are
done automatically without any user’s intervention.
Users may send images in arbitrary format. Format
conversion, image resampling and watermarking are
performed with the use of the freely distributed
program ImageMagick. The computer on which the
application is hosted is equipped with the Linux
operation system, web server Apache and database
server MySQL. Own programs of the shared image
repository are written with the use of the scripting
language PHP.
2.3 User Roles in Telehematology
The list of user roles in the image repository together
with a description of user privileges follows.
1) Author: user may create new studies and edit
existing own studies in the TEMP and PENDING
state. The user may send messages to other authors
and guarantees and associate the messages to
particular studies. 2) Guarantee: user checks studies
in the PENDING state, i.e. the studies which are
completed by their authors. The user may change the
state of studies from the PENDING to the
APPROVED state. The user may send messages in
the same manner as an author. 3) Dummy: the
end-user of the shared image repository, who may
only view the studies in the APPROVED state.
User’s view is restricted only to the resampled and
converted images. Anonymous users may view only
watermarked images. 4) Administrator: user with all
privileges, who performs supervision over the
repository. The user can extend the thesaurus of
keywords or modify the hierarchic-tree structure of
the image collection according to new requests from
the guarantees.
All roles except the administrator role can be
assigned not only in the global manner for the whole
repository, but users may be granted also within a
restricted subset of the tree-hierarchic structure.
3 PRACTICAL ASPECTS
During the initial phase of the Telehematology
project there was a variety of difficulties which had
to be cleared. The most important component of the
project was always meant to be a stable and
user-friendly shared image repository. Thus, the
worst difficulties had been expected in this part of
the project. However, the worst problems finally
came out from the quality of captured images. Most
of CCD as well as CMOS digital cameras which
were tested required additional image editing in
order to compensate for errors in white balancing.
Images with an incorrect mixture of primary colors
(red, green, blue) are not suitable for education
purposes. In addition, such images with a color cast
did not either motivate hematologists to extend the
image collection nor to utilize the software resources
of the project for image consultation. Having
employed advanced image operations with the use of
the software GIMP solved the problem.
During the first year of operation the authors
have stored 336 images organized into 52 studies
from which 31 have been still in the TEMP state and
only 13 studies have been in the PENDING state.
Only 7 studies have achieved the APPROVED state,
what has showed us that the communication tools
provided for authors and guarantees need to be
improved, in order to speed up the process of
revising studies into their final versions.
The importance of our Telehematology project
lies in enabling students to access a well-organized
and described collection of digital microscopy
images for their undergraduate as well as
postgraduate education in a wide range of medical
specialties such as hematology, biology, histology,
anatomical pathology, oncology etc. The web-
oriented character of the project allows utilization of
the gathered image material for the contact tuition as
well as for self-study purposes.
Students at the Faculty of Medicine of Masaryk
University usually find their multimedia and
e-learning materials with the use of faculty’s
educational portal http://portal.med.muni.cz
, which
is described in (Dusek et al., 2006) in detail. The
reference to the Telehematology project is included
there among plenty of others.
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4 CONCLUSIONS
In this paper, the Telehematology project at Masaryk
University was presented, mainly from its ICT point
of view. Key problems lying in the quality of
captured images were mentioned.
The most original part of the developed image
repository from the user’s point of view is the
thesaurus of keywords implemented in the form of
the interactive prompter. Its usage avoids scrolling
obscure long lists or time-consuming searching in
tomes to get a right term.
The major part of the ICT solution for the shared
image repository in the Telehematology project is
used also in other web-based learning applications at
Masaryk University, such as Image Atlas of Digital
Mamography, Image Atlas of Dental Surgery, 3-D
Models in Nerosurgery and many more, which are
connected to medical image documentation.
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