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Integrating Neurosurgical Images in Patients’ Medical Records

The DICOM Solution

In view of the problems associated with exchanging images of different formats and the major risk of identification errors in the absence of consistent rules of identification, a committee comprised of expert associations (notably the American College of Radiology – ACR) and a group of major players in the medical imaging industry (notably the National Electrical Manufacturers Association – NEMA) decided in 1983 to work together to create an international standard for medical imaging. The standard which resulted from this work is known by the acronym DICOM, which stands for Digital Imaging and Communications in Medicine. Neurosurgery is one field where this standard is gaining more and more importance. Leica Microsystems has therefore included the DICOM option for its neurosurgical microscopes through ETIAM integration products like DICOM Izer and Print-in.


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Images linked to the patient’s medical record

"The integration of intraoperative images in the patient’s medical record makes it possible to trace the procedures performed during the operation. This, in turn, improves the clinical support which can be offered to patients, the doctor treating them and even to their surgeon", explains Dr. Victor Scordidis, neurosurgeon at the Clinique Notre-Dame de Grâce (CNDG) in Gosselies, Belgium. Like many other hospitals around the world, the CNDG attaches great importance to integrating images from medical examinations into the patient’s medical record. As Filippo Palagi, system architect of the hospital, points out, "The compilation of a computerised medical record which integrates medical reference documents, e.g. laboratory reports, reports on operations, and the key images they refer to is a major foundation of safe and reliable hospital practice." The DICOM medical imaging standard meets these needs perfectly.

International radiology standard ready for neurosurgery

"DICOM has been a successful standard in the field of radiology for over 15 years and allows radiologists and clinicians to benefit from the advantages of digitising medical images. The standard makes it possible to access images for the purpose of interpretation, enables collaborative exchange between experts and allows the creation of secure image archives", says Emmanuel Cordonnier, Vendor Co-Chair of the DICOM Standards Committee. "Furthermore, DICOM is a standard which is constantly evolving in order to take into account the actual needs of medical practitioners in all areas of speciality as the use of medical imagery increases", he explains.

Neurosurgery is a field which makes great use of imaging (MRI, scanners) and also produces many ­images through surgical microscopes.

Powerful microscope for neurosurgery

Neurosurgery is a form of microsurgery and, as such, requires the use of a surgical microscope for a range of operations such as herniated cervical or lumbar discs, tumour surgery or aneurismal surgery. The Department of Neurosurgery at the CNDG is the first establishment in Europe to have obtained the innovative surgical microscope Leica M720 OH5.

Digitisation of intraoperative video images

The majority of neurosurgical pathologies at the department – particularly tumours of the brain or spinal column – are treated by Dr. Scordidis. As well as being able to record images and videos of surgical operations in digital format using the video digitisation system integrated in the Leica M720 OH5, Dr. Scordidis also wanted a reliable infrastructure for securely archiving relevant images with a link between these images and the patient’s medical record – an essential requirement for being able to fully exploit this data in his practice.

Meetings were held between specialists in the fields of medicine, information technology and biomedicine at CNDG to find a solution to meet these needs. The solution that was adopted was the integration of significant images and video sequences in the hospital imaging archive – referred to as PACS for Picture Archiving and Communication System – with the DICOM option available through ETIAM’s DICOM Izer, on the Leica M720 OH5 surgical microscope.

Left: View of a computerised medical record. Right: Dr. Victor Scordidis, neurosurgeon at the Clinique Notre-Dame de Grâce (CNDG) in Gosselies, Belgium, consulting the intraoperative images archived on the DICOM network via the patient’s medical record.

Secure patient database for many purposes

The data securely archived on the PACS using the ETIAM’s DICOM Izer option of the Leica M720 OH5 can be easily used by neurosurgeons who are already familiar with the PACS visualisation tools. The recorded intraoperative images make up a secure patient database which allows the neurosurgeon to review the major phases of the operations performed at a later date, particularly for the purpose of postoperative support. This material can also be made available for training new specialists, for case studies within the department or even within the framework of exterior collaboration (e.g. requests for an opinion or experts’ groups).

With respect to legal aspects, the integration of surgical images on the imaging network makes it possible to trace and securely archive imagery from examinations. The images can also be used to supplement the report on the operation intended for the referring doctor, thus strengthening the relationship between the neurosurgeon and the referring doctors, e.g. by distributing reports on CD including a selection of intraoperative images. The patient benefits through this infrastructure in the form of full monitoring of his/her case and his/her neurosurgeon can obtain a complete overview of the examinations and operations carried out including MRI, scanners, intraoperative and postoperative images.

Pioneering hospitals

The approach taken by the CNDG shows the way forward for other hospitals which have also started considering the integration of images from surgical operations. Notable examples include LKH Klagenfurt, Austria; the University Hospital of Basle, Switzerland; HAITS Hospital Authority, Hong Kong, China and the CHU of Charleroi, Belgium.

Integrating images in the DICOM network requires skills that are not within the core expertise of optical  imaging modalities providers. "Thanks to the support of André Arcq, ETIAM representative within Belgium, I was able to deploy seamlessly the DICOM integration connectivity to take advantage of this competitive feature", indicates Mr Didier Prairie, Leica sales representative for operating microscopes in Belgium. "The strong expertise of ETIAM in DICOM connectivity makes this company the key partner for such an integration."