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放射科医师如何借由开源软体增进效率
以自动化骨密度报告系统为例
蔡依达 (I-Ta Tsai)
(I-Ta Tsai)
PCMan tsaiid
进入正题
以开源软体
架構
自动化骨密度报告系统
來 偷懶 增进效率
I have no relevant financial or non-financial
relationship(s) within the products or
services described, reviewed, evaluated or
compared in this presentation.
骨質疏鬆

Osteoporosis
Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.
James Heilman, MD
CC BY-SA 3.0
?骨密度报告

Bone Density
脊
椎
髖
部
前
臂
性別
男女
≥ 50 y/o
< 50 y/o
停經前
停經後
Z Score
-2.0
Below
Within
T Score
-1.0
-2.5
Normal
Low Bone Mass
Osteoporosis
Average bone mineral density (BMD) of L1 to L4 is 0.939 gm/cm2, about
93% of the mean of young reference value (T-score = -0.6).
The BMD of right proximal femur is 0.711 gm/cm2, and is about 84% of
the mean of young reference value (T-score = -1.4).
The BMD of right 1/3 forearm is 0.666 gm/cm2, about 97% of the mean of
young reference value (T-score = -0.3).
Conclusion:
The BMD meets the criteria of low bone mass, according to the WHO
(World Health Organization) classification.
Average bone mineral density (BMD) of L1 to L4 is 0.939 gm/cm2, about
93% of the mean of young reference value (T-score = -0.6).
The BMD of right proximal femur is 0.711 gm/cm2, and is about 84% of
the mean of young reference value (T-score = -1.4).
The BMD of right 1/3 forearm is 0.666 gm/cm2, about 97% of the mean of
young reference value (T-score = -0.3).
Conclusion:
The BMD meets the criteria of low bone mass, according to the WHO
(World Health Organization) classification.
!
錄音
打字
+
科技始终来自於

人类的惰性
?How
LiberaBMD
A ruby-on-rails based web application for analysis
of Hologic bone densitometry. It provides a web
interface to show the patient and examination
lists, and with a pre-defined reporting template, it
generates the final report according to the
interpretation algorithm of bone mineral density. It
also has web APIs for the final report generation,
which can be integrated into other radiology
information system.
https://github.com/tsaiid/libera-bmd!
DB Schema
{
"l1_included":1,
"l2_included":1,
"l3_included":1,
"l4_included":1,
"l1_area":16.285641436031202,
"l1_bmc":16.99838341485105,
"l1_bmd":1.043765054119572,
"l2_area":18.333654385665113,
"l2_bmc":20.458727470207037,
"l2_bmd":1.1159110475107186,
"l3_area":17.929959525400736,
"l3_bmc":19.19764387749801,
"l3_bmd":1.070702019728566,
"l4_area":18.29426952124908,
"l4_bmc":18.99286785102212,
"l4_bmd":1.0381867299463152,
"tot_area":70.84352486834612,
"tot_bmc":75.64762261357822,
"tot_bmd":1.06781279946417,
}
SPINE
{
"troch_area":12.187268473622307,
"troch_bmc":6.42159083076162,
"troch_bmd":0.5269097701966838,
"inter_area":20.527471477257816,
"inter_bmc":17.39763568286712,
"inter_bmd":0.8475294047852795,
"neck_area":5.237099303926052,
"neck_bmc":3.387444524551131,
"neck_bmd":0.6468169358583088,
"wards_area":1.1355205967391069,
"wards_bmc":0.4129044211119751,
"wards_bmd":0.3636256553141525,
"htot_area":37.951839254806174,
"htot_bmc":27.20667103817987,
"htot_bmd":0.7168735843213304,
}
HIP
{
"ru13tot_area":6.06894105963075,
"ru13tot_bmc":3.3610065904212476,
"ru13tot_bmd":0.5538044540880316,
"rumidtot_area":12.08358326600947,
"rumidtot_bmc":5.287974125787681,
"rumidtot_bmd":0.4376163931987372,
"ruudtot_area":7.000375234646343,
"ruudtot_bmc":1.9609613883207748,
"ruudtot_bmd":0.2801223252455898,
"rutot_area":25.15289956028656,
"rutot_bmc":10.609942104529702,
"rutot_bmd":0.4218178536076827,
}
FOREARM
?T & Z Scores
自己斯構自己算
SCORE
{
"if_current":1,
"ethnic":"O",
"sex":"M",
"reftype":"S",
"bonerange":"1234",
"if_default":1,
"y_min":0.1,
"y_max":1.5,
"x_min":20.0,
"x_max":90.0,
"age_young":25.0,
}
REFERENCE CURVE
x_value y_value std l_value
20.0 1.017 0.111 1.0
25.0 1.017 0.111 1.0
35.0 1.009 0.121 1.0
45.0 0.964 0.119 1.0
55.0 0.941 0.138 1.0
65.0 0.913 0.138 1.0
75.0 0.895 0.159 1.0
85.0 0.892 0.115 1.0
REFERENCE CURVE
0.500
0.675
0.850
1.025
1.200
20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
BMD + STD
BMD
BMD - STD
T- & Z-SCORE
z =
x µ
Standard score
?!
但计算出来的score
有时会有点小误差
Proper calculation of Z-­scores requires the use of an
accurate age value, i.e. you must calculate the actual
age (DXA Exam Date – Patient birth Date). This will
yield an age such as 56.77547634, not 56.0.
Next you must linearly interpolate between the
Reference BMD just above and just below the
subject’s actual age to get the actual age-­matched
BMD value.
“
”
Thomas Kelly
Principal Scientist at Hologic
Export DB
EMR Request
Web API
AutoHotkey (AHK) is a free, open-source macro-creation
and automation software for Windows that allows users to
automate repetitive tasks. It is driven by a scripting
language that was initially aimed at providing keyboard
shortcuts, otherwise known as hotkeys, that over time
evolved into a full-fledged scripting language.
• Expand abbreviations
• Mouse or keyboard macro
• Component Object Model (COM)
::btw::by the way
^k::
MouseMove, 111, 222
Click
Send ^v
Return
; Access an IE object by WinTitle and Internet Explorer_Server Number
; By jethrow
; http://www.autohotkey.com/board/topic/47052-basic-webpage-controls-with-
javascript-com-tutorial/
!
WBGet(WinTitle="ahk_class IEFrame", Svr#=1) { ;// based on ComObjQuery docs
static msg := DllCall("RegisterWindowMessage", "str", "WM_HTML_GETOBJECT")
, IID := "{0002DF05-0000-0000-C000-000000000046}" ;// IID_IWebBrowserApp
;// , IID := "{332C4427-26CB-11D0-B483-00C04FD90119}" ;// IID_IHTMLWindow2
SendMessage msg, 0, 0, Internet Explorer_Server%Svr#%, %WinTitle%
if (ErrorLevel != "FAIL") {
lResult:=ErrorLevel, VarSetCapacity(GUID,16,0)
if DllCall("ole32CLSIDFromString", "wstr","{332C4425-26CB-11D0-
B483-00C04FD90119}", "ptr",&GUID) >= 0 {
DllCall("oleaccObjectFromLresult", "ptr",lResult, "ptr",&GUID, "ptr",0,
"ptr*",pdoc)
return ComObj(9,ComObjQuery(pdoc,IID,IID),1), ObjRelease(pdoc)
}
}
}
^l::
wb := WBGet()
!
myL =
(
acc_no = $('iframe[name=frameWork]').contents().find('input[name=OldAccNo]').val();
report_area = $('iframe[name=frameWork]').contents().find('textarea[name=ReportContent]');
!
$.support.cors = true;
!
// jquery plugin for IE8, IE9 cross domain ajax
$.getScript( "http://cdnjs.cloudflare.com/ajax/libs/jquery-ajaxtransport-xdomainrequest/
1.0.1/jquery.xdomainrequest.min.js");
!
$.ajax({
dataType: "json",
url: "http://vghks.tsai.it/bone-density/studies/report/" + acc_no + "/text",
crossDomain: true
}).done(function(data){
if (data.report)
report_area.val(data.report);
else
alert("No data available. Please check the database.");
});
)
!
window := wb.document.parentWindow
window.execScript(myL)
Return
實際運作情況
發報告的速度真的比較快?
App 正確性足不足夠?
人工輸入正式報告正確性如何?
錯誤原因又是哪些?
0 s
400 s
800 s
1200 s
1600 s
264
1,452
p < 0.001
• 5,120 Exams

(2013-01-01 ~ 2013-12-31)




117
(98.3%)
2
(1.7%)
119
307
(95.4%)
14
(4.6%)
321
424 16 440
(p = 0.146)
DISCUSSIONS
前人的经验
Note: This copy is for your personal non-commercial use only.To order presentation-ready
copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.
1181INFORMATICS
The process of verbally reporting or manually retyping numeric data
generated at dual-energy x-ray absorptiometry (DXA) involves numer-
ous pitfalls.With use of a macro scripting editor, a customized macro
was created to automate the transfer of data generated by a DXA
Informatics in Radiology
Use of a Macro Scripting Editor to
Facilitate Transfer of Dual-Energy X-ray
Absorptiometry Reports into an Existing
Departmental Voice Recognition
Dictation System1
customized to i
mum of five stu
performed on t
from a different
BUT!
人生最厲害就是這個BUT!
c
m
p
f
1181INFORMATICS
The process of verbally reporting or manually retyping numeric data
Informatics in Radiology
Use of a Macro Scripting Editor to
Facilitate Transfer of Dual-Energy X-ray
Absorptiometry Reports into an Existing
Departmental Voice Recognition
Dictation System1
Not Open Source
Quantitative Computed Tomography (QCT) as a Radiology
Reporting Tool by Using Optical Character Recognition
(OCR) and Macro Program
Young Han Lee & Ho-Taek Song & Jin-Suck Suh
Published online: 8 March 2012
# Society for Imaging Informatics in Medicine 2012
Abstract The objectives are (1) to introduce a new concept
of making a quantitative computed tomography (QCT)
reporting system by using optical character recognition
(OCR) and macro program and (2) to illustrate the practical
usages of the QCT reporting system in radiology reading
Keywords Computer in medicine . PACS . OCR . QCT.
Reading room
Introduction
J Digit Imaging (2012) 25:815–818
DOI 10.1007/s10278-012-9464-8
Fig. 3 The QCT images and OCR-generated texts QCT report images
J Digit Imaging (2012) 25:815–818
Quantitative Computed Tomography (QCT) as a Radiology
Reporting Tool by Using Optical Character Recognition
(OCR) and Macro Program
Young Han Lee & Ho-Taek Song & Jin-Suck Suh
Published online: 8 March 2012
# Society for Imaging Informatics in Medicine 2012
J Digit Imaging (2012) 25:815–818
DOI 10.1007/s10278-012-9464-8
Not Open Source




LIMITATIONS
Bone Densitometry 

Manufacturers
Bone Densitometry 

Manufacturers
CONCLUSIONS
https://github.com/tsaiid/libera-bmd

https://github.com/tsaiid/ahk-smartwonder
?自己報告自己救
Q&A
woodleywonderworks @ Flickr

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