Use Imaging Tools to Give EMR Apps X-Ray Vision

As an electronic medical record (EMR) application developer, you face a number of complex issues, including interoperability, optimizing the user interface, maintaining data integrity, and ensuring data privacy and security.

Faithful display of images is one of the more complex requirements, even when diagnostic quality isn’t required. There are many sizes, resolutions, bit depths, and file formats that may need to be supported. Software to compress, manipulate, and display medical images must be compatible, reliable, fast, and well supported.

Luckily, the ability to properly handle images in your application is one area where there’s help. The manipulation of images is a specialized knowledge area that is extensive and costly to reproduce and usually best implemented through third-party software development toolkits (SDKs). Here are some of the benefits you can expect to gain by integrating imaging SDKs into your EMR applications:

Compliance with Standards

Radiological imaging relies on a variety of lossy and lossless image compression standards, while document imaging has its own set of image formats. These standards are varied, complex, and many continue to evolve. New standards are always under development, so maintaining and verifying compliance is a never-ending task.

Using SDKs takes the burden off you. When you’re selecting an SDK vendor, you’ll want to verify that they work with standards committees and compliance organizations to maintain timely format support within their products. It’s also a good idea to investigate the level of support you’re likely to receive. Sometimes applications outside the EHR can create non-compliant images, so it’s important to understand whether a tool will correctly handle the images automatically or how the vendor will address such instances.

Rendering and Processing Speed

Images created during radiology can be much larger than typical photographs. Compressing, decompressing, or manipulating these large images while still maintaining image quality imposes very high demands on CPUs, particularly when processing large numbers of images on servers. With that in mind, you’ll want to evaluate performance and memory utilization when selecting a vendor.

Anticipating Future Needs and Requirements

Although your current vision may not include TIFF documents, or Lossless JPEG files, or Windows 7 or Silverlight support, a new customer may introduce a sudden change in requirements that was previously unforeseen. Since imaging SDKs are built for thousands of implementers, they support an incredible array of imaging technologies. Since hundreds of functions are available to you at no added cost, you may discover ways to enhance your end-user’s viewing experience and capabilities. Adding another one can be as easy as adding a few lines of code to your existing application. If another SDK is required later, there are many advantages of using one from the same vendor.

Support for Specialized Image Characteristics

Medical images can have characteristics that rarely occur in other photographs or documents. For example, EKG and maternity labor monitoring devices can create images that are only a few hundred pixels high, but many thousands of pixels wide. Advanced imaging SDKs are built to manipulate larger images than would normally be supported by the basic development environment, and to do so more quickly. This results in faster display times, reduced flicker during image panning, scrolling, or zooming, and other improvements that are much appreciated by end-users when viewing images. Microscopy images also tend to be very large color images, showing high detail over many cells.

Another common image series that is used in cardiology is the angiogram. Here, a series of images is displayed in a video, or cine loop, showing how a radiopaque dye travels through key arteries. The imaging software must be fast enough to decompress, scale, and display these images at the same rate as they were recorded.

Since this is such a specialized area, you’ll want to ensure code quality is a factor in considering vendors. Look for a company that has a track record of experience handling these types of images and has stable, tested code that’s been successfully used in the field by a variety of other application providers. This will reassure you that the code has been well tested through the real-world processing of millions of images.

Image from an angiogram video series

High-Gray Image Support

Accurate diagnosis using medical images can benefit from the ability to resolve very fine differences in the densities of the areas under observation. A typical 24-bit color JPEG image, for example, can actually only represent 256 different levels of gray. To store more variations in wave penetration, radiology equipment often uses from 10 to 16 bits of information for each pixel. This increases the number of possible gray levels that can be recorded from only 256 up to as many as 65,535. Unless your imaging tools are designed to handle these “high-gray” images, however, you won’t be able to properly decode or display these files.

Moreover, most typical monitors are not capable of accurately displaying more than 256 shades of gray. To be able to see all of the available information in these images, adjustable controls for the width and center of the range of viewing data are needed. Default window Width and Center values are frequently stored along with DICOM images, and may need to be adjusted as images are studied. Also, specific look-up tables (LUTs) can be used to map non-linear curves to more accurately match display characteristics to wave penetration variations. These controls and features are built into a variety of viewing tools designed for medical images.

Why You Should Consider Using Imaging SDKs

EMR solution design and development requires critical knowledge of clinical objectives and patient data relationships. The use of SDKs, whether individually or in combination, offers many advantages, such as standards compliance, experience and reliability, and speed. They also yield valuable benefits, such as reduced development time and lower costs. View our imaging SDKs