The History of Sharing Medical Images

Posted by Les Trachtman on Apr 21, 2017 3:53:00 PM

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xMedical image sharing has come a long way since the discovery of x-rays in 1895, when you may have had to deliver radiography images to a physician by horseback or bicycle. In a sense, however, knowing the history of medical image sharing is more important than ever.

In order to understand how the field will be advancing in the future, we need to have a clear understanding of where we came from and how we got here. With that in mind, here's a brief overview of how doctors and clinics have shared medical images in the past and present—and a look at how things might change in the future.

Film

Medical imaging began with modalities, mainly X-ray machines, that worked much in the same way that cameras take pictures on physical film. An image would be exposed on a piece of film, and the film would then be developed.

Often doctors would have darkrooms in their offices dedicated solely to medical imaging. The images would be developed on large pieces of acetate or film, after which they were held against a light box for viewing.

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The main benefit of film for medical images was that it was the best option at the time. In the absence of alternatives, people could obtain a somewhat portable image to perform a read, and then take it to a specialist if necessary. In addition, it was almost impossible to make a copy of the original image, giving patients a high assurance of confidentiality over their sensitive information.

Of course, the difficulty involved in copying film images was a double-edged sword. Having only one copy of the image meant that it was difficult to share and difficult to store. Additionally, its size made it harder to transport.

Digitalization

Due to these drawbacks involved in using film for medical images, there was both a need for a better solution and a technological revolution that provided it. This solution was digital film. The evolution in imaging technology made it inevitable that physical film would fade away thanks to the manifold benefits of digital film. Digital images could be: (1) shared much more easily with other physicians, and (2) stored in a doctor's office with a much smaller footprint than images on film.

Along with digitalization, there was an evolution in medical imaging modalities, from a 2-D viewpoint to a multidimensional one. Techniques such as computed tomography (CT) scans and magnetic resonance imaging (MRI) provided richer perspectives than a 2-D piece of film. These new modalities gave physicians higher-resolution images as well as more defined images in multiple dimensions. Furthermore, they provided a new dimension—time—with modalities such as ultrasounds.

However, with these improvements in imaging came new challenges. Digitalization made it easier to copy and share images. On the flip side, patient confidentiality and image security were negatively affected. In a certain sense, it was now easier to lose, delete, or destroy images; so more care had to be taken to preserve them.

In addition, as medical imaging transitioned from film to digital format, physicians were unable to control all aspects of the imaging process themselves, forcing them to become dependent on technical experts.

Cloud-Based Storage

As these drawbacks to digitalization became more apparent, physicians began searching for solutions. This search led to the next major evolution in medical imaging: from "simple" digital image storage to cloud-based digital image storage.

Rather than needing to maintain a server on-premises, physicians and clinics could offload the task of storage to a third-party resource. Image storage became a utility that could be purchased on an as-needed basis, rather than a physical database that needed to be supported and maintained.

The benefits of cloud-based storage weren't limited to the convenience of outsourcing, however. People quickly realized that images stored in the cloud could easily be accessed and shared from any location. What's more, any number of users, distributed across any number of locations, could view the same image concurrently.

This convergence of technology and opportunity was a major boon for physicians and has had a major impact on how medical practices operate today.

A Look Ahead

From a higher-level perspective, the trends in medical image sharing seem fairly clear. Beginning with film as the fundamental scanning technology, we progressed to digitalization and then multidimensional digitalization, which provided increased resolution and dimensions. Most recently, medical images have moved into the cloud, allowing for easier sharing and storage.

Throughout this timeline, there's been a continual growth towards improving the accuracy of diagnoses, as both the pictures themselves and the ability to share them get better. We've moved from a single individual doing a read in one location to higher-resolution pictures that can be read in one location, and finally to higher-resolution pictures that multiple people can read in multiple locations.

Now that we have high-resolution digital images, one natural next step is computer-aided analysis. Companies such as IBM have used machine learning techniques to develop the Watson supercomputer, which can do a first read of an image and identify potentially problematic images.

Although the point where machines can replace doctors is a long way beyond the horizon, computer-aided analysis through the power of big data is certainly an exciting new domain to explore for medical imaging.

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Topics: medical imaging, cloud pacs

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