CollabDDS: Collaborative Digital Diagnosis System
India, a developing country has huge pressure on its health systems for meeting the health needs of our increasing population. There is huge unmet demand for provision of medical services in rural areas where most of our country's population lives. In today's era of modern medicine, a lot of emphasis is laid on radiological diagnostics for patient treatment planning. Higher centers where experts in these fields are present or located are mostly confined to urban India. Then there are centers of excellence in these field which are further limited to very few and countable on fingers. This disparity directly affects the quality of radiological teaching and understanding of the subject between students of different medical and dental colleges. Organizations with expertise in different areas viz. National Informatics Centre, New Delhi, All India Institute of Medical Sciences, New Delhi, Indian Institute of Technology-Bombay, Mumbai and CSIR-Central Scientific Instruments Organisation, Chandigarh joined in for effective development, implementation and roll-out of an application which could bring a shift in the way in which radiological diagnosis and teaching is carried out.
The Model Project:
The model project "Network Enabled Medical Diagnosis and Education in Skeletal Imaging using X-Rays" funded by the National Knowledge Network (NKN), was undertaken as a Proof of Concept to provide a network based system for radiological and orthodontic diagnosis using X-Rays. The area of study being complicated required expertise in varied domains such as but not limited to Orthodontics, Orthopedics, Radiology, Computational Methods, CAD/ Rapid Prototyping, Image Processing & Pattern Recognition. Project was planned in two phases; first one being to develop an application which could enable visualization and processing of radiological data over a collaborative platform and second to effectively roll out and enhance the application as per the end user needs.
Goals and Objectives:
The project has been envisaged and is in progress keeping in view two goals. First one is to connect Primary Health Centres (PHC's) with expert radiologists/ doctors & dentists at Medical/ Dental colleges and Hospitals using suitable Information, Communication and Technology (ICT) tools and channel for real time radiological data transmission. This platform would enable physicians at remote level PHC's to have real time radiological diagnosis for their patients. Further, experts could use this platform to collaborate. The high-bandwidth and low-latency capability of the NKN would provide an ideal platform for data transmission as radiological data is huge in size and thus poses problems for utilization in real time because of latency in data transmission. This would prove to be of extreme value for both patients and primary level physicians in rural areas for radiological consultation with experts sitting at tertiary centres in real time and thus provide better diagnoses and treatment.
The second objective was to use this platform to build a repository of rare clinical cases for teaching of medical and dental students thus providing these students with an opportunity to study cases which are currently limited to the centers of excellence in medical and dental field.
With this vision an application CollabDDS: Collaborative Digital Diagnosis System has been developed
The strength of CollabDDS over telemedicine/web based consultation lies in its real time collaborative environment where both the doctor and expert will view the same image simultaneously. The expert could interpret the image for diagnosis. This kind of a collaborative activity amongst PHC's with Medical/Dental Colleges & Hospitals and Centres of Excellence would help to provide improved diagnosis.
Development of CollabDDS: Collaborative Digital Diagnosis System
CollabDDS provides a real time collaborative environment to visualize medical (Skeletal) and dental images (digitized X-Ray images or DICOM data) for diagnosis and treatment planning. CollabDDS has various image processing tools to visualize the data and also annotate. An inbuilt repository of annotated images can be used for education. Further it enables real time collaboration for diagnosis between physician at PHC level and experts at medical colleges and hospitals. CollabDDS is unique as it allows the viewing and processing of digitized X-Rays in various standard image formats like JPEG and DICOM and also allows this data to be saved for later review/ study.
The patient submits his/her X-Ray to the Primary Health Center or Secondary Health Center. This is transmitted to the connected higher level centers after scanning it. The digitizer at the time of scanning permits the technician to enter certain details and have the X-Ray in DICOM format if required. DICOM files along with the relevant diagnosis are stored in the Repository at the data center to be accessible for any future reference and teaching purposes.
A repository of teaching files will be created for the purpose of education. Provision of such a repository would prove extremely beneficial for education and research for medical/dental undergraduates and postgraduates and researchers as such a repository is still lacking in our country. CollabDDS may also enable design and fabrication of orthodontic/orthopedic e-models, custom implants, prosthesis and surgical instruments using CAD models created from X-ray/CT images.
The first version of the CollabDDS V1.0 was released on July 04, 2012. Based on the continuous feedback from the experts, latest version 1.6 was released on August 19, 2014. Dental module for Cephalometric analysis has also been introduced in this version.
The Benefits of CollabDDS are:
- Efficient Digital Workflow of X-Ray Imaging ( Skeletal and Dental)
- Improved Diagnosis and Treatment through Collaborative Consultation
- Enhancement of Quality of Medical Services in Rural Areas
- Reliability, Security and Accessibility of Medical Records
- Education based on Expert Diagnosis
Pilot Implementation of Collaborative Digital Diagnosis System (CollabDDS)
With the proof of concept having gone through successfully, a Pilot Project for Implementation of CollabDDS at Medical and Dental Colleges and Hospitals has been undertaken. This is an extension of the POC to the Operational Research Phase as a prelim to rollout. This pilot implementation is used to evaluate the efficiency and effectiveness of remote diagnosis. Further this phase also incorporates a module which carries out Cephalometric analysis for orthodontic surgeons to enable diagnosis and treatment planning of their patients. This phase would also include the Enhancement of CollabDDS and Advanced Applications on 3D imaging. It would involve the reconstruction of 3-D models from CT / Surface images, development of methodologies for orthopedic implant development using 3D models.
The list of Medical and Dental Colleges for Pilot Implementation of CollabDDS is as follows:
- Government Dental College And Hospital, Ahmedabad
- Government Dental College, Goa
- SN Medical College, Agra
- Andhra Medical College and King George Hospital, Visakhapatnam
- King George's Medical University, Lucknow
- SMS Medical College Hospital, Jaipur