MIRC: Case Study
Using MIRC Software for Education
and Research
The Children’s Hospital of
Philadelphia
Since CHOP is a teaching hospital,
our main focus is using the MIRC
Teaching File system for Educational
purposes
Basic Setup Overview

At CHOP we have a designated server for
the Teaching File which resides in our data
center.
 We have used the Teaching File Software to
create two storage services:
– Primary Storage(containing teaching files)
– Secondary Storage(containing normal cases)
Why Normal Cases?

Normal Cases are a valuable tool to NonRadiology Personnel
 By giving access to cases that are
considered “normal”, a ER resident can
decipher where a problem area exists.
Image on the left is technically inadequate as the patient is swallowing
during the exposure, giving the false impression of pre-vertebral
soft tissue thickening.
Image on the left is that of a normal High KV magnified airway in a normal patient
without symptoms. The patient on the right is experiencing a barking cough, clinically
concerning for croup. This image shows the textbook finding of the “steeple sign”,
which is the hallmark of croup on a frontal High KV magnified view of the airway.
MIRC System Setup
A quick peek at the CHOP Teaching File Website
Login:
Security Levels

To prevent untrained users editing and
deleting cases.
 Allow Attending Radiologists access to
modify all teaching files.
 Security levels are also setup to gain access
to different storage services.
What do the levels look like?

Support staff has Admin access.
 Attending doctors have access to edit,
delete, and submit cases to all storages.
 Radiology residents/fellows have access to
submit, review cases in all storages, and edit
their cases.
 Non-Radiology doctors have access to view
only.
How do we create our
Teaching Files?
Creation through Radpix

Our department utilizes Weadock Inc.
Software called Radpix.
 This allows us to create teaching files from
specific areas while watermarking our
images that are sent to the system.
How does this work?

Images are sent to one destination from any
PACS workstation.
 The images are then available at any
“Radpix” workstation in the department.
 The resident or fellow can then create their
teaching files and send them to the server
for publication.
A brief look at how our system is set up.
Let’s take a look at how this
works:
Program Startup
Opening Images
Choose the images you want to open
Once your images are open:
Let’s create the teaching file
This is what the authoring tool looks like
First we must configure the
authoring tool.
Choose your Options:
Adding a watermark:
Fill in your History, Abstract and Keywords for the case
along with patient information if you are including it.
Fill in any areas that apply:
Add a title and your image properties:
The images sections allows you to move
images up and down and add captions
You can annotate images to point out
specific areas of interest:
You can annotate images to point out
specific areas of interest:
Authentication avoids untrained entries:
Adding a quiz to aid in education:
Now lets upload and see what
our teaching file looks like on
the web.
One Nice Feature:
MIRC Software allows for GIF uploads which let you as the user
Add moving files to the teaching file which can enhance the learning
Experience for the resident/fellow that is using the case.
Requirements for entry?

All teaching file cases must be approved by
an Attending Radiologist before entry.
 Substantial documentation as to reasoning,
interest factor and diagnosis explanation are
required.
 Also a helpful number of images should
accompany the documentation.
Benefits of Digital Teaching
File?
The implementation of an electronic teaching file
in a busy academic practice/training program is
initially cumbersome, but like any computer based
system, once the initial data are entered, becomes an
invaluable resource, replacing standard analog film
teaching files with easily accessible JPEG file,
either from the digital DICOM source image in the
case of newer studies, or digitized analog cases from
cases that predate digitally aquired images.
Benefits of Digital Teaching
File?
•This provides for a large bank of teaching file cases
that are stored on their own dedicated server, and
that are accessible through the hospital intranet, and
if desired, through the internet (world wide web).
•The cases are a resource for teaching of not only
the Radiology trainees, technologists, and staff, but
also allow for further education of the general
medicine trainees and other subspecialties within
the hospital and the university.
Benefits of Digital Teaching
File?
Cases can be compared to a bank of normal cases,
corrected for age, and be correlated with clinical
and pathological findings. Online references can
be provided, and links to these sites can be created
in order to provide up to the date literature that
applies to the case at hand.
Benefits of Digital Teaching
File?
Cases can be coded by ACR codes, actual
diagnoses, or the combination of the two. This
allows for review of individual cases, or if desired,
by group of cases with the same or similar
diagnoses, therefore facilitating research
possibilities, provided appropriate IRB approval is
received prior to the start of the cases to be
reviewed for the purposes of clinical research.
Plans for the future:
Children’s Hospital of Philadelphia plans to
expand its teaching file to be the most
comprehensive collection of cases. With full
server expandability our storage is limitless.
 Also we plan to move forward with making our
site available to other organizations so that we can
share in the knowledge to aid our patients

Thank you for joining us today
Special thanks to Dr. Avrum Pollock
for your help.