RT Image — December 6, 2010
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Case Study | Making the Transition
Patrick Chokron

DICOM Izer eases digital film data conversion

WORLDCARE CLINICAL (WCC) is a global imaging contract research organization for clinical trials in the pharmaceutical, biotechnology, and medical device industries. With an 18-year heritage specializing in imaging, WCC has processed more than 1 million images and enrolled 4,000 sites in more than 50 countries.

WCC captures and collects images that have been acquired from international sites. Each clinical trial varies in the number of different sites, from 50 to 300, and these images arrive in different formats. With such a dearth of information, time-consuming problems tend to arise.


Approximately half the images WCC receives are uploaded digitally and automatically incorporated into the WCC PACS. The remainder of the images arrive in either printed film or digital format on a CD or DVD.

In order to be archived and interpreted, films need to be digitized and organized according to the patient, study, and modality. In addition, patient identifiers must be removed to conform to GCP requirements. If handled manually, this process can be tedious, since the patient’s name may appear in several locations on the film.

However, WCC found a device that made the process easier. With the DICOM Izer from ETIAM, the process of digitizing films became more efficient. DICOM Izer allows us to scan, mask, format, and archive images to prepare them for interpretation. The images come from a broad variety of modalities, including CT, MRI, and hard-copy X-rays.

With DICOM Izer, we separate the multiple images of a typical study using a process called “cookie-cutting.” By using this cookie-cutting method, we can separate each one into a single image, and then straighten them and trim uneven borders if necessary.

DICOM Izer also allows us to make the images completely anonymous by masking any patient identification before sending them to the PACS for use by reading radiologists.


When images arrive on CD or DVD, they often are not 100- percent DICOM compliant. This deficiency is the result of various imaging processes still in use in certain parts of the world. It may also be attributed to antiquated equipment or less-than-modern imaging procedures.

To assure compatibility, we use ETIAM’s Open LiteBox, which allows us to import non-DICOM compliant images and configure different DICOM fields that need to go through deidentification prior to sending images to our PACS for use by radiologists. With Open LiteBox Publisher, we can print and label duplicate Cds when clients and sites request them for archiving purposes.

ETIAM trained members of the WCC staff to work with both DICOM Izer and Open LiteBox. The products are intuitive and the staff, who work with a variety of software, finds the ETIAM software easy to use.

WCC is satisfied with both ETIAM products and technical services. We often receive images that can’t be imported because of compatibility issues. In each instance, ETIAM responds quickly to help solve ongoing problems. In some cases, they may even revise the software when it’s necessary. That kind of responsiveness is rare, and a main reason WCC partnered with ETIAM to devise a solution to our problems.

| Patrick Chokron is director of software engineering for WorldCare Clinical in Boston. Direct comments and questions to editorial@rt-image.com.