A web-based image viewer for multiple PET-CT follow-up studies

There exist many viewers for single-modal medical images that are efficient and are equipped with powerful analysis tools. However, there is a distinct lack of efficient image viewers for multi-modality images, particularly for displaying multiple follow-up studies that depict a patient´s response to treatment over time. Such viewers would be required to display large amounts of image data. In this study, we present the TAGIGEN viewer - a web-based image viewer designed specifically for the visualisation of multi-modality follow-up studies. We innovate by defining a series of dynamically generated image grid layouts that display sets of related images together in order to improve the ability to compare and assimilate the myriad images. We adopted a web-based client-server image streaming technology, thus enabling interactive navigation of the images in a computationally efficient manner. Furthermore, our web-based approach is interoperable and requires no software installation. We evaluated the ability of our viewer in displaying and understanding a patient´s follow-up images in a case study with combined positron emission tomography and computed tomography (PET-CT) follow-up scans. We conducted a usability survey on 10 participants to measure the usefulness of our viewer, used as an outpatient viewer e.g. viewer designed for use by the patients, in tracking a patient´s disease state across four PET-CT studies. Our initial results suggest that our viewer was able to efficiently visualise the patient data over time, and that the web-based implementation was fast (loading on average within 5.6 seconds with real-time navigation) and easy to use (overall survey score higher than 4 / 5).