# Patent

## Title
System and method for visual annotation and knowledge representation

## Abstract

A method and system for visually annotating an image. Annotations and notes to images, such as digital medical and healthcare images, may be stored in a structured vector representation alongside image information in a single, non-volatile and portable file or in a separate file from the image. The annotations may be composed of point, line and polygon drawings and text symbols, labels or definitions and captions or descriptions. The annotations may be structured in a manner that facilitates grouping and manipulation as user defined groups. The annotations may be related to an image but not inextricably bound such that the original image is completely preserved. Annotations may further be selectively displayed on the image for context appropriate viewing. The annotations may be retrieved for purposes such as editing, printing, display, indexing and reporting for example, and may be displayed on an image for interactive use with an embedded self-contained user interface.

## Background
BACKGROUND
1. The Field of the Invention
The present invention relates generally to a method and system for annotating an image, and more particularly, but not necessarily entirely, to a computerized method and system for creating, storing, displaying and associating structured, vector based, interactive visual annotations and interactive visual notes (also referred as “IVN”) with a digital image.
2. Description of Background Art
Annotation of visual material is a necessary activity, one that represents an important part of teaching, publishing and communicating visual information. Since the widespread adoption of computers and especially the Internet, the use of digital images in computer-assisted presentations has grown tremendously. Doctors, educators, geologists, architects, engineers, scientists are examples of professions where the use of digital images is becoming more widespread.
Image annotating, in a broad sense, includes any technique which allows an author to label, point to or otherwise indicate some feature of the image that is the focus of attention, including textual commentary. Providing an individual with the ability to add symbols, labels and captions to describe the contents of an image or to convey a concept and direct the viewer to important features of an image has been established for decades. It has been long accepted that assigning captions or a definition and providing an option to write a legend that further describes a region of interest that is unique to an image allows an author to convey intellectual information regarding the structures in the image itself. Traditional methods for annotating images have allowed authors to place pointers, textual information and labels to indicate structures contained in an image but that information remains static. Moreover, to change annotated features on an image often requires that the author scrape off the rub-on labels and start over or to reprint the image and start over with annotating the features of the image.
Today, digital image data is generated from a vast array of electronic devices and with the wide acceptance of the use of computers to accomplish the tasks of annotation gives rise to that fact that many applications have been designed to give authors the ability to annotate electronic image data. The same traditional sets of tools that have allowed authors to prepare image data for publication have essentially been reproduced in an electronic environment and can be used in addition to, or completely replace, traditional tools for annotating images.
Digital images are typically stored as raster images, also referred to as bitmap images. Examples of formats that are raster based include JPEG, GIF, BMP, PNM, TIFF, PPM, PNG and many others. Raster images are generally defined to be a rectangular array of regularly sampled values, known as pixels. Each pixel (picture element) has one or more numbers associated with it, generally specifying a color which the pixel should be displayed in. Most formats for raster images, including those mentioned above, compress the pixel information to shrink the size of the data needed to encode the image.
Authors of digital material are finding that creating, presenting, and cataloging digital images is a difficult task despite the technologic improvements. Visually annotating or illustrating digital images with symbols and text is a fundamental task many users of images must perform when preparing material for illustration. For example, clinicians and biomedical investigators must make visual annotations when preparing material for illustration.
Annotating visual media has evolved from scratch-on LETRASET® dry transfer labeling to using expensive, sophisticated and complicated image manipulation computer software like ADOBE® PHOTOSHOP® or MACROMEDIA® FREEHAND® software. At the same time, the need to illustrate images with annotations requires very little (symbols, labels, shapes and arrows) and remains a simple task. While rub-on labels certainly have large drawbacks, i.e., they cannot be used for annotating digital images, they embody the simplicity of annotating an image quickly with the necessary information. Sophisticated software, while capable of generating simple annotations, requires a high degree of skill and knowledge to navigate the complexity of options and functions to achieve what is, in the end, a simple task. Moreover, the previously available systems and methods do not promote interactivity with a user, neither in their output nor in their presentation. Thus, simplicity, interactivity and low cost continue as unsatisfied objectives for the process of effectively annotating visual digital material despite technologic improvements.
Not only is most image manipulation software functional overkill for creating simple annotations, this software flattens images where the annotations are “fixed” to the image much like rub-on labels. The flattening of image annotations causes several problems that also existed with rub-on labels: editing difficulties, poor image quality, lack of interactivity and information loss. These problems are further illustrated below.
Annotations are not easily edited in a flattened image. The process of editing a flattened image requires using the original image—often in a proprietary format—in the native environment of the authoring software. This process requires locating the original (not the presentation image currently in use) image or images—typically on a local hard drive—making the changes and then redistributing that image to the various publishing targets: Internet/WWW, paper-based copies, and so on. If the original image is lost then the annotations must be completed again from scratch. Those that have used this process—locating an image, making changes, then redistributing the image—can attest to the time and frustration involved.
In the previously available systems and methods, annotations when flattened become part of the raster-based (drawn with pixels) image as opposed to being stored as vector (drawn in true physical space) information. As the raster annotations are re-scaled (zoom in or out) their appearance often become incomprehensible.
Flattening of annotations to an image means not only that the annotations cannot be scaled accordingly, it means that the annotations cannot be manipulated in other ways, such as, creating interactive presentations for the purpose of communicating a visual relationship or integrating the annotations into a learning assessment tool. Since the Internet has emerged as a viable medium to deliver educational materials, presentors are more often using the Internet to provide computer-assisted presentations of educational material. Moreover, providing computer-assisted presentations has become easier than ever with the advancements in technology, computer hardware, software and improvements in the Internet and World Wide Web as delivery a mechanism. For example, in an illustration of brain anatomy it may be necessary to illustrate the neurology and gross anatomy side-by-side. But it may also be useful to hide or turn off the gross anatomy in order to illustrate the neurology then turn the gross anatomy back on to illustrate the relationship(s) between the two groupings. This scenario could be solved with raster images, however, it would require three images—one with neurology, one with gross anatomy, and one with both. Thus, there is four times the effort to produce this basic level of interactivity. Additionally, If these images are being viewed on the Internet it would mean three times longer wait in addition to the labor and disk space utilized in producing three images. As the interactivity of an educational presentation increases the effort involved with raster images will grow exponentially.
The fourth and possibly the most significant problem arising from flattened annotations is the loss of information. For example, in the situation of medical research and instruction, scientists, teachers, physicians, residents and students go to a network, such as the Internet, expecting to find resources on a particular topic by entering a keyword or phrase representing the subject or title of their objective. In order for a resource to be found, information about that resource must be indexed or cataloged like the age-old library card catalog.
Annotated images are one example of the valuable resources that need to be integrated into a catalog or index in order to be found and to realize their value. Annotated images offer more value than the base image in that there is intellectual or authored content assigned to the features of the image providing instructive value beyond the image itself. The annotations are part of the content. In order to index the annotated image this and other information—metadata—about the image (subject, keyword, format, date created, copyright, etc.) must be cataloged. However, annotations that are flattened to the image are not available for cataloging. Either the content of the annotations is lost or the annotations must be entered again into another system and associated with the image. This de-coupling of content from the image and re-entry of the annotations into a separate storage system which is required when using the previously available systems and methods results in a more labor intensive, complex and disjoint procedure.
Another disadvantage to using a flattened image is the inability to allow multispecialty authoring. Multispecialty authoring is the ability to add visual annotations, stored as groups, according to authorship. Often it is necessary that several different individuals annotate the same image. For example, several different specialties in the medical field may need to annotate an x-ray image. Using a flattened image, this would be extremely difficult.
Another drawback to flattened images is that it is difficult to modify annotated images to make them context appropriate. Annotated images often contain annotations that are not appropriate for the persons viewing the image for a variety of reasons. For example, this might include information that is prohibited from being disseminated by privacy laws or simply information that is irrelevant given the audience. Removing or hiding from view the annotations from a flattened image is not efficient due to the fact that the annotations are embedded in the image.
Still another drawback to the use of flattened images is the difficulty in reusing the annotated image. Reusing images in a variety of different mediums is an attractive option for authors. Authors will often decide to publish annotated image data to a variety of media. Some will publish in traditional peer reviewed journals and textbooks and others will want to publish annotated material to the World Wide Web. Moreover, the context in which an image will appear may require that the content, both image and annotations, be presented differently. When working from a flattened image, a great deal work must be duplicated to provide suitable flattened images for each context. Thus, it is in the best interest of the system architect and the author to create an archive image with associated annotations and store annotations as vector information or text data.
Reuse (linking or referencing) enables authors to easily and accurately link information, and then maintain links across document revisions and system changes. Adhering to a reuse policy could potentially reduce storage costs, and reuse rather than duplication promotes sharing of existing authored material rather than recreating it. The traditional known forms of output-based reuse include print publication, color plates, 35 mm slides, and the many forms of digital publication (e.g., PDF, HTML, etc.). Another form of reuse is in-system digital reuse of existing information. For example, a user might add multiple sets of annotations to an image and then desire to activate or inactivate the various sets of annotations to customize the image for use in different contexts, such as on a world wide web page, in a print document, or in the portable document format (PDF).
As discussed above, the previously available methods and systems are thus characterized by several disadvantages that are addressed by the present invention. The present invention minimizes, and in some aspects eliminates, the above-mentioned failures, and other problems, by utilizing the methods and structural features described herein.



BRIEF DESCRIPTION OF THE DRAWINGS
The features and advantages of the invention will become apparent from a consideration of the subsequent detailed description presented in connection with the accompanying drawings in which:
FIG. 1 is a flow chart showing the steps carried out in accordance with one illustrative embodiment of the present invention.
FIG. 2 is a reproduction of a computer display showing the various features of one illustrative embodiment of the present invention.
FIG. 3A illustrates an example of an annotated image in accordance with one aspect of the present invention.
FIG. 3B illustrates the non-embedded nature of the annotations in FIG. 3A in accordance with one aspect of the present invention.
FIG. 4 is a flow chart showing the steps carried out in accordance with one illustrative embodiment of the present invention.
FIGS. 5A and 5B illustrate the interactive nature of the annotations in accordance with one aspect of the present invention.
FIG. 6 is a diagram showing the steps carried out in accordance with one illustrative embodiment of the present invention.
FIG. 7 is a flow diagram illustrating the multispecialty annotation features provided by one illustrative embodiment of the present invention.



DETAILED DESCRIPTION OF THE ILLUSTRATIVE EMBODIMENTS
For the purposes of promoting an understanding of the principles in accordance with the invention, reference will now be made to the illustrative embodiments described herein. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications of the inventive features illustrated herein, and any additional applications of the principles of the invention as illustrated herein, which would normally occur to one skilled in the relevant art and having possession of this disclosure, are to be considered within the scope of the invention described and claimed.
The publications and other reference materials referred to herein to describe the background of the invention and to provide additional detail regarding its practice are hereby incorporated by reference herein. The references discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as a suggestion or admission that the inventors are not entitled to antedate such disclosure by virtue of prior invention. Further, it must be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise.
In describing and claiming the present invention, the following terminology will be used in accordance with the definitions set out below.
As used herein, “comprising,” “including,” “containing,” “characterized by,” and grammatical equivalents thereof are inclusive or open-ended terms that do not exclude additional, unrecited elements or method steps.
As discussed above, the main drawbacks which accompany the previously available flattening image annotations results in a variety of undesirable side effects: repetition of work, increase in authoring effort, increased organization requirements, increased complexity, difficulties to automate image cataloging, reduced instructional capability. All of the problems associated with the use of raster based images can either be eliminated or reduced substantially by not flattening the annotations to the image by the use of storing the annotations as vector based graphics.
With these objectives in focus, the illustrative embodiments of the present invention will define the requirements of a digital non raster-based annotation architecture and annotating methodology for digital images that will serve as a basis for use in a number of exemplary areas: authoring tools, presentation programs, and cataloging systems. The solution which is desirably provided in accordance with one aspect of the present invention is to separate the annotation information from the image information and at the same time attach or store the annotation information with the image file as vector-based text information. This method makes the annotations and metadata accessible, for example accessible to a user performing text searching for pertinent information, while still keeping the image and annotation information linked together.
The features and advantages of the invention will be set forth in the description which follows, and in part will be apparent from the description, or may be learned by the practice of the invention without undue experimentation. The features and advantages of the invention may be realized and obtained by means of the instruments and combinations particularly pointed out in the appended claims.
The present invention contemplates a system and method that allows annotations to be captured in a non-raster format. Because the annotations are stored in a vector file that is linked to the image file, the annotation will travel with the image information and the process of editing image annotations becomes much easier. As used herein, a “vector image” or “vector information” means a graphic comprising shapes, curves, lines, and text which together make the image. These shapes, curves, lines, and text can be constructed using mathematical formulas or other instructions as is known in the art to describe them instead of defining a grid of pixels as is the case with raster or bitmap images. A vector image can be in a two or three dimensional format.
With vector based image annotations it is not necessary to manage multiple original versions in a proprietary format or distribute multiple copies of the same image. The annotations remain accessible—at any time—for editing in the published image (the one most easily retrieved) without reverting to prior versions or copies. Thus, image annotation workflow is streamlined while at the same time reducing disk space usage.
Separation of the annotations in accordance with the present invention in this way makes it possible for a computer to catalog the resource automatically by “looking into” the resource itself for the annotations and metadata rather than requiring a person to enter this information into a separate system. Thus, the present invention's exemplary separation of annotations of an image simplifies and facilitates the automated cataloging of image resources improving the retrieval and increasing the value of image resources.
Referring now to FIG. 1, a process and methodology for annotating digital images with vector annotations is shown in accordance with the principles of the present invention. The first illustrative step is to open an image file (110) to annotate. Typically, the image file is a raster based image, for example a bitmap image and can be an image stored in one of many available formats such as, without limitation, JPEG, BMP, PNM, PNG, TIFF, and PPM. PNG as an image format is useful because it is supported by most image manipulation programs and, more importantly, because the PNG file itself can be used as a storage container for other types of information in addition to image information.
The image typically resides in a permanent storage medium such as on a hard drive, CD, DVD, flash memory or other similar storage device. The image can stem from any number of sources including, without limitation, a scanned image, a digital photograph, a work created on a computer, such as an architectural drawing, computed tomography, magnetic resonance image or any other valid source for a digital image. The image can be in a two dimensional or three dimensional format.
Once the image has been selected and opened (110), the next step is for the author to annotate the image (112). Typically, the step of annotating an image (112) can include several different substeps depending upon the needs of the author. Generally, an annotation will include one or more of the following: a region of interest, a pointer, and textual information such as a symbol, a label and/or a caption. The visible portion of the annotation on the image may include the region of interest, the pointer and the symbol. The region of interest, pointer and symbol may allow a medical educator, for example, to identify anatomical structures that convey relevant information about that image. Each of these will be defined in more detail below.
The region of interest is the visible portion of the annotation that is of interest. For example, in the medical field, a region of interest could be a feature or structure on an image (e.g., pathology, tumor, nerve) that conveys a clinical or research finding. While any manner to mark the region of interest will suffice, an author generally draws a point, line, or polygon to indicate a region of interest. The region of interest may be described by a set of points that may define a polygon, polyline or set of points, for example. A polygon may be used when the region of interest is a well-defined area, the polyline (or edge) may be used when the separation of regions is of interest and the points may be used when the interesting features are too small to practically enclose with a polygon.
The pointer for the annotation is partially defined by the author and partially computed based on where the author initially places it. For example, the author selects where the tail of the pointer should appear, and an algorithm calculates the closest point on the region of interest to place the pointer tip. This dual mechanism for anchoring the pointer allows the author to make choices about the layout of visual information on the image, without relying on a totally automated, and potentially unpredictable, layout algorithm. It is also within the scope of the present invention to utilize free from placement of pointers.
The textual information that is defined by the annotation methodology and includes the symbol, label and caption. Providing the ability to add textual information about the annotation enables the author to comment or add their expert knowledge on contents of an image in the form of a symbol, label and caption. The comments may refer to a detail of the image or the annotated image as a whole. The symbol, label and caption are a set of information commonly used across many fields, but may have specialty-specific terminology.
The symbol that is customarily associated with a visual piece of the annotation is taken from the textual information that is derived from a lexicon or free text entry. In the one illustrative embodiment of the present invention, the symbol is an abbreviation, typically derived from the label. The character length of the symbol allows it to be drawn on the image with numerous sets of other annotations, without obscuring visual information or interfering with the other annotations. When the symbol is used in this manner, it may be used as a key to link the visual annotation to the textual information. As mentioned, the symbol may be derived from a lexicon relating to the field in which the author is working. The symbol may be a lexicon specific piece of textual information that allows the annotation to be linked to a larger body of information outside the image. For authors who do not use predefined lexicons during the authoring process, the symbol may be enough to match the annotation with external information.
The label is the word or phrase that defines the visual annotation. For medical purposes, this label may also be taken from a lexicon or vocabulary, which enables dictionary-style lookup in the software implementation. The lexicon-specific piece of textual information allows the annotation to be linked to a larger body of information outside the image. For authors who do not use lexicons during the authoring process, the symbol may be enough to match the annotation with external information. The illustrative embodiments of present invention does not restrict or define lexicons because use of lexicons is the author's preference or institution's policy. If the label is drawn from a defined lexicon, it should at least be consistent across the author's work.
The caption is defined as a sentence or paragraph that describes the annotation. The description may include references to other pieces of information that may be part of an index or hypertext system. The caption should not contain information about the image as a whole, which is handled through a constant non-visual annotation.
Throughout the annotation process, the author should also be able to determine the presentation attributes. The presentation attributes define how the annotations should be drawn when rendered. The visible parts of the presentation attributes may also be interpreted differently depending on the medium (e.g. laser printer, journal article or web browser). The presentation attributes may include size, color, pointer type and tip location.
Illustrative of the embodiments of the present invention, each of the attributes may have only three or four options presented to the user to provide better control over presentation and annotation reuse. All presentation attributes in the present invention may be guidelines for the rendering and reuse of visual characteristics including fonts, sizes and colors. The Hypertext Markup Language (HTML) has used this approach with success.
The options for the annotation size attribute may be, without limitation, small, default and large, for example. This option controls the size of the pointer and associated text rendered with the visual annotation. The options for annotation color may be, without limitation, “light,” “default” and “dark,” for example. This option may control the color of the region of interest (polygon), the pointer and any text that is rendered as part of the annotation. The color that each of the three-color attributes map to may be defined in a style sheet.
The pointer type options may be, without limitation, “spot,” “line,” “pin,” “arrow” and “arrowhead,” for example. Other pointer types may be added, but these four options form the illustrative foundation for the kinds of pointers that may appear with the region of interest. The style sheet and rendering software may control the details (appearance) of these pointers.
In accordance with one illustrative embodiment of the present invention, the pointer tip option may control where the tip of the pointer appears relative to the region of interest. The options may include “center” and “edge,” for example. Using this attribute, the embodiment of the present invention may determine the actual pixel location of the pointer tip. The illustrative embodiments of the present invention may alternatively utilize free form placement.
Once the image has been annotated, the next step is to save the annotations and metadata, if present, as vector information linked to the image (114). The term linking, in addition to its normal meaning, also means, for the purposes of this application to save the vector information inside the image file itself or as a separate file. Some image formats, such as PNG, allow the vector information to be saved inside of the image file itself.
It will be appreciated that one advantage to saving the annotations and metadata as vector information is that vector based annotations improve the quality of image presentation because the annotations can be re-drawn or scaled dynamically based on their “equation” within the geographic space of the image. Therefore, image annotations can be shown clearly at all scales as the viewer re-scales the presentation (zooms in or out). In the same way that annotations can be scaled they can also be dynamically manipulated to create instructive and exciting interactive presentations, integrated into a learning assessment program, or other goal oriented task.
In accordance with the illustrative embodiments of the present invention, it is possible to store text information such as vector-based image annotations and metadata inside the image file along side the actual image information. The metadata includes any additional information about the image or annotations that may be useful. For example, the metadata may include the names of persons adding annotations to the image, including the date and time that the annotations were performed. The metadata may also include patient information in the case of medical images. The metadata may also include the names of persons who have viewed the image or annotations and the date and time of the viewing.
If storing text information inside the image file along side the actual image information is not possible, the annotation can also be stored in a separate file from the image with a relational mechanism, all in accordance with the illustrative embodiments of the present invention. This text information is not automatically displayed as a default by most image viewers and remains visually hidden. However, this information is accessible to many programming languages for interactive display, annotation drawing, publishing to multiple targets and cataloging. In this manner, storing metadata and vector-based annotations as text inside the image file, this information can more easily “travel” with the image information.
While the vector information can be stored in any format, one preferred method is to store the vector information in the extensible Markup Language (“XML”) format. This methodology ensures that annotations remain accessible as vector data, not embedded in the image, as well as maintain the links between the image and annotation information. It will be appreciated that storing the vector information in the XML format allows the annotations and images to become re-usable. Moreover, with vector-based image annotations, management of multiple original versions in a proprietary format or distribution of multiple copies of the same image is not necessary.
Further, in accordance with the illustrative embodiments of the present invention, the output is not platform specific. Rather, the output format may utilize the Scalable Vector Graphics (“SVG”) format, which is an extension of the eXstensible Markup Language (XML) specification. Metadata that includes visual annotations, author information, lexicons and information related to the authoring sessions are stored within the file. SVG facilitates extensibility, interactive web viewing, and reuse. SVG also allows the annotations and visual expert knowledge (i.e., labels and captions) to remain linked to the image, as opposed to embedding the annotations to the image. To facilitate the interactivity of the annotated images, the illustrative embodiments of the present invention utilize Adobe's SVG plug-in (Adobe Systems, San Jose, Calif.) for viewing annotated images over the Internet.
It will be appreciated that this form of output facilitates cross-media distribution. Cross-media publishing is a term that defines a set of methods that allow source material to be collected at a single source in a manner allowing reuse and redistribution across multiple delivery channels such as the Internet, electronic books, textbooks and presentations. For example, the medical content market development continues to be a thriving industry that ranges from standard textbooks and references to digital subscription services and web portals. In other words, an image annotated using the present invention is easily transported from one form of media to another form of media.
The present invention has been developed for the cross media publishing and digital content authoring markets is designed to integrate into existing systems for visually annotating images that are to be used for publishing in textbooks, on the Internet as a subscription Continuing Education module or on CD-ROM.
FIG. 2 illustrates an exemplary image that might be displayed on a computer screen that has been annotated pursuant to the an illustrative embodiment of the present invention as explained above. This example is useful for understanding the different features of the illustrative embodiment of the present invention and should not be construed as limiting in anyway. As can be observed, several regions of interest have been marked on the image. One region of interest, indicated by reference numeral 118, is noted by the label 122 “Cyst” which is connected to the region of interest 118 by a pointer 120. Also, a caption 124 and symbol 126 for the region of interest 118 can be observed. In this manner, it will be appreciated that the annotations are useful in conveying information to the observer. FIG. 2 also exemplifies the advantageous use of groups and views in accordance with the present invention.
FIGS. 3A and 3B respectively show an annotated image and the annotations without the image. The annotations shown in FIG. 3A show marked regions of interest with their respective pointers and labels. As can be seen, the annotations are “overlaid” over the original image as shown in FIG. 3A. FIG. 3B demonstrates that the annotations are not embedded in the original but are in fact stored in a separate file that is preferably linked to the image file. The annotations are stored in an image independent vector format for high-resolution display at all scales. Note that the original image remains unedited and more importantly, no pixels of the original raster image were changed or edited.
In accordance with the illustrative embodiment of the present invention, the separate annotation file may contain a digital signature of the image file in case the two files are separated. As will be explained in greater detail below, reuse of the image is facilitated since the original image remains unchanged and the annotations remain linked to the image.
It will be appreciated that because the annotations are not embedded into the image, they can be referenced, grouped (as shown in FIG. 2) and indexed for a variety of purposes. In addition, while multiple annotations can be added to an image, not all of the annotations need be displayed at the option of the presenter, to create a context appropriate annotated image. These multiple annotations can be interactive as will be explained below.
FIG. 4 is an illustrative example of the methodology of how the present invention facilitates a plurality annotations and groupings. The first step is to select and open an image (128) that has been stored electronically. The author then is free to define a region of interest (130) and add the appropriate symbols, labels and pointers (132) as desired. The author is then free to chose to add additional annotations (136). It should be noted that the author may be adding annotations to an image already annotated by another person (referred to herein as “multiuser authoring”). This is particularly true in a medical setting where several doctors may be adding annotations to the same image.
Once the image has been annotated, the next step is to group or order the annotations hierarchically (136). The order is a character sequence that allows the annotations of the image to be organized in an outline format, allows the annotations to be grouped (or nested) logically, and may impart priority (like the first annotation in the outline is the most important). The order is treated as an annotation but is used to identify and set up the hierarchy that the visual annotations fall into. This piece of textual information is an invisible annotation that links the pieces of textual information consisting of the symbol, label or caption to the image.
In accordance with the illustrative embodiments of the present invention, the textual information that is the order or grouping, is linked and stored with the image, much like the chunks of data that are embedded within Portable Networks Graphics (PNG) format. This feature is similar to the concept of a table of contents. The textual information that defines the order or grouping of the visual annotations is a constant, non-visual annotation always exists at the first position in the outline, and is a part of the information used to create the image's metadata.
In accordance with another desirable feature of the illustrative embodiments of the present invention, the region of interests can optionally be organized into context-appropriate views (138). Context-appropriate viewing of an image and related annotations is a feature that allows the annotations on an image to be turned on or off for a particular audience or presentation. The annotation view attribute controls the visibility of an annotation because the annotations are separate from the image and are separate from each other. Thus, the view attribute can turn annotations on/off in a context-appropriate manner. Depending on the context, portions of annotations may be viewed in a presentation while other portions remain hidden. As represented at step 140, saving the file with annotations as vector information linked to the image is carried out in accordance with the illustrative embodiments of the present invention.
FIGS. 5A and 5B are exemplary of context appropriate viewing in accordance with the illustrative embodiments of the present invention described herein. In FIG. 5A, as can be seen in the box 142, all of the annotations for this image have been selected and are being displayed. As seen in FIG. 5B, the box 144 shows that only the first two annotations have been selected and displayed. It is important to note that the underlying image is the same for both of the annotated images. That is, both of the FIGS. 5A and 5B use the same file for the underlying image. Because the annotations are saved in a separately from the image (not embedded in the image), the annotations can be selectively displayed on the image.
Desirably, in the illustrative embodiments of the present invention, an annotation and related textual information (i.e., label or caption) consist of discrete pieces of information that, when viewed, are interactive. Interactivity in this sense is defined as giving the viewer the ability to turn on/off annotated groups on the image. Annotations and associated textual information are viewed and controlled independently from the image.
Likewise, reuse of the image is facilitated by providing an open “hook” to link the image and related annotations to larger cataloging systems. The ability to reuse underlying annotated images for different purposes (i.e., publication, web viewing or professional conferences) is an important improvement of the present invention over the previously available systems and methods. The present invention gives the author the ability to annotate an image once and reuse the annotations or the image with or without the previous annotations. Authors can store the archived image with the linked annotations. Importantly, the images remain unaltered because the annotations are not embedded into the image. Therefore, the image remains in an archival format and can be reused for other purposes or applications.
As explained previously, in accordance with the present invention, by adopting open standards such as XML and SVG in the illustrative embodiments of the present invention, authors have the ability to save images with the annotations linked to the images, in a structured format of XML (SVG). The open and extensible features of SVG promote indexing of the image with associated annotations and textual information, thus allowing images and annotations to be catalogued in a database or asset management system.
In the previously available systems and methods, the complexity of most graphical programs and the problems caused by flattening image annotations, there is often no way to relate or group annotations as can be done with the present invention. Most of these previously available graphical programs will allow the user to create any visual appearance desired. However, these programs are only interested in the appearance of things and do not keep track of the inherent structure, relationships or intellectual groupings of the annotations as does the present invention.
For example, in gross anatomy there are many anatomical groupings. These groupings represent an intellectual categorization that can be visually illustrated. Thus, there are two valuable aspects to such groupings: visual and inherent intellectual structure. An author may group annotations by using color to create the visual relationships. With the previously available pertinent software programs this is the end result. Other than the appearance of the image there is no way of knowing that (or working with) an annotation is part of one group or another. The structure of these groupings—which annotated feature belongs to which group—is lost when using the previously available systems and methods. In other words, it is not possible to interactively illustrate such relationships without retaining the intellectual structure of the annotations. Using the simple example provided above, using the previously available systems and methods it is not be possible to visually hide the gross anatomy so as to illustrate the relationship to neurology without retaining the information structure. Moreover, using the previously available systems and methods it is not be possible to dynamically integrate these relationships in a learning assessment tool by asking questions such as, “What group does the visible feature below to: gross anatomy or neurology?”
In addition, in accordance with the illustrative embodiments of the present invention the retained structure of annotations could be used to automatically generate an image caption or a hierarchical legend of the annotated features. Without access to these relationships via a separation from the base image, as is done with the present invention, the dynamic and interactive features are not possible.
FIG. 6 is a diagram showing the data flow carried out in accordance with an illustrative embodiment of the present invention. The first step is to extract the image data. The extractor (146) is an illustrative process that reads the digital information and assembles the auxiliary information for use by a human or computer (or any other data processing device) for annotation in accordance with the illustrative embodiments of the present invention. Digital information can also consist of color settings, grayscale levels, image pixel dimensions, or the type of image the user is requesting, i.e., TIF, JPEG, DICOM, etc. A human user or a wide variety of machine processes may initiate the process of extraction during the open image dialog.
The next step is to organize the data. The organizer (148) acts upon the extracted information, and arranges the digital information to reflect the human user's conceptual organization in the illustrative embodiments of the present invention. The organization of the digital information reflects its origin or intended use by permitting the user to decide what the intended use will be. Organization includes, but is not limited to, a hierarchy, set, slices, channels, sequence and a single source of digital information (e.g., a single image). For example, micro thin slices of tissue that contain the same cells, but are stained differently to identify different cell types in each slice. In this example, the organization is a single cross section of cells with each slice showing unique cell types.
The next step is to construct the annotations. The constructor (150) is a machine aided human user process that allows visual annotation elements to be created manually by the user in the illustrative embodiments of the present invention. The constructor (150) represents a class of visual elements that includes, but is not limited to, a point, a line, a polygon, a plane and a cube. The constructor (150) annotation elements available to the human user are selected by a computer process based on applicability to the dimensions of the original digital information.
The next step is to segment the data. In the illustrative embodiment, the segmentor (152) is a computer process that automatically (with no human intervention) identifies and detects visual features (i.e. edges, areas, planes, cubes, etc.) within the digital information, and automatically creates visual and non-visual annotations for those features. The segmentor (152) falls within the common definition of segmentation within the computer graphics industry.
The indicator (154) is a machine aided human user process that allows visual indication elements to be created manually by the user in the illustrative embodiments of the present invention. The indicator (154) represents a class of visual elements that includes, but is not limited to, a spot, a string, an arrowhead, an arrow and a pin. Each indicator (154) has a core set of properties that include the anchor point (e.g., the tip of an arrow) and the properties that govern its shape for visual presentation. The indicator (154) allows the author in the process of annotation to focus the attention of a human user (viewer), and visually ties feature relevant information to the annotation when it is not appropriate to display the information directly on the annotation itself. The indicator (154) maintains the relationships between visual and non-visual annotation elements and image data (including image data which is 1D, 2D, 3D, or 4D).
The connector (156) is a visual or non-visual machine aided human user process that allows connection elements to be created manually by the user in the illustrative embodiments of the present invention. A connection element enables the human user to define the relationship of two or more annotations. The definition of the connector (156) relationship determines how machine, such as a computer, presents the connection, and how the human user may interact with the connection and connected annotation elements. Connectors (156) include, but are not exclusive to, groups, views, rules and structural hierarchy of annotated features. For example in the case of a medical image, the carotid sheath contains the carotid artery, internal jugular vein and the vagus nerve. The connector (156) defines the structural relationship between the carotid sheath and the elements contained in the carotid sheath. The connector (156) provides the ability to define or select a context-appropriate view based on the groups of annotation.
The descriptor (158) is a machine aided human user process that allows description elements to be created manually by the user in the illustrative embodiments of the present invention. A description element may be attached to any other annotation element, and appear visually with the annotation or as a dynamic visual element like an Interactive Visual Note. A description element may be free-form text, or may follow a coding convention or lexicon to constrain the description entry of the human user. For example, in the case of a medical image the descriptor (158) may contain a clinical note entered by an attending physician, a pathology report entered by a pathologist, or a caption that defines an aspect of the annotated region of interest.
The illustrative embodiments of the present invention provide particular advantages in view of the provision of features related to Interactive Visual Notes. Some uses will find that IVN is the most desirable feature of the present invention. IVN is supported by many illustrative embodiments of the present invention and provides, inter alia, interactive on/off functions. In addition to using the symbol for on/off presentation and the combination of symbol-label-caption for generation of legends, in accordance with some illustrative embodiments of the present invention the symbol-label-caption may also be used for extensive note taking on an annotation-by-annotation basis without obscuring the visual presentation or requiring a separate “reporting” interface. The embodiments of the present invention providing such advantageous features provide that reports or extensive notes may be contextually presented on demand by the user while viewing the image and associated annotations. This feature provides the advantage, that the user does not have to interrupt his “visual” workflow to obtain text-based information. Particular illustrative embodiments of the present invention provided a handle or “hot-spot” at the end of the pointer or arrow (which could be located anywhere) which triggers the dynamic display of a reporting window that may have text, tables, charts and possibly other secondary information or even contain an image that is used as a reference. This feature advantageously makes the given visual presentation much more rich while improving the user's efficiency and workflow.
The deductor (160) is machine process that may or may not be aided by human user input to analyze and deduce new visual and non-visual information from the pre-existing annotated information using a set of defined rules in the illustrative embodiments of the present invention. The deductor (160) is a mechanism for automating information manipulation within the annotation process that may require a mix of human input and computer algorithms. For example, in a medical image a deductor (160) may count the number of each type of cell and the mean distance between the cells in a slice of stained tissue. In the case of a medical image, the deductor (160) may create output that could be read and be integrated into an existing system for cell analysis. The deductor (160) could also create output that is read and applied to a template in a publishing process.
The presenter (162) is the machine process that creates the interactive visual interface based on the visual and non-visual annotated information for consumption and manipulation by a human user in the illustrative embodiments of the present invention. The manner in which the presenter (162) creates the visual interface may be determined by viewing goals, role or privilege level of the human user. Also, the presenter (162) may be constrained by technical limitation of a computer system upon which it resides, which requires the presenter (162) to generate a visual interface appropriate computer system. For example, a user might be a student who receives a simplified presentation for study purposes, which may be different than the same information presented for reference purposes to an expert user.
FIG. 7 illustrates an example of one application of the present invention utilizing multispecialty authoring. It is to be understood that the example illustrated in FIG. 7 is merely illustrative of the many different beneficial applications of the present invention. The example of FIG. 7 shows how multiple authors may contribute annotations incrementally to the same image without variation to the original image, i.e., embedding the annotations in the original image. The primary care physician 164 is presented with a patient with a headache. The primary care physician 164 orders that an image 166 be taken of the affected area. A pediatrician 168 receives the image 166 along with the initial clinical assessment made by the primary care physician 164. After reviewing the image 166, the pediatrician 168 annotates the pathology and adds clinical notes thereby creating an annotated image 166A.
Still referring to FIG. 7, a pediatric neurologist 170 then receives the annotated image 166A and adds additional annotations thereby creating annotated image 166B. Annotated image 166B is then sent back to the primary care physician 164 with the annotations of both the pediatrician 168 and the pediatric neurologist 170. The primary care physician can then view the annotations interactively, that is, either separately or jointly.
An example of the structured output of vector information in the XML format is shown in Appendix 1. It should be understood that the structured output contained in Appendix 1 is provided for exemplary purposes only and should not be construed as limiting the present invention in anyway.
The following examples illustrate the various applications of the present invention. The examples are for illustrative purposes only and should not be construed as limiting in anyway but instead should be taken as representative of the wide applicability of the present invention to many different fields and professions.
EXAMPLE 1
A neurosurgeon reviews a volume rendered set of MRI data that indicates the patient has an aneurysm. The neurosurgeon visually annotates a region of interest and adds a clinical note that is linked to the region of interest. The neurosurgeon identifies a previously undetected aneurysm and marks that region for consult with the neuroradiologist. The annotated image set may be sent to, or checked back into radiology imaging system with the annotations and added expert content linked to the three-dimensional model. The surgeon calls the radiologist for a consult on the second aneurysm prior to sending the patient to surgery. The radiologist adds a clinical note that confirms the additional diseased region of interest without destroying the original information that was added by the surgeon. The neurosurgeon consults with the patient, outlining the second aneurysm prior to the surgery. Other neurosurgeons and radiologists, with the appropriate permissions, may check out the visually annotated image data set for review as reference or further multi-user annotation
EXAMPLE 2
An investigator proceeds with an experiment which involves staining serial sections of a primate retina with three neurotransmitters to determine what cells interact with the neurotransmitters and the levels of interaction. The scientist discovers that one neurotransmitter affects all cell types and proceeds to cut serial sections of the tissue and combine them into a three dimensional surface rendering that maps the neurotransmitters and cells that are affected. The scientist visually annotates one of the synaptic ribbons that is formed within the secondary neuron framework and adds an expert interpretation of the synaptic interaction. The scientist sends the image to a colleague for an additional expert opinion of the structures. The colleague makes visual notes on the image set (without destroying or altering the underlying image set). The visual note is comprised of lines, polygons and points with associated text-based symbols and descriptions that outline an area on the image set. The visually annotated image set is maintained and examined by a molecular biologist for additional expert opinion of the interactions between neurotransmitters and cell types. The additional visual annotations and expert visual notes are stored with the originating scientist's notes.
EXAMPLE 3
A plant biologist receives digital electron photographs/images (EM) of a stained tissue sample from a diseased plant. The plant biologist draws shapes (polygons, lines or edges, and points), pointers and textual symbols and descriptions with the visual annotation technology to indicate a region of interest and communicate expert understanding/interpretation of the EM images. This annotated image may be sent to, or checked back into a cataloging system at an agricultural center to be viewed by other individuals. Other plant biologists, with the appropriate permissions, may check out the image and visual annotation set for review as reference or further multi-user annotation. The annotated image may also be used for print output for a publication or sent electronically (email, Internet) to other experts for consultation. Such visual assets may later be used for time-based comparisons of the same area or as supporting material in a legal proceeding.
EXAMPLE 4
A chemist determines the chemical structure of a compound that reduces the fat absorption in the large intestine. The chemist runs an electrophoretic gel to determine the weight of the chemical structures that make up the compound and discovers that one structure has different properties than the others. The chemist generates a digital image and visually annotates the questionable structure on the digital image. The chemist sends the image to another chemist for an additional expert opinion of the structure. The receiving chemist makes visual notes on the image (without destroying or altering the underlying image). The visual note is comprised of lines, polygons and points with associated text-based symbols and descriptions that outline an area on the image. These notes are then stored with the originating chemist's notes and are reviewed for any problems or questions. Likewise, both chemists can make additional visual notes about the work performed or problems encountered which are subsequently stored for review by other chemists and colleagues. The visual notes can be linked to additional images as they are generated as part of the investigation.
EXAMPLE 5
A geologist receives digital aerial photographs/images of an earthquake fault area. The geologist may check-in the image(s) into a cataloging system. The geologist draws shapes (polygons, lines or edges, and points), pointers and textual symbols and descriptions with a digital annotation tool to communicate expert understanding of the aerial images. This annotated image may be checked back into the cataloging system. Other geologists with the appropriate permissions may check-out the image and visual annotation set for review as reference or further multi-user annotation. The annotated image may also be used for print output for a publication or sent electronically (email, Internet) to other experts for consultation. Such visual assets may later be used for time-based comparisons of the same area or as supporting material in a legal proceeding.
EXAMPLE 6
A contracting electrician receives a digital blueprint for wiring a residential building. While reviewing the digital blueprint (image) the electrician makes visual notes on the blueprint (without destroying or altering the underlying blueprint). The visual note is comprised of lines, polygons and points with associated text-based symbols and descriptions. These notes are then stored with the general contractor and are reviewed for any problems or questions. Likewise the on-site electrician doing the wiring may review the visual notes to facilitate on-site work. While performing the on-site work the on-site electrician makes additional visual notes about the work performed or problems encountered which are subsequently stored for review by the general contractor and contracting electrician.
EXAMPLE 7
A homeowner receives a digital blueprint from architect. While reviewing on-site progress the homeowner applies visual notes to blueprint for later communication to architect and general contractor. The general contractor can use the annotated regions of the blueprints to convey information to subcontractors. The notes are stored and reviewed by architect, general contractor and subcontractor. The architect, general contractor and subcontractor in turn, make additional annotation and notes. All notes and adjustments to the original blueprint are logged for review by all parties.
EXAMPLE 8
The manager of a road construction project opens a map of the worksite and visually outlines the areas to be excavated and the areas of concern like telecommunications or sewer lines that should be avoided. This underlying map of the worksite with the applied expert knowledge of the project manager is given to the excavation crew for spatial guidance on where to and where not to excavate. Annotations and visual notes can be created and applied to layers in a system where one layer is telecommunications, another layer outlines water and sewer lines or electrical power lines. The annotations and visual notes are not embedded in the layers of images but remain in their original positions as the underlying images are changing.
EXAMPLE 9
A mineralogist opens a digital microscopic image of a mineral sample as part of a mineral (oil, mining) exploration project. The expert mineralogist visually annotates the image with shapes (polygons, lines, points) and associated text-based symbols and descriptions. The image and associated visual annotations are logged and stored in the enterprise system. This analysis resides as reference material for later investigation and subsequent review and annotation by senior investigators for directing the exploration investigation. In addition, the analysis may be archived and retrieved at a later time for exploration reconsideration. The visual annotations are designed to be linked to the image data set and can be linked to additional images as they are generated as part of the investigation.
EXAMPLE 10
An individual author can open an image in the visual annotation software. The author can then identify a region of interest and outline the region of interest, place an arrow and label indicating some feature in or on the region of interest and assign a group to the collective (e.g., abnormal structures versus normal structures) and write a caption for the annotated region of interest. The annotated groups can be organized in a hierarchical fashion according to the author's outline (e.g., a table of contents). The author can continue to visually annotate features on the same image or a set of images without destroying the underlying image(s), or having the visually annotated structures collide with one another. At the time of publishing the author may select from the hierarchy of annotated regions of interest by turning off and on individual or groups of regions of interest and associated captions for output to a digital press or other publication media (e.g., WWW or CD-ROM).
EXAMPLE 11
A physician viewing an image of a cyst that has been heavily annotated over time by multiple specialist's can obtain particular advantage from the Interactive Visual Note (IVN) feature of selected illustrative embodiments of the present invention. In embodiments of the present invention incorporating IVN, the physician can select a single region of interest that contains additional information regarding the region of interest. For example, of immediate interest may be a cyst for which two annotations are selectively displayed. Each annotation outlines the cyst margins indicating a change over time (one outline at an early date shows a smaller cyst than that at a later date). At the end of each pointer for each annotation is a “hotspot.” By moving the mouse pointer to that hotspot the user is dynamically presented a microscopic image of the pathology as well as a table reporting the microbiological/molecular findings. These results may be extensive and would, if not hidden as a default, take up the entire screen. But, these reports can be called up on demand while viewing the image, which is the main (in the case of this user) analytic medium. In contrast, previously available systems typically show the user the image and then the user must read the interpretation (in some of the illustrative embodiments of the present invention replaced by interactive visual annotations and brief notes, such as symbols-labels -captions) and view reports at separate locations. In accordance with selected illustrative embodiment of the present invention, the reporting or display of any related information can now be displayed or provided at the same location as the image, which improves the workflow of the user.
EXAMPLE 12
The interactive visual note (IVN) feature of selected embodiments of the present invention provides physicians and healthcare support personnel with solutions to effectively and efficiently access and use the medical knowledge base across practice environments; facilities decision support and medical training. For example, healthcare specialists in the field administering small pox vaccines require the ability to collect visual image data of vaccinated individuals and add clinical findings that allow them to track the efficacy of the vaccination. The healthcare specialist in the field may annotate the affected region of interest (inoculation site) using a pointer, label or caption on the image and add a note to the annotations that supports the clinical findings. Additional annotations can be placed at the margins on the inoculation site indicating a change in scar formation over time (an outline at a later date shows a larger affected region of interest than that at a later date). The medical specialist in the hospital setting receives the annotated images as a visual reference to develop a medical plan and reviews the field specialists' findings to determine if the inoculation was successful and adds an expert opinion of the findings to the annotated image data. Expanding on the above example, the field specialist reviews the medical specialist's expert findings and adds additional findings to the annotated region of interest such as adverse drug interactions observed in the field or changes observed in the inoculation site. The information remains linked to the visually annotated regions of interest and can be dynamically presented to the user as an IVN when the mouse cursor is in the “hot-spot”. This collection of information, residing in a consistent user interface, can be reviewed by the appropriate governing body (for example, Centers for Disease Control) for additional indications or used to identify populations at risk. Field and medical specialists and officials who track small pox inoculations review medically relevant information in a consistent interface.
EXAMPLE 13
Visually annotating a region of interest and adding a clinical note to indicate a clinical finding and linking that information to the patient record is also advantageously included in selected embodiments of the present invention, which can also function as a tool for decision support by the user. For example, a primary care physician located in a rural clinic treats a patient for a neck mass. The patient does not respond to antibiotics so the primary care physician requests a clinical and radiology consult and at a tertiary care facility. The radiologist visually annotates a region of interest (neck mass) and also visually annotates the abnormal or affected anatomy surrounding the neck mass. The radiologist calls for a surgical consult. The surgeon identifies and visually annotates an additional region of interest but also adds a clinical note to clarify the findings. The surgeon consults with the radiologist prior to surgery on the additional findings that grouped according to the surgical grouping. The radiologist's findings are grouped according the radiology group and do not collide with the surgeons findings. Continuing this example, the surgeon removes the neck mass and sends it to pathology for testing. The pathologist visually annotates the histopathology and indicates the regions of interest that correspond to the CT regions of interest verifying the findings of the radiologist and the surgeon. The pathologist's findings can also be contained in the interactive visual note along with the clinical findings of the radiologist and surgeon. The visual annotations, clinical notes and pathology report is contained in one record that can be viewed by the primary care physician in the rural clinic. The clinical case becomes a clinical reference for future congenital neck mass diagnosis.
EXAMPLE 14
The visual annotation and knowledge representation features of the illustrative embodiments of the present invention can improve the delivery and quality of healthcare in the field environment. By leveraging the capability to transmit data using low bandwidths, vital medical information and essential medical expertise can be shared regardless of location and made available as far forward in a military theater of operations as necessary, without increasing the logistical footprint. This feature is particularly advantageous for deployed forces operating in an austere environment and a geographically distant theater supporting combat or humanitarian assistance operations where certain medical specialties may not be available. For example, a medic can capture visual information and annotate affected regions of interest in the field and send it to a central surgical hospital for immediate consult and triage. The medical specialist in a surgical facility can make a decision to transport the patient and at the same time, add a clinical note indicating initial findings for the patient that can be reviewed by the intake physicians. The ability to collect clinical notes among healthcare providers at all levels, ensures consistency in presentation of complex medical information. Providing an interface that medical professionals can use across skill levels and practice environments simplifies the medical decision making process between hospital and clinics to deployed forces and improve diagnosis, treatment, and evacuation decisions. Improved medical decision support can be critical on-board deployed ships, for example. By offering improved diagnosis, the illustrative embodiments of the present invention can prevent the unnecessary evacuation of personnel to medical facilities when they otherwise could be treated on-board ship.
From an understanding of the foregoing, it will be appreciated that the present invention advantageously allows: (1) A region of interest to be specified within an image using a raster independent notation, and promote the capture of associated textual information; (2) For each annotation to be easily manipulated (moved, sized, deleted) independently from other annotations (non-embedded annotations); (3) Annotations to be grouped using user defined group names (hierarchical groupings); (4) Annotations to be presented using user defined preferences (context appropriate viewing); (5) Multiple images to be viewed and annotated concurrently (multispecialty authoring); (6) Annotations to be saved in a simple format, for example XML, that may be permanently associated with the image; and (7) Image and annotations can be exported as a “flat” rasterized image for use in HTML pages, digital slide presentations and publications (providing cross-media capability).
Appendix 2, set forth below, contains an illustrative example of one embodiment of programming code that can be executed on a computer in accordance with the features of the present invention. It should be understood that the code in Table 2 should not be construed as limiting of the present invention in anyway.
It is to be understood that the above-described arrangements are only illustrative of the application of the principles of the present invention. Numerous modifications and alternative arrangements may be devised by those skilled in the art without departing from the spirit and scope of the present invention and the appended claims are intended to cover such modifications and arrangements. Thus, while the present invention has been shown in the drawings and described above with particularity and detail, it will be apparent to those of ordinary skill in the art that numerous modifications, including, but not limited to, variations in size, materials, shape, form, function and manner of operation, assembly and use may be made without departing from the principles and concepts set forth herein.

## Claims

1. A method of visually annotating a digital image, the method comprising:
presenting a digital image in a user interface of a display;
receiving information defining a region of interest identified by a user interacting with the presented digital image;
receiving textual information associated with the received information, wherein an annotation comprises the received information and the received textual information;
presenting the digital image overlaid with the received information and the received textual information;
presenting a plurality of annotation indicators in the user interface, an annotation indicator of the plurality of annotation indicators including the received textual information associated with the annotation;
receiving a selection of a first annotation indicator of the presented plurality of annotation indicators; and
presenting the digital image without the received information and the received textual information associated with the received selection.

2. The method of claim 1, wherein the digital image is an image of at least, a portion of a human body.

3. The method of claim 1, further comprising electronically storing the annotation as vector based information linked to the digital image.

4. The method of claim 3, wherein storing comprises storing the annotation in a second file and said digital image is stored in a first file.

5. The method of claim 3, wherein storing comprises storing the annotation in the same file which contains the digital image.

6. The method of claim 3 wherein storing comprises storing the annotation as text information.

7. The method of claim 6, wherein the annotation is stored in an extensible markup language compatible format.

8. The method of claim 3 wherein the annotation is stored in a format that can be electronically queried.

9. The method of claim 1, further comprising hierarchically organizing the annotations into logical groupings based on a user defined structure.

10. The method of claim 1, wherein at least part of the annotation utilizes user defined lexicons.

11. The method of claim 1, further comprising defining metadata associated with the annotation.

12. The method of claim 11 wherein the metadata is stored with the annotation.

13. The method of claim 11 wherein the metadata comprises at least one selected from the group consisting of: the name of the author or creator of the annotation, a date indicating when the annotation was created, a title, a subject, a description, and an area of specialty of the author or creator.

14. The method of claim 1, wherein the region of interest is defined as an area selected from the group consisting of: a point, a set of points, a polygon, and a polyline.

15. The method of claim 1 wherein the annotation can be displayed according to a predefined user grouping.

16. The method of claim 1 wherein the annotation is uniquely identified.

17. The method of claim 1 wherein the digital image comprises a sequence of digital images.

18. The method of claim 1, wherein the textual information includes a symbol and a label.

19. The method of claim 18, further comprising presenting the symbol or the label adjacent the defined region of interest in the user interface based on a user selection.

20. The method of claim 18, wherein the textual information further includes a caption.

21. The method of claim 1, further comprising receiving pointer information associated with the received information, wherein an annotation further comprises the received pointer information.

22. The method of claim 21, wherein the received pointer information includes secondary information related to the received information.

23. The method of claim 22, further comprising presenting the secondary information in the user interface based on activation of a hot-spot associated with a pointer created in the user interface based on the received pointer information.

24. The method of claim 1, further comprising:
receiving second information defining a second region of interest identified by the user interacting with the presented digital image;
receiving second textual information associated with the received second information, wherein a second annotation comprises the received second information and the received second textual information; and
associating the annotation and the second annotation with a first annotation group.

25. The method of claim 24, further comprising:
receiving a selection of the first annotation group to present overlaid on the displayed digital image; and
presenting the digital image with the annotation and the second annotation.

26. A device for visually annotating a digital image, the device comprising:
a processor; and
a computer memory operably coupled to the processor, the computer memory comprising programming code that, upon execution by the processor, performs operations comprising
presenting a digital image in a user interface of a display;
receiving information defining a region of interest identified by a user interacting with the presented digital image;
receiving textual information associated with the received information, wherein an annotation comprises the received information and the received textual information;
presenting the digital image overlaid with the received information and the received textual information;
presenting a plurality of annotation indicators in the user interface, an annotation indicator of the plurality of annotation indicators including the received textual information associated with the annotation;
receiving a selection of a first annotation indicator of the presented plurality of annotation indicators; and
presenting the digital image without the received information and the received textual information associated with the received selection.

27. The device of claim 26, wherein the programming code further performs operations comprising:
receiving second information defining a second region of interest identified by the user interacting with the presented digital image;
receiving second textual information associated with the received second information, wherein a second annotation comprises the received second information and the received second textual information; and
associating the annotation and the second annotation with a first annotation group.

28. The device of claim 27, wherein the programming code further performs operations comprising:
receiving a selection of the first annotation group to present overlaid on the displayed digital image; and
presenting the digital image with the annotation and the second annotation.

29. A computer memory comprising programming code therein that, upon execution by a processor, causes a computer to:
present a digital image in a user interface of a display;
receive information defining a region of interest identified by a user interacting with the presented digital image;
receive textual information associated with the received information, wherein an annotation comprises the received information and the received textual information;
present the digital image overlaid with the received information and the received textual information;
present a plurality of annotation indicators in the user interface, an annotation indicator of the plurality of annotation indicators including the received textual information associated with the annotation;
receive a selection of a first annotation indicator of the presented plurality of annotation indicators; and
present the digital image without the received information and the received textual information associated with the received selection.

30. The computer memory of claim 29, wherein the programming code further causes the computer to define metadata associated with the annotation.

31. The computer memory of claim 29, wherein the programming code further causes the computer to store the annotation as vector based information linked to the digital image.

32. The computer memory of claim 29, wherein the textual information includes a symbol and a label.

33. The computer memory of claim 32, wherein the programming code further causes the computer to present the symbol or the label adjacent the defined region of interest in the user interface based on a user selection.

34. The computer memory of claim 32, wherein the textual information further includes a caption.

35. The computer memory of claim 29, wherein the programming code further causes the computer to receive pointer information associated with the received information, wherein an annotation further comprises the received pointer information.

36. The computer memory of claim 35, wherein the received pointer information includes secondary information related to the received information.

37. The computer memory of claim 36, wherein the programming code further causes the computer to present the secondary information in the user interface based on activation of a hot-spot associated with a pointer created in the user interface based on the received pointer information.

38. The computer memory of claim 29, wherein the programming code further causes the computer to: receive second information defining a second region of interest identified by the user interacting with the presented digital image; receive second textual information associated with the received second information, wherein a second annotation comprises the received second information and the received second textual information; and associate the annotation and the second annotation with a first annotation group.

39. The computer memory of claim 38, wherein the programming code further causes the computer to:
receive a selection of the first annotation group to present overlaid on the displayed digital image; and
present the digital image with the annotation and the second annotation.