Advancing Progressive Web Applications to Leverage Medical Imaging for Visualization of Digital Imaging and Communications in Medicine and Multiplanar Reconstruction: Software Development and Validation Study
Authors: AboArab Mohammed A. , Potsika Vassiliki T. , Theodorou Alexis , Vagena Sylvia , Gravanis Miltiadis , Sigala Fragiska , Fotiadis Dimitrios I. 
Published: October 2024

Background
In medical imaging, 3D visualization is vital for displaying volumetric organs, enhancing diagnosis and analysis. Multiplanar reconstruction (MPR) improves visual and diagnostic capabilities by transforming 2D images from computed tomography (CT) and magnetic resonance imaging into 3D representations. Web-based Digital Imaging and Communications in Medicine (DICOM) viewers integrated into picture archiving and communication systems facilitate access to pictures and interaction with remote data. However, the adoption of progressive web applications (PWAs) for web-based DICOM and MPR visualization remains limited. This paper addresses this gap by leveraging PWAs for their offline access and enhanced performance.

Objective
This study aims to evaluate the integration of DICOM and MPR visualization into the web using PWAs, addressing challenges related to cross-platform compatibility, integration capabilities, and high-resolution image reconstruction for medical image visualization.

Methods
Our paper introduces a PWA that uses a modular design for enhancing DICOM and MPR visualization in web-based medical imaging. By integrating React.js and Cornerstone.js, the application offers seamless DICOM image processing, ensures cross-browser compatibility, and delivers a responsive user experience across multiple devices. It uses advanced interpolation techniques to make volume reconstructions more accurate. This makes MPR analysis and visualization better in a web environment, thus promising a substantial advance in medical imaging analysis.

Results
In our approach, the performance of DICOM- and MPR-based PWAs for medical image visualization and reconstruction was evaluated through comprehensive experiments. The application excelled in terms of loading time and volume reconstruction, particularly in Google Chrome, whereas Firefox showed superior performance in viewing slices. This study uses a dataset comprising 22 CT scans of peripheral artery patients to demonstrate the application’s robust performance, with Google Chrome outperforming other browsers in both the local area network and wide area network settings. In addition, the application’s accuracy in MPR reconstructions was validated with an error margin of <0.05 mm and outperformed the state-of-the-art methods by 84% to 98% in loading and volume rendering time.

Conclusions
This paper highlights advancements in DICOM and MPR visualization using PWAs, addressing the gaps in web-based medical imaging. By exploiting PWA features such as offline access and improved performance, we have significantly advanced medical imaging technology, focusing on cross-platform compatibility, integration efficiency, and speed. Our application outperforms existing platforms for handling complex MPR analyses and accurate analysis of medical imaging as validated through peripheral artery CT imaging.