Teaching File and Clinical Trial Export

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Teaching File and Clinical Trial Export (TCE) lets users flag images and related information for automatic routing to teaching file authoring or clinical trials management systems.


Teaching files are valuable training tools in radiology and other imaging specialties. Many residents are required to create and maintain teaching files and many experienced practitioners keep files of interesting cases for their own reference and to share with colleagues.

Participation in clinical trials is a growing need and both a potential source of revenue and a driver of quality improvement.

In order to accomplish these tasks efficiently, a user must be able to:

  • Flag appropriate images and add supplemental information
  • Anonymize image studies, often using reversible anonymization (pseudonymization) in research trials
  • Route the study to the appropriate destination (a teaching file system or clinical trial repository)

DICOM standards provide the essential mechanisms for performing these tasks.

TCE image.jpg


  • Enables a radiologist working at a diagnostic workstation to select, annotate and export images to a teaching file system or clinical trials repository
  • Enables efficient teaching file creation and clinical trial participation without significant disruption to the normal diagnostic workflow
  • Enables selecting key images from an image study for export
  • Enables adding supplemental information appropriate to subsequent use of the images in education or research


TCE uses basic DICOM services and the IHE Key Image Note profile.

TCE-capable PACS can provide imaging professionals with tools that enable them to create teaching files or send images for clinical trials efficiently, without disrupting the diagnostic workflow. The user can select studies or key images from studies to send, provide supplemental textual information and send them to appropriate destinations (a teaching file system or clinical trials repository) configured in the system.

Systems Affected

  • PACS, PACS workstations and reporting systems can be enhanced, using TCE, to enable users to select, annotate and send images and studies, as well as reports and other information
  • Teaching file systems and research data repositories conforming to TCE can receive and manage images, studies and other information sent from TCE-compliant PACSes

Actors and Transactions

Export Selector

  • identifies information to be sent to a teaching file or clinical trial system
  • e.g. a user function on a PACS diagnostic workstation
  • can include images, reports, evidence documents, presentation states and additional information

Export Manager

  • accepts selected objects
  • de-identifies and re-identifies with pseudonymous values
  • remaps to trial-specific identifiers and populates clinical trial specific attributes (Remap Identifiers option)
  • sends pseudonymized DICOM objects and updated manifest to a Receiver.


  • a local teaching file system
  • a clinical trial repository
  • a clinical trial system that transfers images to the central review facility

TCE transactions.jpg TCE groupings.jpg


Profile Status: Final Text


IHE Radiology Technical Framework:

  • Vol. 1 - Section 17 (TCE Profile)
  • Vol. 3 - Sections 4.50 Store Instance; 4.51 Store Export Selection; 4.52 Store Additional Teaching File Information; 4.53 Export Instances

Underlying Standards:

Related Profiles

  • Key Image Note [KIN] enables users to flag images as significant and add notes.

Reference Articles

  • Translating the IHE Teaching File and Clinical Trial Export (TCE) Profile Document Templates into Functional DICOM Structured Report Objects. Aaron W. C. Kamauu,Scott L. DuVall, Andrew P. Liimatta, Richard H. Wiggins, III and David E. Avrin. J Digit Imaging. 2008 December; 21(4): 390–407.
  • IHE TCE-based Teaching File Solution Linked with an Open Source eLearning Platform. P Mildenberger, MD; K Wunder, C M Ahlers, MD; J Schneider, MD; C Dueber, MD; G Klos, Mainz, GERMANY; (mirc@radiologie.klinik.uni-mainz.de). Online Poster.