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Teleradiology

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Saint-Flour. modality. DICOM Viewer ' on duty ' H. Mauriac ... Saint-Brieuc. modality. STAR-IE. Brittany. Inter-hospital project. Which needs for such projects? ... – PowerPoint PPT presentation

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Title: Teleradiology


1
Teleradiology
  • Joël Chabriais, MD, MS

2
Teleradiology - Telewhat?
  • One propose a segmentation
  • Teleteaching
  • Telelearning
  • Teleexpertise
  • Teleconsultation
  • Telediagnosis
  • TeleXXX
  • My purpose teleradiology in daily radiological
    practice (telediagnosis teleexpertise)

3
Teleradiology - Why?
  • In some area there is a lack of radiologists.
  • Sometime it could be financially accurate to have
    only one radiologist on duty for several
    radiological facilities.
  • Boston experimentation a contract with an
    Israeli and an Asian Hospitals to have only
    daytime reading.
  • Access to specialized expertise.

4
Teleradiology in France
  • Some applications dedicated to neurosurgery
  • Point to point,
  • Specific,
  • Launched at the beginning of the nineties,
  • Expensive and not easy to use.
  • New projects dedicated to general radiology.

5
Teleradiology projects in France
  • Auvergne
  • Aquitaine
  • Brittany
  • Lorraine

6
Teleradiology in Cantal
  • Mountainous area transportation difficulties
    (winter).
  • Lack of radiologists.
  • Three main hospitals in the département
  • Only one have senior full time radiologists,
  • One have an half time radiologist,
  • The last one have only interim radiologists,
  • Frequency of duty is too high in each hospital.
  • Sometime specialized second advice could be
    necessary -gt patient records have to be sent to
    university hospitals.

7
The projects
  • Send examinations to on duty radiologist home.
  • One radiologist on duty for all three hospitals.
  • Along the day, ability to send examination from
    one hospital to another directly from daily used
    working tools to daily used working tools.
  • Simplicity of use.
  • Security.
  • Federate all imaging departments of the
    département to manage them as an unique entity.

8
Cantal
9
Implementation
Radiologist home
H

CT / MRI


Aurillac



Duty server
DICOM viewer  on duty 





DMZ


Mediation server

Internet Access



10
Inter-hospital project - Cantal





Internet Access

11
Security Principle
Other facility or on duty radiologist home
Local networkt of the main facility (Aurillac)
Main facility DMZ
Decryption / Encryption
Mediation server
Gateway
Gateway
https channel
DICOM Application
DICOM Application
DICOM Network
12
Difficulties
  • Several different HIS/RIS (one per hospital).
  • No PACS at this time (probably one at Aurillac in
    two or three years).
  • Management of reports make on duty.

13
Auvergne
14
Today, Cantal Medical Imaging Federation
15
Tomorrow, Auvergne Medical Imaging network?
University Hospital
16
Hospitals in Auvergne
17
Auvergne Medical Imaging Network
  • Each département will have its own network with
    nodal point in the main hospital at the
    préfecture (main town of the département).
  • All four networks will be federated on
    Clermont-Ferrand University Hospital (CHU).
  • At the CHU a server will be able to
  • Give access to images in the DMZ,
  • Import images in the local PACS,
  • Send images to the right specialist on duty
    home for advice.

18
Brittany Inter-hospital project
H
H
H



RENNES
Vitré
Saint-Brieuc
CT / IRM
modality
modality








STAR-IE

STAR-IE





STAR-IE






DMZ









Mediation Server


MEGALIS


Internet Access

19
Which needs for such projects?
  • Receive request with images for daytime work as
    well as on duty at home.
  • Send a report from home to the right hospital
  • Deal with several different HIS/RIS/PACS for a
    Radiologist on duty?
  • Ensure security and patient privacy on home
    computer

20
Identified issues
  • Security
  • Privacy
  • Second advice request (teleconferencing?)
  • Image streaming
  • Reporting
  • DICOM SR? (needs of templates for reporting and
    for second advice)
  • HL7 CDA? (in France no product CDA ready)
  • .doc, .rtf, .pdf? (not secure formats)

21
Other questions
  • Identify what is in DICOM, HL7 or IHE domain
  • Is there matter for work item proposals in DICOM?

22
The topic is open for discussion
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