Teleradiology

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Teleradiology

• Joël Chabriais, MD, MS

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Teleradiology - Telewhat?

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

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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.

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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.

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Teleradiology projects in France

• Auvergne
• Aquitaine
• Brittany
• Lorraine

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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.

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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.

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Cantal
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Implementation
Radiologist home
H

CT / MRI


Aurillac



Duty server
DICOM viewer  on duty 





DMZ


Mediation server

Internet Access



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Inter-hospital project - Cantal





Internet Access

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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
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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.

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Auvergne
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Today, Cantal Medical Imaging Federation
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Tomorrow, Auvergne Medical Imaging network?
University Hospital
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Hospitals in Auvergne
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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.

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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

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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

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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)

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Other questions

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

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The topic is open for discussion