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CHEP 2000, Padova, 2000 February 7-11
Remote Consult in RadiotherapyHEP Technologies
in Health Physics!
Maurizio Ferraris, Paolo Frixione, Sandro
Squarcia
Dipartimento di Fisica e Sezione INFN Università
degli Studi di Genova squarcia_at_ge.infn.it
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New technologies have completely changed medical
duties
Health care needs...

• Physical devices are quickly improving
• Computed Tomography,
• Nuclear Resonance,
• Computer Radiography,
• Echography.
• Informatics is becoming more and more important
• Networking among clinical departments is now
  usual

... and physics transfer
- We are in hospitals (Health Physics) - We have
technologies - We know how to fit them in medical
world
Teleconsultation for better patient care!
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Modern Radiology Department
Remote connection
PC
CR
CR
Computer Radiography devices
Juke Box CD
SD100
SD100
Archive devices
Medical report and consultation devices
WS
WS
WS
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Multiple integration
Hospital Information System (HIS)
Radiological Information System (RIS)
Booking
Hospital Area Network
Medical report
Picture Archive Computer System (PACS)
Clinical modalities (TC, MR, CR...)
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Teleconsultation

• Construction of a clinical folder with images
• Possibility of on-line interaction
• Possibility of follow-up check
• Possibility of statistical clinical data
  elaboration

Foundation for the use development of hadrons
(instead of electrons/gammas) in radiotherapy
cancer cure
Has supported NORMA Network Oriented Remote
Medical Archive
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NORMA
A ad hoc clinical folder for images transmission
Network Oriented Remote Medical Archive
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Hardware security
Hospital global network

• Two area completely separated
• Two Ethernet card in the firewall
• A true gate from outside world
• Secure clinical data accessibility

Radiotherapy (or radiology) divisional network
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Software security
Patient data identification
Level 1 Pathology Statistical analysis (free for
network partners) Level2 Teleconsultation Anamnes
is and diagnosis (on owner authorization) Level
3 Treatment Patient general data (on patient
authorization)
Access mode
Patient clinical folder owner
Owner mail address
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NORMA characteristics
Patient information
General system information
Menu frame Blue for data insertion Green for data
consultation
Body Frame
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Active image selection
Different data handling possibility
Clinical images (JPEG format) not for
teleconsulting!
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DICOM Information Model
Digital Information and COmmunication in Medicine
Clinical information retrieved Patient
personal data Study information
Series description of clinical image
series Image data describing clinical images
(mode and pixel definitions)
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DICOM IMAGES
Remote consulting tool
NORMA helps physicists and medical doctors to
select the best treatment planning in
radiotherapy discussing on images retrieved from
DICOM PACS through a client/server
application developed in Java.
DICOM module WWW-DICOM gateway
JAVA SERVER
Remote consulting client
Remote consulting client
Hospital A
Hospital B
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Digital Images Retrieve
Workstations
NORMA
To LAN Network
PACS System
WWW-DICOM Gateway
Modalities
Eurostore Connection
Image Transfer Connection
Eurostore archive
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EUROSTORE Project
European Project to design and develop an high
performance distributed storage system

• Consortium formed by scientific and industrial
  partners
• QSW (Supercomputer - UK)
• CERN (Science - Swiss)
• DESY (Science - Germany)
• HCSA (Space Technology - Greece)
• TERA Foundation (Science - Italy)
• HNMS (Met-Service - Greece)
• AMC (Medical - Greece)

Features Scalability
Reliability and security
Easy hardware and software support
Eurostore (Java 100) will run on, almost, all
hardware and software systems available today
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WWW-DICOM gateway
Client/server architecture Presentation
logic Web Browser Application server Web
Server Business logic DICOM gateway Data
management DICOM Server
CGI interface
JPEG conversion
HTTP
WWW Browser
WWW Server
DICOM gateway
DICOM Server
DICOM gateway opens and submits a DICOM
association to DICOM Server, receives a response
and makes JPEG conversion
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(HTML JavaScript)
Data Exchange Mode
Web Browser
WWW Domain
Intranet
(HTTP)
WWW-DICOM Gateway
Sun
SPARCserver 1000
Web Server
DICOM Domain
Sun
DISKserver 1000
WWW MODULE
(URL-encoding)
CGI Library
(Name-value pairs)
(HTML file)
LAN
(DICOM protocol)
Requests Parser
Response builder
(Data) (Commands)
(Data)
(Images)
DICOM Application Entity
Sun
JPEG translation
Data decoding
Data encoding
Sun
DISKserver 1000
Image processing
DICOM MODULE
DICOM Upper Layer
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Teleconsulting Features and Functionalities

• Feature
• Secure
• user authentication
• secure socket layer protocol
• activities registration on log file
• Platform independent
• Java applet running on every Web Browser

• Functionality
• Access to medical image archives (PACS)
• Selection (and transmission) of clinical images
  zone
• Discussion of clinical cases among remote users

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Client/Server Teleconsulting Architecture
Client Java Applet for running on every Web
Browser

• Communication management
• Graphical user interface
• - mouse drawing on clinical images
• - information exchange using the chat area

Server Java application installed on NORMA system

• Client communication management
• Log files activities registration
• Multithread software architecture

Protocol Communication performed using a
built-in proprietary network protocol
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JAVA Teleconsulting
JAVA Applet
HTTP Connection
Proprietary protocol
CLIENT A
JAVA SERVER
WEB SERVER
JAVA Applet
Proprietary protocol
HTTP Connection
CLIENT B
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Proprietary Protocol
Client 1
Java Server
Client 2
Time
Waiting for connection
Connection Request
Send priority code
C O N N E C T I O N
Receive code
Waiting for client 2 connection
Connection Request
Send priority code
Receive code
Send ID client 2
Receive and send ID2
Receive ID2
Verify connection status (polling)
DATA EXCHANGE
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Connection to the PACS System
User Autenthication
DICOM association
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DICOM Connection Monitoring
DICOM Console

• Visualization of data exchanged during DICOM
  communication

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DICOM Patient Data Consulting
Patient list
Patient personal data
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DICOM Study Information
Study list
Study information
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DICOM Series Information
Series list
Series information
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DICOM Images
Retrieve of clinical images
Dump of DICOM dataset
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Images Remote Consult
Toolbar
Help area
Discussion area
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Conclusions
The developed system is a research product
helping physicists/medical doctors to select the
best radiotherapy treatment planning
Users working in different places can discuss
interesting clinical cases visualizing in a Web
Browser supporting Java the same diagnostic
images at the same time highlighting zones of
interest