Teleradiology
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Transcript Teleradiology
Teleradiology
Joël Chabriais, MD, MS
Teleradiology - Telewhat?
One propose a segmentation:
Teleteaching
Telelearning
Teleexpertise
Teleconsultation
Telediagnosis
TeleXXX
My purpose: teleradiology in daily radiological
practice (telediagnosis ± teleexpertise)
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.
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.
Teleradiology projects in
France
Auvergne
Aquitaine
Brittany
Lorraine
…
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 -> patient records have to be sent
to university hospitals.
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.
Cantal
Implementation
H
Radiologist home
CT / MRI
Aurillac
Duty
server
DICOM viewer
« on duty »
DMZ
Mediation
server
Internet Access
Inter-hospital project - Cantal
H
Aurillac
H
Saint-Flour
H
Mauriac
Domicile radiologue
DICOM Viewer
« on duty »
CT / IRM
Duty
Server
modality
modality
DICOM Viewer
« on duty »
DICOM Viewer
« on duty »
Domicile radiologue
DICOM Viewer
« on duty »
DMZ
Mediation
Server
Domicile radiologue
DICOM Viewer
« on duty »
Internet Access
Security Principle
Local networkt of the main facility
(Aurillac)
Other facility or
on duty radiologist home
Main facility DMZ
Decryption
/ Encryption
Mediation server
Gateway
Gateway
https channel
DICOM
Application
DICOM
Application
DICOM
Network
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.
Auvergne
Today, Cantal Medical Imaging
Federation
Mauriac
St-Flour
Aurillac
???
Cantal
Tomorrow, Auvergne
Medical Imaging network?
???
University
Hospital
???
???
Clermont
-Rerrand
???
Moulins
???
???
Puy-de-Dôme
Mauriac
St-Flour
Allier
???
???
Puy-en-Velay
Aurillac
???
???
Cantal
Haute Loire
Hospitals in Auvergne
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.
Brittany
Inter-hospital project
H
RENNES
CT / IRM
H
Vitré
modality
STAR-IE
STAR-IE
DMZ
Mediation
Server
MEGALIS
Internet Access
H
Saint-Brieuc
modality
STAR-IE
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
…
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)
…
Other questions
Identify what is in DICOM, HL7 or IHE
domain
Is there matter for work item proposals
in DICOM?
The topic is open for discussion