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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