rsna 2012: country reports - dicom- related activities around the world brazil alair sarmet santos...

RSNA 2012: Country Reports - DICOM-Related Activities around the World

BRAZIL

Alair Sarmet Santos MD. PhDTeleradiology Committee of Brazilian College of Radiology (CBR)

CBR Brazilian’s representant in DICOM Standards Committee

Use of Teleradiology in Distance Education through a Special Interest Group on Medical

Residency in Radiology

An innovative experience in BRAZIL

Authors: Santos AA, MD, PhD1 ; Rogacheski E, MD2; Monteiro AMV, MD, PhD3; L A Messina, PhD4; Haddad AE, PhD5

Affiliations: Fluminense Federal University1, Federal University of Paraná2, State niversity of Rio de Janeiro3, Brazilian Telemedicine Network Coordinator4, Brazilian Telehealth Network Program Coordinator5.

INTRODUCTIONINTRODUCTION

Brazil is a country with continental dimensions, and for this reason it still presents asymmetry concerning health services supply. For this purpose, Brazilian Federal government has launched two programs nationally integrated in Telehealth:

•University Networks in Telemedicine (RUTE), supported by the Brazilian Ministry of Science and Technology and Innovation (MCTI), responsible for interconnecting university hospitals with national and international centers of excellence;

•Telehealth Brazil Networks, supported by The Brazilian Ministry of Health uniting the University Center of Telehealth to centers and remote municipality health unities.

INTRODUCTIONINTRODUCTION

•Special interest groups [SIGs] are groups concerned with some particular part of interest in health services, health education, health research, informatics infrastructure, ethics and legislation

•Until now, Brazilian Teleradiology SIGs include: Pediatric Radiology (RADPED), Neuroradiology, Thoracic Radiology, Abdominal Radiology and Medical Residency and Specialization in Radiology.

PURPOSEPURPOSE

Demonstrate a Brazilian experience in the use of

Teleradiology in distance education through the creation

of a Special Interest Group (SIG) on Medical Residency

and Specialization in Radiology .

EDUCATIONAL METHODOLOGYEDUCATIONAL METHODOLOGY

•Monthly virtual meetings on the 1st Tuesday from noon to 1pm (Brazilian time);

•A rotation scheme of presentations from different Brazilian educational institutions and from members of the Education Committee of the Brazilian College of Radiology (CBR);

•Resident doctors take part actively, and also make thematic presentations;

•The participation of Medicine graduating students is allowed and stimulated.

•The access is free with previous invitation through a specific mailing;

•Every meeting is recorded in order to be reused by the groups.

INFRASTRUCTURE METHODOLOGYINFRASTRUCTURE METHODOLOGY

• The connection for SIG’s among university hospitals is made through video conference demanding high speed as well as specific equipment, while webconferences, connecting the universities with remote municipalities, uses just a computer with internet. • To associate both technologies, UERJ Telehealth Center included an endpoint linked to a work station with a web server that transmits the videoconference’s audio and video to remote points. •The management’s web software used was Adobe Connect Pro (Burlington, New Jersey USA), installed in a Dell server, Windows Server 2008, Intel Xeon Processor E5450, 3GHz, and RAM memory of 4GB.•The combination of both technologies was made through the capture of the audio using a sound board, and of the video using a capture card that are sent to a work station and distributed to the points connected to the web conference. •The remote access to the web conference was made through a browser Web, that will demand only a browser and an add in, whose installation is going to be required at the first access to a virtual room of the web conference.

BRAZILHigh speed networks available for university hospitals

Ministry of Science, Technology and InnovationAvaiable on http://rute.rnp.br/

RESULTSRESULTS

First virtual meeting of SIG on Medical Residency and Specialization in Radiology

• RSNA meeting: main information of interest of medicine residents in Radiology.

• Brazilian Protocol for Training in Radiology and Imaging Diagnosis. The role of the resident in Radiology: rights and obligations.

• Protection in Radiology: the ALARA principle. Ordinance 453/98.• The interference of the levels of anxiety and depression in RDI

residents.• Civil Responsibility: rights and duties of the physician under an

administrative and judicial perspective (medical-legal implications for the practice of Radiology).

• Adverse reactions to the contrastive.• Annual Evaluation on Medical Residency in Radiology.• Introduction to Clinical Research in Medical Radiology. How to publish a

paper in science magazines.• Homogenization of medical residency in Brazil. Ranking residency in

Radiology.• Code of Ethics in Medicine – The Mistake in Radiology.

RESULTSRESULTSThemes presented

RESULTSRESULTS

•The Brazilian College of Radiology has created a Subcommittee for Subcommittee for Training and Medical Residency of CBR Training and Medical Residency of CBR (SAR) due to the positive experience of the SIG on Medical Residency in Radiology.

•The activities of SIG on Medical Residency contributed to the planning of the I Brazilian Meeting of Residents and Trainees (ENAR) I Brazilian Meeting of Residents and Trainees (ENAR) of CBR, held in October 12, 2011, in Recife, Pernambuco, Brazil, a pre Brazilian Congress of Radiology – 2011.

I ENAR subjects

• Radiologists and the new Code of Ethics in Medicine• Round Table: Rights and Duties of the Residents/Trainees and

the Role of the Supervisor and Preceptors• Annual Evaluation of the Residents/Trainees in Radiology in

Brasil.• CBR’s Advantages to Residents/Trainees. SAR – Subcommittee

Trainees and Residents: Why?• Rationalization of complementary examinations• Guide of CEAR Inspections and Classifying Criteria of Medical

Residency Services in Radiology in Brazil.• Critical Analysis of CEAR Inspections in 2012. Analysis of the

Questionnaire with Residents and Trainees.

The actions of SIG on Medical Residency team and the relation with the Education Committee of the Brazilian College of Radiology has contributed to the II Brazilian Meeting of II Brazilian Meeting of

Residents and Trainees in RadiologyResidents and Trainees in Radiology held at the Brazilian Congress of Radiology on September 5th, 2012.

CONCLUSION

The SIG Medical Residency in Radiology represents a major advance for improving the comprehensive training of the future radiologist, not just from the standpoint of technical-scientific, but also associative, because it promotes the integration with the Brazilian College of Radiology and also with the Brazilian medical entities, especially the Regional Medical Boards.

FUTURE PERSPECTIVEFUTURE PERSPECTIVE

The SIG on Medical Residency in Radiology represents a major advance for improving the comprehensive training of the future radiologist, mainly for the possibility of interactivity among the programs of medical residency in CBR and also between CBR and international programs of training and specialization in Radiology and Imaging Diagnosis.

REFERENCESREFERENCES

[1]Telemedicine University Network. Accessible in http://rute.rnp.br/

[2] Telehealth Brazil Networks. Accessible in

http://www.telessaudebrasil.org.br/php/index.php

[3] Brazilian College of Radiology. Accessible in http://www.cbr.org.br/

[4] Telehealth Center of State University of Rio de Janeiro. Accessible in

www.telessaude.uerj.br

Low-Cost Teleradiology:

A Brazilian Solution for

Emergency Care Units

telerradiologia@telessaude.uerj.br

Monteiro AMV1; Santos AAS2; Bhaya A3; Bahia P3;

Tonomura E3; Santos ML2; Grande J3 ; Ferreira L3;

Diniz E1;

Neves AL4; Haddad AE5.

State University of Rio de Janeiro 1; Federal Fluminense University 2; Federal University Rio de Janeiro 3; State Health Secretary of Rio de Janeiro 4;

BRAZIL Ministry of Health 5

PURPOSE

Demonstrate low-cost solution for digitalization

of X-ray examinations in an Intermediary

Emergency Care Unit (UPA) of the State Health

Secretary of Rio de Janeiro.

Present the feasibility of a multi-institutional

project to collaborate in public health, helping to

improve diagnosis and treatment of patients with

lung diseases, especially tuberculosis,

in State of Rio de Janeiro, BrazilState of Rio de Janeiro, Brazil.

OVERALL PROJECT OBJECTIVES

Teleconsuting n of a multidisciplinary team, involving radiologists, engineers, information technology

professionals and others.

Implementation of a low-cost and reproducible solution for teleradiology.

Providing a method to digitalize conventional X-ray films and transmitting them to teleradiology university centers via Internet, where qualified radiologists can provide second opinions to general physicians.

METHODS & MATERIALS

Figure 1: Showing the overlapping A4 size areas to be superposed.

Materials: Commerical A4 scanner with transparency media adapter, analog X-ray film, image stitching software.Methods: Use scanner geometry & standard X-ray film sizes to stitch 2 or 4 A4 sized partial scans seamlessly into the original large format X-ray, producing a digital image in DICOM format. This optimized image stitching software was developed in this project and is called ScanRx. The next 2 slides give a visual overview of the algorithm that drives ScanRx.

Image stitching algorithm

Figure 2: The comparison area chosen in the left partial image

Figure 3: The area which is searched in the right partial image

to achieve a match with the left image comparison area

Figure 4: Final stitched image after 2 or 4 matchings.

METHODS & MATERIALS

Development of a web teleconsultation software

Web Access: www.telessaude.uerj.br/riotelerx

PROJECT RESULTS

Second-opinion primarily for chest X-rays: social impact to provide second opinion, primarily for lung diseases (tuberculosis) at 8 Intermediary Emergency Care Units in Rio de Janeiro

700 digital images were sent (88% adults and 12% children & adolescents)

15% were diagnosed as pulmonary tuberculosis and the patients were referred to specialized tuberculosis units.

Primary tuberculosis Secondary tuberculosis

Tuberculosis images

We have implemented a collaborative second opinion

teleradiology program including Radiology Departments of

the most important University Hospitals in Rio de

Janeiro.

The sustainable low-cost solution teleradiology provide a

successful support in teleradiology which improve quality of

doctors care for Emergency Care Units in Rio de Janeiro.

CONCLUSION

CLINICAL RELEVANCE/APPLICATION

Disseminate among the physician's a new low-cost solution for teleradiology which

was unusual at public health in Brazil.

The low-cost software solution was development by COPPE-UFRJ and funded by the Brazilian Innovation Agency for Research and Project Financing (FINEP)- Science and Technology

Ministry. The teleradiology second opinion software was

development by the Telehealth Center team (UERJ) and funded by the Brazilian National

Telehealth Program - Health Ministry

MEETING COMMITTEE DICOM Nikko, Japan2012/4/16-18

alairsarmet@globo.com

THANK YOU !