MILLENSYSTele-Radiology Solution

• Introduction• Workflow/ Components• Communication / Optimization• Millensys Teleradiology Features• Failure and restore scenario• Similar Project (Eastern Cape, South Africa)• Q&A

Main Topics

Teleradiology of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of interpretation and/or consultation

What is Tele-Radiology

Why is Tele-Radiology Needed

• Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient.

• Radiologists are increasingly a scarce resource, given that imaging procedures are growing by ~15% annually against an increase of only ~2% in the Radiologist population

• The virtual radiology network (VRN) is a modern service for radiology groups that collects digital imaging studies from multiple, geographically-dispersed locations and delivers them securely, reliably and efficiently to physicians over the Web.

• Teleradiology improves patient care by allowing Hospitals to outsource subspecialty expertise needed but not found except in big cities.

Tele-Radiology, Definition

TeleradiologyWorkflow / Components

Hospital 1 Hospital 2 Hospital NHospital 3

Images sent to main server using priority

queuing

Image are be sent to

service provider PACS

Imag

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aila

ble

O

N W

eb

Statical Info. are

sent to management

Images to be sent to Millensys MINI

PACS at other branches

Verified reports to be sent to

datacenter server

Verified reports are sent to

datacenter server

Verified re

ports to

be sent

BACK to A

cquisition serv

er

Verified reports to be sent

BACK to Acquisition server

Service Provider NService Provider 1

Tele-Radiology, Workflow

Tele-Radiology, Proposed Solution

Tele-Radiology, One Solution

InternetAnd

Intranet

Report with

Dictation

Work Online/ Offline

Processand

Diagnose

Search Worklist

High Availability

Archive

Web-basedAdministrator

Use MultipleCompression

One Solution , MILLENSYS Web-based Teleradiology

Data Center

Service Provider

Hospital

Tele-Radiology, Solution Components

Reporting Workstations

Web Viewing

Mobile Viewing

Radiology Scheduling

Data Center Web-PACS

Store/forward MiniPACS

Billing and MonitoringAdministration

Service Provider PACS(Optional)

Tele-Radiology, Data Center

Billing and Monitoring

Administration

Dealing with Emergency Cases:Tele-Radiology, Emergency Cases

Study IdentificationN : Normal Study (No report needed)R : To be ReportedE : Emergency etc.The report is sent back to the Hospital

The Technician identifies the case as an Emergency

The Case is sent to the PACS Server with High Priority

Emergency case is sent to the Data Center before any Normal Case

Emergency case is sent to the Service Provider to be reported

The case is reported and sent back to the data center

TeleradiologyCommunication / Optimization

Tele-Radiology, Communications

ADSL

SDSL

56 kbps

2Mbps - 14.4 Mbps Stationary

348 kbps Moving

54 Mbps

24 Mbps (1:4)

24 Mbps (1:1)

CT Image TransmissionCT Image Information    CT Image Size 0.5 MBCT Image Size after Lossless Compression 0.25 MBAverage Study Size (2-Slice CT) 100 ImageTotal Average Study Size after compression 25 MB   

Link Speed ADSL 4Mbps (1:4) 1 MB Upload

Band Width Utilization 50%  

Idle Time Between studies 30 seconds

Average Time to send 1 image 5.00 seconds

Average Time to send 1 Study 8.83 Minutes

Total Studies sent per hour 6.79 StudyLink Speed SDSL 4Mbps (1:1) 4 MB UploadBand Width Utilization 60%  Idle Time Between studies 20 secondsAverage Time to send 1 image 1.38 secondsAverage Time to send 1 Study 2.29 MinutesTotal Studies sent per hour 26.18 Study

CR Image TransmissionCR Image Information    CT Image Size 10 MBCT Image Size after Lossless Compression 5 MBAverage Study Size (2-Slice CT) 2 ImageTotal Average Study Size after compression 10 MB   

Link Speed ADSL 4Mbps (1:4) 1 MB Upload

Band Width Utilization 50%  

Idle Time Between studies 30 seconds

Average Time to send 1 image 100.00 seconds

Average Time to send 1 Study 3.83 Minutes

Total Studies sent per hour 15.65 StudyLink Speed SDSL 4Mbps (1:1) 4 MB UploadBand Width Utilization 60%  Idle Time Between studies 20 secondsAverage Time to send 1 image 21.17 secondsAverage Time to send 1 Study 0.71 MinutesTotal Studies sent per hour 85.04 Study

Load balancing Should be an issue for multi-site/multi-modality transmission

Tele-Radiology, CT and CR Transmission

*The previous examinations depend on the size of each case and the type of connectivity available for each site.

*The previous examinations depend on the size of each case and the type of connectivity available for each site.

Tele-Radiology, Mammography Transmission

Mammography Image TransmissionCR Image Information    Image Size 10 MBImage Size after Lossless Compression 5 MBAverage Study Size (2-Slice CT) 4 ImageTotal Average Study Size after compression 20 MB   

Link Speed ADSL 4Mbps (1:4) 1 MB Upload

Band Width Utilization 50%  

Idle Time Between studies 30 seconds

Average Time to send 1 image 100.00 seconds

Average Time to send 1 Study 7.17 Minutes

Total Studies sent per hour 8.37 StudyLink Speed SDSL 4Mbps (1:1) 2 MB UploadBand Width Utilization 50%  Idle Time Between studies 20 secondsAverage Time to send 1 image 50.33 secondsAverage Time to send 1 Study 3.36 Minutes

Total Studies sent per hour 17.88 Study

• Load balancing Should be an issue for multi-site/multi-modality transmission

• Using Digital Mammography, the image sizes will be much higher (x6) and we need either to increase the link speed to able to reach the same studies.

Tele-Radiology, Optimization and Compression

Hardware Compression

Software Compression

Compression of WAN traffic using WAN Routers with Layer 2 payload compression or Layer 3 TCP/IP header compression using Cisco Internetwork Operating System (Cisco IOS)

Compression Methods• Lossless JPEG (1:2)• Lossless JPEG 2000 (1:4)• Lossy JPEG (1:9 ~ 1:70)

Streamed Communication

• Using traffic dispersion to increase the download speed and the utilization of the link bandwidth

• Using rule-based auto-routing techniques to insure the delivery of studies between servers.

TeleradiologyMillensys Features

• Pure Web-Based Technology • Same GUI for all users• Depending on Active Server Pages “ASP” Model.• Streaming with Dispersion over low band width lines.• Multiple compression methods for studies• Simple-Fast Search Results.• Resume downloading of studies when connection failure.• No need for special communication ports.• Embedded reporting tool with dictation and speech option.• Fast client Setup.• Automatic client update.• Supports of multi-branch hospitals• Built for the enterprise

Tele-Radiology, Technology

• Priority queuing for emergency studies• Secure over the Internet and HIPAA compliant• Auto-routing between acquisition and reporting facilities• Multiple compression methods (JPEG, JPEG2000)• Handles transmission of studies and reports.• Short term archive in hospitals• Long Term archive in Data Center• Clustered Solution to get 99.9% uptime• Monitors the Round-trip time for studies• Assure the delivery of studies when link failure• Resume transmission automatically when link is up

MILLENSYS PACS “MIPACS”

Tele-Radiology, Archive

• Run on any Web Browser• Streaming technology In viewing and download.• User defined image compression for rapid download• Customized worklist with user profile• Visual Hanging Protocols• Rapid operations for large studies• Display static and dynamic studies• Oblique, Bi-Oblique and Curved MPR/MIP• Slice Locator / Pilot Image for CT/MRI• Printing on DICOM and A4 Printers• Multiple Measurements• Image Processing and Annotations• 3D Reconstruction and Fly-Through Option

Vision Tools WebViewViewing

Tele-Radiology, Web Distribution

• Web Reporting• Template Reporting• Compatible with Microsoft Word • Voice Dictation and Transcription • Speech Recognition (Option)• Send Reports back to Hospitals

Tele-Radiology, Web Reporting

Dictation

Transcription

Vision Tools WebViewReporting

• Web administration• Single administration for

PACS/RIS• Manage user profiles• Manage user rights• View Audit logs• Manage Multi-Branches

Tele-Radiology, Web Administration

MiAdmin web based administrator

Tele-Radiology, Administration

• Report on the type of studies transmitted• Report is user selectable• Report is generated from the web

STUDY STATUS REPORT

Tele-Radiology, Administration

• Monitor the round-trip time for studies from the time the study is acquired till the final report is sent back to the hospital

ROUND TRIP REPORT

Tele-Radiology, Administration

• Generate multiple bills on the reported studies.

BILLING REPORT

Compression on the web JPEG Lossy/Lossless, JPEG 2000

CR study (Lossless) delivered in less than a minute over a 1Mbps ADSL Upload

Priority queuing , Emergency Studies have highest priority in transmission

Reports are sent back in Text and dictated voice formats

User Selectable compression before download

Roaming Profile for radiologists

Works with Any PACS solution, MILLENSYS or Third Party

View Images and Report on Multi-Monitor Configuration

Compression

Transmission

Facilities

Multi-Level Security

Tele-Radiology, Major Features

• HIPAA Compliance

• Web Based Administration at Data Center

• Log Files to monitor system operations and users

• Clustered Solution in Data Center to guarantee 99.9% uptime operation

• SAN Storage is a non single point of failure device with RAID 5 storage

• Store and forward for images from Hospitals to Data Center enable continuous operation in case of link failure.

• Cases resume transmission when link is up automatically.

Administration & Management:

Tele-Radiology, Security

Any Questions ?