Remote Consult in RadiotherapyHEP Technologies in Health Physics!

Dipartimento di Fisica e Sezione INFN

Università degli Studi di Genova

squarcia@ge.infn.it

Maurizio Ferraris, Paolo Frixione, Sandro Squarcia

CHEP 2000, Padova, 2000 February 7-11

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!

New technologies have completely changed medical duties

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Modern Radiology Department

SD100 SD100

CR CR

WS WSWS

PC

Juke Box CD

ComputerRadiographydevices

Archive devices

Medical report and

consultation devices

Remote connection

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Multiple integration

Picture Archive Computer System(PACS)

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Clinical modalities (TC, MR, CR...)

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Hospital Information System (HIS)

RadiologicalInformation System (RIS)

Medical report

Booking

Hospital Area

Network

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

NORMA

A ad hoc clinical folder for images transmission

Network

Oriented

Remote

Medical

Archive

Hardware security

• Two area completely separated

• Two Ethernet card in the firewall

• A true gate from outside world

• Secure clinical data accessibility

Hospital global network

Radiotherapy (or radiology) divisional network

Software security Patient data identification

Patient clinical folder owner Access mode

Level 1: Pathology

Statistical analysis

(free for network partners)

Level2: Teleconsultation

Anamnesis and diagnosis

(on owner authorization)

Level 3: Treatment

Patient general data

(on patient authorization)

Owner mail address

NORMA characteristics

Menu frame

Blue for datainsertion

Green for data consultation

General system information

Body Frame

Patient information

Active image selection

Clinical images (JPEG format)

not for teleconsulting!

Different data handling possibility

Clinical information retrieved

Patient personal data

Study information

Series description

of clinical

image series

Image data describing

clinical

images (mode

and pixel

definitions)

DICOM Information ModelDigital

Information and

COmmunication in

Medicine

Remote consulting tool

DICOM moduleWWW-DICOM gateway

JAVA SERVER

Remoteconsulting

client

Remoteconsulting

client

Hospital A Hospital B

NORMA helps physicists and medical

doctorsto select the best

treatment planning in radiotherapy

discussing on images retrieved from DICOM PACS

through a client/server application

developed in Java.

DICOM IMAGES

Digital Images Retrieve

To LAN

Network

PACS System

WWW-DICOM Gateway

Eurostore Connection

Modalities

WorkstationsNORMA

Eurostore archive

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Image Transfer

Connection

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

WWW-DICOM gateway

Client/server architecture:

Presentation logic: Web BrowserApplication server: Web ServerBusiness logic: DICOM gatewayData management: DICOM Server

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WWW Browser

WWW Server

DICOMServer

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CGI interface

DICOM gateway

HTTPJPEG

conversion

DICOM gateway opens and submits a DICOM association to DICOM Server, receives a response and makes JPEG conversion

Sun

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(HTML + JavaScript)

Intranet

Web Server

Web Browser

CGI Library

Requests Parser

DICOM Upper Layer

Data encoding Data decoding Image processing

JPEG translation

Response builder

(Data) (Images)(Data)

+(Commands)

(Name-value pairs) (HTML file)

(HTTP)

(URL-encoding)

DICOM MODULE

WWW MODULE

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DICOMApplication Entity

LAN (DICOM protocol)

Data Exchange Mode

WWW Domain

DICOM Domain

WWW-DICOM Gateway

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

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-inproprietary network protocol

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JAVASERVER

WEBSERVER

HTTP Connection

HTTP Connection

Proprietary protocol

Proprietary protocol

CLIENT A

CLIENT B

JAVA Applet

JAVA Applet

JAVA Teleconsulting

Proprietary Protocol

Client 1 Java Server Client 2

Waiting for connectionConnection Request

Send priority codeReceive code

Time

Waiting forclient 2 connection

Connection Request

Send priority codeReceive code

Send ID client 2Receive and send ID2

Receive ID2

Verify connection status (polling)

DATA EXCHANGE

CONNECTION

Connection to the PACS System

User Autenthication

DICOM association

DICOM Connection Monitoring

DICOM Console

Visualization of data exchanged during DICOM communication

DICOM Patient Data Consulting

Patient list

Patientpersonal data

DICOM Study Information

Study list

Studyinformation

DICOM Series Information

Series list

Series information

DICOM Images

Dump of DICOM dataset

Retrieve of clinical images

Images Remote Consult

Discussion area

Help area

Toolbar

ConclusionsThe 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 Javathe same diagnostic images at the same time

highlighting zones of interest