Teleradiology

Joël Chabriais, MD, MS

Teleradiology - Telewhat?

Teleradiology - Telewhat?

One propose a segmentation:TeleteachingTelelearningTeleexpertiseTeleconsultationTelediagnosisTeleXXX

My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)

One propose a segmentation:TeleteachingTelelearningTeleexpertiseTeleconsultationTelediagnosisTeleXXX

My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)

Teleradiology - Why?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.

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

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.

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

Teleradiology projects in France

AuvergneAquitaineBrittanyLorraine…

AuvergneAquitaineBrittanyLorraine…

Teleradiology in Cantal

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.

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 projectsThe projectsSend 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.

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.

CantalCantal

DMZ

H

AurillacCT / MRI

Mediationserver

Dutyserver

Radiologist home

Internet Access

DICOM viewer« on duty »

ImplementationImplementation

DMZ

H

Aurillac

CT / IRM

MediationServer

DutyServer

Internet Access

Domicile radiologue

DICOM Viewer« on duty »

H

Saint-Flour

modality

DICOM Viewer

« on duty »

H

Mauriac

modality

DICOM Viewer

« on duty »Domicile radiologue

DICOM Viewer

« on duty »

Domicile radiologue

DICOM Viewer« on duty »

Inter-hospital project - Cantal

Inter-hospital project - Cantal

Mediation server

Decryption/ Encryption

Gateway

DICOMApplication

DICOMNetwork

Gateway

https channel

Local networkt of the main facility(Aurillac)

Main facility DMZOther facility oron duty radiologist home

Security PrincipleSecurity Principle

DICOMApplication

DifficultiesDifficulties

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.

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.

AuvergneAuvergne

Today, Cantal Medical Imaging Federation

Today, Cantal Medical Imaging Federation

Aurillac

Mauriac

???

St-Flour

Cantal

Tomorrow, Auvergne Medical Imaging

network?

Tomorrow, Auvergne Medical Imaging

network?Clermont-

Rerrand

???

???

???

Puy-de-Dôme

Aurillac

Mauriac

???

St-Flour

Cantal

Puy-en-Velay

???

???

???

Haute Loire

Moulins

???

???

???

Allier

UniversityHospital

Hospitals in AuvergneHospitals in Auvergne

Auvergne Medical Imaging Network

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.

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.

DMZ

H

RENNES

CT / IRM

MediationServer

STAR-IE

MEGALISInternet Access

H

Vitré

modality

STAR-IE

H

Saint-Brieuc

modality

STAR-IE

Brittany Inter-hospital project

Brittany Inter-hospital project

Which needs for such projects?

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

…

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 issuesIdentified issues

SecurityPrivacySecond advice request (teleconferencing?)

Image streamingReporting:

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)…

SecurityPrivacySecond advice request (teleconferencing?)

Image streamingReporting:

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 questionsOther questions

Identify what is in DICOM, HL7 or IHE domain

Is there matter for work item proposals in DICOM?

Identify what is in DICOM, HL7 or IHE domain

Is there matter for work item proposals in DICOM?

The topic is open for discussion