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

RSNA 2012: Country Reports - DICOM-Related Activities around the World BRAZIL. Alair Sarmet Santos MD. PhD Teleradiology Committee of Brazilian College of Radiology (CBR ) CBR Brazilian’s representant in DICOM Standards Committee.

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

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  1. RSNA 2012: Country Reports - DICOM-Related Activities around the World BRAZIL Alair Sarmet Santos MD. PhD Teleradiology Committee of Brazilian College of Radiology (CBR) CBR Brazilian’s representant in DICOM Standards Committee

  2. 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.

  3. INTRODUCTION • 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.

  4. INTRODUCTION • 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 Residencyand Specialization in Radiology.

  5. PURPOSE 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 .

  6. EDUCATIONAL 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.

  7. INFRASTRUCTURE 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.

  8. BRAZILHigh speed networks available for university hospitals Ministry of Science, Technology and Innovation Avaiable on http://rute.rnp.br/

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

  10. RESULTS Themespresented • 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.

  11. RESULTS • The Brazilian College of Radiology has created a Subcommittee for 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) of CBR, held in October 12, 2011, in Recife, Pernambuco, Brazil, a pre Brazilian Congress of Radiology – 2011.

  12. 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.

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

  14. 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.

  15. FUTURE 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.

  16. REFERENCES [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

  17. Low-Cost Teleradiology: A Brazilian Solution for Emergency Care Units 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 telerradiologia@telessaude.uerj.br

  18. 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, Brazil.

  19. 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.

  20. METHODS & MATERIALS • 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. Figure 1: Showing the overlapping A4 size areas to be superposed.

  21. Image stitching algorithm Figure 3: The area which is searched in the right partial image to achieve a match with the left image comparison area Figure 2: The comparison area chosen in the left partial image Figure 4: Final stitched image after 2 or 4 matchings.

  22. METHODS & MATERIALS • Development of a web teleconsultation software Web Access: www.telessaude.uerj.br/riotelerx

  23. 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.

  24. Tuberculosis images Primary tuberculosis Secondary tuberculosis

  25. CONCLUSION • We have implemented a collaborative second opinion teleradiology program including Radiology Departments of the most importantUniversity Hospitalsin Rio de Janeiro. • The sustainable low-cost solution teleradiology provide a successful support in teleradiology which improve quality of doctors care for Emergency Care Unitsin Rio de Janeiro.

  26. 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

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

  28. THANK YOU ! • alairsarmet@globo.com

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