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Teleradiology

Teleradiology. Jo ël Chabriais, MD, MS. Teleradiology - Telewhat?. One propose a segmentation: Teleteaching Telelearning Teleexpertise Teleconsultation Telediagnosis TeleXXX My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise). Teleradiology - Why?.

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Teleradiology

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  1. Teleradiology Joël Chabriais, MD, MS

  2. Teleradiology - Telewhat? • One propose a segmentation: • Teleteaching • Telelearning • Teleexpertise • Teleconsultation • Telediagnosis • TeleXXX • My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)

  3. 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.

  4. 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.

  5. Teleradiology projects in France • Auvergne • Aquitaine • Brittany • Lorraine • …

  6. 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.

  7. The projects • 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.

  8. Cantal

  9. Implementation Radiologist home H CT / MRI Aurillac Duty server DICOM viewer « on duty » DMZ Mediation server Internet Access

  10. H H H Aurillac Saint-Flour Mauriac Domicile radiologue Domicile radiologue Domicile radiologue CT / IRM modality modality DICOM Viewer « on duty » DICOM Viewer « on duty » DICOM Viewer « on duty » DICOM Viewer « on duty » DICOM Viewer « on duty » Duty Server DMZ Mediation Server Inter-hospital project - Cantal Internet Access

  11. Security Principle Other facility or on duty radiologist home Local networkt of the main facility (Aurillac) Main facility DMZ Decryption / Encryption Mediation server Gateway Gateway https channel DICOM Application DICOM Application DICOM Network

  12. Difficulties • 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.

  13. Auvergne

  14. Mauriac St-Flour Aurillac ??? Cantal Today, Cantal Medical Imaging Federation

  15. ??? ??? Clermont-Rerrand Mauriac St-Flour ??? Puy-de-Dôme Aurillac ??? ??? ??? ??? ??? Moulins Puy-en-Velay Cantal ??? ??? Allier Haute Loire Tomorrow, Auvergne Medical Imaging network? University Hospital

  16. Hospitals in Auvergne

  17. 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.

  18. Brittany Inter-hospital project H H H RENNES Vitré Saint-Brieuc CT / IRM modality modality STAR-IE STAR-IE STAR-IE DMZ Mediation Server MEGALIS Internet Access

  19. 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 • …

  20. Identified issues • Security • Privacy • Second advice request (teleconferencing?) • Image streaming • Reporting: • 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) • …

  21. Other questions • Identify what is in DICOM, HL7 or IHE domain • Is there matter for work item proposals in DICOM?

  22. The topic is open for discussion

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