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Teleradiology Joël Chabriais, MD, MS
Teleradiology - Telewhat? One propose a segmentation: Teleteaching Telelearning Teleexpertise Teleconsultation Telediagnosis Tele. XXX My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)
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.
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.
Teleradiology projects in France Auvergne Aquitaine Brittany Lorraine …
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.
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.
Implementation H Aurillac Radiologist home CT / MRI Duty server DICOM viewer « on duty » DMZ Mediation server Internet Access
Inter-hospital project - Cantal H Aurillac H H Saint-Flour Mauriac Domicile radiologue DICOM Viewer « on duty » CT / IRM modality DICOM Viewer « on duty » Duty Server modality DICOM Viewer « on duty » Domicile radiologue DICOM Viewer « on duty » DMZ Mediation Server Domicile radiologue DICOM Viewer « on duty » Internet Access
Security Principle Local networkt of the main facility (Aurillac) Other facility or on duty radiologist home Main facility DMZ Decryption / Encryption Mediation server Gateway https channel DICOM Application DICOM Network
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.
Today, Cantal Medical Imaging Federation Mauriac St-Flour Aurillac ? ? ? Cantal
Tomorrow, Auvergne Medical Imaging network? ? University Hospital ? ? ? Clermont. Rerrand ? ? ? Moulins ? ? ? Puy-de-Dôme Mauriac St-Flour Allier ? ? ? Puy-en-Velay Aurillac ? ? ? Cantal Haute Loire
Hospitals in Auvergne
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.
Brittany Inter-hospital project H RENNES CT / IRM STAR-IE H modality STAR-IE DMZ Mediation Server MEGALIS H Vitré Internet Access Saint-Brieuc modality STAR-IE
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 …
Identified issues Security Privacy Second advice request (teleconferencing? ) Image streaming Reporting: DICOM SR? (needs of templates for reporting and for second advice) HL 7 CDA? (in France no product CDA ready) . doc, . rtf, . pdf? (not secure formats) …
Other questions Identify what is in DICOM, HL 7 or IHE domain Is there matter for work item proposals in DICOM?
The topic is open for discussion