Teleradiology Concepts and Models discussion lecture.

1. TeleRadiology
Dr. S.F.B.Nazir
Consultant Radiologist

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

3. Teleradiology – Basic Concepts

4. For Viewing and Reporting

7. 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.
 Eg: A contract with TeleRadiology Service
Provider Company(Our Company) with any
Hospital or Diasnostic center in India or even
at International Levels - Daytime Reporting or
Night Hawks.
 Access to specialized expertise.

8. Teleradiology
 Lack of radiologists.
 Lack of full time radiologists, half time
radiologist,
 Sometime specialized second advice could
be necessary -> patient records can be sent
for second opinions.

9. The projects
 Send examinations to “on duty” radiologist Home.
 One radiologist on duty for all Multiple hospitals.
 Ability to send examination (radiology images – like
x-rays, CT scan, MRI or any patient data) from one
hospital to another or to reporting center directly
from daily used working tools.
 Simplicity of use.
 Security.

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

11. Inter-hospital project - Sample
H
Aurillac
H
Saint-Flour
H
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

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

13. Difficulties
Several different HIS/RIS (one per
hospital).
No PACS in Hospitals.
Management of reports.

14. Medical Imaging Network
 Each hospital department will have its own
network with nodal point in the main hospital.
 All four networks will be federated on Main
Server.
 Main 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
or Our center for reporting.

15. Which needs for such
projects?
 Receive request with images for reporting at
home and / Main Office.
 Send a report from home / Office to the right
hospital
 Deal with several different HIS/RIS/PACS for a
Radiologist on duty?
 Ensure security and patient privacy on home
computer and server.
…

16. Identified issues
 Security
 Privacy
 Second advice request (teleconferencing?)
 Image streaming
 Reporting:
 DICOM SR (Structured Report)? (needs of
templates for reporting and for second advice)
 HL7 CDA? (in Europe - CDA ready)
 .doc, .rtf, .pdf? (not secure formats)
…

17. Other questions
Identify what is in DICOM, HL7 or IHE
domain

18. Some Possible TeleRad
Models

29. The topic is open for discussion