Andre Schröter

How to deal with security issues in teleradiology

The use of teleradiological systems for medical image communication is increasing significantly. Digital images can be transferred over public telephone (e.g. ISDN) lines to colleagues for interpretation and/or consultation. Thus, a new quality is being introduced into the process of radiological diagnostics. However, technical implementation of such systems is accompanied by little consideration of legal, i.e. data protection and security, issues. In this paper we describe a concept for data protection in teleradiology which unites aspects of privacy and security as well as user aspects. After highlighting the legal situation in Germany we describe the methodology used for deriving the security profile for teleradiology in Germany. As a result the set of security measures which have to be employed with a teleradiology system is listed. A detailed description follows of how the software requirements are implemented in the teleradiology software MEDICUS.

A three-generation model for teleradiology

This paper proceeds from the definition of teleradiology. It identifies three different generations of teleradiology systems and includes those systems that are not regarded as teleradiology systems by the authors. A list of requirements pertinent to users of first-generation teleradiology systems is introduced. Most of the requirements have been realized in a new generation teleradiology system called CHILL.

An interactive system for volume segmentation in computer-assisted surgery

Computer-assisted surgery aims at a decreased surgical risk and a reduced recovery time of patients. However, its use is still limited to complex cases because of the high effort. It is often caused by the extensive medical image analysis. Especially, image segmentation requires a lot of manual work. Surgeons and radiologists are suffering from usability problems of many workstations. In this work, we present a dedicated workplace for interactive segmentation integratd within the CHILI (tele-)radiology system. The software comes with a lot of improvements with respect to its graphical user interface, the segmentation process and the segmentatin methods. We point out important software requirements and give insight into the concepts which were implemented. Further examples and applications illustrate the software system.

Mobile teleradiology: all images everywhere

This paper describes the ongoing work on mobile teleradiology systems in the EC-funded project MTM. The current development is based on the CHILI software architecture which provides a PACS and tel ...

The German teleradiology system MEDICUS system description and experiences in a German field test

MEDICUS is a teleradiology system which has been developed in a joint project of the German Cancer Research Center (Deutsches Krebsforschungszentrum) and the Transfer Center Medical Informatics (Steinbeis-Transferzentrum Medizinische Informatik) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. Special attention has been given to the design of the user interface and data security, integrity, and authentication. The software is in use in 13 radiology departments in university clinics, small hospitals, private practices, and research institutes. More than 25 thousand images have been processed in 6 months. The system is in use in six different application scenarios. MEDICUS is running under the UNIX operating system. The connection of the modalities could in most cases not be realized with the DICOM protocol as older machines were not equipped with this standard protocol. Clinical experiences show that the MEDICUS system provides a very high degree of functionality. The system has an efficient and user friendly graphical user interface. The result of a comparison with other systems shows that MEDICUS is currently the best known teleradiology system. Cost reductions are already obvious, but additional research has to be performed in this field. An even more powerful commercial successor is currently under construction at the Steinbeis-Transferzentrum Medizinische Informatik in Heidelberg.

Extending a teleradiology system by tools for visualization and volumetric analysis through a plug-in mechanism

This paper describes ongoing research concerning interactive volume visualization coupled with tools for volumetric analysis. To establish an easy to use application, the three-dimensional-visualization has been embedded in a state of the art teleradiology system, where additional functionality is often desired beyond basic image transfer and management. Major clinical requirements for deriving spatial measures are covered by the tools, in order to realize extended diagnosis support and therapy planning. Introducing a general plug-in mechanism, this work exemplarily describes the useful extension of an approved application. Interactive visualization was achieved by a hybrid approach taking advantage of both the precise volume visualization based on the Heidelberg ray-tracing model and the graphics acceleration capabilities of modern workstations. Several tools for volumetric analysis extend the three-dimensional-viewing. They are controlled by adequate input devices to select locations in the data volume, measure anatomical structures or initiate a segmentation process. Moreover, a haptic interface can be connected to provide a more realistic feedback while navigating within the three-dimensional-reconstruction. The work is closely related to research in the field of heart, liver and head surgery. In cooperation with our medical partners the development of tools as presented facilitates the integration of image analysis into the clinical routine.

Experiences with the German teleradiology system MEDICUS

This paper introduces the teleradiology system, MEDICUS, which has been developed at the Deutsches Krebsforschungszentrum (German Cancer Research Center) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. The global software architecture is explained in the article. Special attention has been given to the design of the user interface and data security, integrity and authentication. The software has been evaluated in a German field test at 13 radiology departments in university clinics, small hospitals, private practices and research institutes. More than 30 thousand images have been transmitted using this system during a 9 month period. Realized application scenarios are: in-house communication, image and report delivery to referring hospitals, remote reporting, radiotherapy treatment planning and research cooperation. Experience has shown that the system is easy to use and saves time. It obviates the need for patient transport and reduces film costs. Experiences of individuals while using the system during the field test helped define the functionality of the second generation teleradiology system which is even more flexible and is also available as a commercial product.

Evaluation des CHILI-Teleradiologienetzwerks nach 4 Jahren im klinischen Einsatz

ZusammenfassungDas CHILI-Teleradiologienetzwerk besteht aus mehr als 60 installierten Systemen in Deutschland und den USA. Radiologische Bilder und kardiologische Multiframebilder werden mit Hilfe des CHILI-(Tele-)Radiologiesystems in Routine ausgetauscht. In diesem Artikel wird untersucht, wie das System im klinischen Betrieb eingesetzt wird. Dies geschieht auf der Basis von Logfiles, die durch das System generiert werden. In diesen Dateien werden die verwendeten Funktionen und Protokolle, die Menge der importierten Daten, durchgeführte Übertragungen, und weitere wichtige Informationen gespeichert. Betrachtet werden Zeitpunkt und Anzahl der Bildimporte für die einzelnen Modalitäten sowie die zur Datenübertragung verwendeten Methoden und Protokolle. Es werden unterschiedliche Aspekte der Telekonferenz betrachtet und schließlich medizinische Anwendungsszenarien in den verschiedenen Einsatzumgebungen beschrieben. Ein wichtiges Ergebnis dieser Evaluation ist, dass das System nicht nur als Notfallsystem dient, sondern darüber hinaus im täglichen Gebrauch als allgemeine multifunktionale Workstation mit fortgeschrittenen Funktionen für Teleradiologie und Telekardiologie eingesetzt wird.AbstractThe CHILI teleradiology network has more than 60 installations in Germany and the USA. Radiological images and cardiological multiframe series are exchanged in clinical routine. This article investigates in what way and how often the system is used. This is done by means of accounting files that are produced automatically by the system. User functions, transmission protocols, data quantity, frequencies and time of data transmission and teleconferences are evaluated and discussed in this paper. Different application scenarios have been identified and are described and analyzed as well. An important result is, that the system is not merely an emergency system. Instead, it is used in daily routine as a multifunctional, multimodality workstation with advanced features for teleradiology and telecardiology.

Reality and perspectives in teleradiology: a personal view based on personal experiences

This paper is a subjective view based on 8years of personal experience in teleradiology.We think the results are of interest totelemedicine in general.Telemedicine is a broad field, which can bedefined in different ways. A Japanese defini-tion of 1996 described it as ‘‘… the use of anyelectrical signal to transmit medical informa-tion…’’ [1]. This is a very technical and sim-plistic view. The University of Athens inGreece published a more detailed definition:‘‘… the transfer of electronic medical data(i.e. high resolution images, sounds, livevideo, and patient records) from one locationto another.’’ [2]. A broader definition, whichtakes the entire health care system into ac-count, says: ‘‘… the use of telecommunica-tions technology to deliver health careservices and health professions education tosites that are distant to the host site or educa-tor…’’ [3].The driving factors in telemedicine wereinvestigated in a study by Frost and Sullivan[4]. The following reasons were identified fordeveloping and using telemedicine: first, thereis pressure to reduce costs. Centralization,specialization and outsourcing need this tech-nology. Furthermore, there is a need forgreater efficiency in the health care system.Advances in technology help in implementingtelemedicine systems today. The dissemina-tion of international standardization is animportant aspect in implementing systemsthat are interoperable. Examples of suchstandards are DICOM, MEDICOM andHL7. The shift from institution-based care tocitizen- and homecare-centered provision isanother important driver. Increased health-care demands can only be satisfied withtelemedicine. Aging populations need tele-monitoring to cut costs and isolated patientsneed and demand full healthcare services.Physicians are motivated to implementtelemedical applications since they recognizean income potential [4].Telemedicine can help patients, physiciansand other medical staff as well as medicalinstitutions, insurance carriers, politiciansand the medical devices market according tothis study [4].

A teleradiology concept for entire Greenland

Digital medicine in the virtual hospital of the future G. Graschew Æ T.A. Roelofs, S. Rakowsky Æ P.M. Schlag SRU OP 2000, Max-Delbrueck-Center and Robert-Roessle-Klinik, Charité, Berlin, Germany Abstract Provision of global healthcare requires global interoperability of medical services Therefore, the creation of a Virtual EuroMediterranean Hospital for a real integration is proposed. Preoperative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. An integrated satellite–internet platform allows for e-learning, real-time telemedicine and medical assistance. Due to the distributed character of the virtual hospital the implementation of Grid-enabled technologies and services becomes important.