Markus Schwab

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.

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.

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].

The evolution of a German teleradiology system.

This paper describes the evolution of a german teleradiology system. The development started from simple image file transfer, continued with a dedicated teleradiology system and ended up with a general radiology workstation with teleradiology features. The main features, advantages and drawbacks of the different generations are described. The own developments are compared with developments at other places. The influence by standards is also included in this investigation. The latest systems are mainly used by the radiologists and the image transfer for scientific cooperation is nowadays just one of several application fields of teleradiology.

Konsequenzen des Medizinproduktegesetzes für die Erstellung von Bildverarbeitungssoftware Qualitätssicherung gemäβ ISO 9001 als Lösungsansatz

In der medizinischen Bildverarbeitung hat der Einsatz von Software einen hohen Stellenwert. Dabei stehen neue Methoden zur Bildanalyse im Vordergrund. Urn den klinischen Einsatz in Routine zu gewahrleisten, sind bei der Entwicklung solcher Programme einerseits die Schnittstellen zu anderen Informationssystemen (KIS, RIS, PACS) zu berucksichtigen, andererseits aber auch gesetzliche Vorgaben. Insbesondere haben sich seit dem Inkrafttreten des Medizinproduktegesetzes im Jabr 1995 fur die Erstellung medizinischer Software viele Anderungen ergeben. Dieser Beitrag stellt vor, welche Vorschriften fur die Softwareerstellung von Bedeutung sind, und erarbeitet eine Losung, die im Umfeld der Medizininformatik besonders geeignet ist.

CHILI: Eine Integrationsplattform für medizinische Bildverarbeitungsmethoden

Bildverarbeiter in der Medizin stehen immer wieder vor dem Problem, das sie sich neben der eigentlichen Bildanalyseaufgabe mit zusatzlichen Funktionen beschaftigen mussen, die nichts mit dem eigentlichen Problem zu tun haben. Die Integration der realisierten Losung in das spatere klinische Umfeld ist ein immer wiederkehrendes Problem. CHILI ist eine erweiterungsfahige Radiologic-Workstation mit Telekonferenzfunktionen. Diese ist vollstandig in das radiologische Umfeld eingebettet. Durch den CHILI Plugln-Mechanismus kann das System nachtraglich um Bildanalysemethoden erweitert werden. Entwickler profitieren durch geringeren Entwicklungsaufwand und Anwender durch geringere Kosten und einfachere Bedienung, da die neuen Methoden in bekannten Softwareumgebungen und mit gewohnter Benutzungsschnittstelle angewendet werden konnen. Zusatzliche Rechner oder unnotige Datentransfers konnen entfallen. Dieser Bericht stellt die gmndlegenden Mechanismen des Pluglns vor und untersucht an realisierten Plugln-Losungen aus verschiedenen Bereichen die Moglichkeiten und Grenzen des Systems.