Ulrike Baur

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.

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.

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.

Extending a teleradiology system by tools for 3D-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 3D-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 the 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 Raytracing Model and the graphics acceleration of modern workstations. Several tools for volumetric analysis extend the 3D-viewing. They offer 3D-pointing devices to select locations in the data volume, measure anatomical structures or control segmentation processes. A haptic interface provides a realistic perception while navigating within the 3D-reconstruction. The work is closely related to research work in the field of heart, liver and head surgery. In cooperation with our medical partners the development of tools as presented proceed the integration of image analysis into clinical routine.

Volume visualization and interactive tools plugged into a teleradiology system

This paper presents ongoing research in the field of volume visualization, interactive volumetric analysis and teleradiology. To cover the complete scenario from image acquisition to computer-based diagnosis and therapy support, interactive tools for volume visualization and volumetric analysis have been integrated into a state of the art teleradiology system through a general plug-in mechanism. Visualization is demonstrated as a hybrid approach integrating precise volume visualization based on the Heidelberg Raytracing Model with fast surface rendering. With respect to volumetric analysis, tools extend the 3D-viewing. They allow to measure distances, angles, areas and volumes through 3D- pointing and user controlled segmentation processes. Various input devices can be connected to control the navigation of the viewer or objects in the scene. Moreover, a haptic interface has been investigated. The realistic perception through force feedback while navigating within the 3D- reconstruction was positively judged by the medical users as well as software developers. The work is closely related to research in the field of heart, liver and cranio-facial surgery planning. In cooperation with our medical partners the development of tools as presented proceed the integration of image analysis into the clinical routine.