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CHEP 2000, Padova, 2000 February 7-11. Remote Consult in Radiotherapy HEP Technologies in Health Physics!. Maurizio Ferraris, Paolo Frixione, Sandro Squarcia. Dipartimento di Fisica e Sezione INFN Università degli Studi di Genova [email protected]

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CHEP 2000, Padova, 2000 February 7-11

Remote Consult in RadiotherapyHEP Technologies in Health Physics!

Maurizio Ferraris,

Paolo Frixione,

Sandro Squarcia

Dipartimento di Fisica e Sezione INFN

Università degli Studi di Genova

[email protected]


New technologies have completely changed medical duties

Health care needs...

  • Physical devices are quickly improving

    • Computed Tomography,

    • Nuclear Resonance,

    • Computer Radiography,

    • Echography….

  • Informatics is becoming more and more important

  • Networking among clinical departments is now usual

  • ... and physics transfer

    - We are in hospitals (Health Physics)

    - We have technologies

    - We know how to fit them in medical world

    Teleconsultation for better patient care!


    Modern Radiology Department

    Remote connection

    PC

    CR

    CR

    Computer

    Radiography

    devices

    Juke Box CD

    SD100

    SD100

    Archive devices

    Medical report and consultation devices

    WS

    WS

    WS


    Multiple integration

    Hospital Information System (HIS)

    Radiological

    Information

    System (RIS)

    Booking

    Hospital Area Network

    Medical report

    Picture Archive

    Computer System

    (PACS)

    Clinical modalities (TC, MR, CR...)


    Teleconsultation

    • Construction of a clinical folder with images

      • Possibility of on-line interaction

      • Possibility of follow-up check

      • Possibility of statistical clinical data elaboration

    Foundation for the use development of hadrons (instead of electrons/gammas) in radiotherapy cancer cure

    Has supported NORMA

    Network Oriented Remote Medical Archive


    NORMA

    A ad hocclinical folder for images transmission

    Network

    Oriented

    Remote

    Medical

    Archive


    Hardware security

    Hospital global network

    • Two area completely separated

    • Two Ethernet card in the firewall

    • A true gate from outside world

    • Secure clinical data accessibility

    Radiotherapy (or radiology) divisional network


    Software security

    Patient data identification

    Level 1: Pathology

    Statistical analysis

    (free for network partners)

    Level2: Teleconsultation

    Anamnesis and diagnosis

    (on owner authorization)

    Level 3: Treatment

    Patient general data

    (on patient authorization)

    Access mode

    Patient clinical folder owner

    Owner mail address


    NORMA characteristics

    Patient information

    General system information

    Menu frame

    Blue for data

    insertion

    Green for data consultation

    Body Frame


    Active image selection

    Different data handling possibility

    Clinical images (JPEG format)

    not for teleconsulting!


    DICOM Information Model

    Digital

    Information and

    COmmunication in

    Medicine

    • Clinical information retrieved

    • Patient personal data

    • Study information

    • Series description

    • of clinical image series

      • Image data describing clinical images (mode and pixel definitions)


    DICOM IMAGES

    Remote consulting tool

    NORMA helps

    physicists and medical doctors

    to select the best

    treatment planning

    in radiotherapy

    discussing on images retrieved from

    DICOM PACS

    through a

    client/server application developed in

    Java.

    DICOM module

    WWW-DICOM gateway

    JAVA SERVER

    Remote

    consulting

    client

    Remote

    consulting

    client

    Hospital A

    Hospital B


    Digital Images Retrieve

    Workstations

    NORMA

    To LAN

    Network

    PACS

    System

    WWW-DICOM

    Gateway

    Modalities

    Eurostore

    Connection

    Image Transfer Connection

    Eurostore

    archive


    EUROSTORE Project

    European Project to design and develop an high performance distributed storage system

    • Consortium formed by scientific and industrial partners

      • QSW (Supercomputer - UK)

      • CERN (Science - Swiss)

      • DESY (Science - Germany)

      • HCSA (Space Technology - Greece)

      • TERA Foundation (Science - Italy)

      • HNMS (Met-Service - Greece)

      • AMC (Medical - Greece)

    Features: Scalability

    Reliability and security

    Easy hardware and software support

    Eurostore (Java 100%) will run on, almost, all hardware and software systems available today


    WWW-DICOM gateway

    • Client/server architecture:

    • Presentation logic: Web Browser

      • Application server: Web Server

      • Business logic: DICOM gateway

      • Data management: DICOM Server

    CGI

    interface

    JPEG

    conversion

    HTTP

    WWW

    Browser

    WWW

    Server

    DICOM

    gateway

    DICOM

    Server

    DICOM gateway opens and submits a DICOM association to

    DICOM Server, receives a response and makes JPEG conversion


    Sun

    Sun

    SPARC10

    . . . . . .

    . . . . . .

    Sun Sparc 10

    Data Exchange Mode

    (HTML + JavaScript)

    Web Browser

    WWW Domain

    Intranet

    (HTTP)

    WWW-DICOM

    Gateway

    Sun

    SPARCserver 1000

    Web Server

    DICOM Domain

    Sun

    DISKserver 1000

    WWW MODULE

    (URL-encoding)

    CGI Library

    (Name-value pairs)

    (HTML file)

    LAN

    (DICOM protocol)

    Requests Parser

    Response builder

    (Data)

    +

    (Commands)

    (Data)

    (Images)

    DICOM

    Application Entity

    Sun

    JPEG translation

    Data

    decoding

    Data encoding

    Sun

    DISKserver 1000

    Image processing

    DICOM MODULE

    DICOM Upper Layer


    Teleconsulting Features and Functionalities

    • Feature:

      • Secure

    • user authentication

    • secure socket layer protocol

    • activities registration on log file

      • Platform independent

      • Java applet running on every Web Browser

    • Functionality:

      • Access to medical image archives (PACS)

      • Selection (and transmission) of clinical images zone

      • Discussion of clinical cases among remote users


    Client/Server Teleconsulting Architecture

    Client: Java Applet for running on every Web Browser

    • Communication management

    • Graphical user interface

      • - mouse drawing on clinical images

      • - information exchange using the chat area

    Server: Java application installed on NORMA system

    • Client communication management

    • Log files activities registration

    • Multithread software architecture

    Protocol: Communication performed using a built-in

    proprietary network protocol


    JAVA Teleconsulting

    JAVA Applet

    HTTP Connection

    Proprietary protocol

    CLIENT A

    JAVA

    SERVER

    WEB

    SERVER

    JAVA Applet

    Proprietary protocol

    HTTP Connection

    CLIENT B


    Proprietary Protocol

    Client 1

    Java Server

    Time

    Client 2

    Waiting for connection

    Connection Request

    Send priority code

    C

    O

    N

    N

    E

    C

    T

    I

    O

    N

    Receive code

    Waiting for

    client 2 connection

    Connection Request

    Send priority code

    Receive code

    Send ID client 2

    Receive and send ID2

    Receive ID2

    Verify connection status (polling)

    DATA EXCHANGE


    Connection to the PACS System

    User

    Autenthication

    DICOM association


    DICOM Connection Monitoring

    DICOM

    Console

    • Visualization of data exchanged during DICOM communication


    DICOM Patient Data Consulting

    Patient list

    Patient

    personal data


    DICOM Study Information

    Study list

    Study

    information


    DICOM Series Information

    Series list

    Series

    information


    DICOM Images

    Retrieve of

    clinical images

    Dump of

    DICOM dataset


    Images Remote Consult

    Toolbar

    Help area

    Discussion area


    Conclusions

    The developed system is a

    research product helping physicists/medical doctors

    to select the best

    radiotherapy treatment planning

    Users

    working in different places

    can discuss interesting clinical cases visualizing

    in a Web Browser supporting Java

    the same diagnostic images at the same time

    highlighting zones of interest


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