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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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slide1
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]

slide2
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!

slide3
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

slide4
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...)

slide5
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

slide6
NORMA

A ad hocclinical folder for images transmission

Network

Oriented

Remote

Medical

Archive

slide7
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

slide8
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

slide9
NORMA characteristics

Patient information

General system information

Menu frame

Blue for data

insertion

Green for data consultation

Body Frame

slide10
Active image selection

Different data handling possibility

Clinical images (JPEG format)

not for teleconsulting!

slide11
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)
slide12
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

slide13
Digital Images Retrieve

Workstations

NORMA

To LAN

Network

PACS

System

WWW-DICOM

Gateway

Modalities

Eurostore

Connection

Image Transfer Connection

Eurostore

archive

slide14
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

slide15
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

slide16
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

slide17
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
slide18
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

slide19
JAVA Teleconsulting

JAVA Applet

HTTP Connection

Proprietary protocol

CLIENT A

JAVA

SERVER

WEB

SERVER

JAVA Applet

Proprietary protocol

HTTP Connection

CLIENT B

slide20
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

slide21
Connection to the PACS System

User

Autenthication

DICOM association

slide22
DICOM Connection Monitoring

DICOM

Console

  • Visualization of data exchanged during DICOM communication
slide23
DICOM Patient Data Consulting

Patient list

Patient

personal data

slide24
DICOM Study Information

Study list

Study

information

slide25
DICOM Series Information

Series list

Series

information

slide26
DICOM Images

Retrieve of

clinical images

Dump of

DICOM dataset

slide27
Images Remote Consult

Toolbar

Help area

Discussion area

slide28
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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