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Remote Consult in Radiotherapy HEP Technologies in Health Physics!

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 squarcia@ge.infn.it.

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Remote Consult in Radiotherapy HEP Technologies in Health Physics!

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  1. 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 squarcia@ge.infn.it

  2. 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!

  3. 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

  4. 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...)

  5. 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

  6. NORMA A ad hocclinical folder for images transmission Network Oriented Remote Medical Archive

  7. 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

  8. 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

  9. NORMA characteristics Patient information General system information Menu frame Blue for data insertion Green for data consultation Body Frame

  10. Active image selection Different data handling possibility Clinical images (JPEG format) not for teleconsulting!

  11. 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)

  12. 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

  13. Digital Images Retrieve Workstations NORMA To LAN Network PACS System WWW-DICOM Gateway Modalities Eurostore Connection Image Transfer Connection Eurostore archive

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. JAVA Teleconsulting JAVA Applet HTTP Connection Proprietary protocol CLIENT A JAVA SERVER WEB SERVER JAVA Applet Proprietary protocol HTTP Connection CLIENT B

  20. 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

  21. Connection to the PACS System User Autenthication DICOM association

  22. DICOM Connection Monitoring DICOM Console • Visualization of data exchanged during DICOM communication

  23. DICOM Patient Data Consulting Patient list Patient personal data

  24. DICOM Study Information Study list Study information

  25. DICOM Series Information Series list Series information

  26. DICOM Images Retrieve of clinical images Dump of DICOM dataset

  27. Images Remote Consult Toolbar Help area Discussion area

  28. 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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