Remote Consult in RadiotherapyHEP Technologies in Health Physics!
Dipartimento di Fisica e Sezione INFN
Università degli Studi di Genova
Maurizio Ferraris, Paolo Frixione, Sandro Squarcia
CHEP 2000, Padova, 2000 February 7-11
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!
New technologies have completely changed medical duties
SPARCserver 1000
Sun SPARCserver 1000
Sun DISKserver 1000
Modern Radiology Department
SD100 SD100
CR CR
WS WSWS
PC
Juke Box CD
ComputerRadiographydevices
Archive devices
Medical report and
consultation devices
Remote connection
SPARCserver 1000
Sun SPARCserver 1000
Sun DISKserver 1000
SPARCserver 1000
Sun SPARCserver 1000
Sun DISKserver 1000
SPARCserver 1000
Sun SPARCserver 1000
Sun DISKserver 1000
Multiple integration
Picture Archive Computer System(PACS)
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Sun DISKserver 1000
Clinical modalities (TC, MR, CR...)
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Sun SPARCserver 1000
Sun DISKserver 1000
Hospital Information System (HIS)
RadiologicalInformation System (RIS)
Medical report
Booking
Hospital Area
Network
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 hoc clinical folder for images transmission
Network
Oriented
Remote
Medical
Archive
Hardware security
• Two area completely separated
• Two Ethernet card in the firewall
• A true gate from outside world
• Secure clinical data accessibility
Hospital global network
Radiotherapy (or radiology) divisional network
Software security Patient data identification
Patient clinical folder owner Access mode
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)
Owner mail address
NORMA characteristics
Menu frame
Blue for datainsertion
Green for data consultation
General system information
Body Frame
Patient information
Active image selection
Clinical images (JPEG format)
not for teleconsulting!
Different data handling possibility
Clinical information retrieved
Patient personal data
Study information
Series description
of clinical
image series
Image data describing
clinical
images (mode
and pixel
definitions)
DICOM Information ModelDigital
Information and
COmmunication in
Medicine
Remote consulting tool
DICOM moduleWWW-DICOM gateway
JAVA SERVER
Remoteconsulting
client
Remoteconsulting
client
Hospital A Hospital B
NORMA helps physicists and medical
doctorsto select the best
treatment planning in radiotherapy
discussing on images retrieved from DICOM PACS
through a client/server application
developed in Java.
DICOM IMAGES
Digital Images Retrieve
To LAN
Network
PACS System
WWW-DICOM Gateway
Eurostore Connection
Modalities
WorkstationsNORMA
Eurostore archive
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Sun SPARCserver 1000
Sun DISKserver 1000
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Sun SPARCserver 1000
Sun DISKserver 1000
Image Transfer
Connection
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 BrowserApplication server: Web ServerBusiness logic: DICOM gatewayData management: DICOM Server
SPARCserver 1000
Sun SPARCserver 1000
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WWW Browser
WWW Server
DICOMServer
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Sun SPARCserver 1000
Sun DISKserver 1000
CGI interface
DICOM gateway
HTTPJPEG
conversion
DICOM gateway opens and submits a DICOM association to DICOM Server, receives a response and makes JPEG conversion
Sun
. . . . . . . . . . . .
SPARC10Sun
Sun Sparc 10
SunSPARCserver 1000
SunDISKserver 1000
(HTML + JavaScript)
Intranet
Web Server
Web Browser
CGI Library
Requests Parser
DICOM Upper Layer
Data encoding Data decoding Image processing
JPEG translation
Response builder
(Data) (Images)(Data)
+(Commands)
(Name-value pairs) (HTML file)
(HTTP)
(URL-encoding)
DICOM MODULE
WWW MODULE
Sun
SunDISKserver 1000
DICOMApplication Entity
LAN (DICOM protocol)
Data Exchange Mode
WWW Domain
DICOM Domain
WWW-DICOM Gateway
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-inproprietary network protocol
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Sun SPARCserver 1000
Sun DISKserver 1000
JAVASERVER
WEBSERVER
HTTP Connection
HTTP Connection
Proprietary protocol
Proprietary protocol
CLIENT A
CLIENT B
JAVA Applet
JAVA Applet
JAVA Teleconsulting
Proprietary Protocol
Client 1 Java Server Client 2
Waiting for connectionConnection Request
Send priority codeReceive code
Time
Waiting forclient 2 connection
Connection Request
Send priority codeReceive code
Send ID client 2Receive and send ID2
Receive ID2
Verify connection status (polling)
DATA EXCHANGE
CONNECTION
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
Patientpersonal data
DICOM Study Information
Study list
Studyinformation
DICOM Series Information
Series list
Series information
DICOM Images
Dump of DICOM dataset
Retrieve of clinical images
Images Remote Consult
Discussion area
Help area
Toolbar
ConclusionsThe 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 Javathe same diagnostic images at the same time
highlighting zones of interest