1. Teleradiology Joël Chabriais, MD, MS

2. Teleradiology - Telewhat?  One propose a segmentation:  Teleteaching  Telelearning  Teleexpertise  Teleconsultation  Telediagnosis  TeleXXX  My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)  One propose a segmentation:  Teleteaching  Telelearning  Teleexpertise  Teleconsultation  Telediagnosis  TeleXXX  My purpose: teleradiology in daily radiological practice (telediagnosis ± teleexpertise)

3. Teleradiology - Why?  In some area there is a lack of radiologists.  Sometime it could be financially accurate to have only one radiologist on duty for several radiological facilities.  Boston experimentation: a contract with an Israeli and an Asian Hospitals to have only daytime reading.  Access to specialized expertise.  In some area there is a lack of radiologists.  Sometime it could be financially accurate to have only one radiologist on duty for several radiological facilities.  Boston experimentation: a contract with an Israeli and an Asian Hospitals to have only daytime reading.  Access to specialized expertise.

4. Teleradiology in France  Some applications dedicated to neurosurgery:  Point to point,  Specific,  Launched at the beginning of the nineties,  Expensive and not easy to use.  New projects dedicated to general radiology.  Some applications dedicated to neurosurgery:  Point to point,  Specific,  Launched at the beginning of the nineties,  Expensive and not easy to use.  New projects dedicated to general radiology.

5. Teleradiology projects in France  Auvergne  Aquitaine  Brittany  Lorraine  …  Auvergne  Aquitaine  Brittany  Lorraine  …

6. Teleradiology in Cantal  Mountainous area: transportation difficulties (winter).  Lack of radiologists.  Three main hospitals in the département:  Only one have senior full time radiologists,  One have an half time radiologist,  The last one have only interim radiologists,  Frequency of duty is too high in each hospital.  Sometime specialized second advice could be necessary -> patient records have to be sent to university hospitals.  Mountainous area: transportation difficulties (winter).  Lack of radiologists.  Three main hospitals in the département:  Only one have senior full time radiologists,  One have an half time radiologist,  The last one have only interim radiologists,  Frequency of duty is too high in each hospital.  Sometime specialized second advice could be necessary -> patient records have to be sent to university hospitals.

7. The projects  Send examinations to “on duty” radiologist home.  One radiologist on duty for all three hospitals.  Along the day, ability to send examination from one hospital to another directly from daily used working tools to daily used working tools.  Simplicity of use.  Security.  Federate all imaging departments of the département to manage them as an unique entity.  Send examinations to “on duty” radiologist home.  One radiologist on duty for all three hospitals.  Along the day, ability to send examination from one hospital to another directly from daily used working tools to daily used working tools.  Simplicity of use.  Security.  Federate all imaging departments of the département to manage them as an unique entity.

8. Cantal

9. DMZ H Aurillac CT / MRI Mediation server Duty server Radiologist home Internet Access DICOM viewer « on duty » Implementation

10. DMZ H Aurillac CT / IRM Mediation Server Duty Server Internet Access Domicile radiologue DICOM Viewer « on duty » H Saint-Flour modality DICOM Viewer « on duty » H Mauriac modality DICOM Viewer « on duty » Domicile radiologue DICOM Viewer « on duty » Domicile radiologue DICOM Viewer « on duty » Inter-hospital project - Cantal

11. Mediation server Decryption / Encryption Gateway DICOM Application DICOM Network Gateway https channel Local networkt of the main facility (Aurillac) Main facility DMZ Other facility or on duty radiologist home Security Principle DICOM Application

12. Difficulties  Several different HIS/RIS (one per hospital).  No PACS at this time (probably one at Aurillac in two or three years).  Management of reports make on duty.  Several different HIS/RIS (one per hospital).  No PACS at this time (probably one at Aurillac in two or three years).  Management of reports make on duty.

13. Auvergne

14. Today, Cantal Medical Imaging Federation Aurillac Mauriac ??? St-Flour Cantal

15. Tomorrow, Auvergne Medical Imaging network? Clermont -Rerrand ??? Puy-de-Dôme Aurillac Mauriac ??? St-Flour Cantal Puy-en-Velay ??? Haute Loire Moulins ??? Allier University Hospital

16. Hospitals in Auvergne

17. Auvergne Medical Imaging Network  Each département will have its own network with nodal point in the main hospital at the préfecture (main town of the département).  All four networks will be federated on Clermont-Ferrand University Hospital (CHU).  At the CHU a server will be able to:  Give access to images in the DMZ,  Import images in the local PACS,  Send images to the right specialist “on duty” home for advice.  Each département will have its own network with nodal point in the main hospital at the préfecture (main town of the département).  All four networks will be federated on Clermont-Ferrand University Hospital (CHU).  At the CHU a server will be able to:  Give access to images in the DMZ,  Import images in the local PACS,  Send images to the right specialist “on duty” home for advice.

18. DMZ H RENNES CT / IRM Mediation Server STAR-IE MEGALIS Internet Access H Vitré modality STAR-IE H Saint-Brieuc modality STAR-IE Brittany Inter-hospital project

19. Which needs for such projects?  Receive request with images for daytime work as well as on duty at home.  Send a report from home to the right hospital  Deal with several different HIS/RIS/PACS for a Radiologist on duty?  Ensure security and patient privacy on home computer  …  Receive request with images for daytime work as well as on duty at home.  Send a report from home to the right hospital  Deal with several different HIS/RIS/PACS for a Radiologist on duty?  Ensure security and patient privacy on home computer  …

20. Identified issues  Security  Privacy  Second advice request (teleconferencing?)  Image streaming  Reporting:  DICOM SR? (needs of templates for reporting and for second advice)  HL7 CDA? (in France no product CDA ready) .doc,.rtf,.pdf? (not secure formats)  …  Security  Privacy  Second advice request (teleconferencing?)  Image streaming  Reporting:  DICOM SR? (needs of templates for reporting and for second advice)  HL7 CDA? (in France no product CDA ready) .doc,.rtf,.pdf? (not secure formats)  …

21. Other questions  Identify what is in DICOM, HL7 or IHE domain  Is there matter for work item proposals in DICOM?  Identify what is in DICOM, HL7 or IHE domain  Is there matter for work item proposals in DICOM?

22. The topic is open for discussion