Teleradiology in Freiburg
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1 Teleradiology in Freiburg Regional National Regional medical centers with Freiburg Stroke Unit / Neurosurgery Regional trauma surgery with Freiburg Neurosurgery 15 Regional Hospitals connected Very fast reaction (emergency) Second opinion (bone tumors, mammography ) Clinical trials International Medical Service Care for International Patients Second opinion Preparation of patients stay Training of radiologists 1
2 Teleradiology network state of Baden-Württemberg Mannheim Heidelberg Karlsruhe Ludwigsburg -Bietigheim Stuttgart Villingen- Schwenningen Ulm Secure internet based image transmission: Freiburg DICOM Communication DICOM (Norm) Web-Access 2
3 First scenario: DICOM-Communication Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Teleradiology Client Client: DICOM Viewing Station Chili Server s1.telerad.uniklinik-freiburg.de Radiology Firewall & Router Surgery Intranet Klinikum Firewall Internet VPN Neurology s2.telerad.uniklinik-freiburg.de Best solution if frequent and bidirectional communication is needed Cardiac Surgery RIS PACS 3
4 Second scenario: SSL-tunnelling Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Teleradiology client Client: DICOM Viewing Station Java Applet / SSL / Token Chili Server: SSL-Server s1.telerad.uniklinik-freiburg.de Radiology Firewall & Router Surgery Intranet Klinikum Firewall Internet SSL s2.telerad.uniklinik-freiburg.de Neurology Cardiac Surgery RIS PACS Excellent solution if unidirectional communication from client to Freiburg is sufficient. Clients existing workstations can be used. Freiburg appears as a DICOM node on workstation. Use of hardware generated tokens + PIN enhances Security. 4
5 Third scenario: DICOM Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Net: Internet VPN Teleradiology client Client: DICOM Viewing Station Net: Internet VPN DICOM- / PGP Chili Server s1.telerad.uniklinik-freiburg.de Radiology Firewall & Router Surgery Intranet Klinikum Firewall Internet s2.telerad.uniklinik-freiburg.de Neurology Cardiac Surgery RIS PACS Standardized DICOM is good for infrequent exchange of image data. PGP used for security, but need to make shure using the same PGPversions 5
6 What happens to images in Freiburg? Web-Server (Chili) Chili Server Any DICOM storage SCP Firewall s1.telerad.uniklinik-freiburg.de Radiology Application Entity Title encoded as routing target in the Teleradiology Client triggers the routing of images to the target within Freiburg University Hospital. If routed to the PACS, access rights can be associated with AET PACS Neurology Surgery 6
7 Teleradiology Network Universitätsklinikum Freiburg Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS / ISDN VPN neu: St. Josef OG Klinikum OG Bad Säckingen Titisee (Helios) Kliniken des Landkreises Lörrach GmbH Client: Image Devices Klinikum Lahr Client: HIPAX Client Chili Server Neuroradiologie Neurochirurgie s1.telerad.uniklinik-freiburg.de Intranet Klinikum Internet /VPN Firewall / RAS Firewall & Router Helios Kliniken Müllheim & Rosmann Breisach Client: HIPAX Client Netz: Internet / ISDN VPN (Cisco 1760) Neurologie s2.telerad.uniklinik-freiburg.de UMTS /VPN ISDN /VPN Kreiskrankenhaus Emmendingen Client: HIPAX Client Netz: ISDN VPN (Cisco 1760) Stereotaxie RIS PACS Rufbereitschaft Spital Waldshut Client: HIPAX Client Netz: ISDN VPN (Cisco 1760) 7
8 Standard Teleradiology Consultation Step 4 Transmission of Results Fax (DICOM SR) Step 1 Request by Phone call / Fax Step 3 Radiological Diagnosis Second opinion Step 2 Image transmission Standard process time < 48 h 8
9 Teleradiology Process: urgent neuro case Step 4 Neurology 45 min. Neuroradiology Total: min. Step 2 Step 3 15 min. Request Stroke < 10 min. Neurologist on call Neuroradiologist on call Step 1 Trauma Neurosurgeon on call Step 2 Step 4 Neurosurgery 9
10 What does a teleradiology client need Images in standard DICOM format DICOM-workstation or modality able to send images to a DICOM node (DICOM storage SCU) Internet connection: Stable Fast enough Either: Workstation for direct DICOM-communication via VPN Connection to Freiburg s SSL-Server with own Workstation, and token generator Workstation with DICOM- (testing necessary) 10
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