Teleradiology at Freiburg University Hospital
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1 Teleradiology at Freiburg University Hospital Elmar Kotter, MD, Department of Radiology Maria Onyshchenko-Dubow, International Medical Services Ernst Pelikan, Hospital Computer Centre Universitätsklinikum Freiburg 1
2 Welcome to Freiburg, Germany situated in - the south-west of Germany - the Black Forrest - close to Switzerland, France 2
3 Welcome to Freiburg, Germany situated in - the south-west of Germany - the Black Forrest - close to Switzerland, France 3
4 Welcome to Freiburg, Germany situated in - the south-west of Germany - the Black Forrest - close to Switzerland, France 4
5 Welcome to Freiburg, Germany situated in - the south-west of Germany - the Black Forrest - close to Switzerland, France to the University Hospital one of the leading hospitals in Germany in Europe and worldwide 5
6 Welcome to Freiburg, Germany situated in - the south-west of Germany - the Black Forrest - close to Switzerland, France to the University Hospital one of the leading hospitals in Germany in Europe and worldwide and to the Department of Diagnostic Radiology 6
7 Universitätsklinikum Freiburg Klinische Abteilungen 7
8 Universitätsklinikum Freiburg 1599 Beds 1599 Beds ca. ca Employees Employees Budget 469 Mio Klinische Abteilungen Over Over40 40 clinical clinical Departments Departments ca. ca Medical MedicalDoctors 292 Mio Insurance Insurance companies companies Over Inpatients Inpatients Patients/year Patients/year over 1000 Outpatients/day Outpatients/day ca Nurses Nurses ca Medical MedicalStudents 85,2 Mio Ministry Ministryof of Research Research and and Education Education 32,5 Mio State State investments investments 8
9 Department of Radiology State-of-the-art diagnostic and therapeutic procedures proc. / year ( CT / MRI) Computer tomography (CT), including dual source Magnetic Resonance Imaging (MRI), incl. 3 Tesla Digital Angiography and Interventions Digital Mammography, Ultrasound and MR Whole-body imaging MR and CT MRI Research Department Hospital-wide PACS, Post-processing incl. 3D 24 h / 365 days radiologist presence Teleradiology with 24 h / 365 days support 9
10 Teleradiology in Freiburg Regional Regional medical centers with Freiburg Stroke Unit / Neurosurgery Regional trauma surgery with Freiburg Neurosurgery 15 Regional Hospitals connected Very fast reaction (emergency) National Second opinion (bone tumors, mammography ) Clinical trials International Medical Service Care for International Patients Second opinion Preparation of patients stay Training of radiologists 10
11 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 11
12 First scenario: DICOM-Communication Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Netz: Internet VPN Teleradiology Client Client: DICOM Viewing Station Netz: Internet VPN 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 12
13 Second scenario: SSL-tunnelling Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Netz: Internet VPN Teleradiology client Client: DICOM Viewing Station Netz: Internet VPN 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. 13
14 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 14
15 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 15
16 Teleradiology Network Universitätsklinikum Freiburg Universitätsklinikum Freiburg Client: Tiani Server: Chili Server/ Tiani PACS Netz: Internet VPN / ISDN VPN Stand: In Betrieb neu: St. Josef OG Klinikum OG Bad Säckingen Titisee (Helios) Kliniken des Landkreises Lörrach GmbH Client: Image Devices Netz: Internet VPN Stand: In Betrieb Klinikum Lahr Client: HIPAX Client Netz: Internet VPN Stand: In Betrieb 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) Stand: In Betrieb Neurologie s2.telerad.uniklinik-freiburg.de UMTS /VPN ISDN /VPN Kreiskrankenhaus Emmendingen Client: HIPAX Client Netz: ISDN VPN (Cisco 1760) Stand: In Betrieb Stereotaxie RIS PACS Rufbereitschaft Spital Waldshut Client: HIPAX Client Netz: ISDN VPN (Cisco 1760) Stand: In Betrieb 16
17 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 17
18 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 18
19 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) 19
20 What is the benefit for your patients Access to the expertise of more than 1000 highly specialised medical doctors at Universitätsklinikum Freiburg Security of a second opinion from one of the leading medical Universities in Europe (one of the five top Universities in Germany) Possibility to obtain consultation with particular specialists Correct diagnosis and correct treatment even in difficult cases Exchange of expertise between doctors, training of Ukrainien specialists, helping to achieve European standards in radiology 20
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