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Cao LJ, Ruggiero S, Zhao J, Weisser G. [Considerations about the realization of DICOM-E-mail in China]. ZHONGGUO YI LIAO QI XIE ZA ZHI = CHINESE JOURNAL OF MEDICAL INSTRUMENTATION 2007; 31:101-3. [PMID: 17552171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Considering the real conditions in China, the strategy and scheme of DICOM-E-Mail's clinical applications in China are discussed in this paper.
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Tachakra S, Banitsas KA, Tachakra F. Performance of a wireless telemedicine system in a hospital accident and emergency department. J Telemed Telecare 2007; 12:298-302. [PMID: 17022837 DOI: 10.1258/135763306778558169] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.
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Zhang J, Yu F, Sun J, Yang Y, Liang C. DICOM image secure communications with Internet protocols IPv6 and IPv4. ACTA ACUST UNITED AC 2007; 11:70-80. [PMID: 17249405 DOI: 10.1109/titb.2006.879606] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Image-data transmission from one site to another through public network is usually characterized in term of privacy, authenticity, and integrity. In this paper, we first describe a general scenario about how image is delivered from one site to another through a wide-area network (WAN) with security features of data privacy, integrity, and authenticity. Second, we give the common implementation method of the digital imaging and communication in medicine (DICOM) image communication software library with IPv6/IPv4 for high-speed broadband Internet by using open-source software. Third, we discuss two major security-transmission methods, the IP security (IPSec) and the secure-socket layer (SSL) or transport-layer security (TLS), being used currently in medical-image-data communication with privacy support. Fourth, we describe a test schema of multiple-modality DICOM-image communications through TCP/IPv4 and TCP/IPv6 with different security methods, different security algorithms, and operating systems, and evaluate the test results. We found that there are tradeoff factors between choosing the IPsec and the SSL/TLS-based security implementation of IPv6/IPv4 protocols. If the WAN networks only use IPv6 such as in high-speed broadband Internet, the choice is IPsec-based security. If the networks are IPv4 or the combination of IPv6 and IPv4, it is better to use SSL/TLS security. The Linux platform has more security algorithms implemented than the Windows (XP) platform, and can achieve better performance in most experiments of IPv6 and IPv4-based DICOM-image communications. In teleradiology or enterprise-PACS applications, the Linux operating system may be the better choice as peer security gateways for both the IPsec and the SSL/TLS-based secure DICOM communications cross public networks.
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Chateil JF, Masson JP, Hazebroucq V, Silberman B. [Teleradiology: Field of action and recommendations]. JOURNAL DE RADIOLOGIE 2006; 87:1643-50. [PMID: 17095959 DOI: 10.1016/s0221-0363(06)74143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Yu P, Hilton P. Work practice changes caused by the introduction of a picture archiving and communication system. J Telemed Telecare 2006; 11 Suppl 2:S104-7. [PMID: 16375815 DOI: 10.1258/135763305775124867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We studied the acceptance of work practice changes six months after the introduction of a picture archiving and communication system (PACS) in New South Wales. A one-page questionnaire was developed to assess doctors' and nurses' acceptance of work practice changes. Over 100 subjects were surveyed and 76 responded. In all, 92% of participants worked in the intensive-care unit (ICU) or the emergency department (ED). The results showed that the PACS had received a high level of acceptance. The respondents would not like to return to a film-based practice. They were happy with the accessibility of images, especially when patients returned from an X-ray examination. At the time of survey, the doctors still had difficulty in remembering their user name and password. The users rarely or only sometimes used their own user names and passwords to log on the system. They were sometimes annoyed by the automatic time-out function. Nurses were happy that the PACS relieved their burden of searching for X-ray images for doctors. However, they distanced themselves from accessing the PACS, which they regarded as a doctors' tool.
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Kristensen I, Johnsson M, Lind J, Nilsson P, Karlsson M. [Distance pediatric radiotherapy. Telemedicine a good tool to be used for discussions, exchange of experiences and competence]. LAKARTIDNINGEN 2006; 103:1188-90. [PMID: 16696198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Robinson J. Re: “The Nighthawk: Bird of Paradise or Albatross?”. J Am Coll Radiol 2006; 3:302; author reply 303. [PMID: 17412066 DOI: 10.1016/j.jacr.2006.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Indexed: 10/24/2022]
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Schütze B, Kämmerer M, Klos G, Mildenberger P. The Public-Key-Infrastructure of the Radiological Society of Germany. Eur J Radiol 2006; 57:323-8. [PMID: 16324813 DOI: 10.1016/j.ejrad.2005.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 10/14/2005] [Accepted: 10/21/2005] [Indexed: 10/25/2022]
Abstract
Pretty Good Privacy (PGP) encoding is based on the Public-Key-Procedure and permits the safe transmission of medical data. Furthermore it allows the use of an electronic signature provided that keys used belong to the key owner and that the key owner's identity is guaranteed by a trusted third party. Under the auspices of the Radiological Society of Germany (Deutsche Röntgengesellschaft, DRG) its IT-Working Group (Arbeitsgemeinschaft für Informationstechnik, @GIT) built up an appropriate Certification Authority including the required Public-Key-Infrastructure. These @GIT certified PGP keys allow the legal use of telemedicine in Germany. Digital signatures based to those certified keys correspond to the advanced signature according to the German Signature Law.
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Weisser G, Walz M, Ruggiero S, Kämmerer M, Schröter A, Runa A, Mildenberger P, Engelmann U. Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society. Eur Radiol 2005; 16:753-8. [PMID: 16228213 DOI: 10.1007/s00330-005-0019-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Revised: 07/29/2005] [Accepted: 08/23/2005] [Indexed: 10/25/2022]
Abstract
Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions.
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Sugiyama N, Igarashi Y, Kohda E, Kohno A, Suzuki S, Tanaka T, Chiyasu S, Yokokura T. [Use of compressed images for medical checkups: comparison between radiologists' subjective quality assessment and diagnostic usefulness]. NIHON IGAKU HOSHASEN GAKKAI ZASSHI. NIPPON ACTA RADIOLOGICA 2005; 65:359-67. [PMID: 16334387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
With the increasing demand on picture archiving and communication systems (PACS) to handle larger numbers of images, much research has been conducted on the utilization of lossy compression for efficient communication and storage in PACS systems. The receiver operating characteristics (ROC) method is commonly used to determine the appropriate compression ratio of lossy images. However, conducting an ROC experiment is impractical at actual medical facilities because it is difficult to prepare and interpret images with different compression ratios for each modality, body part, and acquisition method. On the other hand, experienced radiologists have the ability to subjectively assess the level of image quality required for interpretatior and quantitative analysis. Therefore, by simply viewing images, they are able to determine the appropriate criteria for image quality and derive a practical compression ratio for each application. The present study focused on lossy compression as employed in teleradiology systems for medical checkups. Experiments comparing radiologists' subjective assessment of compressed images against the diagnostic results obtained using these images were conducted in order to investigate appropriate compression ratios and efficient methods for determining them.
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FitzGerald R. Re: “Outsourced Teleradiology Imaging Services: An Analysis of Discordant Interpretation in 124,870 Cases”. J Am Coll Radiol 2005; 2:804; author reply 804. [PMID: 17411934 DOI: 10.1016/j.jacr.2005.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Indexed: 11/23/2022]
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Mildenberger P, Kämmerer M, Engelmann U, Ruggiero S, Klos G, Runa A, Schröter A, Weisser G, Walz M, Schütze B. [Teleradiology with DICOM e-mail: recommendations of @GIT]. ROFO-FORTSCHR RONTG 2005; 177:697-702. [PMID: 15871085 DOI: 10.1055/s-2005-858049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
E-mail is ideal for ad-hoc connections in teleradiology. The DICOM standard offers the possibility to append DICOM data types as a MIME attachment to any e-mail, thus ensuring the transmission of the original DICOM data. Nevertheless, there are additional requirements (e.g. protection of data privacy) which must be obeyed. Because of the lack of given standards which would grant interoperability as well as manufacturer independence, teleradiology has not been established in Germany until today. Therefore, the IT-Team (Arbeitsgemeinschaft fur Informationstechnologie, @GIT) of the Radiological Society of Germany (Deutsche Rontgengesellschaft, DRG) set up an initiative to standardise telemedicine by using e-mail. Its members agreed that an e-mail-based variant would be the most practicable way to a communication solution -- as easy to implement as to use. In their opinion, e-mail represents the smallest common denominator for a safe data interchange that would fulfill the legal advantages for telemedicine in Germany.
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Kämmerer M, Mildenberger P, Klos G, Schütze B. [Teleradiology according to the x-ray ordinance--exemplary application of the open source software SecTelMed]. ROFO-FORTSCHR RONTG 2005; 177:691-6. [PMID: 15871084 DOI: 10.1055/s-2005-858092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Establishing a teleradiology connection according to the Rontgenverordnung (RoV) between a peripheral hospital and a university clinic will contribute to improve the radiological emergency treatment on weekends, holidays and at night. It will also better the medical care for patients and help to lower the costs. MATERIALS AND METHODS By using the open source software SecTelMed, the radiological picture is transferred via an internet-linked SSH communication server. The integration of the teleradiological data transfer into the actual workflow is attained by using the already existing PACS infrastructure. While its installation is still under construction, it is actually employed for transferring a patient's preliminary investigations and obtaining second opinions. RESULTS The project proves a reliable and affordable teleradiology according with RoV by using open source software. The applied infrastructure ensures an unproblematical teleradiological treatment as well as a safe picture transfer for medical consulting (second opinion) even for large CT examinations of 1,000 pictures and more. CONCLUSION The implementation of the technical requirements on teleradiology according with the Rontgenverordnung can be reliably attained by applying the open source software SecTelMed.
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Kabachinski J. DICOM: key concepts--part I. Biomed Instrum Technol 2005; 39:214-6. [PMID: 15915601 DOI: 10.2345/0899-8205(2005)39[214:dkci]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In this issue and next, we're investigating different sections of the DICOM Standard to get a grip on what it's all about. The bottom line is to facilitate communication and DICOM addresses all the technical aspects to allow complying OEMs to talk to one another. In part 2, IT World completes its overview on DICOM by exploring UID, networking with DICOM, conformance, and conformance statements.
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Lienemann B, Hodler J, Luetolf M, Pfirrmann CWA. Swiss teleradiology survey: present situation and future trends. Eur Radiol 2005; 15:2157-62. [PMID: 15834572 DOI: 10.1007/s00330-005-2764-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Revised: 03/05/2005] [Accepted: 03/29/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1-2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.
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Pullman D. T-shirts, tennis shoes, and teleradiology: technological efficiency and the end of medicine. CLIN INVEST MED 2005; 28:67-71. [PMID: 15909482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Cramer B. Teleradiology in Canada. CLIN INVEST MED 2005; 28:65-7. [PMID: 15909481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Myers S. Management. Scanning the globe. HOSPITALS & HEALTH NETWORKS 2005; 79:16. [PMID: 15828532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Overseas "nighthawks" can make life easier for radiologists by reading and interpreting scans and X-rays during your staff's off hours. The growing practice does have its critics, however.
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Collmann J, Alaoui A, Nguyen D, Lindisch D. Safe teleradiology: information assurance as project planning methodology. J Am Med Inform Assoc 2005; 12:84-9. [PMID: 15492036 PMCID: PMC543831 DOI: 10.1197/jamia.m1404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 09/21/2004] [Indexed: 11/10/2022] Open
Abstract
The Georgetown University Medical Center Department of Radiology used a tailored version of OCTAVE, a self-directed information security risk assessment method, to design a teleradiology system that complied with the regulation implementing the security provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The system addressed threats to and vulnerabilities in the privacy and security of protected health information. By using OCTAVE, Georgetown identified the teleradiology program's critical assets, described threats to the assurance of those assets, developed and ran vulnerability scans of a system pilot, evaluated the consequences of security breaches, and developed a risk management plan to mitigate threats to program assets, thereby implementing good information assurance practices. This case study illustrates the basic point that prospective, comprehensive planning to protect the privacy and security of an information system strategically benefits program management as well as system security.
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Wollenweber T, Freund M. Ist die Telemammographie eine Option im Mammographie-Screening? - Eine Phantomstudie. ROFO-FORTSCHR RONTG 2005; 177:1284-9. [PMID: 16123876 DOI: 10.1055/s-2005-858373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To show that it is possible to proceed a 20-fold JPEG 2000 wavelet compression of radiographs of a CDMAM phantom without data loss and the usefulness of this technique in telemammography for screening. MATERIAL AND METHODS After digitizing and a 20-fold data compression, four radiographs of a CDMAM phantom were transferred via ISDN to a PACS archive. Using a soft copy work station, the contrast detail detectability of these data sets was compared to the contrast detail detectability of the original radiographs. RESULTS The contrast detail detectability showed no difference for the original radiographs and the data sets. CONCLUSION It is possible to digitize radiographs of a contrast detail mammography phantom, to compress the data sets, to transfer them to a soft copy station and to decompress them without negative influence on the contrast detail detectability.
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Hwang NH. You've got mail. The concerns of electronically outsourcing radiological services overseas. THE JOURNAL OF LEGAL MEDICINE 2004; 25:469-484. [PMID: 15764507 DOI: 10.1080/01947640490887580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
Teleradiology is rapidly establishing its presence as an effective solution to the problem of provision of radiological services in remote locations. Although significant effort has been put into the development and establishment of quality assurance (QA) processes required for the implementation and conduct of this new technology, little attention has been given to the possible use of teleradiology in enhancing quality and safety of radiological practice, and as an alternative to conventional quality improvement (QI) initiatives. This paper critically evaluates teleradiology from the point of view of its potential use in QA/QI and considers its possible advantages as well as limitations. Considering the unique features of teleradiology such as remote access that can be simultaneous at multiple sites, rapid transfer of information and computerized data storage as well as good reproducibility and reliability of data, the authors argue that teleradiology represents an ideal tool which can not only be equivalent to other methods of QA in radiology but in some instances may be superior to them.
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