Networks in the radiology department and the hospital

Visualization of data in radiotherapy using web services for optimization of workflow

BACKGROUND

Every day a large amount of data is produced within a radiotherapy department. Although this data is available in one form or other within the centralised systems, it is often not in the form which is of interest to the departmental staff. This work presents a flexible browser based reporting and visualization system for clinical and scientific use, not currently found in commercially available software such as MOSAIQ(TM) or ARIA(TM). Moreover, the majority of user merely wish to retrieve data and not record and/or modify data. Thus the idea was conceived, to present the user with all relevant information in a simple and effective manner in the form of web-services. Due to the widespread availability of the internet, most people can master the use of a web-browser. Ultimately the aim is to optimize clinical procedures, enhance transparency and improve revenue.

METHODS

Our working group (BAS) examined many internal procedures, to find out whether relevant information suitable for our purposes lay therein. After the results were collated, it was necessary to select an effective software platform. After a more detailed analysis of all data, it became clear that the implementation of web-services was appropriate. In our institute several such web-based information services had already been developed over the last few years, with which we gained invaluable experience. Moreover, we strived for high acceptance amongst staff members.

RESULTS

By employing web-services, we attained high effectiveness, transparency and efficient information processing for the user. Furthermore, we achieved an almost maintenance-free and low support system. The aim of the project, making web-based information available to the user from the departmental system MOSAIQ, physician letter system MEDATEC(R) and the central finding server MiraPlus (laboratory, pathology and radiology) were implemented without restrictions.

CONCLUSION

Due to widespread use of web-based technology the training effort was effectively nil, since practically every member of staff can master the use of a web-browser. Moreover, we have achieved high acceptance amongst staff members and have improved our effectiveness resulting in a considerable time saving. The many MOSAIQ-specific parts of the system can be readily used by departments which use MOSAIQ as the departmental system.

[Automated delivery of codes for charge in radiotherapy]

BACKGROUND AND PURPOSE

For the medical billing of Radiotherapy every fraction has to be encoded, including date and time of all administered treatments. With fractions averaging 30 per patient and about 2,500 new patients every year the number of Radiotherapy codes reaches an amount of 70,000 and more. Therefore, an automated proceeding for transferring and processing therapy codes has been developed at the Department of Radiotherapy Freiburg, Germany. This is a joint project of the Department of Radiotherapy, the Administration Department, and the Central IT Department of the University Hospital of Freiburg.

MATERIAL AND METHODS

The project consists of several modules whose collaboration makes the projected automated transfer of treatment codes possible. The first step is to extract the data from the department's Clinical Information System (MOSAIQ). These data are transmitted to the Central IT Department via an HL7 interface, where a check for corresponding hospitalization data is performed. In the further processing of the data, a matching table plays an important role allowing the transformation of a treatment code into a valid medical billing code. In a last step, the data are transferred to the medical billing system.

RESULTS AND CONCLUSION

After assembling and implementing the particular modules successfully, a first beta test was launched. In order to test the modules separately as well as the interaction of the components, extensive tests were performed during March 2006. Soon it became clear that the tested procedure worked efficiently and accurately. In April 2006, a pilot project with a few qualities of treatment (e.g., computed tomography, simulation) was put into practice. Since October 2006, nearly all Radiation Therapy codes (approximately 75,000) are being transferred to the comprehensive Hospital Information System (HIS) automatically in a daily routine.

Performance of Web-based image distribution: server-oriented measurements

The aim of this study was to assess the performance of Web-based image distribution when multiple personal computers (PCs) are downloading images simultaneously for different server hardware configurations. Using specially developed software, the time-to-display (TTD) of different image types was measured with up to 16 concurrent PCs for various combinations of processor, random access memory (RAM), network connection and image compression. The TTD increased linearly with the number of concurrent PCs but remained under 5 s in most of the cases, even with 16 concurrent PCs. Only with a 10-Mbit/s network connection or with lossy compression were TTDs above 5 s obtained. Two processors instead of one led to a slight and constant improvement of the TTD. Reducing the amount of RAM increased the TTD mainly for computed radiography (CR) images. There was no difference between a 200- and 100-Mbit/s network, but 10 Mbit/s proved significantly worse. When increasing the number of clients lossless compression performed substantially better than lossy. A standard off-the-shelf server provides an appropriate download performance even with 16 concurrent clients. Processor speed and RAM amount are of minor importance, but it is highly recommended to use a 100-Mbit/s network connection and to avoid the application of on-demand lossy compression in a local area network.