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Ziemer LS, De Haan CE, Cardwell AL, Gambino JM, McLear RC, Silverman S, Spattini G, Thompson M. ACVR and ECVDI consensus statement for teleradiology. Vet Radiol Ultrasound 2024; 65:288-293. [PMID: 38507602 DOI: 10.1111/vru.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024] Open
Abstract
Increased demand for the interpretation of diagnostic images by board-certified radiologists and profound advancements in technology have led to extremely rapid growth in the field of veterinary teleradiology over the past decade. The aim of this consensus statement is to provide a guideline for best practices for quality and safety in veterinary teleradiology. The statement addresses appropriate image acquisition and transmission, the creation of teleradiology submissions, quality control in teleradiology, and appropriate documentation of imaging reports, as deficiencies in any of these areas may directly affect the standard of patient care. The consensus statement may be used as a guide for radiologists, primary care veterinarians, technicians, and students for the use of teleradiology in practice.
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Affiliation(s)
- Lisa S Ziemer
- Antech Imaging Services, Philadelphia, Pennsylvania, USA
| | | | - Amy L Cardwell
- Ocean State Veterinary Specialists, East Greenwich, Rhode Island, USA
| | | | | | | | | | - Margret Thompson
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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Yang XJ, Wei W, Zhang Y, Wang YN, Zhang N, Li TQ, Ma TC, Zhang KY, Jiang MC, Ma ZS. What Is the Best Way for Patients to Take Photographs of Medical Images (Radiographs, CT, and MRI) Using a Smartphone? Clin Orthop Relat Res 2021; 479:2228-2235. [PMID: 33787525 PMCID: PMC8445547 DOI: 10.1097/corr.0000000000001731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Teleradiology has become one of the most important approaches to virtual clinical diagnosis; its importance has only grown during the coronavirus 2019 pandemic. In developing countries, asking patients to take photographs of their images using a smartphone can facilitate the process and help keep its costs down. However, the images taken by patients with smartphones often are of poor quality, and there is no regulation or standard instruction about how to use smartphones to take photographs of medical examination images effectively. These problems limit the use of smartphones in remote diagnosis and treatment. QUESTIONS/PURPOSES To formulate a set of guidelines for the most appropriate and effective use of smartphones to capture images (radiographs, CT images, and MR images), and to determine whether these guidelines are more effectively adopted by patients of differing ages and genders. METHODS In this prospective study, a set of step-by-step instructions was created with the goal of helping patients take better smartphone photographs of orthopaedic diagnostic images for transfer to telemedicine services. Following the advice of surgeons, experts in smartphone technology, imaging experts, and suggestions from patients, the instructions were modified based on clinical experience and finalized with the goals of simplicity, clarity, and convenience. Potentially eligible patients were older than 18 years, had no cognitive impairment, and used smart phones. Based on that, 256 participants (patients or their relatives and friends) who visited the orthopaedic department of our hospital from June to October 2020 potentially qualified for this study. A total of 11% (29) declined to participate, leaving 89% (227) for analysis here. Their mean age was 36 ± 11 years, 50% were women (113 of 227), and the patient himself/herself represented in 34% (78 of 227) of participants while relatives or friends of patients made up 66% (149 of 227) of the group. In this study, the diagnoses included spinal stenosis (47% [107 of 227]), disc herniation without spinal stenosis (31% [71 of 227]), vertebral fractures (14% [32 of 227]), and other (7% [17 of 227]). Each study participant first took photographs of their original medical images based on their own knowledge of how to use the smartphone camera function; each participant then took pictures of their original images again after receiving our instructional guidance. Three senior spine surgeons (YZ, TQL, TCM) in our hospital analyzed, in a blinded manner, the instructed and uninstructed imaging files based on image clarity (the content of the image is complete, the text information in the image is clearly visible, there is neither reflection nor shadow in the image) and image position (it is not tilted, curled, inverted, or reversed). If either of these conditions was not satisfied, the picture quality was deemed unacceptable; two of three judges' votes determined the outcome. Interobserver reliability with kappa values for the three judges were 0.89 (YZ versus TQL), 0.92 (YZ versus TCM), and 0.90 (TQL versus TCM). RESULTS In this study, the overall proportion of smartphone medical images deemed satisfactory increased from 40% (91 of 227) for uninstructed participants to 86% (196 of 227) for instructed participants (risk ratio 2.15 [95% CI 1.82 to 2.55]; p<0.001). The proportion of acceptable-quality images in different age groups improved after instruction, except for in patients aged 51 years or older (3 of 17 uninstructed participants versus 8 of 17 instructed participants; RR 2.67 [95% CI 0.85 to 8.37]; p = 0.07). The proportion of acceptable-quality images in both genders improved after instruction, but there was no difference between the genders. CONCLUSION We believe our guidelines for patients who wish to take smartphone photographs of their medical images will decrease image transmission cost and facilitate orthopaedic telemedicine consultations. However, it appears that patients older than 50 years are more likely to have difficulty with this approach, and if so, they may benefit from more hands-on assistance from clinic staff or younger relatives or friends. The degree to which our findings are culture-specific should be verified by other studies in other settings, but on the face of it, there is little reason to believe our findings would not generalize to a reasonable degree. Other studies in more heterogeneous populations should also evaluate factors related to levels of educational attainment and wealth differences, but in the meantime, our findings can give clinical teams an idea of which patients may need a little extra assistance. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Xiao-jiang Yang
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
- Outpatient Department, General Hospital of Eastern Theater Command, Nanjing City, China
| | - Wei Wei
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Yang Zhang
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Ya-nan Wang
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Nan Zhang
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Tian-qing Li
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Tian-cheng Ma
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Ke-ying Zhang
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
| | - Ming-chun Jiang
- Outpatient Department, General Hospital of Eastern Theater Command, Nanjing City, China
| | - Zhen-sheng Ma
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xi'an City, China
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Johnston K, Smith D, Preston R, Evans R, Carlisle K, Lengren J, Naess H, Phillips E, Shephard G, Lydiard L, Lattimore D, Larkins S. "From the technology came the idea": safe implementation and operation of a high quality teleradiology model increasing access to timely breast cancer assessment services for women in rural Australia. BMC Health Serv Res 2020; 20:1103. [PMID: 33256724 PMCID: PMC7708244 DOI: 10.1186/s12913-020-05922-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate experience in breast work to attend onsite assessment clinics, limits capacity of services to offer assessment appointments to women in some regional centres. In response to identified need, local service staff developed the remote radiology assessment model for service delivery. This study investigated important factors for establishing the model, the challenges and enablers of successful implementation and operation of the model, and factors important in the provision of a model considered safe and acceptable by service providers. METHODS Semi-structured interviews were conducted with service providers at four assessment services, across three jurisdictions in Australia. Service providers involved in implementation and operation of the model at the service and jurisdictional level were invited to participate. A social constructivist approach informed the analysis. Deductive analysis was initially undertaken, using the interview questions as a classifying framework. Subsequently, inductive thematic analysis was employed by the research team. Together, the coding team aggregated the codes into overarching themes. RESULTS 55 service providers participated in interviews. Consistently reported enablers for the safe implementation and operation of a remote radiology assessment clinic included: clinical governance support; ability to adapt; strong teamwork, trust and communication; and, adequate technical support and equipment. Challenges mostly related to technology and internet (speed/bandwidth), and maintenance of relationships within the group. CONCLUSIONS Understanding the key factors for supporting innovation, and implementing new and safe models of service delivery that incorporate telemedicine, will become increasingly important as technology evolves and becomes more accessible. It is possible to take proposed telemedicine solutions initiated by frontline workers and operationalise them safely and successfully: (i) through strong collaborative relationships that are inclusive of key experts; (ii) with clear guidance from overarching bodies with some flexibility for adapting to local contexts; (iii) through establishment of robust teamwork, trust and communication; and, (iv) with appropriate equipment and technical support.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia.
| | - Deborah Smith
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, CQUniversity, QLD, Townsville, 4810, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Janet Lengren
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Helen Naess
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Elizabeth Phillips
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Greg Shephard
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | | | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
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Handelman GS, Rogers AC, Babiker Z, Lee MJ, McMonagle MP. Media messaging in diagnosis of acute CXR pathology: an interobserver study among residents. Intern Emerg Med 2018; 13:1257-1263. [PMID: 29705886 DOI: 10.1007/s11739-018-1859-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022]
Abstract
The objectives of the study were to determine whether diagnostic accuracy and reliability by on-call teams is affected by communicating chest radiograph (CXR) images via instant messaging on smartphones in comparison to viewing on a workstation. 12 residents viewed 100 CXR images each with a 24% positive rate for significant or acute findings sent to their phones via a popular instant messaging application and reported their findings if any. After an interval of 42 days they viewed the original DICOM images on personal computers and again reported their findings. There were no statistically significant differences in accuracy, agreement, sensitivity, specificity, positive predictive value or negative predictive value between desktop workstation viewed images and images sent via the mobile application. Media messaging is a useful adjunct for quick second opinions on radiological images, without significant decay in diagnostic accuracy. If technical, ethical and legal issues are addressed, it could be incorporated into practice as a useful adjunct.
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Affiliation(s)
- Guy S Handelman
- Department of Radiology, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Ailin C Rogers
- Department of Surgery, Beaumont Hospital, Dublin, Ireland
| | - Zafir Babiker
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Morgan P McMonagle
- Department of Vascular Surgery, University Hospital Waterford, Waterford, Ireland
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Daucourt V, Petitjean ME, Chateil JF, Michel P. Evaluation of the benefits for the patient arising from an inter-hospital teleradiology network in a French administrative area. J Telemed Telecare 2016; 11:178-84. [PMID: 15969792 DOI: 10.1258/1357633054068964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a prospective study of the teleradiology network which connects 15 hospitals in the Aquitaine area. All transmissions sent over a one-year period were examined (data transmitted at the time of the remote consultation and health outcomes of patients from their medical records). For emergency cases, the main outcome measure of effectiveness was the proportion of avoided transfers. For non-emergency cases, the main outcome measure of effectiveness was the proportion of transfers, hospitalizations and consultations avoided. There were 737 transmissions, of which 664 (90%) met the inclusion criteria. Of these, 562 (85%) were for emergency care and 102 (15%) for non-emergency care. In emergency care, the pathologies most often associated with a remote consultation were cerebral pathologies (88%) and traumatic spinal pathologies (8%); the proportion of avoided transfers was 48%. In non-emergency care, the specialties most often concerned with remote consultations were neurology/neurosurgery (36%), cardiology and pulmonary diseases (17%) and gastroenterology (14%). Transfer was avoided for 37% of the patients and hospitalization for 12%. An additional consultation occurred after remote consultation for 2% of the patients. The results confirm the effectiveness of an inter-hospital teleradiology network.
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Affiliation(s)
- Valentin Daucourt
- Committee for Clinical Evaluation and Quality Improvement in Aquitaine (CCECQA), Xavier Arnozan Hospital, Pessac, France.
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Mammas CS, Saatsakis G, Poulou L, Toulas P, Chasiakos D. Telemedicine Systems in Uterine Transplant: A Feasibility and Reliability Study of the Pre-Grafting Teleradiological Evaluation of the Uterus Graft. Stud Health Technol Inform 2016; 226:21-24. [PMID: 27350456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The pre-grafting Tele-Radiological (TRE) evaluation of the Uterus Graft (UG) on Telemedicine Systems, in Uterus Transplant (UT) is studied by diagnostic sensitivity-specificity analysis based on simulation of TRE of the UG on 10 MR sets of female pelvic digital images by two radiologists, assessing a. The vascular variations of the grafts, and b. The inflammatory and neoplastic lesions of the UG. The pre-grafting TRE of the UG showed: a. Diagnostic unreliability for vascular variations, b. A high diagnostic reliability for inflammatory and neoplastic diseases of the UG (100%), making the MRI based TRE of the UG in UT, feasible and highly reliable for the remote pre-grafting diagnosis of UG pathologic lesions, but unreliable for integrated vascular anatomic and pathologic UG remote evaluation for pre-grafting and pre-transplant decision support and planning.
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Affiliation(s)
- Constantinos S Mammas
- State Scholarship Foundation, Fellowships of Excellence for Postgraduate Studies in Greece-Siemens Program
| | - George Saatsakis
- Aretaieion University Hospital of Athens, Department of Biomedical Technology, National and Kapodistrian University of Athens (NKUA)
| | - Loukia Poulou
- Eugenideion Hospital of Athens, Department of Radiology
| | | | - Demetrios Chasiakos
- B' Department of Gynecology and Obstetrics of the Aretaieion, University Hospital, (NKUA)
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Abstract
Medical images exchanged over public networks require a methodology to provide confidentiality for the image, authenticity of the image ownership and source of origin, and image integrity verification. To provide these three security requirements, we propose in this paper a region-based algorithm based on multiple watermarking in the frequency and spatial domains. Confidentiality and authenticity are provided by embedding robust watermarks in the region-of-non-interest (RONI) of the image using a blind scheme in the discrete wavelet transform and singular value decomposition domain (DWT-SVD). On the other hand, integrity is provided by embedding local fragile watermarks in the region-of-interest (ROI) of the image using a reversible scheme in the spatial domain. The integrity provided by the proposed algorithm is implemented on a block-level of the partitioned-image, thus enabling localized detection of tampered regions. The algorithm was evaluated with respect to imperceptibility, robustness, capacity, and tamper localization capability, using MRI, Ultrasound, and X-ray gray-scale medical images. Performance results demonstrate the effectiveness of the proposed algorithm in providing the required security services for telemedicine applications.
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Affiliation(s)
- Ali Al-Haj
- Department of Computer Engineering, King Abdullah II Faculty of Engineering, Princess Sumaya University for Technology, Al-Jubeiha, PO Box 1438, Amman, 11941, Jordan,
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Whiteman C, Kiefer C, D'Angelo J, Davidov D, Larrabee H, Davis S. The use of technology to reduce radiation exposure in trauma patients transferred to a level I trauma center. W V Med J 2014; 110:14-18. [PMID: 24984400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients with traumatic injuries transferred from rural hospitals to tertiary centers in West Virginia frequently undergo repeat computed axial tomography (CT) imaging upon arrival. The traditional method of sending images on a compact disc (CD) with EMS can be unreliable due to software incompatibility, CD malfunction, or misplacement of the CD. Given the known risks associated with ionizing radiation, physicians are increasingly aware of the need to avoid unnecessary CT imaging. Image storage applications such as ImageGrid provide a means to store images securely without the issues and inherent problems of a CD. These images can be uploaded at the referring hospital and may be viewed from any computer at the receiving facility, by multiple providers--even prior to patient arrival. The goal of this study was to determine if utilizing ImageGrid compared to traditional data transfer by CD resulted in a decrease in the amount and type of images obtained in the initial Emergency Department (ED) evaluation at the tertiary center. METHODS We analyzed data from the Jon Michael Moore Trauma Registry for patients transferred to the Emergency Department at WVU Hospitals from an outside facility. Two study periods were reviewed; prior to ImageGrid implementation and after implementation of the system. Medical records of all patients admitted to the Trauma Surgery Service after a trauma system activation in the ED were reviewed during these time periods. Number and type of CT studies obtained in the Emergency Department were recorded for analysis. RESULTS In the month of July 2010, 183 patients were admitted to the Trauma Surgery service after trauma team activation. Transfers from referring hospitals accounted for 77 of the 108 (42.1%). WVU Hospitals implemented ImageGrid during 2011. In July 2012, 243 patients were admitted to the Trauma Service, of which 105 (41.1%) were transfer patients. After implementation of ImageGridTM there was a significant decrease in the number of repeat CT Scans of the brain (19/27 [70.4%] vs. 18/40 [45.0%], p < .05), as well as CT scans of the chest, abdomen or chest/ abdomen/pelvis (9/18 [50.0%] vs. 2/23 [8.7%], p < .05). CT of the face showed a decreasing trend (5/9 [55.6%] vs. 1/9 [11%], p > .05 [p = 0.06]), but did not achieve statistical significance. After implementation of ImageGrid there was a marked decrease in total CT scans repeated (46/79 [58.2%] vs. 28/107 [26.2%], p < .05). CONCLUSION In West Virginia, the use of image archival systems such as ImageGrid appears to result in less repeat CT imaging upon arrival at a tertiary trauma center. Given risks associated with ionizing radiation and costs of repeat imaging the benefits have important implications for patient safety and cost containment.
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Yilmaz AO, Baykal N. Integration of federated medical systems for vendor neutral image access in teleradiology applications. Stud Health Technol Inform 2014; 205:538-542. [PMID: 25160243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper proposes a framework designed to interconnect medical imaging facilities and teleradiology service providers on a single access interface. This framework aims to solve the interoperability issues of Picture Archiving and Communication System (PACS), Radiology Information System (RIS) and Hospital Information System (HIS) developed by different vendors and enrich the digital health record delivered to non-local radiologists or physicians with the integrated information from several systems. This is achieved by introducing a "Grid Agent" into the domain of medical software systems, which seamlessly integrates with present systems and forms a network to deliver data between other Grid Agents and the "Grid Manager". Resultant solution decreases the access time of medical images by non-local medical staff and increases the efficiency and durability of the teleradiology service architecture.
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Affiliation(s)
- Ayhan Ozan Yilmaz
- Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey
| | - Nazife Baykal
- Department of Medical Informatics, Informatics Institute, Middle East Technical University, Ankara, Turkey
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10
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Abstract
The development of teleradiology brings the convenience of global medical record access along with the concerns over the security of medical images transmitted over the open network. With the prevailing adoption of three-dimensional (3-D) imaging modalities, it is vital to develop a security mechanism to provide large volumes of medical images with privacy and reliability. This paper presents the development of a new and improved method of implementing tamper detection and localization based on a fully reversible digital watermarking scheme for the protection of volumetric DICOM images. This tamper detection and localization method utilizes the 3-D property of volumetric data to achieve much faster processing time at both sender and receiver sides without compromising tamper localization accuracy. The performance of the proposed scheme was evaluated by using sample volumetric DICOM images. Results show that the scheme achieved on average about 65 % and 72 % reduction in watermarking and dewatermarking processing time, respectively. For cases where the images had been tampered, it is possible to detect and localize the tampered areas with improved localization resolution in the images using the scheme.
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Affiliation(s)
- Wenbo Dou
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Chueh Loo Poh
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 70 Nanyang Drive, N1.3 B2-09, 637457 Singapore, Singapore
| | - Yong Liang Guan
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
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Goost H, Witten J, Heck A, Hadizadeh DR, Weber O, Gräff I, Burger C, Montag M, Koerfer F, Kabir K. Image and diagnosis quality of X-ray image transmission via cell phone camera: a project study evaluating quality and reliability. PLoS One 2012; 7:e43402. [PMID: 23082108 PMCID: PMC3474770 DOI: 10.1371/journal.pone.0043402] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/19/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction Developments in telemedicine have not produced any relevant benefits for orthopedics and trauma surgery to date. For the present project study, several parameters were examined during assessment of x-ray images, which had been photographed and transmitted via cell phone. Materials and Methods A total of 100 x-ray images of various body regions were photographed with a Nokia cell phone and transmitted via email or MMS. Next, the transmitted photographs were reviewed on a laptop computer by five medical specialists and assessed regarding quality and diagnosis. Results Due to their poor quality, the transmitted MMS images could not be evaluated and this path of transmission was therefore excluded. Mean size of transmitted x-ray email images was 394 kB (range: 265–590 kB, SD ±59), average transmission time was 3.29 min ±8 (CI 95%: 1.7–4.9). Applying a score from 1–10 (very poor - excellent), mean image quality was 5.8. In 83.2±4% (mean value ± SD) of cases (median 82; 80–89%), there was agreement between final diagnosis and assessment by the five medical experts who had received the images. However, there was a markedly low concurrence ratio in the thoracic area and in pediatric injuries. Discussion While the rate of accurate diagnosis and indication for surgery was high with a concurrence ratio of 83%, considerable differences existed between the assessed regions, with lowest values for thoracic images. Teleradiology is a cost-effective, rapid method which can be applied wherever wireless cell phone reception is available. In our opinion, this method is in principle suitable for clinical use, enabling the physician on duty to agree on appropriate measures with colleagues located elsewhere via x-ray image transmission on a cell phone.
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Affiliation(s)
- Hans Goost
- Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
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Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, Wybier M. Standardized way for imaging of the sagittal spinal balance. Eur Spine J 2011; 20 Suppl 5:602-8. [PMID: 21830081 DOI: 10.1007/s00586-011-1927-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 11/30/2022]
Abstract
Nowadays, conventional or digitalized teleradiography remains the most commonly used tool for the study of the sagittal balance, sometimes with secondary digitalization. The irradiation given by this technique is important and the photographic results are often poor. Some radiographic tables allow the realization of digitalized spinal radiographs by simultaneous translation of X-ray tube and receptor. EOS system is a new, very low dose system which gives good quality images, permits a simultaneous acquisition of upright frontal and sagittal views, is able to cover in the same time the spine and the lower limbs and study the axial plane on 3D envelope reconstructions. In the future, this low dose system should take a great place in the study of the pelvispinal balance. On the lateral view, several pelvic (incidence, pelvic tilt, sacral slope) and spinal (lumbar lordosis, thoracic kyphosis, Th9 sagittal offset, C7 plumb line) parameters are drawn to define the pelvispinal balance. All are interdependent. Pelvic incidence is an individual anatomic characteristic that corresponds to the "thickness" of the pelvis and governs the spinal balance. Pelvis and spine, in a harmonious whole, can be compared to an accordion, more or less compressed or stretched.
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Affiliation(s)
- Gérard Morvan
- Centre d'Imagerie Léonard de Vinci, 43, rue Cortambert, 75116, Paris, France.
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Tan CK, Ng JC, Xu X, Poh CL, Guan YL, Sheah K. Security protection of DICOM medical images using dual-layer reversible watermarking with tamper detection capability. J Digit Imaging 2011; 24:528-40. [PMID: 20414697 PMCID: PMC3092037 DOI: 10.1007/s10278-010-9295-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Teleradiology applications and universal availability of patient records using web-based technology are rapidly gaining importance. Consequently, digital medical image security has become an important issue when images and their pertinent patient information are transmitted across public networks, such as the Internet. Health mandates such as the Health Insurance Portability and Accountability Act require healthcare providers to adhere to security measures in order to protect sensitive patient information. This paper presents a fully reversible, dual-layer watermarking scheme with tamper detection capability for medical images. The scheme utilizes concepts of public-key cryptography and reversible data-hiding technique. The scheme was tested using medical images in DICOM format. The results show that the scheme is able to ensure image authenticity and integrity, and to locate tampered regions in the images.
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Affiliation(s)
- Chun Kiat Tan
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
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14
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Krestin GP, Pieterman H. [Teleradiology: threats and opportunities]. Ned Tijdschr Geneeskd 2011; 155:A2997. [PMID: 21447224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Radiological interpretation and reporting have become a commodity that may be farmed out elsewhere on the planet: teleradiology. The impact of this development fully depends on our understanding of the role of radiology as a specialty. If radiology is solely defined as the provision of medical image interpretation then commoditization of radiology through teleradiology services will lead to a deterioration in the status of radiologists. They may even become redundant as hospital specialists. However, if radiology is seen in a broader context with much more emphasis on its added value through specialized consultancy, then teleradiology may be an important instrument for improvement and optimalisation of imaging services.
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Hawk P. Teleradiology: friend or foe? What imaging's now indispensable partner means for radiology's future and for the quality of care. J Health Care Finance 2011; 37:71-92. [PMID: 21812355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Over the past half decade, teleradiology companies have served as invaluable business partners to local radiology providers grappling with declining reimbursements, shrinking budgets, and an imaging utilization explosion that has rendered workloads unmanageable. The teleradiology business model has helped to stabilize local imaging groups through economies of scale to control costs, by facilitating rapid workflow and report turnaround times, and offering a broad range of subspecialty expertise. Teleradiology has landed radiology at an important crossroads and market forces are actively shaping its future. This article examines the role of technological innovation in teleradiology's success, and suggests that persistent technological and operational limitations raise important questions regarding quality of care. This article also joins the imaging industry's discussion as to whether radiology can be (or has been) commoditized, and explores the feasibility of the commoditization of imaging and its impact on traditional radiology practice. There appears to be an important role for teleradiology in the provision of radiology services going forward, and yet boundaries must be thoughtfully drawn in order to achieve best practices for the specialty's future. tion, commoditization.
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Abstract
This paper presents a lossless watermarking scheme in the sense that the original image can be exactly recovered from the watermarked one, with the purpose of verifying the integrity and authenticity of medical images. In addition, the scheme has the capability of not introducing any embedding-induced distortion in the region of interest (ROI) of a medical image. Difference expansion of adjacent pixel values is employed to embed several bits. A region of embedding, which is represented by a polygon, is chosen intentionally to prevent introducing embedding distortion in the ROI. Only the vertex information of a polygon is transmitted to the decoder for reconstructing the embedding region, which improves the embedding capacity considerably. The digital signature of the whole image is embedded for verifying the integrity of the image. An identifier presented in electronic patient record (EPR) is embedded for verifying the authenticity by simultaneously processing the watermarked image and the EPR. Combining with fingerprint system, patient's fingerprint information is embedded into several image slices and then extracted for verifying the authenticity.
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Affiliation(s)
- Xiaotao Guo
- Department of Biomedical Engineering, Shanghai Jiaotong University, Shanghai 200240, China.
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Wong WS, Roubal I, Jackson DB, Paik WN, Wong VKJ. Outsourced teleradiology imaging services: an analysis of discordant interpretation in 124,870 cases. J Am Coll Radiol 2007; 2:478-84. [PMID: 17411863 DOI: 10.1016/j.jacr.2004.10.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE Outsourcing after-hours radiology coverage to a teleradiology coverage company has become common in recent years. However, concerns have been raised over the quality of these types of coverage and the implications on patient care. This study details the quality assurance program of a teleradiology company that provides after-hours coverage to 64 California hospitals. METHOD The records of all examinations interpreted by 10 radiologists during 2003 were reviewed. Interpretations were compared with the final interpretations of the host practices and evaluated for timeliness. RESULTS A total of 124,870 radiologic studies were interpreted by 10 teleradiologists during 2003. Computed tomography (CT) comprised 74% of these examinations: CT head (35%) examinations were the most commonly transmitted examinations, and CT abdomen/pelvis examinations were the second most common studies (27%). The average turnaround time was 12.2 min; 93% of the examinations were reported within 30 min, and 99% were completed within 1 hour. The overall discordant rate for individual teleradiologists ranged from 0.70% to 1.41%, with an average of 1.09%. Of the most commonly ordered examinations, CT of the abdomen/pelvis had the highest rate of discordance, at 2.1%. CONCLUSIONS Outsourcing to a teleradiology program with an active quality-assurance program can be safe. An active quality-assurance program should be an integral component of any teleradiology program. Constant feedback improves the performance of the radiologists.
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Affiliation(s)
- Wilson S Wong
- Teleradiology Diagnostic Service, Inc., Arcadia, California, USA.
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19
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Affiliation(s)
- Lawrence S Lau
- Southern Health, Department of Diagnostic Imaging, Clayton South Victoria, Australia.
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20
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Mancino PB, Gulick SL. Federal Guidance Outlines Requirements for the Use of Portable Devices. J Am Coll Radiol 2007; 4:523-4. [PMID: 17660113 DOI: 10.1016/j.jacr.2007.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Indexed: 11/23/2022]
Affiliation(s)
- Peter B Mancino
- Garfunkel, Wild & Travis, PC, Great Neck, New York 11021, USA.
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Affiliation(s)
- Paul A Larson
- Radiology Associates of the Fox Valley, SC, Neenah, WI 54956, USA.
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22
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Affiliation(s)
- Tony Smith
- University Department of Rural Health, University of Newcastle, Tamworth, New South Wales, Australia.
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Mildenberger P, Kotter E, Riesmeier J, Onken M, Kauer T, Eichelberg M, Walz M. [The DICOM-CD-Project of the German Radiology Association--an overview of the content and results of a pilot study in 2006]. ROFO-FORTSCHR RONTG 2007; 179:676-82. [PMID: 17492535 DOI: 10.1055/s-2007-963122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
DICOM-CDs are frequently used for medical image data transfer. Many different potential advantages are known, such as improved image quality, handling simplification, and cost optimization. However, there are numerous restrictions in the daily routine. While testing DICOM-CDs at the 2006 German Radiology Congress, we found that more than 70 % of CDs have discrepancies with respect to data structure or content. The German Radiological Association and OFFIS started an initiative to improve the quality of DICOM-CDs. There are three main objectives: To provide requirements for vendors of CD-writing systems, to establish user guidelines for the handling of DICOM-CDs, and to develop a test procedure for DICOM-CDs. Radiologists using such systems should be aware of these developments and use them for RFP's.
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Affiliation(s)
- P Mildenberger
- Klinik für interventionelle und diagnostische Radiologie, Universitätsklinikum Mainz, Langenbeckstrasse 1, 55131 Mainz.
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Singh S, Kumar V, Verma HK. Adaptive threshold-based block classification in medical image compression for teleradiology. Comput Biol Med 2007; 37:811-9. [PMID: 17055471 DOI: 10.1016/j.compbiomed.2006.08.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 07/23/2006] [Accepted: 08/30/2006] [Indexed: 11/13/2022]
Abstract
Telemedicine, among other things, involves storage and transmission of medical images, popularly known as teleradiology. Due to constraints on bandwidth and storage capacity, a medical image may be needed to be compressed before transmission/storage. Among various compression techniques, transform-based techniques that convert an image in spatial domain into the data in spectral domain are very effective. Discrete cosine transform (DCT) is possibly the most popular transform used in compression of images in standards like Joint Photographic Experts Group (JPEG). In DCT-based compression the image is split into smaller blocks for computational simplicity. The blocks are classified on the basis of information content to maximize compression ratio without sacrificing diagnostic information. The present paper presents a technique along with computational algorithm for classification of blocks on the basis of an adaptive threshold value of variance. The adaptive approach makes the classification technique applicable across the board to all medical images. Its efficacy is demonstrated by applying it to CT, X-ray and ultrasound images and by comparing the results against the JPEG in terms of various objective quality indices.
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Affiliation(s)
- Sukhwinder Singh
- Instrumentation and Signal Processing Lab, Department of Electrical Engineering, Indian Institute of Technology Roorkee, Roorkee 247667, Uttaranchal, India
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25
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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 2007; 31:101-3. [PMID: 17552171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Li-ji Cao
- Department of Biomedical Engineering, Shanghai Jiaotong University, Shanghai.
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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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Affiliation(s)
- Sapal Tachakra
- Accident and Emergency Department, Central Middlesex Hospital, School of Engineering and Design, Brunel University, West London, UK.
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28
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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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Affiliation(s)
- Jianguo Zhang
- Shanghai Institute of Technical Physics, Chinese Academy of Sciences, Shanghai 200083, China.
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Affiliation(s)
- J F Chateil
- Unité Radiopédiatrie, Service d'imagerie anténatale, de l'enfant et de la femme, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux cedex.
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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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Affiliation(s)
- Ping Yu
- Health Informatics Research Centre, Faculty of Informatics, School of IT and Computer Science, University of Wollongong, Wollongong 2522, Australia.
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- B Schütze
- Johannes Gutenberg-University of Mainz, Department of Radiology, Langenbeckstr. 1, 55131 Mainz, Germany.
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35
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Affiliation(s)
- Robert M Wachter
- Department of Medicine, University of California, San Francisco, USA
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36
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- G Weisser
- Department of Clinical Radiology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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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 2005; 65:359-67. [PMID: 16334387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Naoki Sugiyama
- Department of Radiological Sciences, International University of Health and Welfare
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- P Mildenberger
- Klinik und Poliklinik für Radiologie, Johannes Gutenberg-Universität Mainz.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- M Kämmerer
- Klinik und Poliklinik für Radiologie, Johannes-Gutenberg-Universität Mainz.
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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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Affiliation(s)
- Jeff Kabachinski
- GE Healthcare-Multi-Vendor & Clinical Services located in Waukesha, WI, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Bernhard Lienemann
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Daryl Pullman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- B Cramer
- Health Care Corporation St John's, St John's, Newfoundland and Labrador, Canada
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Myers S. Management. Scanning the globe. Hosp Health Netw 2005; 79:16. [PMID: 15828532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Jeff Collmann
- ISIS Center, Box 571479, Washington, DC 20057-1479, USA.
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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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Affiliation(s)
- T Wollenweber
- Institut für Radiologie und Neuroradiologie, Klinikum Aschaffenburg.
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Affiliation(s)
- Nathaniel H Hwang
- Southern Illinois University School of Law, Law Journal Office, Lesar Law Building, Carbondale, Illinois 62901, USA
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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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Affiliation(s)
- M Tie
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA.
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