millensys tele-radiology solution introduction workflow/ components communication / optimization...
TRANSCRIPT
• Introduction• Workflow/ Components• Communication / Optimization• Millensys Teleradiology Features• Failure and restore scenario• Similar Project (Eastern Cape, South Africa)• Q&A
Main Topics
Teleradiology of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of interpretation and/or consultation
What is Tele-Radiology
Why is Tele-Radiology Needed
• Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient.
• Radiologists are increasingly a scarce resource, given that imaging procedures are growing by ~15% annually against an increase of only ~2% in the Radiologist population
• The virtual radiology network (VRN) is a modern service for radiology groups that collects digital imaging studies from multiple, geographically-dispersed locations and delivers them securely, reliably and efficiently to physicians over the Web.
• Teleradiology improves patient care by allowing Hospitals to outsource subspecialty expertise needed but not found except in big cities.
Tele-Radiology, Definition
Hospital 1 Hospital 2 Hospital NHospital 3
Images sent to main server using priority
queuing
Image are be sent to
service provider PACS
Imag
e ar
e av
aila
ble
O
N W
eb
Statical Info. are
sent to management
Images to be sent to Millensys MINI
PACS at other branches
Verified reports to be sent to
datacenter server
Verified reports are sent to
datacenter server
Verified re
ports to
be sent
BACK to A
cquisition serv
er
Verified reports to be sent
BACK to Acquisition server
Service Provider NService Provider 1
Tele-Radiology, Workflow
Tele-Radiology, One Solution
InternetAnd
Intranet
Report with
Dictation
Work Online/ Offline
Processand
Diagnose
Search Worklist
High Availability
Archive
Web-basedAdministrator
Use MultipleCompression
One Solution , MILLENSYS Web-based Teleradiology
Data Center
Service Provider
Hospital
Tele-Radiology, Solution Components
Reporting Workstations
Web Viewing
Mobile Viewing
Radiology Scheduling
Data Center Web-PACS
Store/forward MiniPACS
Billing and MonitoringAdministration
Service Provider PACS(Optional)
Dealing with Emergency Cases:Tele-Radiology, Emergency Cases
Study IdentificationN : Normal Study (No report needed)R : To be ReportedE : Emergency etc.The report is sent back to the Hospital
The Technician identifies the case as an Emergency
The Case is sent to the PACS Server with High Priority
Emergency case is sent to the Data Center before any Normal Case
Emergency case is sent to the Service Provider to be reported
The case is reported and sent back to the data center
Tele-Radiology, Communications
ADSL
SDSL
56 kbps
2Mbps - 14.4 Mbps Stationary
348 kbps Moving
54 Mbps
24 Mbps (1:4)
24 Mbps (1:1)
CT Image TransmissionCT Image Information CT Image Size 0.5 MBCT Image Size after Lossless Compression 0.25 MBAverage Study Size (2-Slice CT) 100 ImageTotal Average Study Size after compression 25 MB
Link Speed ADSL 4Mbps (1:4) 1 MB Upload
Band Width Utilization 50%
Idle Time Between studies 30 seconds
Average Time to send 1 image 5.00 seconds
Average Time to send 1 Study 8.83 Minutes
Total Studies sent per hour 6.79 StudyLink Speed SDSL 4Mbps (1:1) 4 MB UploadBand Width Utilization 60% Idle Time Between studies 20 secondsAverage Time to send 1 image 1.38 secondsAverage Time to send 1 Study 2.29 MinutesTotal Studies sent per hour 26.18 Study
CR Image TransmissionCR Image Information CT Image Size 10 MBCT Image Size after Lossless Compression 5 MBAverage Study Size (2-Slice CT) 2 ImageTotal Average Study Size after compression 10 MB
Link Speed ADSL 4Mbps (1:4) 1 MB Upload
Band Width Utilization 50%
Idle Time Between studies 30 seconds
Average Time to send 1 image 100.00 seconds
Average Time to send 1 Study 3.83 Minutes
Total Studies sent per hour 15.65 StudyLink Speed SDSL 4Mbps (1:1) 4 MB UploadBand Width Utilization 60% Idle Time Between studies 20 secondsAverage Time to send 1 image 21.17 secondsAverage Time to send 1 Study 0.71 MinutesTotal Studies sent per hour 85.04 Study
Load balancing Should be an issue for multi-site/multi-modality transmission
Tele-Radiology, CT and CR Transmission
*The previous examinations depend on the size of each case and the type of connectivity available for each site.
*The previous examinations depend on the size of each case and the type of connectivity available for each site.
Tele-Radiology, Mammography Transmission
Mammography Image TransmissionCR Image Information Image Size 10 MBImage Size after Lossless Compression 5 MBAverage Study Size (2-Slice CT) 4 ImageTotal Average Study Size after compression 20 MB
Link Speed ADSL 4Mbps (1:4) 1 MB Upload
Band Width Utilization 50%
Idle Time Between studies 30 seconds
Average Time to send 1 image 100.00 seconds
Average Time to send 1 Study 7.17 Minutes
Total Studies sent per hour 8.37 StudyLink Speed SDSL 4Mbps (1:1) 2 MB UploadBand Width Utilization 50% Idle Time Between studies 20 secondsAverage Time to send 1 image 50.33 secondsAverage Time to send 1 Study 3.36 Minutes
Total Studies sent per hour 17.88 Study
• Load balancing Should be an issue for multi-site/multi-modality transmission
• Using Digital Mammography, the image sizes will be much higher (x6) and we need either to increase the link speed to able to reach the same studies.
Tele-Radiology, Optimization and Compression
Hardware Compression
Software Compression
Compression of WAN traffic using WAN Routers with Layer 2 payload compression or Layer 3 TCP/IP header compression using Cisco Internetwork Operating System (Cisco IOS)
Compression Methods• Lossless JPEG (1:2)• Lossless JPEG 2000 (1:4)• Lossy JPEG (1:9 ~ 1:70)
Streamed Communication
• Using traffic dispersion to increase the download speed and the utilization of the link bandwidth
• Using rule-based auto-routing techniques to insure the delivery of studies between servers.
• Pure Web-Based Technology • Same GUI for all users• Depending on Active Server Pages “ASP” Model.• Streaming with Dispersion over low band width lines.• Multiple compression methods for studies• Simple-Fast Search Results.• Resume downloading of studies when connection failure.• No need for special communication ports.• Embedded reporting tool with dictation and speech option.• Fast client Setup.• Automatic client update.• Supports of multi-branch hospitals• Built for the enterprise
Tele-Radiology, Technology
• Priority queuing for emergency studies• Secure over the Internet and HIPAA compliant• Auto-routing between acquisition and reporting facilities• Multiple compression methods (JPEG, JPEG2000)• Handles transmission of studies and reports.• Short term archive in hospitals• Long Term archive in Data Center• Clustered Solution to get 99.9% uptime• Monitors the Round-trip time for studies• Assure the delivery of studies when link failure• Resume transmission automatically when link is up
MILLENSYS PACS “MIPACS”
Tele-Radiology, Archive
• Run on any Web Browser• Streaming technology In viewing and download.• User defined image compression for rapid download• Customized worklist with user profile• Visual Hanging Protocols• Rapid operations for large studies• Display static and dynamic studies• Oblique, Bi-Oblique and Curved MPR/MIP• Slice Locator / Pilot Image for CT/MRI• Printing on DICOM and A4 Printers• Multiple Measurements• Image Processing and Annotations• 3D Reconstruction and Fly-Through Option
Vision Tools WebViewViewing
Tele-Radiology, Web Distribution
• Web Reporting• Template Reporting• Compatible with Microsoft Word • Voice Dictation and Transcription • Speech Recognition (Option)• Send Reports back to Hospitals
Tele-Radiology, Web Reporting
Dictation
Transcription
Vision Tools WebViewReporting
• Web administration• Single administration for
PACS/RIS• Manage user profiles• Manage user rights• View Audit logs• Manage Multi-Branches
Tele-Radiology, Web Administration
MiAdmin web based administrator
Tele-Radiology, Administration
• Report on the type of studies transmitted• Report is user selectable• Report is generated from the web
STUDY STATUS REPORT
Tele-Radiology, Administration
• Monitor the round-trip time for studies from the time the study is acquired till the final report is sent back to the hospital
ROUND TRIP REPORT
Compression on the web JPEG Lossy/Lossless, JPEG 2000
CR study (Lossless) delivered in less than a minute over a 1Mbps ADSL Upload
Priority queuing , Emergency Studies have highest priority in transmission
Reports are sent back in Text and dictated voice formats
User Selectable compression before download
Roaming Profile for radiologists
Works with Any PACS solution, MILLENSYS or Third Party
View Images and Report on Multi-Monitor Configuration
Compression
Transmission
Facilities
Multi-Level Security
Tele-Radiology, Major Features
• HIPAA Compliance
• Web Based Administration at Data Center
• Log Files to monitor system operations and users
• Clustered Solution in Data Center to guarantee 99.9% uptime operation
• SAN Storage is a non single point of failure device with RAID 5 storage
• Store and forward for images from Hospitals to Data Center enable continuous operation in case of link failure.
• Cases resume transmission when link is up automatically.
Administration & Management:
Tele-Radiology, Security