Abstract

Introduction

Materials & Methods

Results

Discussion & Conclusion

References

Discussion
Board

Our use of the Internet and the decision to provide a Web-based interface to our PACS has served us well. In fact, we have employed the same approach to solve several additional problems. The need to create and catalogue radiological teaching files in a filmless environment became apparent soon after the PACS was launched and films were no longer available in CT and MRI. A new Server dedicated to maintaining a database of electronic teaching files, comprising images and text, was developed using the same approach employed to develop the PACS-browser³. The resulting system is now tightly integrated with our PACS, allowing authorized users (primarily radiologists and residents) to easily create teaching files. A major attraction of this new system was that the files become immediately accessible throughout the world by virtue of being on the Internet (see: http://tfserv1.rad.mgh.mcgill.ca/). Figure 2 illustrates a list of cases that match a search on the keyword ``liver''.

Fig. 2: After performing a search of the teaching file database, a list of cases is displayed. The user may display any case (which includes clinical findings, observations, etc. and images), or if authorized, can modify the teaching file.

As the PACS itself grew, its support and maintenance increased in complexity. To address this issue, we developed a suite of Web-based PACS management tools. The resulting tools allow the PACS Administrator to add new users; define new DICOM application entities; setup image routing rules; control defaults for preset JPEG window widths and levels; monitor DICOM image transfer queues, network connections and processes running on each Server. This has greatly facilitated our ability to manage the PACS remotely. Figure 3 shows the PACS administration utilities page.

Fig. 3: Several PACS administration utilities are available through the PACS-browser (to an authorized user only), making it possible to manage the PACS remotely.

More recently, we developed an interface between our PACS and hospital information system (HIS). Our goal was to enable links images residing on the PACS with their corresponding reports. The interface, however, was limited to receiving the radiology orders and returning the reports (to the HIS) after being transcribed. Previously, all radiology reports were transcribed directly into the HIS making them inaccessible to the PACS, so we developed a new Web-based transcription application that allows the reports to be entered on the PACS side while a copy is sent to the HIS. The local copy is then linked to the corresponding images on the PACS and is accessed through the same Web-browser application that is used to view images. Developing a Web-based transcription application has allowed the existing computers in our department (a mix of Macintosh and IBM PC-compatibles) to be used and has grown to include an application currently being evaluated by our radiologists to perform corrections electronically. The latter, in principle, could be used from anywhere on the Internet given adequate security. Ultimately, this will increase the efficiency with which examinations can be interpreted and reported.

The distributed Web Server architecture now employed in our PACS is analogous to the World-Wide-Web itself. Rather than try to centralize the storage and access to all information, it is distributed and linked over the Internet, allowing the collective resources to be shared without any complexity from the user's point of view.

The use of the Internet and our Web-browser to provide access to digital images on our PACS has clearly been successful. We have managed entirely without films in CT and MRI for almost two years now, and for over three years in ultrasound. Despite some initial difficulties related to image quality, the system has provided a new model for image delivery within our institution that is now being expanded to include images from nuclear medicine and, soon, computed and digital radiography.

This model puts greater control of image access into the hands of users. Unfortunately, when one is used to physically handling and carrying films, seeking a networked computer to access images is seen as inconvenient. The challenges to address this issue are largely financial and a matter of habit-changing. The benefits, however, are undeniable: Electronic images do not get lost and allow multiple users access at the same time. Given Internet access, images can be shared world-wide in a matter of minutes and at almost no cost.

Our experience in digital imaging and PACS has been very positive and we are pursuing extensions of this technology into the area of conventional radiography. The Internet and World-Wide-Web have provided us with the means to adopt PACS-related technologies and implement them affordably and effectively in our institution.

The potential for new uses of this technology is clear. Telemedicine and teleradiology are two excellent examples. But there are still several technical challenges that include how to ensure network bandwidth and security. The former is particularly important in the field of radiology where the data volumes are among the highest of all medical specialties. Here, gigabit Ethernet and ATM seem to offer promising solutions. Security, in terms of ensuring privacy of information on public networks, is being addressed through the use of encryption, but its use is still limited. In some areas, private networks have been proposed and are being developed to address these issues. Thus, the role of the Internet in health care is uncertain, but its influence has been undeniable.

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