CHEP 2000 Padova 2000 February 7 11 Remote

CHEP 2000, Padova, 2000 February 7 -11 Remote Consult in Radiotherapy HEP Technologies in Health Physics! Maurizio Ferraris, Paolo Frixione, Sandro Squarcia Dipartimento di Fisica e Sezione INFN Università degli Studi di Genova squarcia@ge. infn. it

New technologies have completely changed medical duties Health care needs. . . Physical devices are quickly improving • Computed Tomography, • Nuclear Resonance, • Computer Radiography, • Echography…. Informatics is becoming more and more important Networking among clinical departments is now usual . . . and physics transfer - We are in hospitals (Health Physics) - We have technologies - We know how to fit them in medical world Teleconsultation for better patient care!

Modern Radiology Department CR Computer Radiography devices Remote connection CR SD 100 PC Juke Box CD SD 100 Archive devices Medical report and consultation devices WS WS WS

Multiple integration Hospital Information System (HIS) Radiological Information System (RIS) Booking Hospital Area Network Medical report Clinical modalities (TC, MR, CR. . . ) Picture Archive Computer System (PACS)

Teleconsultation Construction of a clinical folder with images • Possibility of on-line interaction • Possibility of follow-up check • Possibility of statistical clinical data elaboration Foundation for the use development of hadrons (instead of electrons/gammas) in radiotherapy cancer cure Has supported NORMA Network Oriented Remote Medical Archive

NORMA A ad hoc clinical folder for images transmission Network Oriented Remote Medical Archive

Hardware security Hospital global network • Two area completely separated • Two Ethernet card in the firewall • A true gate from outside world • Secure clinical data accessibility Radiotherapy (or radiology) divisional network

Software security Patient data identification Level 1: Pathology Statistical analysis (free for network partners) Level 2: Teleconsultation Anamnesis and diagnosis (on owner authorization) Level 3: Treatment Patient general data (on patient authorization) Patient clinical folder owner Access mode Owner mail address

NORMA characteristics Patient information General system information Menu frame Blue for data insertion Green for data consultation Body Frame

Active image selection Different data handling possibility Clinical images (JPEG format) not for teleconsulting!

DICOM Information Model Clinical information retrieved Patient personal data Study information Series description of clinical image series Image data describing clinical images (mode and pixel definitions) Digital Information and COmmunication in Medicine

Remote consulting tool NORMA helps physicists and medical doctors to select the best treatment planning in radiotherapy discussing on images retrieved from DICOM PACS through a client/server application developed in Java. DICOM IMAGES DICOM module WWW-DICOM gateway JAVA SERVER Remote consulting client Hospital A Remote consulting client Hospital B

Digital Images Retrieve Workstations NORMA To LAN Network PACS System WWWDICOM Gateway Modalities Eurostore Connection Eurostore archive Image Transfer Connection

EUROSTORE Project European Project to design and develop an high performance distributed storage system Consortium formed by scientific and industrial partners - QSW (Supercomputer - UK) - CERN (Science - Swiss) - DESY (Science - Germany) - HCSA (Space Technology - Greece) - TERA Foundation (Science - Italy) - HNMS (Met-Service - Greece) - AMC (Medical - Greece) Features: Scalability Reliability and security Easy hardware and software support Eurostore (Java 100%) will run on, almost, all hardware and software systems available today

WWW-DICOM gateway Client/server architecture: Presentation logic: Web Browser Application server: Web Server Business logic: DICOM gateway Data management: DICOM Server CGI interface HTTP WWW Browser WWW Server JPEG conversion DICOM gateway DICOM Server DICOM gateway opens and submits a DICOM association to DICOM Server, receives a response and makes JPEG conversion

(HTML + Java. Script) Data Exchange Mode Web Browser Sun. . . SPARC 10. . . WWW Domain Sun Sparc 10 WWW-DICOM Gateway Intranet (HTTP) Sun SPARCserver 1000 Web Server DICOM Domain Sun DISKserver 1000 WWW MODULE (URL-encoding) CGI Library (Name-value pairs) LAN (DICOM protocol) DICOM Application Entity (Data) + (Commands) Sun Requests Parser DICOM MODULE Response builder (Data) Data encoding DISKserver 1000 (HTML file) (Images) JPEG translation Data decoding Image processing DICOM Upper Layer

Teleconsulting Features and Functionalities Feature: • Secure user authentication secure socket layer protocol activities registration on log file • Platform independent Java applet running on every Web Browser Functionality: • Access to medical image archives (PACS) • Selection (and transmission) of clinical images zone • Discussion of clinical cases among remote users

Client/Server Teleconsulting Architecture Client: Java Applet for running on every Web Browser • Communication management • Graphical user interface - mouse drawing on clinical images - information exchange using the chat area Server: Java application installed on NORMA system • Client communication management • Log files activities registration • Multithread software architecture Protocol: Communication performed using a built-in proprietary network protocol

JAVA Teleconsulting JAVA Applet HTTP Connection Proprietary protocol CLIENT A JAVA SERVER JAVA Applet Proprietary protocol CLIENT B HTTP Connection WEB SERVER

Proprietary Protocol Time Client 1 Connection Request C O N N E C T I O N Java Server Client 2 Waiting for connection Send priority code Receive code Waiting for client 2 connection Connection Request Send priority code Receive ID 2 Receive and send ID 2 Verify connection status (polling) DATA EXCHANGE Send ID client 2

Connection to the PACS System User Autenthication DICOM association

DICOM Connection Monitoring DICOM Console Visualization of data exchanged during DICOM communication

DICOM Patient Data Consulting Patient list Patient personal data

DICOM Study Information Study list Study information

DICOM Series Information Series list Series information

DICOM Images Retrieve of clinical images Dump of DICOM dataset

Images Remote Consult Toolbar Help area Discussion area

Conclusions The developed system is a research product helping physicists/medical doctors to select the best radiotherapy treatment planning Users working in different places can discuss interesting clinical cases visualizing in a Web Browser supporting Java the same diagnostic images at the same time highlighting zones of interest