S Ruggiero’s research while affiliated with University of Mannheim and other places

For a region-wide teleradiology network in Germany a vendor-independent Uptime-server concept was defined. The Uptime-server was realized for the availability check and prospective error-detection of the emergency teleradiology servers and clients based on encrypted digital imaging and communication in medicine (DICOM)-e-mail transfers. The concept and the experiences of 2 years of use with more than 30 clients and servers in 15 hospitals and in nine other regional partners are shown. The Uptime-server does provide automated availability checks for all servers and clients, automated checks of the download speed of the Internet lines, and a graphical user interface for the clinical user and the system administrator. A clinical user can display the availability information from all clients and servers in the network (see http://www.teleradiologie-rnd.de). In case of malfunctions during an emergency transfer, immediate reactions are possible, often without the need for help of a hotline or a system administrator. The chosen Uptime-server concept proofed to be reliable; it worked with products from nine different manufacturers without problems. Its statistical output can be used to fulfill the legal requirements of regular availability checks for teleradiology lines.

PURPOSE In Germany, the measurement at viewing distance only, according to DIN 6868-57, is required when testing report monitors for quality assurance. This method requires expensive equipment and allows a combined quantification of both the emitted light from the monitor and reflected light from the display surface. Other methods (AAPM, IEC) rely on complex separate measurements of both reflected and emitted light, some of the methods can be performed with inexpensive on-screen devices. The aim of this study was to evaluate the comparability of two different calibration and testing device types (on screen and at viewing distance) for different testing procedures and conditions. METHOD AND MATERIALS Three different calibrated measurement devices were used. Individual look-up tables for the realization of two different grayscale display functions (DICOM, CIE) on more than 30 displays of different vendors and types (color/grayscale flatscreen displays, glossy/non-glossy notebook displays, 8bit/10bit devices). Luminance, contrast, homogeneity and JND resolution were analyzed at different environmental lightning conditions. RESULTS Under certain conditions, the different measurement techniques lead to comparable results. However, significant differences were found for certain levels of ambient light and different screen types (glossy screens), i.e. regarding the display of darker grey levels. CONCLUSION Under certain conditions, (comparatively inexpensive) on-screen measurement devices can be used for the calibration and quality control of medical report monitors. The tests showed, that after calibration some of the non-dedicated consumer displays may legally be used for reporting in radiology, too. CLINICAL RELEVANCE/APPLICATION The results of the study help radiologists to decide which measurement techniques, monitor types and quality assurance testing intervals may be suitable for their individual setting.

For the connection of several partners to a Dicom-e-mail based teleradiology network concepts were developed to allow the integration of different teleradiology applications. The organisational and technical needs for such an integration were analysed. More than 60 institutions including 23 hospitals in the Rhein-Neckar-Region, Germany were connected. The needed functionality was grouped in six teleradiology applications (emergency consultation, tele-guided examinations, expert consultations, cooperative work, scientific cooperations and homework with on call services) and their technical and organisational needs according to availability, speed of transfer, workflow definitions and data security needs was analysed. For the local integration of teleradiology services the setup and workflow is presented for a standalone teleradiology workstation and a server based teleradiology gateway. The line type needed for different groups of applications and users is defined. The security concept and fallback strategies are laid out, potential security problems and sources of errors are discussed. The specialties for the emergency teleradiology application are presented. The DICOM-e-mail protocol is a flexible and powerful protocol that can be used for a variety of teleradiology applications. It can meet the conditions for emergency applications but is limited if synchronous applications like teleconferences are needed.

Considering the real conditions in China, the strategy and scheme of DICOM-E-Mail's clinical applications in China are discussed in this paper.

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.