Teleradiology is one of the oldest disciplines of telemedicine. Basically, telemedicine teleradiology  is the transmission of medical images from one site to another. Typical scenarios of application are the second opinion request, the transmission of images to another doctor fur further treatment or the delivery of image data to the patient themselves. Another important and particular scenario is the remote interpretation from a different site.
CHILI is a pioneer of teleradiology and started to establish the first teleradiology networks as early as in the beginning of the 90s and actively participated in the standardization of teleradiology. DICOM E-Mail, e.g., was initially based on a proprietary CHILI protocol, which was refined - together with other actors - to a minimum standard for teleradiology of the German Society of Radiology.

Features

  • Manufacturer-independent protocols (e.g. DICOM, DICOM E-Mail according to the German Society of Radiology)
  • Automatic protocol conversion
  • Automatic routing depending on various parameters 
  • Fault tolerance and automatic continuation after interruptions
  • Different solutions for encryption
  • Secured logfiles to provide evidence of transmission

Benefits

  • Low workload for IT staff due to ready-for-use delivery (appliance concept)
  • Safety without VPN connections
  • Cost saving due to minimal administration
  • Increase of turnover due to retention of referring physicians

 

Selection of References

  • Freiburg University Hospital and surrounding hospitals
  • Mannheim Hospital and surrounding hospitals
  • Heidelberg University Hospital and surrounding hospitals
  • Karlsruhe Hospital and surrounding hospitals
  • Teleradiology network of Stuttgart and surroundings
  • Regional teleradiology network of Mecklenburg-West Pomerania (Prof. Dr. Staemmler, Fachhochschule Stralsund)
  • Krankenhaus Nordwest, Frankfurt - Jerudong Park Medical Center Brunei

Highlights

Teleradiology according to x-ray ordinance

We provide counseling and deliver ready-to-use solutions approved according to DIN

Web-based teleradiology

The congenial aspect of this solution is that the external partner does not need to install software

DICOM E-Mail

The minimum standard for teleradiology of the German Society of Radiology

Products

The Teleradiology Router is a program that can be installed locally and receives data from up to three DICOM nodes as C-Store SCP and forwards them to a defined other CHILI system via https-based CHILI protocol using compression. 

Moreover, the system actively queries data via https-based CHILI protocol from a defined CHILI system, buffers them and sends the data to a DICOM node in the local network in the form of C-Store SCU.

The DICOM header data can be modified with configurable values during transfer.

Teleradiology Router

Features

  • Protocol: http/s
  • DICOM receiver node: 3 C-Store SCP
  • Forwarding to another existing CHILI system (e.g. PACS, web server, gateway)
  • Rules for automatic forwarding depending on various parameters (e.g. AET, port, day of week, time)
  • Configurable modification of DICOM header data (e.g. prefix before study ID)

Benefits

  • The cheapest variant of teleradiology when a CHILI partner is available 
  • Sending data in the background without user interaction 
  • Automatic forwarding
  • Largely maintenance-free

The CHILI Teleradiology Gateway Basic is used for receiving and automatically forwarding DICOM image data.  Arriving data undergo intermediate storage in a database. In the case of network interruptions, transfers that have failed are taken up again automatically. Therefore, receipt of all data by the addressee is guaranteed. Transfers can be monitored via a web-based administration interface.

By default, the product contains the protocols DICOM C-Store (SCP and SCU), as well as the transmission via http/s. The DICOM E-Mail protocol is an additional option.

Teleradiology Gateway Basic

Features

  • Protocols included: DICOM C-Store, http/s, DICOM E-Mail (optional)
  • DICOM receiver node: 3 C-Store SCP
  • Transmission nodes: unlimited number of C-Store SCU
  • Rules for automatic forwarding depending on various parameters (e.g. AET, port, day of week, time)

Benefits

  • Transmission on existing modality or in PACS
  • Sending data in the background without user interaction
  • Automatic forwarding to different partners
  • Largely maintenance-free

The CHILI Teleradiology Gateway Advanced is used for receiving and saving DICOM image data. The image data can be sent via the web-based CHILI Viewer or automatically transmitted to the teleradiological partner according to defined rules.

In the case of network interruptions, transfers that have failed are taken up again automatically, so that it is guaranteed that all image data reach the addressee.

The product involves a web-based viewer for visualization that has interpretation quality. Transfers can be monitored via a web-based administration interface.

By default, the product contains the protocols DICOM C-Store (SCP and SCU), as well as the transmission via http/s. The DICOM E-Mail protocol is an additional option.

Teleradiology Gateway Advanced

Features

  • Web-based viewer for display and interpretation of data sent and received (two simultaneous users)
  • Protocols included: DICOM C-Store, http/s, DICOM E-Mail (optional)
  • DICOM receiver node: 3 C-Store SCP
  • Transmission nodes: unlimited number of C-Store SCU
  • Rules for automatic forwarding depending on various parameters (e.g. AET, port, day of week, time)

Benefits

  • Viewer that is suited for interpretations (EU medical device class IIb)
  • Transmission on existing modality or in PACS
  • Sending data in the background without user interaction
  • Automatic forwarding to different partners
  • Largely maintenance-free

CHILI Web's high quality of software is not only used for in-house image distribution, but also for teleradiology.  Various scenarios of use can be thought of: 

Within the scope of teleradiology according to the German X-ray ordinance, the teleradiologist can access images at home and interpret them using the CHILI Web Viewer. 

Pictures may be provided to referring physicians or patients (temporarily). It is possible to save the data (download) on the own computer and to upload previous studies.

Referring physicians or patients can upload previous studies prior to treatment or admission to hospital.

Teleradiology by web distribution

Features

  • No software installation on the Clients, since web-based
  • No dependence on specific browsers or versions
  • Can be combined with PACS systems of other manufacturers
  • Compression: with or without loss (with or without loss of the diagnostic meaningfulness)
  • Action taken in view of data protection and data safety: Encryption per https, client certificates, web application firewall

Benefits

  • No software installation for the user. Only an internet browser (any one) is required
  • Integrated functions for acceptance and consistency testing of teleradiology according to the German x-ray ordinance (DIN 6868-159) included
  • Cost optimization by teleradiology at night and on weekends
  • Process improvement by uploading previous studies prior to admission to hospital
  • Improved reputation among referring physicians and patients by providing results of previous studies
  • Increase of referrals

The CHILI Teleradiology Portal covers the whole teleradiological workflow; from creating a request by a medical-technical radiology assistant (MTRA) to providing data for accounting. During the process, the Teleradiology Portal records all individual steps.

A MTRA directly enters the request into the Teleradiology Portal or into the HIS/RIS. The teleradiologist checks whether a radiological examination is indicated and if required, he or she will request for it. Independent from the location, the teleradiologist can assess the images and create a medical report.

If required, the requests for the radiological examinations and the reporting in the primary systems can take place via interfaces on side of the modality whereas the teleradiologist can create reports within the RIS/PACS system.

Properties

  • Complies with the relevant legal regulations of RöV, QS-RL, and DIN 6868-159
  • Covers medical, workflow-related, and accounting-related data in a single overall system
  • Location-independent access to the system
  • Roles and rights concept (MTRA, radiologist)
  • Integration to the primary systems (HIS/RIS/PACS) via IHE-compliant interfaces

Advantages

  • Electronical request and reporting process
  • Guided steps through the workflow
  • Complete recording of all steps
  • Integrated quality assurance according to DIN 6868-159
  • Image acquisition via DICOM All data everywhere and anytime available
  • Provision of accounting-related data

This software solution makes radiological images and reports available to a referring physician or a patient for viewing and downloading. A separate password-protected login, the temporary sharing of data via a transmitted URL, or an access code provides access to the web-based portal.

In the opposite direction, previous examinations, requests for consultations and second opinions can be uploaded to the portal.

For both scenarios the user only requires a Java-supporting Internet browser.

Properties

  • Provision of image data and reports via web technology
  • Encrypted data transfer
  • Temporary limitation possible
  • Exporting DICOM data to the own computer
  • Option for creating a CD (subject to charging)
  • Upload access for referring physicians and patients

Advantages

  • No software installation required for referring physicians and patients
  • Data protection through encryption and access control
  • Displayed data is restricted to own patients
  • Bidirectional data exchange
  • Data exchange is independent of media (no films, CDs, …)
  • Reinforces referring physician loyalty