World Wide Web Based Access to Radiological Data:
Two years experience

Björn Bergh, Jens Ricke, Dirk Emmel, Roland Felix

Strahlenklinik and Poliklinik
Charité, Campus Virchow-Klinikum
Medical Faculty of the Humboldt-University of Berlin, Germany

Objectives:

The main objective was to establish the general availability of all radiological data to the whole campus, even to associated hospitals and practitioners. This should be achieved on the basis of established standards.

Technique:

To suit the above needs a WWW-Access-System (WAS) was developed inhouse that interfaces the RIS via HL7 and the PACS via DICOM. Core components are a secure WWW-Server and an underlying database system. The WAS operates in the following manner: upon arrival of an image in the PACS, an HL7 message containing general demographic data and specific DICOM information is generated and sent to the WAS. After receipt of the message a DICOM C-Get is performed to fetch the image. A thumbnail (128x128 Pixel) is created and stored together with the demographic information followed by an HL7 query to the RIS to retrieve additional information on the examination (e.g. report, procedure, clinical information). After role-based authorisation and request by the user the available information on a patient is packed into a dynamically generated WWW-page which includes the thumbnails and the reports. This page is sent via HTTP. By a mouse click on the thumbnail the WAS initiates a DICOM C-Get and the original DICOM-image is fetched and forwarded to the user. A helper application (DICOM Viewer) is started so that all kinds of image manipulation and post-processing can be undertaken. The user can choose between the basic image set with the full resolution and a shrinked which has half the size for performance reasons.

Experiences:

The solution has been operational for about two years within various wards with great success. Advantages from the technology point of view are: the platform independence; no extra client development necessary which avoids efforts in support and maintenance; the possibility to provide solutions for technical problems which otherwise could hardly be solved in a standardised manner. This concerns mostly the access control an the integration of images and reports which are only vaguely addressed in standards like e.g. DICOM. Clinical users pointed out two main advantages: the general availability of all images on almost any computer just minutes after the images had been acquired and the simple usage. In the majority of the cases the shrinked image quality was sufficient for their purposes, so that around 90% of the cases could be cover with the WWW systems. The only critical issue of importance, in particular for Digital Radiography images which can have up to 28 MB, was performance. The following cost savings could be determined: by employing WWW-based access systems the amount DICOM workstations, which are very costly, decreases significantly; all available hardware may be used, additional software purchases are not needed; the simple usage avoids time and thus money consuming training programs and teaching periods.

Conclusions:

The authors believe that the WWW-based access to radiological data is the only suitable approach that is in the same way technically possible, clinically acceptable and financially affordable with the today existing restrictions in the healthcare sector. In an appropriate combination with DICOM workstations it satisfies all clinical needs. The current restrictions in performance can be solved by implementing the system technically closer to the PACS structure itself using e.g. CORBA or DCOM.

Corresponding author:

Björn Bergh

Strahlenklinik and Poliklinik Charité,

Campus Virchow-Klinikum

Medical Faculty of the Humboldt-University of Berlin,

Berlin,  Germany

e-mail : bergh(at)charite.de

Oral presentation at EuroPACS'98, Barcelona, Spain