Remote Consultation and Diagnosis in a Global PACS Environment

A Global PACS is a national network which interconnects several PACS networks at medical and hospital complexes using a national backbone network. A Global PACS environment enables new and bene cial operations between radiologists and physicians, when they are located in di erent geographical locations. This paper presents three user scenarios which enable remote consultation and diagnosis between radiologists at a Local PACS site and a Remote PACS site. One scenario, called remote consultation, allows the radiologist to view the same image folder at both Local and Remote sites so that a diagnosis can be performed. The paper describes the user interface, database management, and network communications software which has been developed in the Computer Engineering Research Laboratory and the Radiology Research Laboratory at the University of Arizona. In the remote consultation and diagnosis operation, a set of images is requested from the database archive system and sent to the Local and Remote workstation sites on the Global PACS network. Once the images are displayed on the workstations, the radiologists use pointing overlay commands, or frames, to point out features on the images. Each workstation transfers these frames to the other workstation, so that an interactive session for diagnosis takes place. In this phase, we use xed frames, variable size frames and free hand frames to outline an object. The data packets for these frames must traverse the national backbone in real-time. We accomplish this feature by using TCP/IP protocol sockets for communications. The remote consultation and diagnosis operation has been tested in real-time between the University Medical Center at the University of Arizona and the Bowman Gray School of Medicine at Wake Forest University, over the Internet. In this paper, we present performance data based on test between these two sites and show the feasibility of the operation in a Global PACS environment. Future improvements to the system will include real-time voice and interactive compressed video scenarios. This work is sponsored by the National Science Foundation and Toshiba Medical Systems Division.