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Rural Image Storage and Retrieval


A  Rural and Global PACS provides its services in  real-time and non real-time. Images transferred are usually provided in non real-time,  requested prior to the consultation session. In  this scenario,   medical  images  (up  to  4096x4096x8)  and   patient information  are transferred to the destination  within  minutes. Typical resolution for a radiology modality is 2048x2048 pixel and 12 bits per pixel. This  is an example of non real-time image transfer for  storage or  retrieval.  Requests for image storage and  retrieval  occurs off-line and images are exchanged between an imaging equipment or workstation on a Local PACS and  the database archive system on a Remote  PACS. Local PACS users have access to an  image  directory service  for  image location. This scenario is used  to  retrieve image sets for research, education and diagnosis.


Rural Virtual Consultation Services

The rural virtual consultation service scenario involves  two or  more  medical  experts  located respectively at  a  Local  and  Remote (rural) viewing  workstation. These workstations can be located  anywhere in the country.  The physicians establish a consultation  session for  the purpose of examining images and recording  a  diagnosis.  They  both see the same image on their workstation screen.   Each viewing workstation provides a pointer that allows the  physician to  point  to parts of the image.  When the physician  moves  the pointer,  the  Remote  site sees the resulting  movement  of  the pointer on their display.  Additionally, workstations have  image processing  capabilities  that allow the  physicians to manipulate and analyze the image. These features are also displayed on the other monitors  at the same time as the originating workstation.  Voice interaction between the physicians takes place interactively.  In order  for  all  this to take place in  real-time,  the  pointing commands,  voice  packets, and image processing  parameters  are transmitted  to the remote site. Our tests shows round-trip delay times of less than 100 milliseconds for the image annotation commands, making the pointing operations real-time to the physicians. During the  remote  consultation and  diagnosis session, the image annotation commands  and  voice are recorded and stored for later playback. The playback session can  then  be observed  as it actually occurred. The  session  may include  image  annotation, such as graphics and  text  comments. Each physician has control over the parts of the session that are stored for the diagnosis.

 Figure 2. shows the operations and services in  the remote consultations scenario.


Figure 2.

  Virtual Consultation Services with Multi-Media viewing

In this scenario, a videoconference is conducted between the Local and Remote physicians. Two uses are possible, 1) display video of the two consulting physicians, and 2) display a live or recorded video of an operative procedure. This video is displayed in a sub-window during a consultation session. The digitized video is recorded at the Local WS site and can be saved as part of the patient record and for layer review. This scenario will require at least a T1 MBPS network to the rural sites, in order to display slow scan motion video. The initial bandwidth of the ATEN is a T1 (1.544 MBPS) links to the rural sites and the video conferencing will then operate at 5-8 frames per second. This scenario will be useful during ultrasound consultations. The  clinicians are able to access image cases from a DBAS unit at University of Arizona.  A  film scanner or digital camera unit must  be available  at  the rural clinic for the University of Arizona to  provide  remote consultation  services. The images are digitized, formatted,  and transferred to the DBAS at the Local PACS at the University of Arizona for later consultation sessions.

In rural clinics that have no Internet connection, a telephone  line  and 28.8 KBPS modem are used to access the nearest Local PACS network with a SLIP interface. The image annotation and real-time voice scenarios required at least a T1 speed to the rural sites. The viewing workstation performs  the same as a direct Internet connection. For video services,  T3 or greater network speeds are required for the remote sites.