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Image and Medical Data Communication Protocols for Telemedicine and Teleradiology

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Image and Medical Data Communication Protocols for Telemedicine and Teleradiology Image and Medical Data Communication Protocols for Telemedicine and Teleradiology Dissertation vom Fachbereich Informatik der Technischen Universität Darmstadt zur Erlangung des akademischen Grades eines Doktor der Ingenieurwissenschaften (Dr.-Ing.) genehmigte Dissertation von Dipl.-Phys. Ilias Sachpazidis aus Mesolongi, Griechenland Referenten der Arbeit: Prof. Dr.-Ing. Dr. h.c. Dr. Eh J. L. Encarnação Prof. Dr.-Ing. Georgios Sakas Tag der Einreichung: 10 July 2008 Tag der mündlichen Prüfung: 24 September 2008 Darmstadt 2008 - D17 Image and Medical Data Communication Protocols for Telemedicine and Teleradiology For further information about this publication, please contact Department of Cognitive Computing and Medical Imaging Fraunhofer Institute for Computer Graphics Fraunhoferstr. 5 D-64283, DARMSTADT GERMNAY phone: +49-6151-155 507 fax: +49-6151-155-480 e-mail: [email protected] homepage: http://www.igd.fhg.de/˜isachpaz to my dad and mom. iii Contents Acknowledgments xv Abstract xvii 1 Introduction 1 1.1 Motivation . 1 1.2 Current Problems . 2 1.3 Topic and structure . 3 1.4 Main results . 5 2 State-of-the-art 7 2.1 Telemedicine taxonomy . 7 2.2 Telemedicine protocols . 8 2.3 Telemedicine devices . 9 2.4 Telemedicine applications . 14 2.5 Data types and volumes . 25 2.5.1 Communication pathways . 26 2.5.2 Size of medical data . 28 2.5.3 Bandwidth requirements . 28 2.6 Conclusions . 28 3 Integrated protocols for data and imaging exchange 33 3.1 Introduction . 33 3.2 Binary transmission . 36 3.2.1 Out-Of-Band data transmission . 36 3.2.2 In-Band-Data Transmission . 36 3.3 In-Band-Data protocol extension . 40 3.4 On-line collaboration . 45 3.5 Off-line collaboration . 51 3.6 Security issues . 54 3.7 Results, innovation and own contribution . 54 4 Integration of telemedicine devices 57 4.1 Traumastation . 57 4.2 Medication adherence . 68 4.3 Results, innovation and own contribution . 73 v 5 Applications 79 5.1 @HOME . 79 5.1.1 Approach Followed . 80 5.1.2 Overview of the @HOME platform . 82 5.1.3 Data volumes and communication . 85 5.1.4 @HOME for adherence monitoring . 85 5.1.5 Results from medication adherence pilot study . 88 5.1.6 @HOME for acute cardiac care . 92 5.1.7 Results from the cardiac pilot study . 94 5.1.8 Conclusions . 100 5.2 T@LEMED . 100 5.2.1 Introduction . 100 5.2.2 Medical services . 102 5.2.3 Deployment . 106 5.2.4 Results . 118 5.2.5 Conclusions . 119 5.3 T@HIS . 123 5.3.1 Introduction . 123 5.3.2 Imaging collaboration application . 126 5.3.3 System collaboration aspects . 127 5.3.4 AmerHis . 131 5.3.5 Medical Imaging Network Deployment . 134 5.3.6 Results . 136 5.3.7 Conclusions . 139 5.4 TENPET . 141 5.4.1 Introduction . 142 5.4.2 Imaging collaboration application . 145 5.4.3 Communication aspects . 149 5.4.4 Use cases . 153 5.4.5 Deployment . 154 5.4.6 Results . 154 5.4.7 Conclusions . 162 6 Conclusion and Future work 167 A DICOM 173 A.1 Medical imaging standards . 173 A.2 Imaging representation . 182 A.3 Instant messaging protocols . 193 A.3.1 ICQ . 193 A.3.2 AOL/Oscar . 193 A.3.3 IRC . 195 A.3.4 SIP/SIMPLE . 196 A.3.5 Skype . 196 A.3.6 Jabber/XMPP . 196 B TeleInViVo 201 Bibliography 213 vi List of Figures 1.1 Growth in number of images per study and number of CT studies performed between 1998 and 2006 . 4 1.2 CT storage used per year . 5 1.3 Traumastation . 6 2.1 An ultrasound device device . 10 2.2 Ambulatory blood pressure device . 12 2.3 Blood oxygen saturation device . 13 2.4 ECG Device (CardioPerfect PC based ECG) . 14 2.5 Medication dispenser . 15 2.6 DELTASS overview . 16 2.7 Overall architecture of the TOPCARE platform . 18 2.8 The health professional interface. The browser-based representation of the electronic health record of a patient shows a trend curve for blood pressure readings in a homecare scenario . 18 2.9 TeLeCare system overview . 19 2.10 CHILI communication schema making use of e-mail . 20 2.11 DicomWorks overview . 22 2.12 System architecture of medical imaging collaboration application . 23 2.13 Graphical user interface of the medical imaging application . 24 2.14 2x2 view of the DICOM enabled viewer . 24 2.15 TeleDamon user interface . 25 3.1 URI-protocol communication . 39 3.2 Data blocks . 42 3.3 Graphic view of additional data transmission effort . 44 3.4 Plots of data overheads produced by the XML encapsulation, when n and b ranges from 0 to 1 MB . .→∞ . 46 3.5 Doctors sharing the same user interface . 47 3.6 Controlling messages exchanged among users . 47 3.7 Establishing an on-line collaboration . 48 3.8 Shutdown an on-line collaboration . 49 3.9 State diagram of on-line collaboration . 49 3.10 Bandwidth in conjunction with number of messages . 51 3.11 Bandwidth and grouping of events . 52 3.12 Offline message dispatcher . ..
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