Regional Medical Imaging in the Czech Republic

Dissemination of medical knowledge, tools supporting and assisting in decision making and accessing relevant and accurate sources of information for scientific research, all enhance the synergy among the medical community and play a very important role in healthcare and consequently bring benefits to all people, particularly the community served. The digital environment, from its very beginning, delivers medical users many advantages such as increased efficiency, cost savings and in particular enhances the quality of medical care.

New telemedicine scenarios and new strategies must be introduced not only amongst local medical departments but also at the regional and global level. The strategies must therefore take into consideration local as well as regional and even global aspects. A successful system must be fully integrated into systems that support daily routine procedures as well as integrate into other technologies related to medicine.

Institute of Computer Science of Masaryk University

System supporting regional medical imaging has been developing at the Institute of Computer Science of Masaryk University since 1998. The goal was to establish an open, collaborative environment that supports broad cooperation, improves cost-effectiveness, quality of treatment as well as coordinated research and education in the area of processing of medical image data.

The basis of the system is a set of DICOM (Digital Image Communication in Medicine) compliant applications like DICOM based regional PACS (Picture Archiving and Communication System) streamlining distribution of medical image information in regional and national level. The system enables secure communication of more than 300 healthcare institutions and medical specialists mostly from the Czech and Slovak Republic.

The goal of our research is the system enabling the medical imaging to be organised different way. The system providing new alternatives for integration of standard DICOM applications and existing services covering daily routine in healthcare institutions as well as providing new platform for very efficient cooperation in regional level: sharing of expensive medical facilities, more efficient utilisation of time of medical specialists, greater specialisation of radiology departments, shared access to the knowledge databases of reference case studies enabling more efficient diagnostic process, etc.

There are reliable long-term image archives located at the Masaryk University where the image studies are being sent from the individual hospital PACS systems. So the image data are partly distributed in short-term archives of incorporated healthcare institutions as well as they are safely stored in long-term archive in the centre.

Radiological Communication Center

Radiological Communication Center creates the opportunity to transfer highly sensitive patient image data between various DICOM compatible medical devices from inside the medical institution with DICOM compatible medical devices located in another institution via open Internet. Communication system consists of central servers located at the Institute of Computer Science of Masaryk University and specialized components deployed inside private networks of involved medical institutions. These components are equipped with DICOM communication interface and represent standard DICOM nodes within DICOM application domain of the institution. As the external communication runs over the open Internet all the transfers are protected by asymmetric encryption. This technology can support simple workflows as well as quite complex solutions like distribution of medical images through a domain composed by many medical institutions (regional PACS).

Knowledge Management

For radiological training (to become an excellent radiologist) it is necessary to have broad approach to large knowledge databases. Tailored PACS forms the basis for teaching and research applications. This PACS is used as a trainer for radiologists and students as well as works as a reliable archive of anonymous image studies and related anonymous files forming case studies of real patients. Personal data of all involved image studies as well as of all other related files are modified, patients are made anonymous. As the patient can be treated in many different healthcare institutions the coordinated modification of his/her identity (replacement with fictitious one) is necessary. We need to prevent disclosure of his/her identity as well as not to lose complex view of patient’s treatment. Even if the patient is being treated in different hospitals fictitious identity of all of his/her recordings in knowledge databases is the same.

Regional Collaborative Environment

The shared regional collaborative environment is more than just a set of computer network applications. Gradually, it changes the thinking of medical specialists and gets them to cooperate and share data about patients in electronic form. It builds a network of medical specialists. The impact of this work is not only in patient care but also in the education of involved specialists. The implementation of the system has increased the speed of communication among individual hospitals, allowed decision consultations, and brought various other advantages due to dedicated network connections.

It should be considered as an implementation of possible general access to radiology images together with other patients' data related to the images and in accordance with appropriate access rights to enable the best healthcare for a particular patient in "all reasoned cases".

Current ICT as well as existing and developing standards enable physicians in the region to deliver some services by the computer network. It means that medical specialists from distant specialised departments can consult urgent cases or make decisions. It is a concept of expert centres based on the practises of telemedicine. Image studies of every patient can be referred to a distant expert centre for a primary diagnostic or second opinion. This way a much higher quality diagnosis can be assured. It is obvious that this concept is not achievable by the functionalities of conventional hospital information systems.

Masaryk University is the main co-ordinator of this long-term activity dealing with demands coming from radiology departments, evolving legislative standards and technology limitations in practice. The big advantage of an academic environment is that it can serve as a "trustworthy neutral exchange point" for all participating institutions.

In general, the project is clearly orientated to support society-wide healthcare initiatives in the Czech Republic as well as the programmes realized by other countries.