DicomWorks could offer first wave of teleradiology sea change

Some developing countries, and others already developed, are turning to an open source teleradiology solution called DicomWorks, a tool originally released in 1998 as an alternative to $15,000 commercial DICOM viewers.

Since then, DicomWorks has been tailored to provide a free teleradiology platform. Its developers see it as the first wave of a sea change in teleradiology.

"We believe that proprietary teleradiology solutions with dedicated lines and proprietary software will make way for a new generation of teleradiology solutions based on DICOM and IHE using secured Internet connections," said DicomWorks developer Dr. Philippe Puech, of the department of medical informatics and biostatistics at the Centre d'Etudes et de Recherches en Informatique Médicale, Faculté de Médecine, in Lille, France.

International teleradiology networks based on DicomWorks have begun appearing in Africa and elsewhere. One network connects physicians in Mali, Benin, Morocco, and Algeria to French radiologists in Marseille, Lyon, and Fréjus. All the networks use DicomWorks' built-in e-mail import and export functions. They share a single e-mail account on a simple e-mail server in Marseille to avoid security issues.

All that's required of requesting physicians in Africa and remote radiologists in Europe is a DicomWorks client application (available free at http://dicom.online.fr/) installed on any standard PC or Mac connected to the Internet. Communication is over regular Internet connections.

Any user can upload a case on the e-mail server and specify a particular recipient using a predefined list. Alternatively, cases can be left available to all radiologists so they can be viewed by several experts.

Non-DICOM images are converted to DICOM format. Transmitted images are left in DICOM format, anonymized, and compressed using a lossless algorithm, then attached as a single file to the e-mail message.

"DicomWorks is also used in Afghanistan, Chile, Alaska, and Germany," Puech said.

Since DicomWorks is so simple to use, some radiologists use it to transmit cases to colleagues down the hall or across town. DicomWorks was one of the first DICOM viewers to provide a PACS-like interface, which important to radiologists grappling with an increasing number of images in a series.

Portuguese radiologist Dr. Jose Drago of Centro Hospitalar Barlavento Algarvio in Portimao calls DicomWorks an inexpensive entry-level means of entering the complex world of medical imaging.

"The system is an easy way to view and distribute images in DICOM format," Drago said.

Drago uses the system to export images directly to PowerPoint and JPEG.

"I also use the scrapbook feature to easily create new DICOM studies for presentations or review," he said.

DicomWorks speaks 18 languages and currently has over 51,000 registered users. Registration is free. System downloads average about 4000 a month.

"Surprisingly, the majority of users are from the U.S.," Puech said.

DicomWorks Version 2.0, pending in 2008, will have an improved 2D viewer, multiscreen support, an SQLITE database engine, full DICOM communications and DICOM RT support, and encrypted e-mail for teleradiology.

Other DicomWorks details are documented in the June issue of the Journal of Digital Imaging (2007;20(2):122-130).