Real-time ‘chat' over Internet lets physicians confer electronically

Consultation between radiologists and referring physicians is part of routine medical practice, but this critical interaction can't occur electronically with PACS designs now in use.

A system incubating in the research beds of the Radiology Informatics Laboratory at Johns Hopkins University may change that. Collabora is a teleradiology scheme optimized for real-time interactive consultation over the Internet.

"Current PACS aspire to deliver medical images anywhere at anytime and provide convenient tools to view these images, but what if a physician wants to review the images with a radiologist?" said Dr. John Eng, a radiologist at Johns Hopkins University. "With a PACS, the physician still must physically go to the radiologist?just as in the days of film."

Eng's Collabora project is designing a workstation to support remote collaboration between radiologists and referring physicians through real-time display synchronization and annotation functions optimized for medical imaging. Collaboration functions are managed by a special server much in the same way as Internet chat rooms.

In addition to standard image manipulation functions, Collabora's display can be synchronized to that of another Collabora workstation so that radiologists can point out image findings and diagnoses in real-time to remotely located referring physicians. Unlike general teleconferencing systems, according to Eng, Collabora's display is highly interactive despite managing large numbers of images, and the user can choose from several display synchronization modes and collaborative functions.

Collabora interfaces with any DICOM-compatible archive. Key components were developed in Java language, which brings the additional advantage of support for multiple computer platforms. Java also enables online distribution and support for encrypted Internet protocols of greater security and robustness than DICOM.

An important feature of the Collabora project is its reliance solely on established, open electronic standards?it assumes images are stored in a standard DICOM archive. All communication between components of the Collabora project are via the Internet standard TCP/IP protocol, according to Eng.

"The emphasis on standards results in a system that is compatible with many types of PACS environments and is easier to install, maintain, and upgrade," he said. "With appropriate security protocols, these standards allow the images and collaboration sessions to be carried over the Internet instead of expensive dedicated networks."