gms | German Medical Science

Introduction: Sharing data is crucial for a proper treatment of patients since it reduces duplicated medical procedures, especially in radiology, and speeds up patient care if all documents are readily available. Even though different methods like DICOM E-Mail [1], direct VPNs, and sharing images via IHE XDS-I [2], [3] are established, none of the existing systems [4], [5] meet all demands of medical communicators who need to access all of a patient’s available data, preferably displayed in one system, at any time and without delay for data transmission.

Whereas a huge data load is liked to other methods, DICOM images stay at their source in the hospital’s primary PACS with XDS-I sharing, which provides a maximum of data control. Images are only transferred between locations if they are eventually needed. On the other hand, when actually accessed, a large amount of data has to be transferred ad hoc to make it available for viewing at different locations.

Aiming to overcome this drawback, we combined an XDS-I-based method with an Imaging Cache and integrated the system into the clinical workflow.

Methods: The Document Source and Consumer were combined in a single system acting as Imaging Cache, which buffers DICOM images for later use, while the KOS documents are registered and stored in the Registry or Repository respectively. This cache is organized such that images are deleted according to their study date and time of last access, ensuring that the most recent and frequently accessed studies are always available in the cache for quicker access.

In a second step, the Registry and Repository were coupled and when queried for images, instead of simply returning the KOS document, a link to a full-featured web-based DICOM viewer, provided by the Imaging Cache, is returned, allowing the requestor to stream images from there with a fast and low bandwidth access. This workflow was further enhanced by adding a Request Broker, which extracts location data from the queried KOS documents and redirects the streaming requests to the according source or Imaging Cache in a multi-site setup. Since all requests are passed via HTTPS, security is implicitly built-in.

Results: The authors built a fast and reliable sharing system for DICOM images based on the IHE XDS-I profile with some adaptions to the clinical workflow. Streaming mechanisms were used to speed up image data transmission for viewing at different sites. Only the required data is streamed to the workstation, whereas the original DICOM image stays at its origin. Though this solution is a vendor-specific enhancement to the IHE profile, the system stays fully IHE XDS-I compliant and still allows sharing data by using only the standard protocols and transactions.

Discussion: A state-of-the-art sharing system for DICOM images that is used in a productive clinical environment was established and is ready to grow with more participants. The system is the basis for an elaborated interdisciplinary collaboration where data, and in particular images, can now be shared fast, secure, and easily between medical professionals.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.