International Radiology Exchange - Low cost informatics tools used in teleradiology outreach and charity work (

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Presentation that illustrates the work performed by (International Radiology Exchange) in outreach work within radiology. …

Presentation that illustrates the work performed by (International Radiology Exchange) in outreach work within radiology.

Note that this is a version of presentation that was also presented at RSNA 2009. Posted for educational purposes.

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  • 1. Low Cost Informatics Tools and Software Enabling Teleradiology for International Outreach Garry Choy, MD, MSc Sung Han Kim, MD Stewart Worrell, MD Efren Flores, MD Salvatore DeLuca, MD Paul Heinzelmann, MD
  • 2. Exhibit Goals
    • Introduction to outreach efforts of iRadX
    • Illustrate the unique circumstances and requirements for teleradiology outreach to underserved regions of world
  • 3. Exhibit Goals
    • Discuss features of selected free informatics tools available for image transmission
    • Demonstrate via case-study how iRadX has utilized informatics to perform teleradiology outreach at minimal cost
  • 4. iRadX (International Radiology Exchange) – Our Mission
    • Primary Mission:
      • Clinical image interpretation (educational purposes or second opinion)
    • Additional Initiatives:
      • Education
      • Medical Imaging Equipment Procurement
      • Travel Grants / Fellowships
  • 5. Outreach Model Primary International Medical Outreach Organizations NGOs Volunteer Organizations
  • 6. Collaborating Organizations
    • Partners in Health
    • Interplast
    • WiRED International
    • Operation Village Health
    • iCons International Consultation Service
    • Harvard Neurology Residency-India Exchange
    • Harvard Medical School – China Exchange Program
    • Mount Auburn Hospital
  • 7. Where Has iRadX Served?
    • Cambodia
    • Burundi
    • Malawi
    • Rwanda
    • Haiti
    • China
  • 8. Sample Cases From Abroad
  • 9. Sample Cases From Abroad
  • 10. Sample Cases From Abroad
  • 11. Requirements For Image Transmission From Technology-Limited Areas
    • Internet Connection (typically only modem-based and low bandwidth connections are available)
    • Adequate data transfer speeds for practical use
    • Support for simple image formats such as JPG & GIF as well as DICOM
  • 12. Limitations in Providing Teleradiology Infrastructure
    • Hardware
      • Many systems require special servers or appliances
      • VPN and other network devices needed
    • Cost
      • Who will pay for all this?
      • Who will handle the demands of technology infrastructure?
  • 13. Real-life IT Challenges
    • Many systems still film-based; not digital
    • PACS and DICOM usually are not ubiquitous as in developed nations
    • Older, legacy systems do not enable simple DICOM image export
  • 14. Pictured: Ratanakiri Provincial Hospital, Cambodia and x-ray reading room iRadX Partner, Operation Village Health, Center for Connected Health @ Massachusetts General Hospital
  • 15. How does iRadX receive images?
  • 16. Images Can Be DICOM or JPG/GIF Acquired Via Digital Camera of Actual Film or Console
  • 17. Selected Examples of Tools used by iRadX
    • Email
    • Web-based imaging storage service such as Picasa
    • Mobile Image transmission:
      • Real-time video streaming ( )
      • Mobile based MMS
    • HIPAA Compliant Secure Digital Document Delivery services:
      • Yousendit
    • Social Media platforms
      • radRounds
    • DICOM transmission services
      • Intelemage
  • 18. Email
    • Electronic mail is a proven and reliable method of communication
    • Email with attachments is often the only data transfer tool available to providers
      • Simple and Fast
      • Free
      • Allows for attachments ( images and other documents)
      • Depending on service, may not be HIPAA compliant or secure
      • May not allow for transfer of large datasets
  • 19. Web-based Imaging Storage Services
    • Web-based image storage platforms such as Picasa can be utilized
      • Simple web-based access
      • Manages JPG and GIF images effectively
      • Native image organization and management tools
      • Free web-based accounts
      • Media sharing
  • 20. Picasa Cases are organized by folders
  • 21. Picasa Each folder is organized by built-in layout tool
  • 22. Picasa Each JPG or GIF image can be viewed individually
  • 23. Secure File Transfer Services
    • Numerous file transfer services currently exist such as YouSendit
    • YouSendit is HIPAA compliant
      • Large file transfer up to 2GB
      • File delivery tracking
      • Password protected secure delivery
  • 24. YouSendit
  • 25. Mobile-Phone MultiMedia Messaging Service (MMS) Even in resource poor settings, mobile technology is ubiquitous and more frequently available than land-based internet connections Analogous to text messaging, multimedia messaging (MMS) on enabled-cellular phones can transmit multimedia including images, audio, and video to other mobile devices or email accounts
  • 26. Live or Recorded Video Feeds through Mobile Phones
    • iRadX has collaborated with , platform available on numerous phones to transmit live or recorded video feeds
    • iRadX successfully utilized for interpreting plain film, ultrasound, and CT
    • Offers secure and private storage of data
  • 27. Mobile Video/Image Streaming with To see more cases originally streamed live, please visit: Recorded Cine of Chest CT demonstrating an atrial myxoma
  • 28. Social Media for Sharing Images
    • Use of simple image sharing facilitated by social media (such as radRounds ) has enabled discussion among volunteer radiologists of iRadX
    • Private groups and images can ensure secure sharing and discussion of clinical cases
  • 29. DICOM transfer with inteleGRID from Intelemage
    • Using inteleGRID , users submitting images can use a simple URL to begin upload process ( )
    • No special hardware, software, or VPN's are required allowing anyone to use it
    • Volunteer radiologists of iRadX are alerted each time a new study is received
  • 30. DICOM transfer inteleGRID from intelemage
  • 31. Summary – Teaching Points
    • Many informatics tools are free, universally accessible, and user friendly, enabling effective practice of teleradiology for international outreach
    • Teleradiology outreach can be performed easily without significant IT infrastructure investment
    • A referring physician from anywhere around the world can seek the expertise of a radiologist via these free tools
  • 32. For more information on our work in global outreach in medical imaging…
    • Please visit our website:
    • International Radiology Exchange
    • For volunteer or collaboration opportunities, please contact us at [email_address]
  • 33. To learn more about any of the services discussed in this presentation:
    • Picasa –
    • Qik –
    • YouSendit –
    • radRounds –
    • Intelemage –