A multi-tier image streaming teleradiology system

With the advent of real-time image streaming, a new paradigm for development of image display and viewing systems that communicate with Picture Archiving and Communication (PACS) systems can be proposed. In this paradigm, the high bandwidth requirements of current systems can be significantly relaxed and security features can be seamlessly adopted and enforced. Based upon this paradigm RealTimeImage and OARG have developed a multi-tiered web-based image display and analysis system for teleradiology. The system architecture consisted of a backend module to communicate with the PACS system via direct file system access or standard DICOM protocols, an Image Server to stream image data to its clients using RealTimeImage Pixel-On-Demand (TM) streaming technology and a web-based client to provide image display and analysis functionality. The system was used in a clinical research study that required analysis of several hundred images and included participants located at various remote geographical locations. Performance and maintainability of the system were objectively quantified. Usability issues were subjectively identified by the various users of the system. It was observed that the performance of such a system is comparable to that of today's systems over fast LAN, even if the user is connected via standard, dial-up connections. This level of performance was achieved without compromising the usability of the system required for the research study.