Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society

Abstract

Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions.

The Use of Teleradiology in Turkey: Current Situation and Attitudes of Radiologists

“…In our study, it was revealed that 41.6% of the participants did not use teleradi-ology systems and we consider that the main reasons and lack of financial support and technical problems. 7,[10][11][12] It was also found that DICOM was the most commonly transmitted format (63.3%), as revealed in the European and Swiss survey. 7,10 In our study, the most common reason for the use of teleradiology outsourcing was revealed as secondary readings and expert consultation, and the most common disadvantages were revealed as insufficient integration of clinical history and lack of contact with the radiologist.…”

Teleradiology applications with DICOM-e-mail

“…Commercial gateways also allow the integration of these non-DICOM attachments into the DICOM workflow using a web server. DICOM images and non-DICOM attachments are joined with these solutions, as long as they are encoded using the X-tags according to the German national DICOM-e-mail standard [5,6].…”

“…The DICOM-e-mail protocol is described in detail in [6]. In summary it is based on the exchange of standard e-mails with an additional encryption according to the OpenPGP standard [12,13].…”

“…The national German standard for teleradiology as defined by the German Radiology Society in 2004 is also based on this protocol [5][6][7]. DICOMe-mail is a legacy free protocol and allows the secure exchange of DICOM images and other file based information using standard Internet connections and mailboxes.…”

Application of Multiprotocol Medical Imaging Communications and an Extended DICOM WADO Service in a Teleradiology Architecture

“…In [2], an example of DICOM protocols' vendor-specific addition for the implementation of certain teleradiology solutions is demonstrated. Moreover, a variety of common Internet protocols, that is, HTTP, FTP, SMTP, IMAP4, POP3, as well as vendor-dependent protocols are evidently acceptable in certain teleradiology solutions [3–5]. …”