Webbase Online Consulting System for quasi real time consultations of cardiac images

The authors have constructed a web base consulting program (Online Consulting System: OCS) for cardiac images especially for coronary angiograms. The DICOM movies from the PACS server of the catheterization laboratory are uploaded by secured 128 bit Virtual Private Network (VPN) connection without compression by a “send to DICOM node” command to a mini PACS hosting the OCS. After then the php modul checked the AETITLE + IP source, the communication is taking place on the TCP/IP 104 port. The uploads of the images of one patients takes 1-15 minutes depending on the bandwidth and the size of the DICOM files. After the upload, the movies can be downloaded by a real-time-like speed from any Internet connected place. The secured connection is performed by SSL protocol (https) which identifies the “receiver”. The viewer is based html5, therefore it runs in any browser program without the need for further application; however it is also possible to download the original DICOM files for further evaluations. Tablets and mobiles with the usual platforms can also be used for the consultations, the latter has the advantage in urgent cases, because sending an SMS or E-mail containing the link of the uploaded urgent coronary angiography enables the consultant invasive cardiologist to see immediately the movies on his/her smartphone or tablet or PC. The OCS can integrate the consultations of cardiac imaging modalities (echocardiography, CT, MR, IVUS, OCT) in DICOM forms. Using the OCS also for ECG trace transmission, the system is also useful for prehospital consultations during the treatment of acute coronary syndrome.