Fig 4.

An example of an international teleradiology solution installed between Africa (Mali, Benin, Morocco, Algeria) and France (Marseille, Lyon, Frejus) using DicomWorks’ built-in e-mail import and export functions: Requesting physicians (1 and 2) and remote experts (3) only need a DicomWorks client application installed on a standard PC connected to the Internet. They all share a single e-mail account on a simple mail transfer protocol/POP e-mail server (here on a dedicated server in Marseille to avoid security issues), but they can also have individual accounts. In the first case, images are imported from non-DICOM modalities (5) and converted to DICOM-compatible files using DicomWorks on station 1. In the second case, images from a CT scanner are native DICOM and easily sent to DicomWorks using a Store-SCP client application on the PC. Communications use regular Internet connections. Any user can upload a message on the e-mail server and specify a recipient (8) using a predefined list (in local preferences file). Cases can also be left available to all physicians (7), so that unanswered cases can be viewed by several experts. Transmitted images are left in DICOM format, but anonymized, compressed using a lossless algorithm, and attached as a single file to the e-mail message. Images are retrieved using DicomWorks’ built-in POP client that filters messages addresses to its specific “USERID” (fixed and encrypted in local preferences), or to “ALL.” Reviewing is performed using DicomWorks viewing tools. A simple “Answer” button is available to send a response (that may contain a reference JPEG image) to the original sender (9).