See belo. Tim Churches wrote:
> David Forslund wrote:
Tim Churches wrote:
See http://story.news.yahoo.com/news?tmpl=story2&u=/zd/20050105/tc_zd/142004
"Two radiologists recently developed open-source software, called OsiriX, to display and manipulate complex medical images on the popular portable devices called iPods. "
Check the screenshots on their homepage at http://homepage.mac.com/rossetantoine/osirix/Index2.html - wow!
I wonder how they address patient privacy issues when storing lots of images on oft-stolen iPods? Presumably the patient identifiers associated with the images, if not the images themselves, are encrypted?
>>
This is not part of the Dicom specification. It could be done, but then the images wouldn't be Dicom conformant. But then the viewer isn't Dicom compliant either. Dave
Standards notwithstanding, encouraging people to carry fully identified but unprotected confidential medical information around on a device which is, I understand, a magnet for thieves doesn't seem very wise to me. But add some encryption of patient identifiers and it becomes a fabulous idea. I am sure the developers would have considered this, and perhaps encryption is already offered?
It isn't so simple. Dicom is intended for health providers (primarily radiologists) to exchange information. The issues of encryption show up in the transmission of images which doesn't have to be in the image itself and in the "watermarking" of images to ensure that they aren't altered or forged. I think it is a good idea to encrypt patient identifiers in this situation, but I don't believe it is in the standard at this point. I'm not sure the real value of carrying around CT scans or X-Rays in a iPod-like device, however. They can't be of a lot of clinical value because of the poor resolution of the devices, and most patients aren't going to be able to deal with them in any significant way. A record of what CT scans are available (with a URI or somehting similar) would be very useful so that when one visits a physician, they might be able to bring them up for viewing from the references. A small flash memory device should suffice for this purpose. We have used flash memory for selected CT scans in our TeleMed system and it does work fine. We actually encrypted the data in the image (contrary to the Dicom spec) so that the images themselves wouldn't indicate who they belong to. But the operating conditions of the system, of course, would reveal the patient identity through their medical record. One area that we have looked at with the military is carrying around the medical record of recent events to go with the patient for emergency care. Historical imaging isn't really necessary, but a record of what was just done to the patient including imaging could be very useful. One could encrypt the device itself so that unauthorized access is prevented. This is supported by a number of flash memory devices today, including the use of a thumb print. They are quite inexpensive compared to an iPod and would provide the necessary infrastructure.
Dave
Tim C
