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J. Andonegui et al.

 

 

Fig. 16.2 Model for managing and processing ophthalmic image and data

16.3.2.2 Data Scheme for Images

The retinograph and the workplaces of the GPs and the ophthalmologists are in different locations, though the images are accessed remotely. To remotely manage all retinographies, a network in compliance with the DICOM standards must be deployed. This network can be divided into three main nodes: the devices performing the image capture, the PACS server, and the DICOM

visualization stations. To make communication possible between the three nodes, each needs to carry out certain requirements of the DICOM standard (Fig. 16.2).

Fundus Camera VISUCAM Pro NM

During the Þrst year, a retinal camera TRC NW6S was used. For the second and third years, a camera VISUCAM Pro NM was chosen. The two

16 Diabetic Retinopathy Screening with Nonmydriatic Retinography by General Practitioners

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Fig. 16.3 Graphic interface of the DICOM viewer ClearCanvas Workstation

most relevant DICOM features of this fundus camera are: (1) the modality worklist service class provider (SCP) (to work with consistent patient data, the device must be able to download the worklist from the PACS instead of creating a new one manually [17]) and (2) the DICOM C-STORE as a service class user (SCU). After making all pertinent captures in a study, the retinograph must be able to send recently created DICOM Þles to the PACS server [17].

PACS Server

The function of a PACS is to administer the image ßow through the DICOM network. It is in the middle of the data system, so it has to support several image management tasks such as storage, retrieval, and access to images acquired with different devices. In our screening model, the server

receives fundus images from retinographs and stores them. When a user accesses a study, the PACS server Þrst checks the userÕs permission and allows access to images only if the permission is correct.

Both sides of the connection (device-server and server-workstation) must agree before a successful connection is established. This step prevents an unidentiÞed person from uploading or downloading images from the server. For that reason, it is necessary to deÞne the serverÕs (SCP) and local machineÕs (SCU) application entity (AE) title, hostname, or IP (internet protocol) and port number for both sides of the connection.

ClearCanvas DICOM Visualizer

The DICOM viewer chosen for this project was the ClearCanvas Workstation (Fig. 16.3). It has