Increasing production and use of digital medical imagery are driving new approaches to information storage and management. Traditional, centralized approaches to image communication, storage and archiving are becoming increasingly expensive to scale and operate with high levels of reliability. Multi-site, geographically-distributed deployments connected by limited-bandwidth networks present further scalability, reliability, and availability challenges. A grid storage architecture built from a distributed network of low cost, off-the-shelf servers (nodes) provides scalable data and metadata storage, processing, and communication without single points of failure. Imaging studies are stored, replicated, cached, managed, and retrieved based on defined rules, and nodes within the grid can acquire studies and respond to queries. Grid nodes transparently load-balance queries, storage/retrieval requests, and replicate data for automated backup and disaster recovery. This approach reduces latency, increases availability, provides near-linear scalability and allows the creation of a geographically distributed medical imaging network infrastructure. This paper presents some key concepts in grid storage and discusses the results of a clinical deployment of a multi-site storage grid for cancer care in the province of British Columbia.
Mass proliferation of IP networks and the maturity of standards has enabled the creation of sophisticated image distribution networks that operate over Intranets, Extranets, Communities of Interest (CoI) and even the public Internet. Unified monitoring, provisioning and management of such systems at the application and protocol levels represent a challenge. This paper presents a web based monitoring and management tool that employs established telecom standards for the creation of an open system that enables proactive management, provisioning and monitoring of image management systems at the enterprise level and across multi-site geographically distributed deployments. Utilizing established standards including ITU-T M.3100, and web technologies such as XML/XSLT, JSP/JSTL, and J2SE, the system allows for seamless device and protocol adaptation between multiple disparate devices. The goal has been to develop a unified interface that provides network topology views, multi-level customizable alerts, real-time fault detection as well as real-time and historical reporting of all monitored resources, including network connectivity, system load, DICOM transactions and storage capacities.
Confidentiality, integrity verification and access control of medical imagery and associated metadata is critical for the successful deployment of integrated healthcare networks that extend beyond the department level. As medical imagery continues to become widely accessed across multiple administrative domains and geographically distributed locations, image data should be able to travel and be stored on untrusted infrastructure, including public networks and server equipment operated by external entities. Given these challenges associated with protecting large-scale distributed networks, measures must be taken to protect patient identifiable information while guarding against tampering, denial of service attacks, and providing robust audit mechanisms. The proposed framework outlines a series of security practices for the protection of medical images, incorporating Transport Layer Security (TLS), public and secret key cryptography, certificate management and a token based trusted computing base. It outlines measures that can be utilized to protect information stored within databases, online and nearline storage, and during transport over trusted and untrusted networks. In addition, it provides a framework for ensuring end-to-end integrity of image data from acquisition to viewing, and presents a potential solution to the challenges associated with access control across multiple administrative domains and institution user bases.