IOM Teleradiology Infrastructure and Systems

The IOM Global Teleradiology and QC Center designs, implements innovative technologies in both centers, and operates its programmes and applications in accordance with IOM Information Communications and Technology (ICT) standards. The Centers use:

• A secured Global Picture Archiving and Communications System (PACS) Server to archive all the digital X-ray images replicated from all networked locations. 
• IOM in-house developed web-based teleradiology primary reading and QC applications for radiologist reading of digital radiographs and communications
• Microsoft Team/Skype chat system for real time communication during teleradiology service provision and uninterrupted technical support
• High-resolution radiologist diagnostic monitors and image viewing software for quality reading of the digital radiographs
• Affordable solutions for users to facilitate accessibility to the teleradiology programmes and enhance radiology services for different locations worldwide

Global PACS and networking

The Centers use a global Picture Archiving and Communications System , which is a commercial PACS software installed and configured on a secured global server, with high storage capacity. The PACS is administered by the global teleradiology technical team. The server is maintained and regularly serviced by the IOM Department of Information and Communications Technology (ICT) and follows institutional data protection policies and standards.

As of December 2021, the global and regional PACS servers are networked to more than 121 locations globally and has continued networking to other field locations worldwide. The PACS servers for all locations are installed and regularly maintained by the IOM teleradiology technical team. The Global Teleradiology Center, in coordination with ICT, develops different teleradiology applications and radiology systems in-house. The various systems developed and used by the IOM Teleradiology Programme are described below:

Teleradiology Primary Reading Application

The IOM Teleradiology Primary Reading Application , a web-based application, developed in-house for real-time reading of digital radiographs and communicating the reports, is used for the Teleradiology programmes provided by both Centers and accessed by the users in different locations real-time. Currently, Version 9  is being used. The Teleradiology Primary Reading application has the following key features:

• Contains various chest X-ray reporting forms provided by the respective migrant receiving country governments,
• Includes key functions that allow radiologists to document image quality issues, request additional views, and complete the X-ray reading
• Has a dedicated page for IOM MHACs and other non-IOM locations in different countries to monitor the status of a case, check additional view requests and download reports.
• Other functions include functions for automated assigning of chest x-rays to radiologists for the interpretations, providing panel physicians the ability to request a review of cases if they have queries (Request for review), and for radiologists to perform internal quality assurance (QA) monitoring and review of a percentage of reported cases by peer radiologists (peer review process).
• Additionally, the system allows for user to generate pdf report and/or excel files for the chest x-ray readings for the locations they have access.

Teleradiology Quality Control Applications

The IOM Teleradiology Quality Control Applications,  uses web-based applications developed in-house, is used by IOM Global Teleradiology Center to conduct its global quality control (QC) programmes and communicate with the field locations. These include the Global Teleradiology US QC application and the newly developed comprehensive Global Teleradiology QC application.

Global Teleradiology US QC application
The Global Teleradiology US QC application was developed in 2015 to provide radiology quality control for the pre-migration health activities of United States-bound migrants The application is integrated with other IOM systems and has a semi-automated multiple processes capability that enable the Center to add QC radiologist’s reading, monitor QC process, calculate discrepancy scores, review QC and primary reports, initiate discussions, and generate statistical reports for the QC results. 

New Comprehensive Global Teleradiology QC application
A new IOM Global Teleradiology QC application was developed and rolled out in October 2021 to address limitations of an earlier Teleradiology QC application and allows IOM to conduct QC activities for all programmes, in both IOM and non-IOM locations. The Global Teleradiology QC application has several new features and functionalities, with more automated processes, including sampling from the various databases in use, organization and monitoring of the QC process, as well as notification. This new application is DICOM compliant and capable of communicating with PACS using the DICOM protocol. 

High-resolution diagnostic Monitors 

The Centers are fully equipped with commercially available standard high-resolution diagnostic monitors for viewing X-ray DICOM images. These high-resolution medical grade monitors provide excellent image quality to help radiologists run effective diagnostics for Teleradiology CXR primary reading, QC interpretation, and second opinion consultations. The minimum recommended resolution of a high-resolution diagnostic monitor is >= 3 MP in addition to full standard specification.

Radiology Image Viewing software

The IOM Teleradiology Centers also use Radiologic Image Viewing software, which is a commercial platform independent diagnostic DICOM image viewer software, with an unlimited concurrent users license to review chest X-ray images. The software has multiple image manipulation options to aid radiologists in interpreting CXR images, such as measurement tools, zoom, flip, rotate, adjustment filters, measure area and angle, and other marking tools that are necessary for reviewing CXR findings.

Modality Worklist Application

The centralized Modality Worklist (MWL) Application developed by IOM Global Teleradiology Center, in coordination with ICT, to send the biographic information of applicants from IOM MHD systems as a worklist item to the local field operation PACS, which automates data entry in the X-ray machine. A MWL is one of DICOM’s workflow services. The DICOM MWL is an application service that makes patient demographic information from a radiology information system (RIS) available at a modality (X-ray machine, such as CR or DR), thus eliminating manual data entry and providing data integrity, fast workflow and efficiency.  

The dataset is retrieved from IOM health information systems and sent to the local PACS. The CR or DR machine at the local operation is configured to obtain patient demographic data from the MWL.