title: [Development of a secure and cost-effective infrastructure for the access of arbitrary web-based image distribution systems].
abstract: OBJECTIVE
  To build an infrastructure that enables radiologists on-call and external users a teleradiological access to the HTML-based image distribution system inside the hospital via internet. In addition, no investment costs should arise on the user side and the image data should be sent renamed using cryptographic techniques.
  
  
  METHODS
  A pure HTML-based system manages the image distribution inside the hospital, with an open source project extending this system through a secure gateway outside the firewall of the hospital. The gateway handles the communication between the external users and the HTML server within the network of the hospital. A second firewall is installed between the gateway and the external users and builds up a virtual private network (VPN). A connection between the gateway and the external user is only acknowledged if the computers involved authenticate each other via certificates and the external users authenticate via a multi-stage password system. All data are transferred encrypted. External users get only access to images that have been renamed to a pseudonym by means of automated processing before.
  
  
  RESULTS
  With an ADSL internet access, external users achieve an image load frequency of 0.4 CT images per second. More than 90 % of the delay during image transfer results from security checks within the firewalls. Data passing the gateway induce no measurable delay.
  
  
  CONCLUSIONS
  Project goals were realized by means of an infrastructure that works vendor independently with any HTML-based image distribution systems. The requirements of data security were realized using state-of-the-art web techniques. Adequate access and transfer speed lead to a widespread acceptance of the system on the part of external users.
authors.affiliation: Klinik für Radiologie, HELIOS-Klinikum Wuppertal. thacklaender@wuppertal.helios-kliniken.de
authors.forename: T
authors.initials: T
authors.lastname: Hackländer
authors.forename: K
authors.initials: K
authors.lastname: Kleber
authors.forename: H
authors.initials: H
authors.lastname: Schneider
authors.forename: N
authors.initials: N
authors.lastname: Demabre
authors.forename: B M
authors.initials: BM
authors.lastname: Cramer
mesh_terms: D004496:Education, Continuing; D006801:Humans; D020407:Internet; D010564:Personnel, Hospital / Q000193:education; D011873:Radiology Information Systems; D012637:Security Measures; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface