Ultrasonic diagnostic imaging system with universal access to diagnostic information and images

This invention relates to improvements in ultrasonic diagnostic imaging systems that allow access or control of an ultrasound system from a remote location.

US patent (serial application No. 08 / 607,894) describes an ultrasound system that can be perfected quickly and easily from a remote location. Through a two-way communication with the ultrasound system, performance improvements are transmitted remotely and installed without the need to call the technician. The doctor's diagnostic practice is affected by these rapid and effective improvements to his ultrasound system. The present invention, among other things, provides a new technique to enable. and test such software refinements for ultrasonic diagnostic systems worldwide.

An auxiliary business to the taking of images for ultrasonic diagnosis that arose in the 90s is the handling of ultrasonic images. Ultrasonic image management systems include specialized workstations, ultrasound system interfaces, ultrasound image storage devices and networks that are intended to facilitate ultrasonic diagnostics through

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of handling and storage of off-line ultrasound images. Such systems are intended to allow the physician to accumulate images in a storage medium and then call them from the workstation for review and diagnosis. While ultrasonic image management systems can offer valuable capacity for installations with multiple, intensively used ultrasound systems, they also require a considerable investment. The modules and workstations of an image management system generally have prices that range from dollar levels. A special installation is generally required and image management systems frequently employ proprietary hardware and software, which can act to limit their versatility. It is convenient to provide the advantages of an ultrasonic image management system without these numerous disadvantages.

In accordance with the principles of the present invention, an ultrasonic imaging system for medical diagnosis is provided which can be accessed remotely, interrogated or practically controlled from anywhere in the globe to provide information about its operational characteristics, images of patients and reports, or even for operation of the remotely controlled system. These possibilities can be surprisingly provided by software features that can be obtained

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commercially and personal computer hardware not very expensive, making it possible to face the expense and its use. The embodiments of the present invention describe techniques for modifying an ultrasonic diagnostic imaging system with inexpensive and easy-to-obtain hardware and software, enabling access to the information gathered through the use of the ultrasound system from remote locations. . Embodied embodiments of the present invention are described, which provide means for remotely accessing configuration information from the ultrasound system, performing tests and diagnostics on the ultrasound system from remote locations and even the ability to remotely control The operation of the ultrasound system. The embodiments of the present invention can also provide many of the functions and characteristics of ultrasound image management systems that can be obtained commercially, for only a small fraction of the cost of the typical image management system.

A significant contribution of the ingenuity of the present invention resides in the adaptation of existing hardware and software to allow access to ultrasound systems through an open construction communication network, so that image handling possibilities can be provided to through a

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Personal computer available in conventional stock without hardware, special software or costly documents.

In the figures:

Figure 1 illustrates in the form of a block diagram an ultrasonic diagnostic imaging system that is constructed in accordance with the principles of the present invention to operate through interconnected networks, together with a personal computer that can exchange control information. of the ultrasound and diagnostic system with the ultrasound machine;

Figure 2 illustrates in greater detail the interconnected network components of the ultrasound machine of Figure 1;

Figure 3 illustrates in greater detail the interconnected network components of the personal computer of Figure

1;

Figure 4 illustrates a Web cover (Web home page) of an ultrasound system constructed in accordance with the principles of the present invention as it appears when accessed through an internet from a personal computer or remote location terminal;

Figure 5 illustrates a Web page of a patient's directory for a specific patient that is accessed through the Web cover of Figure 4;

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Figure 6 illustrates an ultrasound image Web page accessed through the Web page of a patient's directory of Figure 5;

Figure 7 illustrates a Web page of a report of a patient that is accessed through the Web page of the patient directory of Figure 5 and shows an ultrasound image without degradation in the ultrasound image quality;

Figure 8 illustrates the main menu of a Web page for diagnosis of the system accessed through the Web cover of Figure 4;

Figure 9 illustrates a configuration registration Web page accessed through the diagnostic page of the system of Figure 8;

Figure 10 illustrates a system control Web page accessed through the Web cover of Figure 4;

Figure il illustrates a Web cover of a network of ultrasound systems constructed in accordance with the principles of the present invention;

Figure 12 illustrates a web page of a patient's directory of a system of the ultrasound system network accessed through the network cover of Figure li;

Figure 13 illustrates another directory web page of a patient from a central server that is accessed through

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The network cover of Figure 11;

Figure 14 illustrates a Web page of the directory of a patient of one of the systems in a network which is accessed through the Web page of the directory of a patient of the network of Figure 13;

Figure 15 illustrates, in block diagram form, a local network of ultrasound systems;

Figure 16 illustrates, in block diagram form, a local network of ultrasound systems connected by a gateway computer to the Internet; and Figure 17 illustrates in block diagram form a local network of ultrasound systems connected by a network modem to a remote personal computer in the network.

Turning first to Figure 1, an image capture system for ultrasonic diagnosis 10 is shown, which is constructed in accordance with the principles of the present invention in the upper half of the drawing in the form of a block diagram. The ultrasound system 10 is constructed to be able to access it by means of a personal computer 100 that is located remotely. The ultrasound system 10 includes a number of conventional components, including a scanning head 12 that transmits ultrasonic waves to a patient's body, receives echoes that return from the interaction of transmitted waves with internal organs and body tissue, and converts the echoes

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received in electric echo signals. The electric echo signals are appropriately delayed and combined by means of a beam former 12 to form coherent beams of echo information. The echo information beams are processed by means of an image processor 16 to form ultrasonic images, which are stored in an image storage part 24a of a storage medium 24. The images can also be further processed by means of a video-processor (which is not ours) to be placed in a suitable grid format to be displayed in a dispaly system 26.

The operation of the ultrasound system 10 is under the control of a control panel 20. The control panel 20 also enables a user to prepare diagnostic reports of the ultrasound examinations performed, using a report generator software package 22 that It is stored in the ultrasound system. Diagnostic reports can be displayed or printed on a printer (not shown), and can also be stored in a report storage part 24b of the storage medium.

In accordance with the principles of the present invention, the ultrasound system of Figure 1 also includes a HyperText Transport Protocol (HTTP) server 30. The HTTP server is connected to access ultrasonic images and

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storage media reports 24, and makes the images and system reports accessible to a personal computer, terminal, or workstation in a remote location. In Figure 1 the server 30 is connected by means of a modem 32 to a wireless (40) or wireless (40) communication network (44). The server 30 makes the diagnostic information of the ultrasound system 10 available to connected users to access the ultrasound system through the communication network 40.

The terminal of such a user is shown in the lower half of Figure 1. This user has a commercially available personal computer (PC) 100, including a PC processor 102, a monitor 108, and a keyboard 110. Installed in the Personal computer 100 is a commercially available Web browser 104 and network software 106, which allows the user to access the World Wide Web from the Internet through a modem 132. The user is therefore able to use the hardware and software of the PC that can be obtained commercially to communicate via the Internet with the ultrasound system through the server 30.

The well-known Internet is the result of developments known as interconnected network technology, which allows computers and computer networks to communicate with computers and computer networks in one place.

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in other places. The basic development of interconnected network technology began in the 1960s under the leadership of the Defense Advanced Research Projects Agency (DARPA) of the United States government, which responded to the requirement of scientists and the military to be able to exchange information through of a computer network. Two basic proposals are possible for communications networks, circuit switching networks and packet switching networks. A circuit switching network operates by forming a dedicated circuit between two points. An example of a circuit switching network is the US telephone network. Once a user of a telephone has been connected to another telephone through switching technology, the capacity of that circuit is established and is not diminished. for any other use of the network. Therefore the advantage of circuit switching is a capacity guarantee once the circuit has been completed. The disadvantage is the cost, since the circuit costs are fixed, regardless of the level of network utilization.

Packet switching uses a different proposal. A message from one user of the network to another is broken into separate units of information called packets. The packets are routed through the network from the place of the sender to that of the receiver by routers

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(high-speed routers) that search the network for a path from sender to receiver. In the place of the receiver the individual packages are received and regrouped to form the original message again. The advantage of packet switching is that the network can handle many messages at the same time by interleaving packets from different senders. The disadvantage of packet switching is that as the network utilization increases, the greater volume of traffic will slow the time required to send all packets of a message through the network.

The proposal for packet commutation was chosen by interconnected network computers due to cost and performance advantages. As many computers can share a network and can communicate quickly in short bursts of packets, dedicated circuit costs are avoided. In addition, the demands for greater capacity are met by the ever increasing performance of the computer. Advances in computer technology provide the ability to manipulate high volumes of data at ever increasing data transfer rates.

DARPA's task was to connect numerous government and civilian computer networks into a unifying interconnection of networks, or the internet. An internet is a group of interconnected networks that operate in a coordinated manner. Some of the most important developments that make them

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Possible internets came from research projects initiated by DARPA. This investigation had a very significant result: it established interconnection standards in networks for packet switching networks to communicate with each other, regardless of the characteristics of the underlying hardware. These standards allow universal communication between computer networks, while allowing individual users to use (or continue to use) hardware of their own choice. Common standards allow participants to individually use and manage their own network hardware while interacting seamlessly with data from other users' universe. This achievement led to the creation of the most famous internet connection, now commonly known as the Internet and its World Wide Web of interconnections. The present invention applies the advantage of the universal connection power Internet and the benefits of the World Wide Web, to ultrasound to improve the practice of ultrasound for medical diagnosis and the possibility of system service by means of an ultrasound technician.

The Internet, as mentioned above, is a network of networks that facilitates the transfer of data between numerous users who are connected to the network. The World Wide Web (the Web) is the name of a high-level user interface that has been created on the Internet to make transfers

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data in an easier and more logical way. The Web provides users with a distributed menu system. The menu pages or screens are shown to the users through which the user can easily request information from another computer, or guest (host). The greatest power of the Web is the ability to link or jump non-linearly from one set of information to another through display elements called hypertext links. When a screen shows something in the characteristic of a hypertext link, usually blue text or a colored outline of a graphic, the user has the ability to click on the element of the hypertext and immediately be transferred to the data or information identified by the hypertext , whether the data is in the same host as the information shown or in another host location in some other part of the world. The user has the ability to then click again on the original screen display, or follow a sequence of links to continue searching for information that can then be transmitted or downloaded (downloaded) from that guest. On the Internet, web addresses with the prefix http: // denote web screens capable of linking hypertext that comply with the published RFC standards of the Internet Engineering Task Force. Through the hypertext links a user can quickly follow pointers and references of the exact information they are looking for.

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The information that returns through these links can be encoded to be reproduced in numerous formats, including text documents, images, graphics, videodisplays and even audio. This power of hypertext link of the Web is taken directly to ultrasound systems and ultrasound information for diagnosis by the present invention.

Turning now to Figure 2, a more detailed block diagram of an ultrasound system constructed in accordance with the principles of the present invention is shown. The interface through which the system physically connects to the network is called a port (port). In Figure 2 the ultrasound system is connected to interconnected networks through a serial port 31. A common hardware device that translates between the digital domain of the ultrasound system and the analog domain of a telephone system is called a modem (modulator / demodulator). Modem 32 converts serial digital data from serial port 31 to analog signals suitable for transmission over telephone lines. The modem also translates analog telephone signals that enter digital data for passage through serial port 31 and use by the ultrasound system. A suitable modem can be obtained from Hayes Microcomputer Products, Inc., which has established standards used by a number of modem manufacturers.

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Communication with modem 32 is established by software known as PPP software (point-to-point protocol) as shown in block 48 of the drawing. The PPP is a standard that allows the use of multiple network protocols through a modem line or other serial connection. You can use other standards such as SLIP (Serial Line Internet Protocol), a standard that allows you to use a communications protocol known as TCP / IP (discussed below), via a modem line or other serial connection, or SSLIP (Compressed Serial Line Internet Protocol), a specialized form of SLIP. After the PPP software has been installed in the ultrasound system, it has to be initialized or configured for the ultrasound system and modem with which it is operating. The configuration information ensures that the PPP software is compatible with features such as the serial port used, the type of modem used, the telephone line, the guest's telephone number and the dialing method, and startup procedures and codes . In general, the configuration information provides positioning regarding the start of a network connection, when a connection is initiated and what happens after the connection has been established. PPP software is incorporated into some Windows 95 operating system software packages like Microsoft Corporation of Redmond, Washington for compatible IBM PCs. PPP software for

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Apple personal computers can be obtained from InterCon Systems Corporation of Herndon, Virginia, among others.

One of the achievements of the DARPA research project in interconnected networks was the establishment of a set of widely used network protocols called the TCP / IP Internet Protocol Suite. TCP / IP is named for its two most used protocols, the Internet Protocol (IP) and the Transmission Control Protocol (TCP). The IP protocol controls the routing of the data and the TCP protocol controls the transfer of the data. TCP / IP provides a common means of interconnection through packet transfer devices known as gateways. A gateway is a specialized network interconnection computer that connects two or more networks and packets of data paths between them.

When the ultrasound system has data that you want to transfer over the Internet, the data is passed to TCP / IP as shown in block 46 of the drawing. TCP encapsulates data in segments called TCP packets with header information that is used to track, control and sort data segments in the proper sequence. As a block of data is transmitted over the Internet in separate packets, some of which can be routed differently by gateways, there is no certainty that the packets will arrive at their destination in the proper order

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or without errors. TCP packets provide a means to ensure the delivery of the selected packets, integrity and order. At the receiving end, the packets are controlled for errors according to the TCP packet header information, the error-free segments are accepted, and the packets are arranged in order to regroup the original data block. The sender keeps track of the acceptances of segments and if a segment is not accepted in time the sender transmits the packet again. If a segment is lost in the initial transmission or received with failures, TCP retains the received segments until all segments are found at the receiving end, at which time they can be ordered in their proper and complete sequence to reorder the Originai data block.

At the transmission end, TCP packets are passed to the IP, which puts the segments in the form of IP packets or datagrams. The datagram contains an IP header that provides the address information used by gateways to route the datagram to its appropriate destination. The IP header contains the source and destination Internet addresses to allow gateways to properly route the data and the receiver to acknowledge receipt of the datagrams. The IP tries to deliver all the datagrams, but does not ensure their delivery. Delivery security is provided by TCP through the

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above.

Like PPP software, TCP / IP needs to be configured for the particular ultrasound system and its environment. Typical configuration information for TCP / IP includes information on the type of local network if the ultrasound system is interconnected in networks locally with other ultrasound machines (e.g., Ethernet or ring network of bit configurations), information with regarding the addresses of other systems in the local network, the gateway address if the system is performing a router function, the name of the user of the ultrasound machine and the access code, the address of the servers in the ultrasound system, the Internet address (IP address) for the ultrasound system and the default domain for the local network. As PPP, the TCP / IP software also comes with some software packages of systems such as Windows 95, and can be obtained for Apple computers from

InterCon.

A key to the successful operation of any internet, and the Internet in particular, is the requirement of a single address for each system, or guest, that is directly connected to the internet. Each user who connects directly to the Internet must obtain an IP address from a central authority known as the Network Information Center

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(NIC), which uses computer mediation to assign IP addresses to those who require them. An IP address is 32 bits long and is expressed with four tenth notations of groups of eight bits, separated by dots, such as 699.59.9.114 (an invalid IP address used as an example here). IP addresses are classified by the size of the network connected to the Internet, with class A addresses reserved for very long networks, class B addresses for medium-sized networks (255 to 65,000 users) such as a university network and class C addresses for networks Small (less than 256 users) taies as a radiological clinic or a hospital. Significantly, IP addresses do not specify an individual computer or machine; rather, they specify an Internet connection.

If an ultrasound machine has two network connections to the Internet, each one must have a unique IP address. A corollary of this aspect is that a local network can use subnet addressing, where each local machine has a subnet address, connecting the network to the Internet to a single guest connection with an IP address that provides access to all local systems to Internet. Subnet addressing is permissible when the sub-addresses of the network are not visible to the users of the Internet itself.

Other type of admissible Internet addressing that

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The NIC manages is the address by domain name. As many users would prefer to address them by meaningful words of a language rather than numbers, the NIC can assign a domain name and subdomain name to a user, and the user can add other subdomain names for which he or she has responsibility for mapping to your network The domain is the highest classification, commercial users being assigned the COM domain name, educational institutions EDU domain name, government institutions GOV domain name, etc. □ n hypothetical domain name for the ultrasound department of a Vétérans Administration Hospital of the US government could be for example ULTRASOUND.VAHOSPITAL.GOV.

In Figure 2 the TCP / IP is connected to a local network medium, in this case an Ethernet 50 connection. The Ethernet 50 connection connects the ultrasound system to other systems in a local network. In an Ethernet network, the systems in the network must be within a maximum allowable distance from each other and all are connected to the same physical network wiring. The data can be transmitted in the Ethernet network at high speed (previously 10 Megabytes per second; current versions have speeds of up to 100 Megabytes per second), being able to transmit each system only when no other system is currently transmitting

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ua through the system. A technique called

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Multiple Access with Collision Avoidance (CSMA / CA) prevents two systems from using the network wiring simultaneously. The ultrasound system can be connected in other types of local networks such as a ring network of bit configurations, where all systems are connected in a continuous chain that passes information through each system in the network. The TCP / IP is configured in the illustrated embodiment for communication via Ethernet locai, or through the worldwide Internet.

Interacting with the TCP / IP and PPP network software is the HTTP server 30. The HTTP server is a software program with which a web browser communicates to access ultrasound system information. The HTTP server responds to external requirements by displaying the information web pages and hypertext connections to additional web pages and information such as ultrasound images and reports. The HTTP server also responds to external requirements to perform a specific action associated with a button or control in the ultrasound system, as described in more detail below.

A constructed embodiment of the present invention uses a populär web server known as Apache, which was compiled and installed in the ultrasound system. The Apache server is public domain software that can r— “S ^ ÛTO-MACtCHAL.

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be downloaded from the Internet at http://www.apache.org/, and comply with the NSA standards. When downloading software, particularly for commercial use, care must be taken to observe copyright laws and the rights of software owners and developers.

The server, like the software previously described, has to be specially configured for the ultrasound system. The Apache server has more than 250 directives to configure the server for its intended application. An important Apache configuration file refers to security. This configuration file controls the access of strangers to elements of, and information about, the ultrasound system. Access may be limited to drives, directories and files specified by the ultrasound system, and limited to reading only. Access may also be restricted to some users and a certain number of simultaneous users and codes may be required. The server records the location of the log file, the file of users who have accessed the system. The configuration files identify the port number used by the server and the server administrator. The configuration files store the location of the files used by the server, including the server's root directory and the addresses of the Web pages and CGI programs (described below) that are used by the server. Other

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Features for which the server can be configured include such features as nultilingual ability.

In response to external requirements, HTTP server 30 transmits pages of Hypertext Markup Language (HTML) 34 to a web browser that asks. The HTML pages describe what the web browser will display on the screen in the remote terminal, including buttons, text, images, animated real-time loops of images, sounds, etc. HTML pages can be directly encoded in software following the instruction published in a number of reference texts such as HTML and CGI Unleashed, by John December and Mark Ginsburg, published by Sams.net Publishing, Indianapolis, Indiana. Simple HTML pages can be written using software for word processing and computer publishing that can be obtained commercially, then encoded in HTML form using software known as Internet Assistant that can be downloaded through Microsoft's front page at www.microsoft .com. Alternatively, the public domain software known as Webmaker can be downloaded from the Internet and used to make Web pages. Web pages contain HTML data marks that describe how the page should be interpreted by a web browser in the remote terminal. Links to the ultrasound image files are provided with IMG marks in the tea code ·

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websites. A HREF hypertext reference provides a means to link to other Web pages on the same ultrasound machine, or to the Web pages on any other host machine on the network or Web. Once the HTML pages were created they are copied to the ultrasound machine and the storage addresses are provided to the HTTP server. When a remote terminal requires viewing a particular web page of the ultrasound machine, the HTTP server 30 is responsible for finding the page and sending its content back to the one that requires it.

The ultrasound system of Figure 2 includes a number of small programs that can be run called Common Gateway Interface (CGI) programs as shown in 36. The CGI programs provide an interface between the HTML pages and the hardware and software of the system. ultrasound. CGI programs communicate with the ultrasound system, requiring the system to perform actions or provide required information such as images, reports, or current status. In a constructed embodiment the CGI programs respond to external information requirements by dynamically creating custom HTML pages where the required information is included. The following examples illustrate the operation of CGI programs that provide patient directories of ultrasound images and reports (patdir), display of an ultrasound image

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selected (dispimage), general purpose programs that perform tasks in response to input arguments (doaction), perform system diagnostics (dodiag) and provide patient directories for a number of ultrasound machines in a network (serverdir).

The CGI programs in the constructed embodiment are stored on the rigid disk of the ultrasound system in a directory called cgi-bin. When performing their operations, CGI programs access ultrasound images and reports that are stored in 24, access and execute diagnostic routines stored in 28, and interact with the controls of the ultrasound system through the ultrasound system controller 18. As an example of a CGI program, Table 1 illustrates the coding of a CGI program that captures an ultrasound image and includes the image in an HTML page. In the constructed embodiment, CGI programs are compiled in the C language for faster execution and security with respect to remote idle manipulation. CGI programs can also be used to format ultrasound images in a data format that is compatible with Web pages. In the constructed embodiment such reformatting is not necessary, however, since the ultrasound system is designed to store ultrasound images in the GIF (Graphie Interchange Format) format,

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an image format that can be read by most web browsers.

The specially modified ultrasound system of Figure 2 can be accessed through a standard personal computer terminal compatible with the standard Internet as shown in Figure 3. The central processing unit of the personal computer (CPU) runs the PC software in response a actions on the keyboard 110 and the mouse (not shown) and shows the ultrasound data and images on the monitor screen 108. The CPU runs the Web browser software 104 to access the Internet through TCP / IP and PPP protocols 146 and 148 configured for the personal computer. The connection to a network is through the serial port 131 of the PC and a modem 132. The PC can be networked to other devices through an Ethernet connection 150. TCP / IP and PPP can be obtained from the sources mentioned below. Web browser software 104 may be obtained from Netscape Communications Corporation of Mountain view, California or Internet Explorer browser may be obtained from Microsoft Corporation and is generally included in the Windows 95 operating software. It is noted that no hardware is required. or special software other than what can be obtained commercially to access the ultrasound system of the present invention.

Some examples of the use of an ultrasound system

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constructed in accordance with the principles of the present invention are shown with reference to Figures 4 to 14. These figures, except for the reference numbers and the illustrative IP address, are current prints (prints) of Web browser screens taken while the A remote terminal explorer was in communication with a constructed embodiment of the present invention.

Figure 4 shows the front page Web of an ultrasound system constructed in accordance with the present invention and identified as HDI 1000 # 1. As the figure shows, this Web cover was acquired by a Netscape web browser. The usual browser control buttons are seen above the Web URL 202 indicator. The URL 202 indicator shows the address used to contact the HDI 1000 # 1 ultrasound system, which is http://699.59.9.114/hdil.html . The html suffix in the address denotes the display as a hypertext Web page.

In the center of the cover of Figure 4 are three hypertext buttons that provide links to other ultrasound information or contrôles. When the user at the remote terminal clicks on the first button 204 with a computer mouse or keyboard key, View Save / Recall Data, a CGI patdir program is created that creates a patient information Web page where they are included ultrasound images of the patient and a hypertext link

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provided to patient reports about that patient. This patient directory Web page is shown in Figure 5. This Web page contains two small ultrasound images 212 and 214 that were obtained from the image storage of the ultrasound system 24a. The user of the remote terminal can click on any of these small images to see the full size of the image with its original image quality, or display the sequence of real time images represented by the small image. The remote terminal makes a choice of these options by clicking on the Image or Cineloop options above the small images. When the user of the remote terminal clicks on Image and then on the small image 212, the HTTP server 30 of the ultrasound system returns a Web page with a large reproduction of the selected image as shown in Figure 6. The Address in Figure 6 shows that the ultrasound system has transmitted an image identified as DAT_SR_1, which is stored in the GIF image format. For transmission speed the small images of the patient directory of Figure 5 can be compressed and read according to the JPEG standard, while the full size image of Figure 6 is transmitted without loss of image quality using the format of GIF image.

By clicking on the back button of the

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In the upper left-hand corner of Figure 6, the user of the remote terminal returns to the Web page of Figure 5. The user of the remote terminal can now click on the Patient Report button 216. In response to the activation of this hypertext link button, the HTTP server 30 causes the execution of a CGI program called prtreport that retrieves the diagnostic reports for the identified patient that are stored in storage 24b and includes them in a Web page for its transmission through the server. The server returns the Web page shown in Figure 7, which contains the patient report information. The functionality of the Internet that is brought to ultrasound by the present invention provides an additional feature that is the ability of the user of the remote terminal to prepare a new patient report or edit an old one. In the same terminal the user of the remote terminal opens a word processing application. Using the Edit feature at the top of the browser in Figures 6 and 7, the user of the remote terminal copies the ultrasound image and the patient report and in turn pastes them into a text processing document. The user of the remote terminal can, for example, paste the ultrasound image first, then the patient report under the image. The user can then edit the text file of the report of the

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patient modifying the report received or creating a new one. Using graphical features of the text processing program, the user of the remote terminal can mark, draw on or mark the specific characteristics of the ultrasound image for easy reference of the report. The new report can be archived at the remote terminal or at a remote location, or even sent by e-mail via the Internet directly from the user's remote terminal to a referring doctor. Additionally, the patient's report with its images can be printed directly from a computer printer connected to the user's remote terminal.

Using the back button again (or an appropriate hyperlink), the user of the remote terminal can return to the cover of Figure 4. When the user of the remote terminal clicks on the second button of hypertext 206, Perform System Diagnostics, HTTP server 30 transmits the Web page of the diagnostic menu of the linked system shown in Figure 8. Each of the hypertext link buttons in the system diagnostics menu will cause the execution of a CGI dodiag program with a different argument, which causes the ultrasound system to make a diagnosis through the system or display system status information such as trial and error records. These remote control functions are convenient when performing a

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Remote diagnosis of the operability of the ultrasound system. For example, clicking on button 222, Perform Configuration Test, causes the CGI dodiag program to execute ultrasound diagnostic routines 28 stored in the ultrasound system and return to the rteb page containing a record of the results of these tests as It is shown in Figure 9.

The ability to perform diagnostic tests on the ultrasound system remotely is especially useful following the remote installation of ultrasound software refinement. After the new software has been installed, this capability is used to run a diagnostic routine by the system that exercises the new software and validates its performance. As in Figure 9, the results of these validation tests are returned to the installer located remotely, verifying the successful installation of the new software.

Another capability of the diagnostic menu by the system of Figure 8 which is especially useful for refinement of ultrasound software is the button 224, Show System Version Numbers. Clicking on this button allows the ultrasound diagnostic programs to return the level or the version number of the software installed in the ultrasound system. Knowing the version or current level of the ultrasound system software is a prerequisite for

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necessary for the installation of any improvement of ultrasound system.

Perform System Diagnostics functions can be performed by a technician on site using a laptop computer. When the technician is with the ultrasound system, there is no need for a modem interconnection; The network link can be made directly. In this case, a cable is connected from the serial port 131 of the laptop computer (Figure 3) to the serial port 31 of the ultrasound system (Figure 2). Alternatively, of course, the Ethernet 50 and 150 connections could be interconnected. In any case, the access and interrogation of the ultrasound system by the technician is performed as described above, but at a much higher data rate of one direct network connection. Therefore, a visiting technician can use his laptop computer to perform a system diagnostic, check error logs, verify software settings and levels, and other system maintenance and repair activities.

By clicking back to the front of the ultrasound system of Figure 4, it is observed that a third hypertext button 208, System Operation Control, is available. Clicking on this button 208 allows HTTP server 30 to execute a CGI program called syscontrol. The CGI syscontrol program creates a Web page where the

<img file="AR011237A1_D0034.tif" />

Ultrasound image most recently produced by the ultrasound system as shown in the center of Figure 10. To the right and below the ultrasound image are shown the user controls of the ultrasound system. The controls shown on the ultrasound system are all hypertext graphics. Clicking on these buttons allows the syscontrol CGI program to issue the order to the ultrasound system controller 18 to change the operation of the ultrasound system according to the function of the selected control. In the constructed embodiment, the buttons on the right of the ultrasound image illustrate the hardkey mode control switches of the system, and the buttons below the image illustrate softkey controls used to change the parameters of the operable system in the selected mode. The hardkey illustrated below, Update, is not an ultrasound system control, but a control for this remote control feature of the present invention. Clicking on Update will ensure that the HTTP server and the CGI programs of the ultrasound system update the image displayed remotely with the ultrasound image most recently produced by the ultrasound system.

These properties mean that a doctor can perform an ultrasound examination from distances of thousands of miles. of the patient, needing only a couple of hands in place in

<img file="AR011237A1_D0035.tif" />

The patient is found to have and manipulate the ultrasound probe. The ability of eminent radiologists and scocardiologists can now be consulted in a diagnostic situation anywhere in the world. Any EMT or technician of a health service can have and manipulate the probe directed by the doctor who is located far away while the doctor controls the operation of the machine to produce the best ultrasound image for diagnosis. As the Internet connection can send and receive audio as well as video information, the instructions of the doctor holding the ultrasound probe can be sent through the same Internet connection as the ultrasound information. The doctor can switch back and forth between 2D and the color modes or any other desired mode, alternatively studying the structure of the tissue and blood flow conditions. In another embodiment, the doctor can switch between individual 2D images of a sequence of spatially different images and the 3D mode, where the sequence of spatially separated images can be performed in a three-dimensional presentation. Cases of difficult diagnosis can be directed to the most appropriate specialist for such cases in a note of the moment. Telemedicine covers telexamination, since the scope of the doctor making the diagnosis is now independent of geography.

<img file="AR011237A1_D0036.tif" />

In the built-in embodiment, the iltrasound system is based on a personal computer configuration and performs the functions of the ultrasound machine as a multi-task operating system, as described in US Pat. (Application SN ATL- 140), filed on September 12, 1996. This operational configuration makes it possible to use the ultrasound system for diagnostic tests performed in the normal way while a remote terminal user simultaneously interrogates the ultrasound system with respect to images, reports and information. The multi-task operating system enables the central processor of the ultrasound system to perform normal ultrasonic imaging and network communications tasks in a time-interspersed manner. To the operator in the system and to the interrogator in the remote terminal, their separate functions seem to be executed in real time, without conflict with the activities of the other. This means, for example, that a doctor can monitor the progress of an ultrasound that operates the ultrasound system by recovering diagnostic images and patient reports from the ultrasound system for a patient while the ultrasound is in the process of conducting an exam. of diagnosis of another patient.

The previous web browser screens were acquired from the network server of a fa ultrasound system

<img file="AR011237A1_D0037.tif" />

individual. As indicated above, it is also possible to connect a number of ultrasound systems in a local network using a single server connected to the Internet. The locai network server includes the communication elements 30, 31, 34, 36, 46 and 48 of the ultrasound system of Figure 2. The Web cover of such a locai network of ultrasound systems is shown in Figure 11. As the Netscape address bar shows, the web browser of the remote terminal user accesses the IP address 599.59.9.114 of the HDI server for the local network. The HDI server 234 is the only machine with a connection to, and an address on, the Internet; The ultrasound systems have subnet addresses in the local network, such as hdil, hdi2, hdi3, etc., which are managed by the HDI 234 server. The local network server is illustrated in the lower graphic 234 'of the cover, and above the server are graphics for eight ultrasound systems connected to the local network. Two of the ultrasound systems, HDI 1000 # 1 and HDI 1000 # 7 are highlighted with a solid edge. This highlight appears as a bright color on the network browser screen and indicates that these two systems are currently active on the local network. Clicking on any of them will make the user of the remote terminal reach the cover of the selected system. Clicking on the graphic regarding the HDI 100 # 7 system will link to the local network server.

<img file="AR011237A1_D0038.tif" />

to the HTTP server of the HDI 1000 # 7 system, which will return the cover of the system as shown in Figure 12. From this cover for system # 7 the user of the remote terminal can access reports and images of the patient, eliminate examinations of the system storage, perform diagnostics by the system or connect directly to the System Operation Control to control the operation of the HDI 1000 # 7 system.

An advantage of the local network is that all systems in the network can use the locai server to store ultrasound images and patient reports, making them accessible to doctors who diagnose, which are located far away even when the ultrasound systems are not in operation. When all the ultrasound systems in the network use the HDI 234 server to store their diagnostic results, all the information will be accessible via the Internet even when the ultrasound systems are disconnected for use elsewhere or disconnected at the end of the day. A remote terminal of a user can be connected to the HTTP server 30 of the HDI server 234 and, on the cover of Figure 11, click on the graphic of the HDI server 234, to take the remote user to the web page of the patient directory that is shown in Figure 13. This patient directory page lists the names of all patients with reports or images stored on the HDI 234 server of the local network and the

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<img file="AR011237A1_D0039.tif" />

identity of the ultrasound system in which the patient was examined. The user of the remote terminal can click on a patient name to access the ultrasound reports and images of the patient's exams, or delete the patient records from the HDI 234 server after they have been reviewed by the doctor or filed. At the bottom of the screen the user is able to make a link to the ultrasound systems that are currently active in the local network. If the user of the remote terminal selects the name of a patient from the Web page of Figure 13, the images and reports of the selected patient are retrieved and displayed by the local network server as shown by the patient directory screen of the patient. Figure 14 As in the case of the Web page of Figure 5, hypertext links are made to the ultrasound images and reports from the patient's directory page.

A number of local ultrasound network settings are shown in Figures 15-17. In Figure 15, four ultrasound systems, a personal computer 244, and a local network server 242 are connected in a local network by a connection port 240. Connection port 240 is a simple device for interconnecting several data lines in series and can be obtained commercially at a cost of approx. $ 250 from Farallon Corporation. The hardware of

<img file="AR011237A1_D0040.tif" />

Local network server 242 cannot be more than a personal computer with the network communications elements listed above and with extended storage for Retention of a large volume of ultrasound images and reports stored by the network's ultrasound systems . A user on personal computer 244 can access the local network server and the individual active ultrasound systems of this local network, or intranetwork, of the same channel described above for eternally accessible internetwork.

The conformation of the network of Figure 16 is similar to that of Figure 15, except that the local network is now accessible to the Internet through a gateway 250. As it is expected that most doctors will not want to manage and maintain their own gateways and routers, the gateway will be more commonly made through a modem or high data rate connection to an Internet service provider. For a low monthly service price the Internet service provider can take care of the complexity of the interconnection in networks where the doctor has great confidence but little operational interest.

Finally, Figure 17 illustrates a network configuration by which a physician can directly access his ultrasound system network, with or without the Internet. The connection port 240 is connected to a network / modem 252 to which

<img file="AR011237A1_D0041.tif" />

it can be accessed via wireless or telephone networks 40 from a remote personal computer 100. Using high-level communication protocols such as File Transfer Protocol (FTP) or Network File Sharing (NFS) that use lower-level TCP / IP as a base, the doctor can dial in your network directly and access diagnostic information, without the need for Internet access. For users who require only limited specific access to their ultasound system network, the configuration in Figure 17 provides an easy and secure means for a physician to remotely access their ultrasound system network and its information.

The ultrasound properties of the Internet and World Wide Web of the present invention, when performed in the form of software, can be easily installed as a refinement of an existing ultrasound system without these properties, either by directly installing the software in the system of ultrasound and connecting a modem or network hardware. The software refinement installation can be done remotely as described in US patent (serial application No. 08 / 607,894), or by giving simple instructions to the owner of the ultrasound system through the system manufacturer to allow the owner to install The capacity itself.

<img file="AR011237A1_D0042.tif" />

TABLE 1 / · ** $ Fi lenente: patdir.c $ ** (e) Copyright 1996 Advanced Technology Labs ** All Rightn Hesexued.

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• include &lt;two / two.h&gt;

• include &lt;etdio.h&gt;

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/ ♦ For each of the ».gif files that were saved, display · / / * a reduced image in the browser. * /

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h count ++; iT (h count »6)

Γ printf (&lt;ZTR&gt; \ n *) ih count »0;

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