First of all, an apology to the moderators for not knowing which category I should have posted this thread in. Second, an apology to the readers for the long post.

This task has frankly been eating me alive for the past two months. What the project at hand dictates is finding a cost-effective medium where doctors, technicians, and biomedical engineers can host and share medical images for a single hospital or across hospitals and medical centers (of course with restricted access to specific users without violating the HIPAA act and complying with the ISO 12052 standard for handling and processing DICOM images). The ultimate goal is to find a solution that can be extended to not only on-line viewing but off-line viewing, and which can be used with any kind of PC, smart-phone, and tablet. The solution is not going to be offered for commercial use; on contrary, it is to be provided for under-privileged hospitals and facilities free of charge (runtime costs if any will be covered partially by my co-owned company and partially by donors on behalf of the hospitals and facilities like the UN or International Red Cross Society i.e. IRCS). This would mean that no cost is incurred on the patient's expenses. It's mostly a service we are planning to provide to encourage doctors and physicians to offer their services for these under-privileged facilities and as a tribute to those who work pro-bono.

The current solutions available are problematic for the following reasons:

1) Ultima system (issued by Medsquare): This is the current system we're using at a hospital in Sarafand (where I'm currently handling the project since I have unrestricted access to all patient data as the head biomedical engineer there). It hosts, processes, and archives all medical images sent via an established network between the host workstation (where Ultima is installed) and the radiology equipment. We also extended the system to all the departments via an internal network so that all the physicians can access the medical images for their patients without having to print them out on films. The pros is that it doubles as a host for the images and an archive as well, it can be accessed via any computer hooked up to the network, it gives full processing capability for the images (including measurements, MPR, cine loops, and other common processing techniques like zooming, panning, and contrast control), it gives the option to burn the DICOM images on a CD/DVD (the workstation is hooked to an EPSON CD/DVD printer) with a DICOM viewer (called EzDicomViewer), and its fees constitute maintenance fees and the one-time installation fees. The cons are the main server (located in France at the headquarters of Medsquare) is Windows based and is extremely problematic when it comes to speed (browsing and processing alike), it doesn't allow importing DICOM images from other hospitals (I'm using the ImageWorks software which comes with the Capsula XL II CR to import them and then send them over the network), and its static IP used for the internal network cannot be accessed from computers outside the network. The last point is the real disadvantage seeing that sometimes there are physicians who are abroad or are not present at the hospital who need to access the images as well. Most of these physicians are referring physicians who do not work at the hospital but refer their patients to the hospital for various reasons (the hospital they work at is not properly equipped, the patient is not covered by a specific facility like the NSSF or Ministry of Health, etc...). I tried studying the option of switching from a static IP to a real IP, but the runtime costs are not within the budget (according to our Internet service provider, it would cost 300$/month as basic fee and the runtime costs cannot be speculated). Also, this means that other facilities and hospitals would have to purchase the system which isn't realistic to most of them (not covered by the budget and not completely covered by donors).

2) ImageWorks (by Fuji Film): This is a software which comes with the Capsula XL II CR. The pros are it can double as a hosting/processing and archiving system, it allows importing DICOM and non-DICOM images, and its fees are the maintenance fees and one-time installation fee. The cons are it is only provided with this brand of CR (a hindrance to hospitals which use Agfa CRs or other brands), it cannot be extended over a network, it cannot acquire a real IP, and it can only export images without a DICOM viewer. The later point is not that problematic seeing that RadiAnt DICOM viewer is an excellent portal to view such images.

3) Telepax (by Healthy IT): Much like Ultima, but with the differences of permitting access to anyone with a username and password on any platform (PC, smartphone, and tablet) as long as there is Internet coverage, storing each image on the server for 7 years running (even if the service was stopped by the hospital/facility), as well as being a pay-per-image facility. The last point is great for smaller facilities, but a total nightmare to any hospital with over 40 bed capacity (for example, the hospital in Sarafand has a capacity of 60 beds, so the runtime cost would be 3000$ to 4000$ per month).

4) MyMedPix247.com: A website hosted online which at first glance seemed amazing (it also has an app which is how I stumbled upon it after searching for apps that can read DICOM images): it is free of charge, provides complete hosting, viewing, and processing capabilities, and allows restricted sharing for a group of users under the same institution (controlled by a designated administrator of their choice, typically the biomedical engineer at the hospital/facility). However, when I was giving it a test drive on hosting a dummy DICOM image, Java problems ensued which were deemed to be from their website. When I contacted the support team, I got no reply no matter how much I tried.

I tried a different approach: interconnecting multiple platforms to use their full potential. I started by finding apps that can process DICOM images. I found a couple, but most required the hosting server to have a real IP (like MITK pocket and Infinitt Mobile Viewer). The best option was having Fast Image Viewer as an app on the smartphones and tablets while having the RadiAnt viewer on PCs. The problem was in finding a way to send the DICOM images from the hosting workstation (where all the medical images were stored) to those platforms. The smaller DICOM files (CR and MRI images) were easy to send via emails; the problem lies with larger files like CT scans and PCI cine loops and series which can reach up to 2 GB.

Then I tried compromising a bit: loosing resolution by converting the images with RadiAnt Viewer on the host workstation to JPEGs for CR and MRI images and WMV files for PCI/CORO series (the form is XA). Again, I hit a brick wall finding a way to represent the CT scans without loosing the data needed to perform the proper diagnostics, especially for the 3D reconstructed slices.

I tried asking other biomedical engineers for their input; few were willing to help out (unfortunately) and even they were convinced that the only solution is designating a real IP to the host workstation.

So I am beseeching your help in finding a cost-effective solution to this problem while adhering to both HIPAA and ISO 12052.