Abstract:
A network apparatus system and method of use adapted for viewing, illustrating, consulting and collaborating on medical images and saving images and illustrations in acceptable DICOM format. Specifically, a Consultant Client or a plurality of Consultant Clients having the capability to view still and streaming video medical images, then illustrating over those images with the ability to save those images. Also a Collaborator Client, a person user or a plurality of Collaborator Clients having the ability to remotely view streaming or still medical images and illustrating over those images. The Collaborator Clients can draw, telestrate and annotate over those images with the ability to save those images. The Collaborator Client also has the ability to work in partnership with other Collaborator Clients, each Collaborator Client viewing the same medical image and each illustrating on the image and each being able to view all users illustrations and medical image simultaneously.

Description:
FIELD 
       [0001]    The invention relates generally to a medical apparatus and method of using the same for receiving and transmitting medical images and audio signals in real time allowing operators to concurrently annotate and telestrate in real time. The invention acquires medical images and through an input device, the operators electronically concurrently collaborate, generally by telestrating, annotating, sketching image overlaying on a captured medical image and can save those images in a DICOM format. 
       BACKGROUND 
       [0002]    This invention relates to a medical imaging real time viewing videoconferencing system, more particularly an apparatus and method of using said medical imaging videoconferencing system with multiple input operators or participant clients viewing each other&#39;s inputs collaboratively and concurrently. 
         [0003]    Videoconferencing systems are becoming more commonly used to conduct meetings and share information, including in the medical field. Participants are typically geographically separated and wish to share ideas and thoughts as they participate in the conference. With such a videoconferencing system, audio and video signals are transmitted over a communication link, such as telephonic, to be reproduced at a remote videoconferencing system so the parties can see and hear each other. In many cases, the videoconferencing systems can support video images allowing each party to view moving camera images, as well as other screen displays. Videoconferencing systems are used in many different ways. Some of the most common is to share computer graphic presentations, such as a POWERPOINT® slide presentation where a user shares his or her slide presentation with others in the conference. The parties can also share video images. The operator uses the available conferencing system and Super Video Graphic Array (SVGA) as a method of viewing these video signals to document and provide camera images on the user&#39;s computer or laptop. 
         [0004]    Past videoconferencing systems have many disadvantages, including but not limited to, if a participant has a question on a slide or aspect of the presentation, the presenter must control the images to scroll back to the location in question and must toggle through the slide presentation to answer the participants&#39; question. Also, in most conferencing systems, the presenter has control over the presentation, and the participant has no control over what other participants can view. 
         [0005]    Recently many inventors have seen the need to allow a plurality of clients or users to collectively collaborate on presented work. These systems allow two or more users of the internet to move or modify Hyper Text Markup Language (HTML) documents with referring to the same. These systems work with browsers and web sharing managers provided in the shared client computer system of a source and receiver, and are constructed in such a manner that the web sharing manager of the shared client computer system of the receiver can receive the event message of the source from the web sharing manager of that source. Accordingly the event message is shared by the source and receiver, and the displaying and controlling of the same web page are simultaneously realized on the shared client computer system. Even further still, as incorporated by reference U.S. Pat. No. 7,310,657 to Nakamura describing in summary, a computer system comprising a plurality of user systems connected to each other being adapted to display a work area on a display screen, alternatively a plurality of users&#39; systems connected to each other though a computer network. In Nakamura user systems include: collaboration work controller having a user management table for registering a node identification code given for each of the user systems and owner identifier related to the node identification code, and an object management table for registering object information related to the node identification code; and an obtainer for obtaining, based on an event entry for an object, the node identification code related to the object by referring to the object management table, obtaining the owner identified related to the obtained node identification code by referring to the user management table, and displaying the object on the screen in the manner that the obtained owner identifier can be discriminated from owner identifiers of other objects. Nakamura shows a display screen where users are participating and collaborating in work drawing annotations simultaneously. The owner identifier identifies the user for each object the owner identifier is displayed to the user watching the display screen with the entry (drawing) of the object from the other user. In other words the owner can be identified; it is possible to identify the owner of the object of the collaborative work easily. Each system runs from each system and does not work from a server but merely each computer runs individually over a network. 
         [0006]    However, in past systems the computer arrangement can be summarized as a plurality of users systems connected to each other, each being adapted to display a work area on a display screen or connected through a computer network. Collaboration of work is done on each system by use of a management table for registered node identification codes given for each system user. That is, every computer system, or one system, requires (as in Nakamura) storage of collaboration user identifier in at least one of the user&#39;s computer system. The inventor of this novel concurrently collaborative communications device and method for use has improved upon the past art by allowing server master control allowing for faster and more efficient performance as well as allowing for a medical Digital Imaging and Communications in Medicine (DICOM) environment. As this invention improves upon and applies in a concurrently collaborative environment in real time, and allows for each user to collaborate simultaneously with all users viewing every other users&#39; work product, as the work product is being created, all coincident with image including video and audio, wherein the medical image is based on a server and the illustrations are appended to that image. 
         [0007]    The traditional way of capturing an image on a medical imaging apparatus commonly called a modality, generally consisted of an operator or technician first conducting a scan. Then, using the modality to save the image, in still or motion video format, into the modality memory or into a main image storage database. Soon afterward, perhaps downloading the image into a hospital database such as a PACS system, Picture Archiving and Communications System (PACS) or PACS server, or medical imaging archives for storage and later retrieval. Herein after referred generically as PACS. PACS can be further defined by; a storage and management system for medical images. Typically, pertaining to the medical field, images such as x-rays, MRI&#39;s and CAT scans require a greater amount of storage than other images in other industries. The doctor would then access the PACS system to retrieve the image, the doctor at that time would call up the image, view and review the image, and conceivably develop a diagnosis based on the information from the image. This system imagery is viewed by a user and diagnosis made without image delay and the user accomplishes all these tasks in real time. Real time referring to events simulated by a computer at the same speed that they would normally occur in real life. In graphics animation, for example, a real time program (such as this inventors system) would display objects moving across the display at the same time they would actually move, or in the case of this invention, a collaborator client views the image in real time and collaborates from client to client with no perceivable delay to any client. The illustrated embodiment is comprised of three essential components, one called Tele Medicine Imagine Management System (TIMS) Server, another called the TIMS Collaborator™, and a third called the TIMS Streamer. The TIMS Server is a computer that manages users, security, licenses, streams, channels and sessions the TIMS Collaborator™ system (i.e. this invention described herein) allows for multiple users in multiple locations to concurrently collaborate on the images, each user to input highlighted graphic electronic traces and annotations over the medical image. TIMS is also a system that allows one or more users located remotely to the imaging modality, to analyze, discuss, and save such analysis or discuss in a clinically relevant manner. Each user is able to view and comment on each of the users input concurrently in real time. The TIMS Streamer server is a device that processes any video output from a video source into a stream. A Stream is defined as at least one image frame that defines a time progression of output from a video source. 
         [0008]    In one embodiment, the TIMS server provides the real-time video and audio communication, as well as a method of recording and transmitting images in DICOM format. DICOM, Digital Imaging and Communications in Medicine, is a medical imaging standard common in the medical industry. DICOM can also be defined as a standard in the field of medical informatics for exchanging digital information between medical imaging equipment (such as radiological imaging) and other systems ensuring interoperability. DICOM, including protocols for device communication over a network, syntax and semantics for commands and associated information that can be exchanged using protocols, a set of storage services and devices claiming conformation to the standard, as well as file format and medical directory structures to facilitate access to images and related information stored on media that shares information. The embodiment can serve as the connection point between any medical imaging modality and a hospital PACS, medical archive or other image repository. This Invention, the TIMS server is able to connect DICOM equipment and older non-DICOM equipment to a hospital network, allowing imaging studies to be stored in PACS. The TIMS Collaborator™, this invention described herein, briefly described as a trace overlay and annotation system that users can collaborate with each other in real time, each viewing each other&#39;s object inputs and those object inputs can be stored with the DICOM data and viewable in PACS. 
         [0009]    The inventor has developed a novel and simple apparatus and method of using the same, to allow a group of persons to concurrently collaborate on a computer system, with each participant viewing each other&#39;s telestrations and annotations in near real time. 
       SUMMARY 
       [0010]    The invention relates generally to a multimedia collaborative conferencing system and method of using the same for generating telestrations and annotations on medical images concurrently with other users. The apparatus includes a medical image acquisition system adapted for receiving and transmitting medical images, constructed from, a computer having communications capability adapted for acquisition and transmission of a plurality of medical imaging and video signals. Wherein the medical image and video signals are acquired at the medical device&#39;s native resolutions, transmitting the signals at their native resolutions and native frame rates to a receiving device, receiving the medical imaging video signals in analog or digital form, and if required, compressing and/or scaling the signal, converting the signal to digital form for transmission, and transmitting the digital signals to a display device. A computer can be defined as typically made of several components such as a main circuit board assembly having a central processing unit, memory storage to store programs and files, other storage devices such as hard drives, and portable memory storage, a power supply, a sound and video circuit board assembly, a display, and an input device such as a keyboard, mouse, stylus pen and the like allowing control of the computer graphics user interface display, where any two or more of such components may be physically integrated or may be separate. Any user on the network can store files on the server and a network server is a computer that manages network traffic. The medical image acquisition system is capable of acquiring signals from a plurality of medical imaging systems including but not limited to, ultrasound, Computer Tomography (CT) scan, fluoroscopy, endoscopy, magnetic resonance imaging, nuclear medicine, echocardiogram ultrasound and microscopy, such signals from medical equipment is also know as modalities. The medical receiving device receiving the video image signal in a plurality of video sources, including but not limited to, S-video, composite color and monochrome, component red blue green video (RGB, three additive primary colors), Digital Visual Interface (DVI), any video transport protocol including digital and analog protocols, high definition multimedia interface (HDMI, compact audio video interface uncompressed digital data), serial digital interface (SDI), and DICOM video in their native, enhanced or reduced resolutions or their native, enhanced or reduced frame rates. The apparatus including a storage device adapted for archiving the video signal in a predetermined digital format including Digital Imaging and Communications for Medicine (or DICOM), Audio/Video Interleaved. Transmitting data includes transmitting the data using secure encryption protocols and transmitting video signal resolution at the same resolution as the received signal. In one illustration, a remote location communicates with the networked computer, for the purpose of collaborating and conferencing. 
         [0011]    An apparatus and method for using the same for concurrent collaboration between users, collaborating by video, audio, telestrations and annotations, including collaborating on medical images that are typically accessed on a storage server database, imaging archives, or continuous streaming video. The streamer server continuously streams images to the TIMS server. Any number of clients can request information from the TIMS server, each client in a conference with another or other clients can view all the clients object inputs as they occur. A client includes a user, typically a person who has interest in using the system for medical review and diagnosis of patient image data. The TIMS server keeps track of all steaming devices that have streams available and show it as such to the consultant clients and collaborator clients and any conduit between. The TIMS server provides continuity with the PACS system and stores information on all the clients. The TIMS server includes: a manager, this component controls the streaming requests to the streamer server and also manages the licensing tasks for the TIMS server, an administrative interface that manages users information, roles information, session information, TIMS server configuration, streamer server configuration, web services wherein the web service interacts with the consultant client and collaborator client, performing such services as sending studies to PACS, retrieving studies from PACS, retrieving study and patient information from a DICOM modality worklist server (DMWL), sending media for a collaboration session to the client participants of that conference, PACS server configuration, text chat information; a DICOM send service, wherein the DICOM send service retrieves the list of studies from the PACS server and sends the studies to the clients. A study being defined as medical images and patient data combined, while a DICOM Modality WorkList is defined as patient and hospital demographic information, including procedure information. 
         [0012]    The TIMS server also manages all the illustration overlays, specifically, the entire client input, sketches, drawings, telestrations and annotations. Illustrations is defined herein as any user input such as but not limited to drawings, sketches, telestrations, letter character text and numeric character text. All illustrations are managed by the TIMS server based on a file sharing scheme where new illustrations keep getting appended to the file on the TIMS server. Only a copy of the populated file is locally maintained on each client&#39;s computer. This approach of appending files on the TIMS server significantly improves performance and reduces image wait time, unlike the prior art approach of each computer having to update the image file and send it. This process of multi layer multi user illustration appending and updating on the TIMS server on any underlying image, including video, without sacrificing bandwidth is novel to this invention. Appending the files to the server periodically can be performed in a synchronous manner or asynchronous manner. Moving images with illustrations back and forth from a computer to a server, results in losing illustration quality or consuming more bandwidth. However, this novel invention appends only the illustration file to the TIMS server. All client computers use a local registration method process, local to the frame used for viewing. Each client is able to use a scalable window so all illustrations are ratio metric based on the underlying image aspect ratio. Therefore, all the illustrations always point to the part of the window and image as originally intended, regardless of window size on the clients computer display. For example, from the TIMS server, the streaming images and the client&#39;s computers that are capturing those images are used in a collaborative session. First, the files are distributed to all the participating clients. A central frame counter originating in the client computer of the person who has play/pause control merely issues frame synchronization commands to synchronize the stream on all client&#39;s systems. This method significantly reduces bandwidth and improves responsiveness of the system. Synchronization can further be optimized by periodic synchronization signals used by the session initiator/controller such that every so many frames are confirmed to be synchronized. The client computer also sends a synchronized command whenever the computer image is paused, thus ensuring that the same frame is available to all participating clients by broadcasting the pause frame number along with the pause command to all participating clients. Client participants can receive video streams directly from the streamer server using a local area network. The invention can also detect if a user has low bandwidth and can compensate by only sending selected frames of the image to that user or if initiator pauses on a frame can send that frame to users. An example of this is that the server sends every third or firth frame of a video to one client so that client does not have any perceivable delay due to low bandwidth. However, client participants using the internet must receive all streams from the TIMS server. This is done to add a level of security so images do not go over the internet without encryption. 
         [0013]    Participants can take several roles. The users can view live streaming video, view selected live streaming video, capture still or motion video, view captured streaming video, and add multiple channels dynamically. In addition, a Consultant Client application is a collaborative, interactive, synchronous or asynchronous media annotation system, which will be used in medical files, used to enable users to collaborate and interact on archived medical images for clinical review and discussions and deciding on relevant medical procedures. The Collaborator Client can perform all of the functions of the Consultant Client, as well as communicate with another or other participating clients, by adding annotations in text or drawing form, text chat, query, save, and retrieve studies to and from PACS, and retrieve study and patient information from a DICOM Modality WorkList server (DMWL). 
         [0014]    Communication between components is summarized as follows: The client (either the Consultant Client or Collaborator Client) sends a request to view a stream to the TIMS server. The TIMS server sends that request to the streamer server. The streamer server provides the stream to the requesting client directly, if connected through a local area network or through the TIMS server, if connected to the internet. When the client sends a request to stop the stream, the TIMS server notifies the streamer server to stop streaming to that client. TIMS server communication with a PACS server is as follows: the client sends a request to the TIMS server to store and/or retrieve studies from the PACS server. The DICOM send service either retrieves the file and sends it to the client, or sends a command from the client to the TIMS server and saves the study as a DICOM file and sends it to the PACS. 
         [0015]    This invention allows for two different types of user participants as defined herein, first is a Consultant Client and the other is a Collaborator Client. The Consultant Client communicates with the TIMS server by retrieving live streams from the streamer server, and in some cases, can capture the stream and view it. Consultant Clients, which can view streams through setting up channels on the network, having the ability to freeze frame streams, illustrate and save. However, the Consultant Client does not collaborate over the network with others. The initiator of the session or host consultant client can illustrate over the image with other consultant clients merely viewing the image and illustrations. An example of this would be a teacher illustrating a surgical procedure to students who merely watch. The Collaborator Client communicates with the TIMS server by retrieving streams from the streaming server, saving and retrieving studies to and from a PACS server, and retrieving patient information from a (DMWL). Collaborator Clients can communicate with each other through collaboration sessions. The Collaborator Client has all the features of the Consultant Client, plus the added functionality of creating illustrations and annotations, while collaborating with others in a session, saving the collaboration session as a DICOM file and have the ability to send the file to a PACS server or other destinations. 
         [0016]    The DICOM send service communication with the TIMS server database checks the patient studies and uploads them in the TIMS server database and saves those studies into a DICOM format and sends those studies to the PACS server. The TIMS server manager communicates with the database, checks the request from clients in the database and notifies the streamer server to start and stop streaming. The web server communicates with the PACS server, which retrieves requested study information from the PACS server. The web server also communicates with the DICOM Modality Work List server and retrieves the patient information needed as part of the study information. The TIMS server and Consultant Client communicate as follows: the Consultant Client is first authorized and then, after authorization, can send a request for a live stream to the TIMS server, the TIMS server notifies the streamer server to start or stop steaming to that client. 
         [0017]    Users or participants, viewing images from a medical modality concurrently collaborate with each other through a collaborative session. These users or participants are also known as Collaborator Clients. Two or more users can concurrently collaborate in a given session. One user can initiate the collaboration session and the other users can enter the session and actively participate in the collaborative session. The initiator can share media (such as a medical modality image) in the collaboration session with it being visible to all participants. All users can add annotations on the media using the draw control on their computer. All the annotations added by any user are available and visible to all the collaboration participants. In addition, users can add telestrating drawings, text annotations, voice annotations, and video annotations to the collaboration as well. Telestrating is defined herein as a device allowing its user to draw a sketch over the medical image. Furthermore, each participant can also use the system to chat with each other using a text chat facility. A separate text computer window box is displayed that allows for each user to instant message each other in text format in a separate window application. One feature of the present invention is that the initiator can disable the edit control of any participant, such that a particular participant will not be able to add or edit the annotation or telestration. At this point, that participant can only view the annotations made by others users. Another feature of the present invention allows the initiator to pass control of the video stream start/stop/pause functions to another participant. This control feature can be edited to enable or disable the functionality to all participants or selected participants and can be done at any time during the collaborative session. 
         [0018]    The invention also works with personal digital assistants Participants (PDA) clients can use these PDAs to view, consult and collaborate. Personal digital assistant is any small mobile hand held device that provides computing and information storage such as hand held computers, phones, media display devices with storage and palm top computers. 
         [0019]    The principle preferred embodiment and modes of operation of the present invention have been described in the forgoing specification. The invention which is intended to be protected herein, however, is not to be construed as limited to the particular embodiments disclosed, since these embodiments are to be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the spirit of this invention. Accordingly, it is expressly intended that all such variation and changes which fall within the spirit and scope of the claims be embraced thereby. 
     
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         [0020]    Other objects, features, and advantages will occur to those skilled in the art from the following description of an embodiment and the accompanying drawings, in which: 
           [0021]      FIG. 1 , shows a block diagram of the invention. 
           [0022]      FIG. 2 , shows a block diagram of a portion of the system. 
           [0023]      FIG. 3 , shows a graphic user interface screen shot of client source select display. 
           [0024]      FIG. 4 , shows a graphic user interface screen shot of client source image with illustration tool bar and collaborate function. 
           [0025]      FIG. 5 , shows a graphic user interface screen shot of client selecting participants to collaborate with. 
           [0026]      FIG. 6 , shows a graphic user interface screen shot of collaboration initiated. 
           [0027]      FIG. 7 , shows a graphic user interface screen shot of collaboration session including medical image and illustrations. 
           [0028]      FIG. 8 , shows a graphic user interface screen shot of client assignment of control to participants. 
           [0029]      FIG. 9 , shows a graphic user interface screen shot of list of multiple collaboration sessions. 
           [0030]      FIG. 10 , shows a graphic user interface screen shot of patient image study information. 
           [0031]      FIG. 11 , shows a graphic user interface screen shot of patient database information. 
           [0032]      FIG. 12 , shows a graphic user interface screen shot of administrative controls. 
       
    
    
     DETAILED DESCRIPTION 
       [0033]    A network apparatus  1  system for allowing users to concurrently communicate; concurrently collaborate, and concurrently consult while viewing medical images  13  on a display screen using sketched and annotated client participant input illustrations over a medical image  13  among a group of remotely located participant clients. 
         [0034]    The network apparatus having a TIMS server  2  including associated data base in communication with a local area network  3 , in some circumstances connected to and having access to a medical PACs server  4  including associated data base all capable of using standard medical DICOM protocol and all having access to a DICOM modality work list server  5  including associated data base providing medical patient information. 
         [0000]    To collect medical images  13  the system together with at least one streaming server  6  in contact with the local area network  3  wherein the streaming server  6  is providing images to the local area network  3  as it receives images from modality  7 , 8 , 9  such as but not limed to, ultrasound, fluoroscopy and video. A participant client can view medical images  13  including telestrating  22 , drawing  23  and annotating notes  24  (or known as illustrations herein) over that image and saving the image with illustrations on a local storage device the collaboration client  10  all connected to a local area network  3 . The local area network  13  for this illustration is a local area network within a hospital. In addition to viewing, illustration  21 , 22 , 23  and locally saving the participant can also use the collaborative consultant client  11  option of the system. A user participant or several user participants ( 10 , 11 ) exchanging ideas and thoughts as Collaborative Clients  10  all connected with a local area network and all having access to the internet  12 , the local area network  13  having two way communications to the internet. 
         [0035]    This system allows for a plurality of Consultant Clients  11  using the apparatus at the same time, as used by this system, the Consultant Client can view medical images and create illustrations over those medical images  13  such as drawing and telestrating, then storing those medical images on a client computer storage device. Different from the Consultant Client  11  where the Collaborator Client  10  can simultaneously draw  21 , telestrate  22  and annotate  13  over medical images  13  the Consultant Client cannot view any other user performing the drawings, telestration and annotations that is the consultant client  11 , wherein the Collaborator Clients can collaborate with each other showing the medical images  13 , drawings  21 , telestrations  22 , and annotations  23  on all client computers at the same time and in real time. Also the Consultant Client  11  can save images locally. The network apparatus system  1  also allows users to concurrently collaborate, as defined by this system, client participants input illustrations  21 , 22 , 23  over a medical image among  13  a group of remotely located participant clients  10 , 11  in other words, there is a plurality of collaborative clients  10  (user participants) using the system simultaneously, the plurality of collaborative clients  10 , retrieve and view medical images  13 , create illustrations  21 , 22 , 23  over medical images  13  such as drawing  21 , annotating  23 , telestrating  22  and storing medical images  13  with illustrations  21 , 22 , 23 , and concurrently viewing all of the collaborative clients inputs  21 , 22 , 23  as they happen and can store all the input  21 , 22 , 23  from all collaborative clients  10  on the local computer storage device, on the PACS server  4 , and on the TIMS server  2  all in DICOM format. In one embodiment the system over the internet  12  can use a personal digital assistant (PDA). 
         [0036]    A method for allowing a plurality of participant clients to concurrently collaborate on medical images  13 , all participants running substantially the same program on each of the clients computers storing the program on each of the clients&#39; computers. Each participant displaying the graphic user interface output  25  of that program on their computer display. Each computer linking the client computer to the TIMS server  2  using a local area network  3  all clients, whether Collaborator Clients  10  or Consultant Clients  11  have access to the local area network  3  and internet  12 . The TIMS server  2  providing licensing permission to each client wherein linking the client to a DICOM Modality worklist server  5  a PACS server  4  for viewing medical images  13  a streamer server  6 . Also the local area network  3  can be linked to the internet  12 . 
         [0037]    Streaming images into a local area network  3  wherein the streaming server  6  having an associated data base in communication with a medical image modality  7 , 8 , 9  acquiring images, streaming images those images to a local area network  3 . A streaming server  5  having an associated data base, the streamer server acquires a list of available medical image modalities from a local area network  3 . Included in this network is a TIMS server  2  having an associated database, identifying each client and the streaming data available to each client; identifying on each client the streaming data that is available on each client&#39;s computer. Also as part of the local area network  3  can be connected to the internet  12 . 
         [0038]    When the client wants to view medical imagery, the client selects a streaming image so he/she can initiate a collaborative or consultant session. As the client is in a session, the system is providing updates to each client&#39;s computer at a rapid frame rate so each client computer is perceivably displaying the same image. In other words, the TIMS server  2  periodically updating the medical image to each of the client&#39;s computers with synchronized signals sent over the local area network  3  such that all images on all client computer displays are the same, including sending clients drawing, annotating, and telestrating illustrations  21 , 22 , 23  over the medical image  13  whenever a participant client pauses. Thus ensuring the same frame refresh rate is available on all client computers wherein each client views what every other authorized client in that session view. Allowing at least one client to draw  21 , annotate  23 , telestrate  22  illustrations over the medical image  13  in a currently collaborative session wherein a client is drawing  21 , annotating  23 , telestrating  22  over the medical image  13 , the client is drawing  21 , annotating  23 , telestrating  22  over the medical image  13  and the computer software working over the network  13  replicating the medical image  13  along with the drawing  21 , annotating  23 , telestrating  23  on all other client computer displays. The image is viewed on a client computer but remains on server as participant creates illustration, the file is appending to the server. Then replicating image streaming to all clients, managing client annotations, in addition to saving on the TIMS server, the user can save the image locally on a computer storage device having the created illustrations of all the concurrent client participants on each of the clients computers. And the software working with the computer can save and store the medical images  13  having the overlaid drawn  21  annotated  23  and telestrated  22  image in a PACS server  4  having an associated database using the DICOM format, and saving the session in a DICOM format. 
         [0039]    An illustrative example how a client would use the system to collaborate on a medical image  13  and how the graphical user interface  14  is seen by the client as the client initiates and works on a collaborative session. The client participant logs onto his/her computer and accesses the local area network  3  whether the client is within the network or enters through the internet  12 . Client opens the preloaded collaborator software. Client then uses his/her input device such as a mouse to select or click on the streaming tab, more than one client can select the streaming tab and they will view the live video at the same time on their computer display. After client selects the streaming tab, a list of available streams ( FIG. 3 ) are displayed and the client participant can choose from one of those selections  15 . At that time, if the client wishes to collaborate on a live streaming ultrasound image,  13  the participant can collaborate ( FIG. 7 )  15 . In this case, one collaborator client  10  (initiator) initiates the session and collaborates with a second collaborator client, client  1 ,  24 , the initiator can decide to request additional clients to join the collaboration session if desired. In addition, a user can query the system for PACS data ( FIG. 11 )  17 . The client can draw  21 , telestrate  22  and annotate  23  over the image as he/she sees fit  18 . The client participant  10 , 11  uses prearranged computer software radio buttons located on the tool bar of the graphical user interface  25  to select what type of illustration  22 , 23 , 24  he/she wishes to use to comment over the medical image  13 . For instance, the participant can select to draw a line  26 , a rectangle  27 , an oval or circle  28 , an open spline  29 , or closed spline  30 . The user participant  10 , 11  can also select a radio button for arrows  31 , free hand telestrate  32  drawing free hand using movement of input device such as a computer mouse, annotate (standard alpha and numeric characters)  33 , and can even annotate with a pointer arrow  34 . The client host, known as the initiator, can select the collaborator radio button  16  tab to collaborate with others (FIG.  5 , 6 ). Clients can also view administrative controls such as user id, client name and email address, roles, status and the like  19 . Now, a plurality of clients can all view the same image and can all draw, telestrate and annotate (illustrations)  18  and all can see each others work ( FIG. 7 ), as each client draws and annotates  18  on the display, all other clients can view the drawing and annotations simultaneously. In addition, the clients can use the chat function and send to all participants, or selected participants instant messages during the session. To differentiate the different illustrations and annotations apart from one another or from client to client, each client is drawing in a unique color. For example, the first clients&#39; illustrations show up in red  22  (initiator  10 ,  11 ) and the second clients (client  24 ) illustrations appear in yellow and so on. One added feature of the system is that the host (client who initiated the session) can control who is invited to the session and who can illustrate ( FIG. 8 ,  9 ). After the clients are satisfied with all the illustrations and agree to save the work, the image with the selected illustrations can be saved in DICOM format including having patient data within ( FIG. 10 )  20 .