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With the current advancement of the information technologies and the growing demand for data sharing, the risk of private data leakages increases. Moreover, the aggregation of multiple data, required for improving quality, may favor the prediction of unrevealed private and sensitive information, in particular in the medical data. Thus, with the current laws and regulations (GDPR, CNIL, HIPAA, etc.), it becomes required to protect the privacy of the patients when dealing with their sensitive data, and in particular when sending them outside the clinical site. Inline with this objective, the data anonymization and pseudonymization emerged among the solutions for safely sharing private data with remote peers. In this work, a particular interest is given to the pseudonymization of the DICOM Real-Time Video (DICOM-RTV) associated metadata that can be generated inside the operating room (OR), and shared via a streaming technology. The pseudonymization, by definition, includes both the notion of de-identification and re-identification, necessary for ensuring patient safety. Thus, the main objective of this paper is to define and conceptualize an architecture for de-identifying DICOM-RTV metadata on-the-fly before streaming them together with the DICOM-RTV video of the ongoing surgery outside the medical facility in real-time.

International audience; With the current advancement in the medical world, surgeons are faced with the challenge of handling many sources of medical information in more and more complex and technological Operating Rooms (ORs). Obviously, in the next generation ones, there will be an increasing number of video flows during the surgery (e.g. endoscopes, cameras, ultrasounds, etc.), which can be also displayed all over the OR in order to facilitate the task for the surgeon and to avoid any adverse events or problems related to inadequate communication in the OR. Additionally, other information needs to be shared, pre/post/during an operation, such as the history of the digital images related to the patient in the PACS and the metadata coming from medical sensors. Moreover, these medical videos captured from the OR can be either displayed on a large screen in the OR in order to provide the surgeon with more visibility, in this case via DICOM-RTV, or streamed outside the OR via a P2P solution. The latter one can serve various purposes such as for teaching medical student in real-time or for remote-expertise with a remote senior surgeons. Hence, this paper addresses the challenges of streaming DICOM-RTV video and metadata flows live from the operating room, typically during an ongoing surgery, in real-time to the outside world. A Proof of Concept is also presented in order to demonstrate the feasibility of our solution.

In order to overcome the challenges of managing real-time transfer of video, and/or audio, and associated medical metadata inside the medical theaters (e.g., operating room), a new DICOM communication service standard emerged. Its main objective is to deliver synchronized videos (potentially synchronized with their corresponding metadata) in real-time to surgeons during a surgery inside an operating room. Moreover, it allows, on one side, the transmission of real-time videos to subscribers with a quality of service comparable to the one inside the operating room, and on the other side, provides a standard that will allow the interoperability between the different medical equipment that produce/consume the media essences. This new DICOM extension is called DICOM Real-Time Video (DICOM-RTV). This paper is an introduction to this extension. It mainly presents the different challenges solved by this extension, illustrates it with relevant use cases, and provides the global architecture of the DICOM-RTV system. &nbsp