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  • 1. ECR 2003 Berthold Wein, MDBerthold Wein, MD Dept. Diagnostic RadiologyDept. Diagnostic Radiology University Hospital AachenUniversity Hospital Aachen The Clinical Benefits of IHEThe Clinical Benefits of IHE The IHE Integration ProfilesThe IHE Integration Profiles
  • 2. ECR 2003 7 Selected Problems:7 Selected Problems: (Overview)(Overview) • Seamless workflowSeamless workflow • Data consistencyData consistency • Image presentationImage presentation • Spiral CT examinationsSpiral CT examinations • Information distributionInformation distribution • Image flaggingImage flagging • Parametric reports of imagesParametric reports of images
  • 3. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 4. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Patient Information Reconciliation Unknown patients and unscheduled orders Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps
  • 5. ECR 2003 WorkflowWorkflow • Most critical issue in a Radiology EnvironmentMost critical issue in a Radiology Environment – Inter- or corrupted information chainInter- or corrupted information chain • Paper based informations -> multiple re-entry of dataPaper based informations -> multiple re-entry of data • Different non adapted subsystems don‘t cooperateDifferent non adapted subsystems don‘t cooperate • Error correction takes huge amount of timeError correction takes huge amount of time – Stale informationStale information • Brandnew information not known (cancellation, change)Brandnew information not known (cancellation, change) – Status update informationStatus update information • Exam registered, finished, archived, reported, deliveredExam registered, finished, archived, reported, delivered
  • 6. ECR 2003 ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Images Availability Query FillerOrder Management Placer Order Management Procedure Scheduled PPS In-Progress / Completed PPS In-Progress / Completed Storage Commit Images Stored PPS In-Progress / Completed Present. State Stored Q /R Key Image Note Q /R Presentation SatesQ /R Images Images Stored Storage Commit Key Image Note StoredPresent. State Stored Key Image Note Stored WorkflowWorkflow
  • 7. ECR 2003 Store ImagesStore Images Storage CommitmentStorage Commitment StorageStorage CommitmentCommitment List of ImagesList of Images PACS &PACS & ArchiveArchive RISRIS ModalityModality PerformedPerformed ProcedureProcedure StepStep Performed Step:Performed Step: Status = CompletedStatus = Completed Performed CT HeadPerformed CT Head Pat Name/ID, Dose,Pat Name/ID, Dose, Accession #, Study UIDAccession #, Study UID Complete List of ImagesComplete List of Images A Closed LoopA Closed Loop •Update IS SchedulingUpdate IS Scheduling •Match Procedure with OrderMatch Procedure with Order •Support Billing Based on MPPSSupport Billing Based on MPPS •Avoid Reading Incomplete ProceduresAvoid Reading Incomplete Procedures IHE Scheduled Workflow in RadiologyIHE Scheduled Workflow in Radiology Modality WorklistModality Worklist WorklistWorklist Procedure ScheduledProcedure Scheduled
  • 8. ECR 2003 Data ConsistencyData Consistency • Trauma patientTrauma patient • Manual wrong data entry at the modalityManual wrong data entry at the modality • System crashedSystem crashed • VIP personVIP person
  • 9. ECR 2003 ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Order Placer Performed Procedure Step Manager Modality Worklist Patient Registration Procedure Scheduled Images Availability Query Images Stored Storage Commit Q /R Key Image Note Q /R Presentation Sates Storage Commit Images Stored PPS In-Progress / Completed PPS In-Progress / Completed PPS In-Progress / Completed FillerOrder Management Placer Order Management Patient Update Patient Update Procedure Update Present. State Stored Q /R Images Key Image Note StoredPresent. State Stored Key Image Note Stored Patient Information ReconciliationPatient Information Reconciliation
  • 10. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 11. ECR 2003 Image presentationImage presentation • Viewing on different monitors / systemsViewing on different monitors / systems • Ensuring print quality outside of the departmentEnsuring print quality outside of the department • Radiologist discussing images with remoteRadiologist discussing images with remote physiciansphysicians • Capture image manipulation to avoidCapture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)redundant work (coronal CT, MR reading, etc.)
  • 12. ECR 2003 Consistent Presentation of ImagesConsistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Original Image Window Level Flip Zoom Area Of Interest Annotate Without Consistent Presentation Area Of Interest Achieving Consistent Presentation Presentation StatePresentation State Presentation LUTPresentation LUT Grayscale StandardGrayscale Standard
  • 13. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 14. ECR 2003 • CT/MR:CT/MR: Head bone / brain separationHead bone / brain separation (external/internal)(external/internal) • CR:CR: Foot/ankle - hand/wristFoot/ankle - hand/wrist – e.g., lateral image of foot shared between AP of ankle and AP of foote.g., lateral image of foot shared between AP of ankle and AP of foot • DR:DR: Trauma patient AP / Lat re-groupingTrauma patient AP / Lat re-grouping – i.e., do all the Aps then rotate the patient once then do Latsi.e., do all the Aps then rotate the patient once then do Lats • MR:MR: MRI/MRAMRI/MRA – to be viewed and billed separatelyto be viewed and billed separately • IR:IR: Diagnostic run and therapeutic runDiagnostic run and therapeutic run – performed contemporaneously, viewed/billed separatelyperformed contemporaneously, viewed/billed separately • US:US: Abdomen and kidneys / retroperitoneumAbdomen and kidneys / retroperitoneum and lymphnodesand lymphnodes Re-arranging SeriesRe-arranging Series
  • 15. ECR 2003 MODALITY IHE – Presentation of Grouped ProceduresIHE – Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single exam Operator groups 2 procedures ChestChest ViewView AbdomenAbdomen ViewView RIS / PACS ChestChest ViewView AbdomenAbdomen ViewView
  • 16. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 17. ECR 2003 Information distributionInformation distribution • Therapy related imagingTherapy related imaging – Radiation therapyRadiation therapy – Computer assisted surgery (orthopaedic,Computer assisted surgery (orthopaedic, neurosurgery, ...)neurosurgery, ...) • Image distribution within the enterpriseImage distribution within the enterprise
  • 18. ECR 2003 Access to Radiology InformationAccess to Radiology Information Providing Access to Radiology Information:Providing Access to Radiology Information: – Internally to RadiologyInternally to Radiology – From Other DepartmentsFrom Other Departments Surgery, Oncology, Pediatrics, etc.Surgery, Oncology, Pediatrics, etc. Query and Retrieve ImagesImages Query and Retrieve ReportsReports Image ArchiveImage Manager Image Display Report Reader Report Repository Query and Retrieve PresentationPresentation StatesStates Query and Retrieve KeyKey ImageImage NotesNotes DICOM Based Transactions
  • 19. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 20. ECR 2003 Image flaggingImage flagging • Flag images within a huge CT-seriesFlag images within a huge CT-series • Informations from radiographer toInformations from radiographer to radiologistradiologist • Dedicated image descriptionsDedicated image descriptions • ........
  • 21. ECR 2003 Different notes on different images Same note on different images for referring physician Here you can see the renal rupture. Note1 for referring physician This is the hematoma. Note2 for refering physician Here you can see the renal rupture. Note1 for refering physician This is the hematoma. Note2 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for referring physician Hematoma everywhere Note3
  • 22. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders
  • 23. ECR 2003 Parametric reports of imagesParametric reports of images DiscussionDiscussion Comparison is made to the prior study of 11.04.1999Comparison is made to the prior study of 11.04.1999. The. The leftleft paratracheal lymph nodeparatracheal lymph node ((image 8image 8,, image 11image 11) now) now measuresmeasures 2.5x2.7x3.1 cm2.5x2.7x3.1 cm increasing fromincreasing from 2.0x2.1x2.62.0x2.1x2.6 previously. No other mediastinal, upper abdominal orpreviously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonaryaxillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal.lesions are seen. The yadda, yadda, yadda are normal. ImpressionImpression Worsening left paratracheal adenopathy.Worsening left paratracheal adenopathy. SignatureSignature
  • 24. ECR 2003 Pattern – Simple Image & Numeric ReportPattern – Simple Image & Numeric Report Simply Adds Measurements to Simple Image ReportsSimply Adds Measurements to Simple Image Reports 0-n CONTAIN S HAS OBS CONTEXT 1 CONTAIN S 0-n Report Text Image Reference Observation Context (See section 5.3.2.3)1-n Section Heading Document Title HAS OBS CONTEXT 0-1 Observation Context (See section 5.3.2.3) 0-n Coded Entry 0-n 0-n INFERRED FROM Image Reference Measurement 0-n Measurement 0-n INFERRED FROM Image Reference Measurement 0-n
  • 25. ECR 2003 Simple ImageSimple Image andand Numeric ReportsNumeric Reports • Based on DICOMBased on DICOM SRSR • Allows to includeAllows to include withoutwithout transcription:transcription: - measurements- measurements - Image links- Image links - structured content- structured content • Integrated with theIntegrated with the imaging workflowimaging workflow • Friendly to XMLFriendly to XML implementationsimplementations • Easy to export toEasy to export to the CPR (HL7)the CPR (HL7)
  • 26. ECR 2003 IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset of a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Basic Security Audit Trail Consolidation & Node Authentication Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details
  • 27. ECR 2003 Clinical Benefits byClinical Benefits by IHEIHE • The power of IHE to improve productivity andThe power of IHE to improve productivity and reduce errors is really greatreduce errors is really great • Clinical workflow will re-gain resourcesClinical workflow will re-gain resources • Systems connectivity increasesSystems connectivity increases • =>=> Daily work will become worthwhile againDaily work will become worthwhile again