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IHE Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I)
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IHE Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I)

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Chris Lindop, IHE Radiology Planning Co-chair

Chris Lindop, IHE Radiology Planning Co-chair

Published in: Health & Medicine, Business

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  • 1. Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I) Chris Lindop
  • 2.
    • Sharing of Imaging Information across health enterprises
    • Imaging Information includes
      • extensive sets of DICOM instances including images, evidence documents and presentation states
      • diagnostic reports provided in a "for display" form
      • selection of diagnostically significant images associated with the report content
    Abstract / Scope
  • 3. Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network PACS B PACS A Radiology-to-radiology Radiology-to- Physicians
  • 4. Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Cross-Enterprise Registry
    • Patient Id= 3547F45
    • Report 5/21/1998 : CT Head  B
    • Study 5/21/1998 : CT Head  B
    • Report 2/18/2005 : Chest Xray  A
    • Study 2/18/2005 : Chest Xray  A
    PACS B PACS A
  • 5. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Cross-Enterprise Registry
    • Patient Id= 3547F45
    • Report 5/21/1998 : CT Head  B
    • Study 5/21/1998 : CT Head  B
    Query for Documents Register Imaging Information for sharing Prior imaging Reports & Studies Register Imaging Information for sharing
  • 6. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Cross-Enterprise Registry Register Imaging Information for sharing Notification of Doc Availability Register Imaging Information for sharing
  • 7. Physicians and Systems within a Regional Health Network for a Routine Imaging Referral Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network Cross-Enterprise Registry
    • Patient Id= 3547F45
    • Report 5/21/1998 : CT Head  B
    • Study 5/21/1998 : CT Head  B
    • Report 2/18/2005 : Chest Xray  A
    • Study 2/18/2005 : Chest Xray  A
    Prior Imaging Report & Study Query for documents Imaging Report & Study Notification of Doc Availability
  • 8. Value proposition
    • Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc.
    • Effective means to contribute and access imaging documents across health enterprises.
      • Without XDS-I, access to the radiology report across health enterprises is difficult
    • Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems.
    • Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest
      • with the same mechanisms used to query other documents
  • 9. Value proposition
    • Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager.
    • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain.
    • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report)
    • Document Content Neutral: Document content is processed only by source and consumer IT systems.
    • Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches .
  • 10. XDS-I Dependencies
    • XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS)
    • New Actors
      • Imaging Document Source
      • Imaging Document Consumer (should be grouped with Document Consumer)
    • Same Actors as in XDS
      • Document Consumer
      • Document Registry
      • Document Repository
    • Added extension to support imaging data (images and reports)
  • 11. Document Consumer Retrieve Document Query Documents Patient Identity Source Patient Identity Feed Imaging Document Source Document Registry Document Repository Provide & Register Document Set Register Document Set Imaging Document Consumer Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve XDS-I Actors and Transactions
  • 12. XDS-I New Transaction requirements
    • XDS-I Actors:
      • Imaging Document Consumer
        • at least one Retrieve ( [RAD-55], [RAD-16], [RAD-17], [RAD-27], [RAD-31] [RAD-35])
      • Imaging Document Source
        • Provide and Register Document Set [RAD-54]
        • WADO Retrieve [RAD-55]
        • Retrieve Images [RAD-16], Retrieve Presentation States [RAD-17] Retrieve Reports [RAD-27], Retrieve Key Image Note [RAD-31], Retrieve Evidence Documents [RAD-45]
    • XDS Actors
      • Document Repository
        • Provide and Register Document Set [RAD-54]
  • 13. Options
    • Imaging Document Source must support at least one of the following options:
      • Extensive Set of DICOM Instances
      • PDF Report
      • NEW Text Report wrapped in a CDA Document
      • NO Text option
      • NO multipart Text / PDF option
  • 14. Sharing of Extensive DICOM Instance Set
  • 15. Document Registry Document Repository Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Manifest Manifest Clinical Encounter Clinical IT System Query Registry Manifest Retrieve Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Retrieve Images Register Manifest Manifest
  • 16. Sharing of Extensive DICOM Instance Set
    • The shared Document is a manifest
      • a Key Object Selection DICOM Instance
        • title : manifest
    • Imaging Document Source is required
      • to ensure that the referenced images from within a published manifest are available to be retrieved
    • Imaging Document Source is responsible
      • for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the manifest)
  • 17. Sharing of Imaging Report
  • 18. Radiology system Report Source Text wrapped into CDA Report PDF Report … .. Findings: Header : Report Type: OB / Gyn BPD ... … .. Radiology Report Impressions : Gestational Age ...
  • 19. Radiology system Report Source Document Registry Document Repository Report Report Clinical Encounter Clinical IT System Query Registry Retrieve Report Register Report Report … .. Findings : Header : Report Type: OB / Gyn BPD ... … .. Radiology Report Impressions : Gestational Age ...
  • 20. Sharing of Reports
    • The shared Report Document format is
      • PDF, Text wrapped in a CDA
    • A report can
      • embed selected images in its PDF format
      • include fully resolved hyperlinks (interactively clickable) that point to the selected images
    • Imaging Document Source is responsible
      • for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document
    • Imaging Document Source is required
      • to ensure that image references are valid links
  • 21. XDS-I Actors / Grouping
    • No specific grouping requirement on Imaging Document Source, however:
      • Imaging Document Source is responsible of ensuring published images in a manifest are available to be retrieved
    • Imaging Document Consumer shall be grouped with a Document Consumer
  • 22. Linking Report to Complete Set of Images Document Repository Document Registry Study Manifest Report Document Entry Document Entry Submission Set
  • 23. Linking Report to Complete Set of Images Document Repository Document Registry Document Entry Submission Set 1 Report Document Entry Submission Set 2 Study Manifest
  • 24. Linking Report to Prior Images and Prior Report Document Repository Document Registry Document Entry Submission Set 3 Prior Study Manifest Document Entry Submission Set 1 Prior Report Document Entry Submission Set 2 Report Document Entry Submission Set 4 Study Manifest
  • 25. Linking Report to Selected Images Radiology system Report Source … .. Findings : Header : Report Type: OB / Gyn Radiology Report Relevant Image Gestational Age ... WADO URI Link to image BPD ... … ..
  • 26. XDS-I Metadata
    • Radiology specific
      • Acquisition Modality (e.g. CT, MR)
      • Anatomic Region (e.g. Arm, Elbow, Hand)
      • Requested procedure (e.g. MRI Knee with contrast)
    • Query example
      • find all “ CT of the Head ” of patient John Doe for the last 2 years
  • 27.