Healthcare information standards (IHE, DICOM, HL7)Presentation Transcript
in the management and integration of virtual slides in Pathology Marcial García Rojo(1), Carlos Peces(2), Jose Sacristan(2), Gloria Bueno(3) 1) Hospital General de Ciudad Real. Spain 2) Castilla-La Mancha Health Care Services (SESCAM) 3) University of Castilla-La Mancha
We describe our experience in the use of emerging IT standards in Pathology , including the integration of Virtual Slides in Pathology general workflow.
A regional project on digital pathology is presented
This digitalization effort has been of special benefit for second opinion (teleconsultation), continuing medical education, and quality assurance in Pathology.
Infrastructures development SANITEL: Communication network BACKBONE inter-province communication network 155 Mbps circuits ATM between TO & AB-CR-CU-GU Gigabit Ethernet ring in province capitals STM-1 STM-1 STM-1 STM-1 E3 _ _ TOLEDO _ _ CIUDAD REAL _ _ ALBACETE CUENCA GUADALAJARA Talavera
Population-based patient database search engine Images Central database YKONOS. Hospital 1 Hospital 2 Primary care centre 1 Primary care centre 2
Standards in Pathology
Integration in Pathology Information Systems has not yet been achieved.
Standardization efforts are progressing to provide integration in healthcare information technology (IT) systems, such as:
CEN TC 251 (pr EN13606): electronic health record
IHE initiative ( http://www.ihe.net/ ): How to use standards
Fist goal is to elaborate a document, the Pathology Technical Framework that identifies the workflow, the IHE actors (i.e. functional components, application roles), and shows the transactions between them.
IHE is an initiative by healthcare professionals and industry to improve the way computer systems share healthcare information.
IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.
Systems developed in accordance with IHE communicate with one another better , are easier to implement, and enable care providers to use information more effectively .
Sitios web relacionados
Integrating the Healthcare Enterprise – Europe: http://www.ihe-europe.org/
IHE.net: http://www.ihe.net/ (American College of Cardiology, Healthcare Information and Management Systems Society and the Radiological Society of North America)
IHE Technical Frameworks: http://www.ihe.net/Technical_Framework/index.cfm
Publish Integration Statements for use in Request For Proposals (RFPs)
2. Specify Integration Profiles
Experienced healthcare IT professionals identify relevant standards and define how to apply them to address the problems, documenting them in the form of IHE integration profiles .
Examples: Use of HL7 (ADT) to send a request of pathology study from the HIS to PIS, and how to retrieve pathology images using DICOM
IHE Pathology. An example of problems to deal with
Pathology images are in a digital format but often without any organization. Model for integration: IHE
A model in digital radiology (Scanner and magnetic resonance) DICOM
DICOM: Digital Imaging and Communications in Medicine , refers to a file header standard.
DICOM headers can “wrap” many commonly used image file types, including JPEG and TIFF
Can we apply DICOM standard in pathology? How this is done with virtual slides? WG26
IHE promotes standards: Advantages of DICOM
Organization: Central repository of medical images for all medical specialties: PACS
Integration with e-Health Record
One viewer for all medical images
proprietary file formats
Actors in Pathology Information Framework
Actors: information systems or components of information systems that produce, manage, or act on information associated with operational activities in the enterprise.
Acquisition Modality – Acquires and creates medical images , e.g. a Computed Tomography scanner or Nuclear Medicine camera. A modality may also create other evidence objects such as Grayscale Softcopy Presentation States for the consistent viewing of images or Evidence Documents containing measurements .
Order Filler – A pathology department-based information system that provides functions related to the management of orders received from external systems or through the department system’s user interface.
Order Placer – A hospital or enterprise-wide system that generates orders for various departments and distributes those orders to the correct department, and manages state changes of those orders.
Image Archive – Provides long term storage of evidence objects such as images, presentation states, Key Image Notes and Evidence Documents.
Image Display – Offers browsing of patients’ studies . In addition, it may support the retrieval and display of selected evidence objects including sets of images, presentation states, Key Image Notes, and/or Evidence Documents.
Transactions in the Pathology Technical Framework
Transactions: Interactions between actors that transfer the required information through standards-based messages.
Filler Order Management –
Contains all the messages required between the Order Filler (PIS) and the Order Placer (HIS) for the notification of a new filler order , as well as the creation of the placer order that reflects it.
Ensure that each filler order will be represented by a placer order, and will have both a filler order number and a placer order number.
It can also be used for order modification or cancellation.
Modality Worklist Provided –
Based on a query entered at the Acquisition Modality,
Listing all the items that satisfy the query.
List of Scheduled Procedure Steps with selected demographic information and information about specimen is returned to the Acquisition Modality.
PACS systems manage images which are DICOM-compliant.
DICOM files are limited in size to 2GB.
Most DICOM systems cannot manage TIFF files with a tiled organization, and/or TIFF files with JPEG or JPEG2000 compression .
For these reasons it is generally not possible to import Aperio SVS files directly into PACS.
Our project: Serendipia
Serendipity: The faculty of making fortunate discoveries by accident .
Knowledge transference opportunities are common, but the key driver in order that transference to take place (encouraging serendipity) are:
The need of the receptor organisation
Perspective by donor and receptor
Adequate resources in order transference to happen
However, concordance between donor and receptor is not easy and often, serendipity is a key factor in success.
Organizations must improve Serendipia probabilities , offering adequate resources and structures.
(British National Space Centre. 2004)
Telepathology HOSPITAL A HOSPITAL B Sender Second opinion
SERENDIPIA Project specific objectives
Pathology Information System (LIS)
Image management (including virtual slides)
Increasing automation in Pathology laboratory
Object identification: Code bar, RFID
Specific workstation for pathologists (high resolution: reports, washable: gross/autopsies)
Data entering (user interface)
Viewing images and text data
Communication interactive tools
Standards: IHE. Actors & Transactions
SESCAM integration design Gross station Autopsy room Micro photo App server J2EE DICOM viewer Virtual slide scanner Virtual slide server Virtual slide viewer Virtual slide repository Path report managing (LIS)
Hospital clinical workload :
Number of specimens per year: 5,000 to 40,000.
# slides per case: 5
Not every case is digitized. Initially, only those requiring collaborative work or when they are of high scientific or teaching interest.
Range of size per slide: 0.5 – 4 GB
Medium size (40x), using JPEG2000 compression: 1 Gigabyte -> 100 times an X-ray film .
Storage needs per hospital
On line storage for 4 years (1 st phase):
Albacete Hosp. (800 beds) : 40 Terabytes.
Almansa (100 beds) : 8 Terabytes.
Villarrobledo (100 beds) : 8 Terabytes.
Alcázar de San Juan (400 beds) : 32 Terabytes.
Tomelloso (100 beds) : 8 Terabytes.
Pathology Information System ( Novopath )
PACS 5.6 ( Udiat ): JPGEG2000 links
Web application J2EE ( Satec )
Image Server software and viewer ( Aurora )
Virtual slide ( Aperio )
User management: LDAP, Kerberos
Balancing web access by hardware, clustering
Integrations by HL7 messaging, no intermediary file
Architecture Reference Hospital J2EE/Aurora SIAP BACKUP PACS/APERIO Tapes library Storage server Application server/Web Linux RH 4.0/iAS Servidor de BBDD Linux RH 4.0 Oracle Cluster 2Gb 2Gb BD SERVICES Server LDAP Solaris 9 Server Backup Linux RH PACS server W2003 SQL Server 2005 iAS/WEB Environment Environment Environment SIAP Environment
Virtual microscopy: Aperio ScanScope
XT: 120-slides / CS: 5 slides
Speed: (15 X 15 mm): <2 min/slide, 20x (frozen s)
Resolution: 40x: 0.25 μm/pixel
Spectrum™ Plus: Multiuser & muti-site
Image analysis (Quantification IHQ)
(original files are single file (TIFF/SVS), or a directory with multiple files (CWS-Composite WebSlide)
Direct print: Leica/Sakura (2D: datamatrix)
Label (resistant) with bar code:
RFID: Identifying with radiofrequency
Low/high frequency. Passive/active
(RFID & bar code)
Single protocol / multi-protocol
Pending: Better standardization
Example: identification of slides by scanner
Reading (high res.) wkst and teleconsultation
Autopsy and gross room: Washable keyboards, mouse and screen.
4 Mpixels 30” (75.62 cm) Pitch: 0.250 mm Size: 2560 x 1600 Brightness: 200(Dicom)/ 370 (max) cd/m2 3 Mpixels 20.8” (52.8 cm) Pitch: 0.207 mm Size: 2048 x 1536 Brightness: 500(Dicom)/ 800 (max) cd/m2
Code bar reading containers / slides
Wash. Keyb. mouse
Storage (8 TB)
Serendipia Project in summary
Code bar reading container /cassettes/slides
Scanner >50 slides
Storage (40 TB)
Centralizing malfunctions or breakdowns notifications and technical consultations.
Permanent, 7x24, 365 days a year availability.
On line information about incidences and notifications.