The document discusses the rapid developments in radiology driven by advancements in technology, patient empowerment, and e-health initiatives. Key areas highlighted include integration of imaging in oncological and surgical treatments, the evolution of PACS systems, and the impact of mobile and cloud computing on patient care. The document emphasizes the need for radiologists to adapt to these changes to enhance patient outcomes and efficiency in healthcare.

1. Image data beyondradiology: newdevelopmentsDr. E. R. Ranschaert1Dr. F.H. Barneveld Binkhuysen2Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, NL Independent Hospital & Healthcare Professional, Soest, NL

2. IntroductionRadiology is a heavily IT-driven specialty, and therefore prone to many new developmentsOther significant factors that influence this process:technical developments & scientific progresspolitical & economical changesNew developments in relation to radiology concerningtreatment (surgery and oncology)imaging techniquesPACSe-HealthDiscussion of effects of these developments on radiology and patient care

3. Jeroen Bosch HospitalNEWready by april 2011

4. teaching hospital

5. 240 medical specialists

6. 4000 employees

7. 500.000 consultations/year

8. 250.000 radiol.ex./year

9. 88 medical residents

10. EPR and digital image archive

11. all modern imaging modalitiesEndoscopic Surgery SuiteControl via touch screenImage with courtesy of Olympus

12. Endoscopic Surgery SuiteHospital networkCommunication via hospital networkCentral storageConsulting patient file from PACS IIOlympus Endoalpha Control Unit

13. Images beyondradiology: surgeryIntegration of images in surgical procedures forstrategic planningprocedure guidancepatient-specific treatment (custom-made implants)teaching (live)International trend: new surgical societiesISCASInternational Society for Computer Aided SurgeryISMICSInternational Society for Minimally Invasive Cardiothoracic SurgeryCAOS-international Society for Computer Assisted Orthopaedic and Spinal Surgery

14. Example: from image to implantPerfect fit !Image with courtesy of Siemens Healthcare

15. Images beyondradiology: oncologyIntegration of imaging in planning & monitoring cancer treatmentsfunctional imaging: CT/MRI diffusion and perfusion, PET-CT, PET-MRI(Automated )quantitative imaging methods (staging , F.U., early response)Integration of interventional radiology & surgeryTACE, RFA, radio-embolisation, cryo-ablation, micro-wave ablation...followed by surgery (e.g. liver)preoperative strategy planning with automated 3D segmentation e.g. liver, breast – new developments arFraunhofer MEVISIntegration with radiotherapy: IGRT with dynamic targetingCT and even MRIIntegration with chemotherapyMRI-guided chemo (temperature-induced drug release)

16. Quantitative imagingused to evaluate responses to cancer treatment or assess tumour burden

17. effectiveness is currently limited due to variability in:

18. imaging hardware

19. post-processing software

20. calibration

21. lack of standard protocols

22. ongoing research to improve automated image-based assessment and comparisonSource: website Laboratory of Imaging Informatics, Stanford University

23. Quantitative imaging & CADAutomated tumour staging and evaluationAutomated detection: CAD systemsImages with courtesy of Siemens Healthcare

24. Quantitative imagingIntegration of morphological and functional information

25. Images in oncology: treatmentIGRTTACEMark tumor-feeding vesselsAutomatic calculation centerlineOverlay on live fluoroscopy

26. Closing the gap between diagnosis and therapy efficient multidimensional image reading

27. precise tumour quantificationImage guidance of various treatment modalitiesmore efficient monitoring of treatment response

28. therapy guidanceDevelopments in techniques Faster scanning protocols & post-processing softwaremore data, greater volumes, better image quality 3Dsupercomputer technology : improved resolution, better dynamics4DFurther integration of imaging with additional information 5D?Various options for 5thdimensionfunction of organs/cells, biomarker information, (dual) energy...treatment: MRI guided chemotherapy and radiotherapy

29. 4D: advanced dynamic imagingImages courtesy of Ziosoft

30. 4D: advanced dynamic imagingImages courtesy of Ziosoft

31. 5D: dynamic + functionalImages courtesy of Ziosoft

32. 5D: MRI + functionalPET/MRI images, with courtesy of Siemens Healthcare

33. Developments in PACS (PACS II)Improved interoperability with other clinical IT-systems, HIS and EPR using IHE standardsEmbedding of clinical tools on 1 single workstation such as:documentation sharing (XDS/XMS), VoIP, integrated voice recognitionEasy access anywhere/anytime (web-based thin client, mobile)Further integration of :pathology images (interactive display of the microscopic fields), endoscopic images (video sequences, video capsule) dermatological imagessurgical imaging: development of “surgical PACS” based upon DICOM and IHE, integration of therapy imaging and model-guided therapy (TIMMS)

34. Seamless integration and interconnectivityThe biggest gains will come from the seamless connectionof RIS/PACS and EPR with imagesIntegration of other applications should appear seamless to the radiologistThe longer term solution is to make transmural image transfer by DVDs and CDs unnecessary. This requires an interconnected, broadly based EPR system (“virtual cloud”)

35. Future PACSThe future PACS will be a "portal" to radiological knowledge:integration of web-based access to scientific literature and information pertaining to diseases incorporation of quantitative imaging methodsautomatic retrieval of images similar images to those under review, to help with making diagnosesSource: Laboratory of Imaging Informatics, Stanford Universityhttp://www.stanford.edu/~rubin/projects.html

36. PACS-Web IntegrationThe (anonymised) data contained in a future connected web of EPR’s could be mined for medical knowledgeThis knowledge could then be put into a national or pan-European databasefor use in making diagnoses and choosing therapiesAbility to capture this information in a usable form depends on technologyphysicians' willingness to use software-rendered adviseprivacy regulations, financial & political support

37. Developments in e-HealthMany new developments in radiology are now driven by the consumerChanges that have increased the appetite for health information :wide-scale access to the Internetinexpensive PC’s mobile devices and servicesmerged functions of cell phone and PCPatients are empowered to research medical questions and have the means to own the results of imaging exams and lab testsSimultaneously political initiatives are taken to make healthcare more efficient through the widespread use of ITChanges are often driven by cost-saving motives and intentions to allow patients to have better control of own health

38. e-health and m-HealthEC eHealth action plan2007iPhone2010M-Healthrevolution1 billion use Internet3,9 billion cell phonesDot comBubble burstsHIPAA2008-2012Wiki Health Google Health2007-2008Health 2.0conferenceDisease-specific onlinecommunities2002-2006PatientSupportGroupsdevelop1999-2000WWW access toHealth info2004 IrelandEU conferenceEmpowering patients