Neelam Dugar
Chair of
Desk-top IntegrationClinical Requirements
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Single sign-on
A single sign-on should authenticate an individual to all applications required by him with a single log-in and password
A radiologists needs access to the 4 applications for purpose of reporting—RIS, PACS, DD/VR, 3D etc
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Single Sign on--Not Present
Log-in process—approx 1 minute.
4 separate log-ins---(4X1) 4 minutes
5 log-ins per day--- (5X4) 20 minutes
Log-ins per week---(20X5)= 100 minutes
Log-ins per year---(100X45)= 4,500 minutes
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Single Sign on--Present
Log-in process—approx 1 minute.
5 log-ins per day--- (5X1) 5 minutes
Log-ins per week---(5X5)= 25 min
1 hr 15 mins saving per week per person
56 hrs 15 mins saving per year for each individual
Huge savings and efficiency gains for a tax-payer funded public service.
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Context for Synchronisation for DTI
Unique episode number--Accession no for radiology
Unique patient identifier--NHS number/PAS no.
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Uses of DTI in radiology
Reporting of radiology exams
Acknowledgement of radiology reports
Integration of 3D/PET-CT/CT colonoscopy etc application with PACS
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Radiology Exam Reporting
RIS: Demographics/Scheduling information
PACS: Radiology Images display
Digital Dictation/Voice recognition application
Scanned request card viewer application
Specialist Applications (sometimes)
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Title of Subject
Current Chest XCurrent Chest X--rayray
Current Chest X-ray
Previous Chest XPrevious Chest X--rayray
Previous Chest X-ray
Reporting WorkflowReporting Workflow
Reporting Workflow
Request cardRequest card
RISRISImaging historyImaging history
DD/VRDD/VR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Reporting Workflow
RIS or PACS Worklist
Criteria for worklist creation
We use “intended radiologist” as the main criteria for creating worklists
Neelam Dugar
Hotseat
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
PACSPACS
PACSTitle of Subject
PACSPACS
PACS
RISRIS
RIS
RIS Worklist for RIS Worklist for HOTSEAT HOTSEAT
UrgentUrgent1. Joe Bloggs1. Joe Bloggs--MAUMAU--Chest XChest X--rayray2. Bob Wilson2. Bob Wilson--SAUSAU--Abdomen XAbdomen X--rayray3. Sarah Jenkins3. Sarah Jenkins--Ward 12Ward 12-- Hand XHand X--rayray
NonNon--UrgentUrgent1. Hannah Floris-GP- Foot X-ray2. Joanne Hampson-OPD- Pelvis X-ray3. James Bond- 007- Gun X-ray
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Automatic Reporting workflow
Click on a patient episode from RIS worklist for reporting
Automatic Synchronised application display for that episode (linked by a unique number)
RIS is the master whilst others are slaves
RIS —demographics and scheduling info
PACS —image display with relevant prior rule
DD/VR to record and process a voice file
Scanned request card/OCM info
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Title of Subject
Current Chest XCurrent Chest X--rayray
Current Chest X-ray
Previous Chest XPrevious Chest X--rayray
Previous Chest X-ray
Reporting WorkflowReporting Workflow
Reporting Workflow
Request card Request card or OCMor OCM
RISRISImaging historyImaging historyscheduling infoscheduling infodemographicsdemographics
DD/VRDD/VR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Automatic Reporting Workflow
Single click should automatically close all 4 applications and bring back to worklist/next episode
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Efficiency Gains
With automatic DTI and automatic prior display—RIS, PACS, DD and SRC---100% increased productivity can be achieved with high volume CR reporting.
Increased productivity also seen with CT/MR reporting
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Exceptions to Automatic Synchronization
Radiologist in middle of a long report: disturbed by a doctor/radiographer to review an image on different patient
Need for RIS and DD/VR to be static, but PACS to display another patient’s image ( loss of synchronization)
By a manual “show images” icon on RIS, once again the applications can be synchronized.
PACS to RIS synchronization should NOT be automatic
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukException
Title of SubjectTitle of Subject
Title of Subject
Request cardRequest cardfor Joe Bloggsfor Joe Bloggs
RIS info forRIS info forJoe Bloggs Joe Bloggs
Digital Digital Dictation in Dictation in
progressprogress
SHOW IMAGESSHOW IMAGES
Title of Subject
Hand XHand X--ray for John Smithray for John Smith
Hand x-ray for John Smith
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Previous Chest XPrevious Chest X--rayray
Previous Chest X-ray
Reporting WorkflowReporting Workflow
Reporting WorkflowTitle of Subject
Current Chest XCurrent Chest X--rayray
Current Chest X-ray
Request card Request card or OCMor OCM
RISRISImaging historyImaging historyscheduling infoscheduling infodemographicsdemographics
DD/VRDD/VR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Careful Planning(Bi-directional DTI)
RIS to PACS is automatic
PACS to RIS is manual synchronization
PACS to RIS enquiry--ensure that there is no incomplete dictation on RIS
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Other Uses of Manual DTI
Results acknowledgement system →PACS
PACS → 3D/PET-CT Fusion/CT colon App
RIS or PACS → pathology results
RIS or PACS → clinical documents/letters
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Results Acknowledgement SystemResults Acknowledgement SystemWORKLIST FOR ABWORKLIST FOR AB(CONSULTANT ORTHOPAEDIC (CONSULTANT ORTHOPAEDIC
SURGEON)SURGEON)UrgentUrgent1. Joe Bloggs1. Joe Bloggs--MAUMAU--Chest XChest X--rayray2. Bob Wilson2. Bob Wilson--SAUSAU--Abdomen XAbdomen X--rayray3. Sarah Jenkins3. Sarah Jenkins--Ward 12Ward 12-- Hand XrayHand Xray
NonNon--UrgentUrgent1. Hannah Floris1. Hannah Floris--GPGP-- Foot XFoot X--rayray2. Joanne Hampson2. Joanne Hampson--OPDOPD-- Pelvis XPelvis X--rayray3. James Bond3. James Bond-- 007007-- Gun XGun X--rayray
Results Acknowledgement S...
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukResults Acknowledgement Sy...Results Acknowledgement Sy...
Joe BloggsJoe Bloggs
Chest XChest X--rayray
There are bilateral lung There are bilateral lung metastasis. I note that the metastasis. I note that the patient is known to have patient is known to have kidney tumour.kidney tumour.
Acknowledge Acknowledge and File Awayand File Away
PACSPACS
Results Acknowledgement S...PACS
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Title of Subject
PET CT on PACSPET CT on PACS
PET CT
PET CT Fusion AppPET CT Fusion App
PET CT Fusion
Reporting WorkflowReporting Workflow
Reporting Workflow
Request cardRequest card
RISRISImaging historyImaging history
DD/VRDD/VR
FUSIONFUSION
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukDesk-top Integration or
Context Synchronization
Important for patient safety
Vital for productivity
Significant cost savings in a tax-payer funded health service.
Pivotal to a integrated health record in a multi-vendor environment
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Thank YouAny Questions?