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ECR 2003The Clinical Benefits of IHE

Berthold Wein, MDBerthold Wein, MDDept. Diagnostic RadiologyDept. Diagnostic RadiologyUniversity Hospital AachenUniversity Hospital Aachen

The Clinical Benefits of IHEThe Clinical Benefits of IHEThe IHE Integration ProfilesThe IHE Integration Profiles


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


IHE Year 4 Integration ProfilesIHE Year 4 Integration Profiles

Access to Radiology InformationConsistent access to images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

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






Key ImageNotes




measurements





Scheduled Workflow



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 information Stale 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


ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Order Placer

PerformedProcedure Step

ManagerModality Worklist

Patient Registration

Images Availability Query

Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Procedure Scheduled

PPSIn-Progress/ Completed PPS

In-Progress/ Completed

StorageCommit

ImagesStored

PPSIn-Progress/ Completed

Present.State

Stored

Q /R KeyImage Note

Q /RPresentation

SatesQ /RImages

ImagesStored

StorageCommit

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored

WorkflowWorkflow


Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete 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


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


ADTPatient Registration

Image Archive

Image Manager

Image Display

Image Creator

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Order Placer

PerformedProcedure Step

ManagerModality Worklist

Patient Registration

Procedure Scheduled

Images Availability QueryImagesStored

StorageCommit

Q /R KeyImage Note

Q /RPresentation

Sates

StorageCommit

ImagesStored




Fil

ler

Ord

erM

anag

emen

t

Placer Order Management

Patient Update

Patient Update

Procedure Update

Present.State

StoredQ /R

Images

Key Image Note

StoredPresent.State

Stored

Key Image Note

Stored

Patient Information ReconciliationPatient Information Reconciliation






Key ImageNotes




measurements



Scheduled Workflow





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 remote Radiologist discussing images with remote physiciansphysicians

• Capture image manipulation to avoid Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)redundant work (coronal CT, MR reading, etc.)


Consistent Presentation of ImagesConsistent Presentation of ImagesReporting Radiologist Referring Physician or

Reviewing Radiologist

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

WithoutConsistent Presentation

Area Of

Interest

AchievingConsistent Presentation

Presentation StatePresentation StatePresentation LUTPresentation LUT

Grayscale StandardGrayscale Standard






Key ImageNotes




measurements



Scheduled Workflow





• CT/MR:CT/MR: Head bone / brain separation Head 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/MRA MRI/MRA – to be to be viewedviewed and and billed separatelybilled 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 / retroperitoneum Abdomen and kidneys / retroperitoneum and lymphnodesand lymphnodes

Re-arranging SeriesRe-arranging Series


MODALITY

IHE – IHE – Presentation of Grouped ProceduresPresentation of Grouped ProceduresRequested Procedure:

CHEST

Report:CHEST

Requested Procedure:ABDOMEN

Report:ABDOMEN

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

Abdomen Abdomen ViewView

RIS / PACS

Chest Chest ViewView

Abdomen Abdomen ViewView






Key ImageNotes




measurements



Scheduled Workflow





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


Access to Radiology InformationAccess to Radiology InformationProviding Providing Access Access to Radiology Informationto Radiology Information::

– Internally to Internally to RadiologyRadiology– FromFrom Other Departments Other Departments

Surgery, Oncology, Pediatrics, etc.Surgery, Oncology, Pediatrics, etc.

Query and Retrieve

ImagesImages

Query and Retrieve

ReportReportss

Image ArchiveImage

Manager

Image DisplayReport Reader

Report Repository

Query and Retrieve

PresentationPresentation StatesStates

Query and Retrieve

Key Key Image Image NotesNotes

DICOM Based Transactions






Key ImageNotes




measurements



Scheduled Workflow





Image flaggingImage flagging

• Flag images within a huge CT-seriesFlag images within a huge CT-series

• Informations from radiographer to Informations from radiographer to radiologistradiologist

• Dedicated image descriptionsDedicated image descriptions

• ........


Different notes on different images

Same note on different images

for referring physicianHere you can see the renal rupture.

Note1for referring physicianThis is the hematoma.

Note2

for refering physicianHere you can see the renal rupture.

Note1for refering physicianThis is the hematoma.

Note2

for refering physicianHematoma everywhere

Note3 for refering physicianHematoma everywhere

Note3for refering physicianHematoma everywhere

Note3 for refering physicianHematoma everywhere

Note3

for referring physicianHematoma everywhere

Note3






Key ImageNotes




measurements



Scheduled Workflow





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 left left paratracheal lymph nodeparatracheal lymph node ( (image 8image 8, , image 11image 11) now ) now measures measures 2.5x2.7x3.1 cm2.5x2.7x3.1 cm increasing from increasing from 2.0x2.1x2.62.0x2.1x2.6 previously. No other mediastinal, upper abdominal or previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary axillary 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


Pattern – Pattern – Simple Image & Numeric ReportSimple Image & Numeric Report

Simply Adds Measurements to Simple Image ReportsSimply Adds Measurements to Simple Image Reports

0-n

CONTAINS

HAS OBS CONTEXT

1

CONTAINS

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


Simple ImageSimple Imageandand

Numeric ReportsNumeric Reports

• Based on DICOM Based on DICOM SRSR

• Allows to include Allows to include without without transcription:transcription:- measurements- measurements- Image links- Image links- structured content - structured content

• Integrated with the Integrated with the imaging workflowimaging workflow

• Friendly to XML Friendly to XML implementationsimplementations

• Easy to export to Easy to export to the CPR (HL7)the CPR (HL7)






Key ImageNotes




measurements



Scheduled Workflow




Basic SecurityAudit Trail Consolidation & Node Authentication

Post- Processing Workflow

Schedule, perform, & notify image processing

& CAD steps

Charge Posting

Collection of billable procedure details


Clinical Benefits by Clinical Benefits by IHEIHE

• The power of IHE to improve productivity and The 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

Date post:	20-Jun-2015
Category:	Health & Medicine
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