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Kevin Robertson, MBA
Topic 9Medical Imaging Informatics
ACS-2816 Health Information Systems
Winter 2020
Two Questions
2
What is the radiologic process role in the healthcare enterprise?
How information systems support and improve the radiologic process?
Topic 9 Outline
3
Introduction to Imaging Systems in Radiology
Basic Concepts
Historical Development
Current Status
Future Directions
Reading: Biomedical Informatics 4th Ed. Ch 20 p593-p610
Introduction to Imaging Systems in Radiology
4
Digital image is a fundamental data type
Biomedical Imaging Informatics (BII)Study methods for generating, manipulating,
managing, and integrating images in many biomedical applications
BII applies to many fields: Radiology, Pathology, Dermatology, Ophthalmology, Cardiology, etc.
Introduction to Imaging Systems in Radiology
5
Diagnostic Imaging / Radiology Reading StationFigure source: usa.healthcare.siemens.com/medical-imaging-it/radiology-information-systems/syngo-workflow
Introduction to Imaging Systems in Radiology
6Figure source: www.flatpaneldr.com/index.php/category/human-medical-dr/
HighlyDistributedSetting
Issues
Introduction to Imaging Systems in Radiology
7
Generic Workflow for Diagnostic Imaging / Radiology Services
Introduction to Imaging Systems in Radiology
8
Identification of Potential Problem Areas in the Diagnostic Process
Figure source: Bui A et al (Eds), Medical Imaging Informatics, Springer 2010, Figure 1.2, p5
Topic 9 Outline
9
Introduction to Imaging Systems in Radiology
Basic Concepts
Historical Development
Current Status
Future Directions
Basic Concepts
10
Roles for Imaging
The Radiologic Process
Image Management and Display
Integration with Other Healthcare Systems
Basic Concepts – Roles for Imaging
11
Detection and diagnosis
Treatment planning
Image-guided treatment
Assessment of response
Estimation of prognosis
Medical communication and education
Research
Basic Concepts – Roles for Imaging: Detection and Diagnosis
12
Image primary useDetection of medical abnormalitiesDiagnostic purposes
Wide variety of imaging proceduresComputer Tomography (CT),Magnetic-resonance imaging (MRI),Ultrasound (US),X-rays, etc.
Basic Concepts – Roles for Imaging: Detection and Diagnosis
13
Rudimentary idea behind using x-rays as a means to create medical images
Figure source: Bui A et al (Eds), Medical Imaging Informatics, Springer 2010, Figure 2.2, p18
Basic Concepts – Roles for Imaging
14
Detection and diagnosis
Treatment planning
Image-guided treatment
Assessment of response
Estimation of prognosis
Medical communication and education
Research
Basic Concepts – Roles for Imaging: Treatment Planning
15
Assists assessment of patient’s healthDisease progression,Treatment response, and/orPrognosis estimation
E.g. Ultrasound to assess fetal size, growth and development
E.g. Computer tomography (cross section view) to assist approach for surgery
Basic Concepts – Roles for Imaging
16
Detection and diagnosis
Treatment planning
Image-guided treatment
Assessment of response
Estimation of prognosis
Medical communication and education
Research
Basic Concepts – Roles for Imaging: Image-Guided Treatment
17
Images can provide real-time guidance
Manipulation and haptic (touch) feedback important
E.g. Endoscopic and minimally invasive surgery
E.g. Surgical Theatre at U of Michigan
Basic Concepts – Roles for Imaging
18
Detection and diagnosis
Treatment planning
Image-guided treatment
Assessment of response
Estimation of prognosis
Medical communication and education
Research
Basic Concepts – Roles for Imaging: Medical Communication
19
Images visualized concurrently with reports and discussions of interpretations
Communicating images essential in telemedicine (e.g. teleradiology, tepathology, teledermatology, etc.) for remote
Viewing
Interpretation
Consultation
Basic Concepts – Roles for Imaging: Education
20
Images essential in medical education and training
Images utilized inCase libraries,Tutorials,Atlases,3-D models,Quiz libraries, etc.
Basic Concepts – Roles for Imaging
21
Detection and diagnosis
Treatment planning
Image-guided treatment
Assessment of response
Estimation of prognosis
Medical communication and education
Research
Basic Concepts – Roles for Imaging: Research
22
Imaging support medical research activities
E.g. Quantitative study of morph metrics (i.e. growth and development)
E.g. Functional mapping of the human brain activity
Figure source: See link at http://psychcentral.com/lib/what-is-functional-magnetic-resonance-imaging-fmri
Basic Concepts
23
Roles for Imaging
The Radiologic Process
Image Management and Display
Integration with Other Healthcare Systems
Basic Concepts – The Radiologic Process
24
Radiology is engaged in all aspects of the healthcare process: detection & diagnosis -> treatment -> follow-up -> prognosis assessment
Primary function is the acquisition and analysis of medical images
Radiologists play a direct role in clinical-problem solving and diagnostic planning
Basic Concepts – The Radiologic Process
25 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 4th Edition, Figure 20.5, p599
Basic Concepts
26
Roles for Imaging
The Radiologic Process
Image Management and Display
Integration with Other Healthcare Systems
Basic Concepts – Image Management and Display
27
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Introduction
28
Storage and retrieval of images for a given exam Challenge as healthcare delivery is dispersed
PACS – Picture-Archiving and Communication System RIS – Radiology Information System Role of technology
High-resolution acquisition High capacity storage High-speed networks, Internet Standardization of formats (i.e. DICOM), data compression Database management systems Workstation design
Basic Concepts – Image Management and Display
29
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Image Acquisition
30 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 18.2, p633
Basic Concepts – Image Management and Display
31
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Storage Requirements
32 Table source: Shortliffe et al, ‘Biomedical Informatics’, 4th Edition, Table 20.1, p600
Modality Image size (pixels)
Images/exam Exam Size (MB)
Computer/DigitalRadiography
5M 3 29
CT 262,144 500 250
MRI 65,536 500 63
Ultra Sound 262,144 50 25
Mammography 20M 4 153
Interventional/Fluro 1M 50 100
Nuclear Medicine 16,384 25 1
Basic Concepts – Image Management and Display: Storage Requirements
33
Mary is expecting a baby and goes to see her obstetrician to find out how her baby is developing. Her obstetrician does an US for 30 minutes to assess the baby’s development. How much laptop storage her obstetrician needs for the baby’s US?
Assumptions: US generates 60 frames / minute, 1 MB = 1024 KB,
1 KB = 1024 B, 1 B = 8 bits
Each frame takes (512 x 512 pixel/frame) x 8 bits/pixel = 256 KB / frame
In one minute, 256 KB/frame x 60 frame/min = 15360 KB/min
In a 30 minutes study, we have 15360 KB/min x 30 min = 460800 KB
= 450 MB
Basic Concepts – Image Management and Display: Storage Requirements
34
Storage requirements increasing due to higher resolution imaging, larger number of images per study and increase in number of studies performed
Data compression Lossless compression Lossey compression (no negative impact to source)
Storage access time
Key images vs total archiving
Storage hierarchies
Basic Concepts – Image Management and Display
35
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Image Transmission
36
LANs and WANs enough to support simultaneous viewing across the enterprise (local and remote)
Network configuration and planning according to data patterns and use, and
Data compression
→ Image transmission time
Basic Concepts – Image Management and Display
37
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Standardization
38
TCP/IP network protocol
DICOM (Digital Imaging and Communication in Medicine) application protocolEnsures all image data can be recognized and
interpreted by any node in the network
HL7 (Health Level 7) application protocolEnsures all systems can exchange operational
information
Basic Concepts – Image Management and Display
39
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Display Capabilities
40
Workstation key for PACS use Radiologist workflow and operation
Comparison multiple images Flexibility in viewing, image manipulation Reshuffling images Zooming in on a specific area, measuring
Each modality has specific display requirements E.g. Mammography needs high resolution for
micro-calcification detection
Basic Concepts – Image Management and Display: Display Capabilities
41 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 18.3, p640
Some Workstation Display Alternatives
Basic Concepts – Image Management and Display: Display Capabilities
42
Physical layout Monitor size Viewing distance Image size
Ergonometric factors Luminance Orientation Kinds of controls Quality of user interface
Basic Concepts – Image Management and Display
43
Introduction
Image Acquisition
Storage Requirements
Image Transmission
Standardization
Display Capabilities
Cost
Basic Concepts – Image Management and Display: Costs
44
Viewing stations
Reading stations
Clinical stations, web-based stations
Network & storage infrastructure
Modalities
PACS / RIS
Human resources / workflows
Basic Concepts
45
Roles for Imaging
The Radiologic Process
Image Management and Display
Integration with Other Healthcare Systems
Basic Concepts – Integration with Other Healthcare Systems
46
Images need to be integrated in the care delivery workflow and its associated data
As healthcare practice becomes more distributed, image distribution changes
HIS need both vertical and horizontal integration
Open architectures and standards facilitate integration, challenge with legacy systems
Basic Concepts – Integration with Other Healthcare Systems: RIS
47
Radiology Information Systems Examination scheduling and performance evaluation Patient registration Radiologists review and analysis of studies Report management and distribution Billing services Quality services (e.g. turnaround time, wait times) Inventory control and preventive maintenance
RIS implemented stand alone or as a component of HIS
PACS must be integrated with RIS and HIS
Topic 9 Outline
48
Introduction to Imaging Systems in Radiology
Basic Concepts
Historical Development
Current Status
Future Directions
Historical Development – Evolution of Image Management into PACS/RIS
49
In the 80’s, researchers realized that work was needed to develop infrastructure Image acquisition from several modalities Storage of image data schemes (long and short
term) Data transmission (local and remote) Workstation display for reading and review
(radiology and clinical) Integration with RIS and HIS Distribution of reports and key images / studies
Topic 9 Outline
50
Introduction to Imaging Systems in Radiology
Basic Concepts
Historical Development
Current Status
Future Directions
Current Status – Image Management
51
PACS Smooth coupling of exam interpretation and
clinical information including old reports Dictation systems integrated at reading
workstations (SpeechQ) Better resolution for studies’ modalities
Teleradiology (Telehealth) Remote access across the distributed network Data compression
Indexing and Image retrieval
Current Status – Information Systems Integration
52
PACS, HIS and RIS integration HIS – RIS link for transfer of patient
demographics, billing, and report information RIS – PACS link for image management Better resolution for studies’ modalities
Referring physician image and report distribution support
DICOM and HL7 role ‘Integrating the Healthcare Enterprise’ (IHE)
initiative role (www.ihe.net)
Current Status – IS Integration –IHE Profiles: Scheduled Workflow
53 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Scheduled_Workflow
Current Status – IS Integration –IHE Profiles: Patient Info. Reconciliation
54 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Patient_Information_Reconciliation
Current Status – IS Integration –IHE Profiles: Post-Processing Workflow
55 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Post-Processing_Workflow
Current Status – IS Integration –IHE Profiles: Reporting Workflow
56 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Reporting_Workflow
Current Status – IS Integration –IHE Profiles: Access to Radiology Info
57 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Access_to_Radiology_Information
Current Status – IS Integration – IHE Profiles: Teaching File & Clinical Trial Exp.
58 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Teaching_File_and_Clinical_Trial_Export
Topic 9 Outline
59
Introduction to Imaging Systems in Radiology
Basic Concepts
Historical Development
Current Status
Future Directions
Future Directions for Imaging Systems
60
Computational & networking capabilities improve image processing functionalities
Modalities with higher spatial, contrast and temporal resolution (3D, 4D)
Widespread access to images and reports, enterprise integration
Content based retrieval
Future Directions for Imaging Systems
61
HL7 / DICOM compliance
Sophisticated GUI (3D, 4D)
Better speech recognition
Database management, image data mining & image data analytics tools
Better image guided tools (e.g. surgery, therapy)
Two Questions
62
What is the radiologic process role in the healthcare enterprise?
How information systems support and improve the radiologic process?