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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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
Patient Information Reconciliation
Unknown patients and unscheduled orders
Scheduled Workflow
Admit, order, schedule, acquire images, notify of completed steps
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
PPSIn-Progress/ Completed
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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.)
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
• 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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
• ........
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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
ECR 2003The Clinical Benefits of IHE
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)
ECR 2003The Clinical Benefits of IHE
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
Basic SecurityAudit Trail Consolidation & Node Authentication
Post- Processing Workflow
Schedule, perform, & notify image processing
& CAD steps
Charge Posting
Collection of billable procedure details
ECR 2003The Clinical Benefits of IHE
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