Johannes Gutenberg-University Johannes Gutenberg-University Department of Radiology, Mainz, GermanyDepartment of Radiology, Mainz, Germany
User User Success StorySuccess Story
prepared by Peter Mildenberger, MD
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TopicsTopics
• Infrastructure (Infrastructure (Hospital / Radiology)Hospital / Radiology)
• IT - responsibilitiesIT - responsibilities• IHE Integration Profiles usedIHE Integration Profiles used• Further developmentsFurther developments• ConclusionsConclusions
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University Hospital Mainz and University Hospital Mainz and Department of RadiologyDepartment of Radiology
• 1500 beds, ~100 wards1500 beds, ~100 wards• 53.000 inpatients/year, 190.000 outpatients53.000 inpatients/year, 190.000 outpatients
• >30 examination rooms>30 examination rooms• ~ 500 exams / d~ 500 exams / d• ~ 15 clinical conferences / d~ 15 clinical conferences / d• RIS since 1988RIS since 1988• PACS since 1996PACS since 1996 (Rad, Neurorad, NUK, Endo, Dent..)(Rad, Neurorad, NUK, Endo, Dent..)
• >30 modalities (e.g. 5 CTs, 5 MRs, 5 CRs, 3 DRs..)>30 modalities (e.g. 5 CTs, 5 MRs, 5 CRs, 3 DRs..)• 15 - 20 GB / d as new data15 - 20 GB / d as new data• ~ 25 TB online (>40 million images)~ 25 TB online (>40 million images)
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Dept. of Radiology
Internal 210 Radiotherapy Ward 401-2bOrthopedics503 Surgery 505 Internal701
Departmental Structure
CT
DL
Skelett
Ward
Thorax
US
MRT
Archive/ Workstation
Mammography
CT
DL
Skeletal R
ICU
Thorax
US
MRT
Skeletal R
DL
CT
DL
Skelett
ICU
Thorax
MRT
WardRadiotherapyAngiogr.Angiogr.
Neuroradiology
Angiogr.
CT
DL
Chest
Skeletal R
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General IT ConceptGeneral IT Concept
• HIS (Administration)• IT Depart in Administration• SAP/R3 and IS-H*• productive
Digital Archive for paperbased filesMedical InformaticsMicrofiche plus Web-Accessnot available yet!
PACS• Radiology• all DICOM - Objects• central server , RAID + long
term storage• DICOM-Viewer• separated workgroup-
servers with on demand access
• productive
EPRIT Department in AdministrationSAP based (IS-H*MED)first pilots (2 of 30 dept)
HL7
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The IHE Radiology Workflow
Modified according to N. Wisrz, PhD, Siemens
X
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MModality odality WWorkorkllist / ist / PPerformed erformed PProcedure rocedure SSteptepMModality odality WWorkorkllist / ist / PPerformed erformed PProcedure rocedure SSteptep
MPPS with auto-matic transfer of:
Exposure TimeTotal doseExposure doseFluoro doseNumber framesFluoro timeNumber series
Exposure TimeTotal doseExposure doseFluoro doseNumber framesFluoro timeNumber series
RIS (gap it!, iSoft) Acq. modality
(Integris, PMS)
MWL:Name, Date of BirthAccession numberUIDs et al.
Name, Date of BirthAccession numberUIDs et al.
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Pitfalls in conventional documentationPitfalls in conventional documentation
81
127
0102030405060708090
correct minorproblems
majormistakes
n = 100
• Exposure data *10-100
• incomplete document
• Diff. in Fluorotime >20%
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Consistency and Completeness of Image ArchivingConsistency and Completeness of Image Archiving
RESULT: ~ 25000 images / d ~ 500 studies / d manual control takes
5 - 15 min / modality ~ 3h/d for the complete
department
RESULT: ~ 25000 images / d ~ 500 studies / d manual control takes
5 - 15 min / modality ~ 3h/d for the complete
department
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Storage Commitment – Push ModelStorage Commitment – Push ModelStorage Commitment – Push ModelStorage Commitment – Push Model
Please take responsibility for safekeeping of data
O.k., commitment for archiving images
permanently
PACS(ImageDevices)
PACS(ImageDevices)
P A C SP A C S
Acq modality
DV
D
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Survey in different Departments (est.)Survey in different Departments (est.)• OphthalmologyOphthalmology• GastroenterologyGastroenterology• UrologyUrology• CardiologyCardiology• OnkologyOnkology• DermatologyDermatology• Dental ImagingDental Imaging• ......• Total (outside Total (outside
Radiology)Radiology)
300 GB / year300 GB / year 300 GB / year300 GB / year 250 GB / year250 GB / year 900 GB / year900 GB / year 400 GB / year400 GB / year 750 GB / year750 GB / year 700 GB / year700 GB / year ...... 5 TB / year5 TB / year
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ConclusionsConclusions
• flexible implementation, less independant from a vendorflexible implementation, less independant from a vendor
• MWL, MPPS, StComm improve clinical workflow, data MWL, MPPS, StComm improve clinical workflow, data consistency, quality of documentation,...consistency, quality of documentation,...
• IHE is a pragmatic model for the clinical scenariosIHE is a pragmatic model for the clinical scenarios
• IHE profiles should become regular part of RFPsIHE profiles should become regular part of RFPs
• IHE Process fit also outside Radiology (e.g. Lab., Card.)IHE Process fit also outside Radiology (e.g. Lab., Card.)
• IHE is NOT a standard, it is beyond !!!IHE is NOT a standard, it is beyond !!!
• IHE solves daily-life problems by Integration ProfilesIHE solves daily-life problems by Integration Profiles
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Using IHE there will beUsing IHE there will beless work for „Consultants“ less work for „Consultants“ like this one....like this one....
