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....