1September, 2005 What IHE Delivers

Key Image NotesKey Image NotesEvidence DocumentsEvidence Documents

Simple Image & Numeric ReportSimple Image & Numeric Report Access to Radiology Information Access to Radiology Information

IHE Vendors Workshop 2006IHE Vendors Workshop 2006Rita Noumeir, Ph.D., Rita Noumeir, Ph.D.,

SoftmedicalSoftmedical

2September, 2005 What IHE Delivers

Key Image NotesKey Image Notes

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Key Image NotesKey Image Notes Value PropositionValue Proposition

There is more to teamwork than images and reportsThere is more to teamwork than images and reports

With IHE, it is possible to attach « electronic post-it™ » to With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication images to increase informal but critical communication between:between:

The Technologist and the Radiologist about specific examination eventsThe Technologist and the Radiologist about specific examination events

The Radiologist and the Technologist about image quality issues The Radiologist and the Technologist about image quality issues

The Radiologist and other department clinicians (surgeon, orthopedist,..)The Radiologist and other department clinicians (surgeon, orthopedist,..)

The Radiologist and collegues about selecting images for conferencesThe Radiologist and collegues about selecting images for conferences

The Radiologist to the Referring Provider, …..etc.The Radiologist to the Referring Provider, …..etc.

Query for the Images/Studies using the codesQuery for the Images/Studies using the codes

This IHE Integration Profile is the cost effective solution This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency)(increases radiology and overall efficiency)

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Don’t Call Us, We’ll Call YouDon’t Call Us, We’ll Call You

““Dave, you read that 3000 slice MR study last night. Can Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me”you highlight the 5 most important images for me” Thinking… “Thinking… “#$@%!%# You#$@%!%# You”, says “Sure””, says “Sure”

““Dr. Channin, I just reviewed 40 cases and marked my Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those”questions on yellow stickies. Can you review those”

Tech to radiologist: Tech to radiologist: “The patient wouldn’t hold still”“The patient wouldn’t hold still”

The solution is……The solution is……

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for referring physicianHere you can see the renal osteopathy.

For teachingFibroosteoclasia

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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

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Key Image Notes Titles are CodedKey Image Notes Titles are Coded

Defined by DICOM. May be extendedDefined by DICOM. May be extended

The note title defines the semantics The note title defines the semantics of the reason of significance.of the reason of significance.

Key Image Notes cKey Image Notes can be queried by an be queried by code.code.

The user comments are meant to be The user comments are meant to be informalinformal..

CodesOf Interest

Rejected for Quality Reasons

For Referring Provider

For Surgery

For Teaching

For Conference

For Therapy

For Patient

For Peer Review

For Research

Quality Issue

For Reporting

8September, 2005 What IHE Delivers

Evidence DocumentsEvidence Documents

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Evidence DocumentsEvidence Documents Value Proposition Value Proposition

Measurements and coded data Measurements and coded data DICOM SR document DICOM SR document

Created by either Acquisition Modality or Created by either Acquisition Modality or Evidence CreatorEvidence Creator

Produced during acquisition or post-Produced during acquisition or post-processing workflowsprocessing workflows

Interpreted along with the imagesInterpreted along with the images

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Evidence DocumentsEvidence Documents

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD...…..

Evidence Document Evidence Document StoredStored

Storage CommitmentStorage Commitment

Query / RetrieveQuery / Retrieve

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Evidence Documents Evidence Documents ExamplesExamples

Mammography CADMammography CAD

Chest CADChest CAD

OB-Gyn Ultrasound MeasurementsOB-Gyn Ultrasound Measurements

Vascular Ultrasound MeasurementsVascular Ultrasound Measurements

Vascular Intervention ResultsVascular Intervention Results

Echocardiography MeasurementsEchocardiography Measurements

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InterpretationInterpretation

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD ...…..

Simple Image & Simple Image & Numeric ReportNumeric Report

Evidence Evidence DocumentsDocuments

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Key Image NotesKey Image Notes

13September, 2005 What IHE Delivers

Simple Image & Numeric Simple Image & Numeric ReportReport

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Can You Make A Report Like This?Can You Make A Report Like This?Institution IdentificationInstitution IdentificationPatient IdentificationPatient IdentificationStudy IdentificationStudy Identification

Technique IdentificationTechnique Identification

DiscussionDiscussion

The liver is normal. There is a focal area of decreased The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., attenuation adjacent to the falciform ligt., likely likely representing focal fatrepresenting focal fat ( (image 22image 22). The spleen, both kidneys, ). The spleen, both kidneys, the … are normal.the … are normal.

ImpressionImpression

CT of the abdomen within normal limitsCT of the abdomen within normal limits

SignatureSignature

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(We can’t either). What about?(We can’t either). What about?

DiscussionDiscussion

Comparison is made to the prior study of 4/11/99Comparison is made to the prior study of 4/11/99. 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 lesions are seen. The yadda, yadda, yadda are normal.normal.

ImpressionImpression

Worsening L Paratracheal adenopathy.Worsening L Paratracheal adenopathy.

SignatureSignature

The solution is……The solution is……

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Simple ImageSimple Imageandand

Numeric ReportsNumeric Reports

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Simple Image & Numeric ReportsSimple Image & Numeric ReportsValue PropositionValue Proposition

Reports’ content is more than words…Reports’ content is more than words…

Based on DICOM SRBased on DICOM SR

Allows to include without transcription:Allows to include without transcription: measurementsmeasurements image linksimage links structured content structured content

Integrated with the imaging workflowIntegrated with the imaging workflow

Friendly to XML implementationsFriendly to XML implementations

Easy to export with HL7Easy to export with HL7

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Pattern – Pattern – Simple Image ReportSimple Image Report

• Minimal Structure : Coded Title and HeadingsMinimal Structure : Coded Title and Headings• Full image links from specific sections of reportFull image links from specific sections of report• Observation Context Observation Context (who, what, when)(who, what, when) may be section specific may be section specific

0-n

CONTAINS 1

CONTAINS

0-n

0-n

INFERRED FROM

Report Text

Image Reference

Observation Context

(See section 5.3.2.3) 1-n

Section Heading

Document Title

Image Reference

0-1

Observation Context

(See section 5.3.2.3)

0-n

Coded Entry

0-n

INFERRED FROM

Image Reference

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Pattern – Pattern – Simple Image & Simple Image & Numeric ReportNumeric 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

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An An illustrationillustration

21September, 2005 What IHE Delivers

Access to Radiology InformationAccess to Radiology Information

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Access to Radiology InformationAccess to Radiology InformationAbstract / ScopeAbstract / Scope

Provides access to radiology information Provides access to radiology information within the rest of the hospital (e.g., ER, OR, within the rest of the hospital (e.g., ER, OR, cardiology, oncology, etc)cardiology, oncology, etc) Images, evidence documents, presentation states, key Images, evidence documents, presentation states, key

image notes, structured radiology reports image notes, structured radiology reports

Query and retrieve based modelQuery and retrieve based model

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Multiple Sources OptionMultiple Sources Option

Allows user access to Allows user access to distributeddistributed Radiology Radiology informationinformation Describes how users can query multiple information Describes how users can query multiple information

sourcessources

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Access to Radiology Information Access to Radiology Information Value PropositionValue Proposition

Improves data accessibility by making Improves data accessibility by making radiology information available within the radiology information available within the hospitalhospital Makes data from different sources available with a Makes data from different sources available with a

single request (Multiple Sources Option)single request (Multiple Sources Option)

Improves patient safety by reducing the use of Improves patient safety by reducing the use of incomplete imaging records (Multiple Sources incomplete imaging records (Multiple Sources Option)Option)

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Access to Radiology Information Access to Radiology Information Value Proposition (2)Value Proposition (2)

Improves efficiency by eliminating the need to Improves efficiency by eliminating the need to perform multiple searches to access complete perform multiple searches to access complete imaging records (Multiple Sources Option)imaging records (Multiple Sources Option)

Cost effective solution for finding the pertinent Cost effective solution for finding the pertinent information for the patient in the Radiology information for the patient in the Radiology domaindomain

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Access to Radiology Information Access to Radiology Information Standards UsedStandards Used

DICOM Query/ RetrieveDICOM Query/ Retrieve Defines Matching keys for response filtering by Defines Matching keys for response filtering by

Image Manager/ArchiveImage Manager/Archive Defines Return keys to be requested by Image Defines Return keys to be requested by Image

DisplayDisplay Defines Returned attributes supported by Image Defines Returned attributes supported by Image

Manager/Archive in query responsesManager/Archive in query responses Defines Returned attributes required to be Defines Returned attributes required to be

displayed on Image Displaydisplayed on Image Display

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Access to Radiology Information Access to Radiology Information Actors/ Actor RequirementsActors/ Actor Requirements

Image Display / Report Reader:Image Display / Report Reader: Required to support the specified query matching and Required to support the specified query matching and

return keys as a “client” (DICOM SCU)return keys as a “client” (DICOM SCU)

Image Manager / Report Manager:Image Manager / Report Manager: Required to support the specified query matching and Required to support the specified query matching and

return keys as a “server” (DICOM SCP)return keys as a “server” (DICOM SCP)

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Access to Radiology Information Access to Radiology Information Multiple Sources OptionMultiple Sources Option

Actors/ Actor RequirementsActors/ Actor Requirements

Image Display / Report Reader:Image Display / Report Reader: Must be able to query from multiple sources and Must be able to query from multiple sources and

consolidate the resultsconsolidate the results

Image Manager / Report Manager:Image Manager / Report Manager: No additional query or retrieve requirements, but must No additional query or retrieve requirements, but must

support Patient Information Reconciliation (PIR)support Patient Information Reconciliation (PIR)

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More information….More information….

IHE Web site: IHE Web site: http://www.ihe.nethttp://www.ihe.net

http://www.himss.org/IHEhttp://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/http://www.acc.org/quality/iheihe..htmhtm

Technical FrameworksTechnical Frameworks

Technical Framework Supplements Technical Framework Supplements – Trial Implementation– Trial Implementation

Non-Technical Brochures :Non-Technical Brochures :

Calls for ParticipationCalls for Participation IHE Fact Sheet and FAQIHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon ResultsIHE Connect-a-thon Results Vendor Products Integration StatementsVendor Products Integration Statements

Questions?

Questions?