Cadre Technique de Radiologie

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Cadre Technique de Radiologie
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Radiology Technical Framework

• Il est décrit en quatre volumes
• V1 Description des cas dutilisation, des
  différents acteurs et des transactions, des
  différents profils
• V2 Détail des transactions et des messages
• V3 Détail des transactions et des messages
• V4 Extensions nationales

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Vue densemble

• Développé depuis sept ans,
• Plus de 15 profils définis ou en cours de
  définition.
• Qui couvrent
• Processus de base
• Demande et réalisation dune acquisition,
  Post-processing, Suivi de lactivité,
  Transmission de cas pour formation et essais
  cliniques
• Transmission des images après interprétation
• Mesures, présentations de limage, images clés,
  rapport
• - Diffusion des informations dimagerie
• Sur CD, au système dinformation médical, tout en
  assurant la traçabilité

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IHE Success Integration ProfilesSolutions to
Real-World Problems in Radiology
Charge Posting
Scheduled Workflow
Admit, Order, Schedule
Patient Information Reconciliation
Collect and post timely billable procedure details
Manage worklists, track status, perform
notify acquisition related step,
Presentation of Grouped Procs
Manage individual procedure image subsets from a
multi-procedure acquisition for viewing
reporting
Reconcile worklists, status, and data objects for
unknown patients and demographics changes
create, store, manage, retrieve use images
Consistent Presentation of Images
Simple Image and Numeric Reports
Evidence Documents
Key Image Notes
Manage, retrieve use objects to record study
evidence
Create, store, manage, retrieve use objects to
flag significant images
Manage simple diagnostic reports with optional
images, measurements
Manage, retrieve use objects for hardcopy and
softcopy grayscale presentation states
XDS for Imaging - Sharing of Imaging Information
across health enterprises
Access to Radiology Information - Consistent
access to images and reports
Portable Data for Imaging - Consistent access to
images and reports on CD Media
ITI ATNA Radiology Option (Replaces Basic
Security)
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Post-Processing Workflow (PPW)
• Reporting Workflow (RWF)
• Portable data Imaging (PDI)
• Access Radiology Information (ARI)

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Scheduled WorkflowPrésentation et points
importants

• Squelette dIHE Radiologie
• Intègre Admission patient, Prescription,
  Acquisition des images, Interprétation des images
  
• Utilise HL7 et DICOM
• Préserve la continuité de la prescription
• Close the Loop
• Maintient la cohérence (accession number), évite
  la confusion entre Filler number, Placer number,
  etc.
• Augmente lintégrité des données
• Saisie unique, transmission de système à système
• Diminue le risque derreurs

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Scheduled WorkflowLes points importants

• Augmente lefficacité du processus
• Utilisation de Worklist
• moins de temps en saisie de données
• initialisation des systèmes semi-automatique
• Sûreté du Stockage
• Storage Commitment
• Moins détudes perdues
• Plus de confiance dans les résultats
• Améliore le suivi de la prescription
• MPPS (management performed procédure step) de la
  Modalité au RIS PACS
• Un retour mieux synchronisé
• Un retour plus précis

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Scheduled Workflow
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IHE Workflow Concepts
IHE a sélectionné trois termes Hl7/DICOM
ORDER Demande dexamen de radiologie
REQUESTED PROCEDURE Une unité de travail
dont le résultat est présenté sous la forme
dun seul rapport (associés à des actes
codifiées et facturables)

• PROCEDURE STEP Plus petite entité du
  workflowScheduled Procedure Step
  Unité de travail à réaliser Performed
  Procedure Step Unité de travail
  réalisé

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Workflow Concept Mapping

• Ces 3 niveaux sont en relation avec des niveaux
  métiers

ORDERA request for imaging service (Accession
Number)
REQUESTED PROCEDURE Units of work resulting in
one Reportwith associated codified, billable
acts(Requested Procedure ID)
PROCEDURE STEP The smallest unit of workin the
workflow (modality worklist entry)
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Normal Workflow
Typical workflow One Order One Procedure One
Report
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Report
Requested Procedure
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Multiple Modality Steps
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Requested Procedure 1
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Post-Processing Workflow (PPW)
• Reporting Workflow (RWF)
• Portable data Imaging (PDI)
• Access Radiology Information (ARI)

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Patient Information Reconciliation Les points
importants

• Extension du Scheduled Workflow
• Coordonne les modifications des données
  démographiques dans le workflow et les objets
  manipulés
• Permet de gérer les cas exceptionnels
• Cas durgence ou trauma Patient inconnu ou pas
  encore enregistré
• Erreurs de saisie
• Autre changement démographique (noms
  jeune/fille vs nom marital)

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Patient Information Reconciliation
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Emergency - Case 3
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Post-Processing Workflow (PPW)
• Reporting Workflow (RWF)
• Portable data Imaging (PDI)
• Access Radiology Information (ARI)

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Access to Radiology InformationLes points
importants

• Fourni laccès aux informations radiologiques
  dans lensemble de létablissement (cardiologie,
  oncologie.)
• Images, evidence documents, presentation states,
  key image notes, structured radiology reports
• Modèle basique de Query and retrieve
• Permet aux utilisateur daccéder à de
  linformation radiologique distribuée
• Décrit comment les utilisateurs peuvent
  interroger des sources dinformation multiples.

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Access to Radiology Information Transaction
Diagram
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Post-Processing Workflow (PPW)
• Reporting Workflow (RWF)
• Portable data Imaging (PDI)
• Access Radiology Information (ARI)

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for referring physician Here you can see the
osteopathy.
For teaching Fibroosteoclasia
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Different notes on different images
Same note on different images
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Key Image Notes Titles are Coded

• Defined by DICOM. May be extended

The note title defines the semantics of the
reason of significance. Key Image Notes can be
queried by code. The user comments are meant to
be informal.
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Simple Image and Numeric Report (SINR)
• Presentation of Grouped Procedures (PGP)
• Portable data Imaging (PDI)
• Reporting Workflow (RWF)

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Problème de la cohérence daffichage
VOI chosen on one display device Rendered on
another with different display Mass expected to
be seen is no longer seen
tumeur visible
tumeur invisible
Slide Provided by David Clunie
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Problème de lincohérence de rendu
0.5
1.0
Tous les niveaux de grisne sont pas
perceptiblessur les différents écrans !
1.5
3.0
Slide Provided by David Clunie
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Consistent Presentation of ImagesTransaction
Diagram

• Consistent Appearance of Images
• Display Devices
• Printed Output

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Consistent Presentation of Images DICOM Standard
Used

• Calibration of the Softcopy Display and the
  Hardcopy Output Devices using DICOM Grayscale
  Standard Display Function (GSDF)
• Creating Hardcopy Output Using DICOM Basic Print
  with Presentation LUT (P-LUT) Support
• Preserving/Using the Softcopy Display Viewing
  Parameters in the DICOM Grayscale Softcopy
  Presentation State (GSPS) container

Cal
Hard
Soft
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Consistent Presentation of Images
Display
Print
Acquire
Slide Provided by David Clunie
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Simple Image and Numeric Report (SINR)
• Portable data Imaging (PDI)
• Reporting Workflow (RWF)

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Simple ImageandNumeric Reports
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Simple Image Numeric ReportsLes points
importants

• Le contenu dun rapport est plus que des mots
• Basé sur DICOM SR
• Permets dinclure sans retranscription
• mesures
• Liens vers les images
• Contenus structurés
• Intégré dans le workflow dimagerie
• Compatible avec des implémentations XML
• Facilement exportable vers HL7

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Pattern Simple Image Report

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

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Pattern Simple Image Numeric Report
Simply adds Measurements to Simple Image Reports
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Un example
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Simple Image and Numeric Report (SINR)
• Presentation of Grouped Procedures (PGP)
• Portable data Imaging (PDI)
• Reporting Workflow (RWF)

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IHE Scheduled Workflow
RIS
PACS Archive

• A Closed Loop
• Update IS Scheduling
• Match Procedure with Order
• Support Billing Based on MPPS
• Avoid Reading incomplete Procedures

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IHE Workflow Concepts
IHE identifies four fundamental workflow
information units
ORDER A request for radiologic service
REQUESTED PROCEDURE A Unit of Reporting
Work with associated codified, billable acts

• Procedure Steps The smallest unit of work in
  the workflow SCHEDULED PROCEDURE STEP A unit
  of work to do PERFORMED PROCEDURE STEP A
  unit of work done

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IHE Workflow is User Driven
Information Unit has its Prime
User
ORDERA request for imaging service (Accession
Number)
REQUESTED PROCEDURE Units of work resulting in
one Reportwith associated codified, billable
acts(Requested Procedure ID)
PROCEDURE STEP The smallest unit of workin the
workflow (modality worklist entry)
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Normal Workflow

• Typical workflow One Order One Procedure One
  Report

Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Requested Procedure
Report
Acquisition Modality
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Multiple Modality Steps
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Requested Procedure 1
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The Group Case Approach
Radiology Department

• ORDER
• A request for RadiologicService
• CT Chest Abdomen

Set of Codifiable, Billable, Acts

• Report
• CT Chest

Acquisition Modality
Report CT Abdo
Set of Codifiable, Billable, Acts
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Group Case
Radiology Department
Set of Codifiable, Billable, Acts
ORDER A request for RadiologicService
Report
Set of Codifiable, Billable, Acts
Report
AcquisitionModality
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Cas d'utilisation du PGP

• CT Thorax/Abdomen/Pelvis
• Neuroradiologie CT Cou CT Thorax
• IRM de différentes section du rachis
• IRM et MRA acquisent simultanément
• IRM du crane et de la nuque à l'aide d'une
  antenne spécialisée
• ...

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Pourquoi a-t-on besoin de PGP ?

• Optimise le confort du patient
• Optimise le temps d'acquisition.

Mais il est nécessaire de

• Maintenir un lien avec chacune des procédures
  groupées
• S'assurer que chacun des ensembles d'images
  correspondants aux procédures demandées soit bien
  identifié et présenté.
• De trier correctement les images sur le film,
  s'est naturel, dans un environement filmless
  c'est moins évident !

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Grouping of Procedures in IHE

• Group Case support is required by the IHE
  Scheduled Workflow Integration Profile
• On Image Managers (PACS)
• On Order Fillers (RIS).
• Group Case support is optional on Modalities.
• PGP requires support of the Group Case Option
  on Modalities.

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PGP Integration Profilebuilds upon SWF and CPI

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IHE Presentation of Grouped Procedures
Requested ProcedureCHEST
Requested ProcedureABDOMEN
RIS / PACS
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IHE PGP - Implementation Example Image Display
Constraints
PGP Actors
Requested ProcedureCHEST
Requested ProcedureABDOMEN
Image Mgr (Incl. Display)
Order Filler
Image Displayhas no access to fullRequested
Procedure Information
Performs a single acquisition
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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Simple Image and Numeric Report (SINR)
• Presentation of Grouped Procedures (PGP)
• Portable data Imaging (PDI)
• Reporting Workflow (RWF)

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PDI Value Proposition

• Media amovible contenant des données Dicom et
  éventuellement des données multimédia (browsable)
• Pour le patient
• Pour le médecin demandeur
• Pour échanger des données au sein de
  létablissement
• Pour échanger des données entre établissement
• Valider linteropérabilité de ce type de media
• Compatibilité avec les navigateurs
• Avoir des CD que lon puisse graver et lire sur
  nimporte quel système !

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PDI Value Proposition

• La validation de linteropérabilité est
  essentielle !
• Problèmes dinteropérabilité réseau
• Immédiats, sans ambiguïté
• Solution rapide
• Problèmes d interopérabilité Media
• Long délai avant la détection (et la
  reconnaissance)
• Long délai avant de résolution
• Large volume de media non inter-opérable créé
  suite aux long délais !

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PDI Actors and Transactions
Distribute Imaging Information on Media
Display
Image Display
Portable Media Creator
Report Reader
Print Composer
Media Importer
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PDI Media Creator

• Create DICOM Compliant CDROM media
• Create web content (optional)

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CDROM Structure
DICOMDIR
Directory of DICOM files
INDEX.HTM
README.TXT
Web content (optional)
IHE_PDI Directory of web files
Other optional content
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CDROM Rules

• DICOM Part 10 compliance will be verified. This
  is done by both MESA tools and the project
  managers.
• IHE_PDI web content corresponds exclusively to
  the DICOM content, although it need not represent
  the entire DICOM content.
• Other content will not be placed in DICOM or
  IHE_PDI directories, but may be placed in other
  locations on the CDROM.
• Do not assume that an application on the media
  will automatically be launched. IHE recommends
  that media readers not automatically run software
  on the media.
• Web content use of XHTML and JPEG formats is
  restricted to ensure interoperability.

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All PDI reading actors

• Shall indicate to the user when they find DICOM
  instances that are not supported by the reader.
• It is recommended that readers not automatically
  run software found on the media (for security
  reasons).

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PDI Importer (Reader) Rules

• Portable Media Importer is required to have
  facilities to accommodate updating patient
  information to use values for the receiving
  enterprise, e.g. update patient ID.
• Portable Media Importer shall be grouped with at
  least one of the following actors
• Evidence Creator
• Acquisition Modality
• Image Manager/Image Archive
• Report Creator
• Report Manager
• Report Repository

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CDROM Creator Rules

• All DICOM file names are limited to 8 characters
  (no extensions). This is the Part 10
  requirement.
• All other file names are restricted to the ISO
  9660 8.3 file name. E.g. support_for_my_app.dll
  would need to be SUPPORT.DLL or some other 8.3
  name.

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Les Profils

• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
• Access to Radiology Information (ARI)
• Key Image Notes (KIN)
• Consistent Presentation of Images (CPI)
• Simple Image and Numeric Report (SINR)
• Presentation of Grouped Procedures (PGP)
• Portable data Imaging (PDI)
• Reporting Workflow (RWF)

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Reporting WorkflowLes points importants

• Plannifie, distribue et trace le statut de tache
  de Reporting comme
• Interpretation
• Transcription
• Verification.
• Worklists sont générées et font lobjet de query

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Reporting WorkflowTransaction Diagram
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Reporting Workflow Grouping

• Report Manager not grouped with neither IM nor DSS

Performed Work Status Update
Report Manager
DSS/OF
RWF Profile
Performed Work Status Update, if needed
SWF Profile
IM/IA
SWF Profile
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Reporting Workflow Grouping

• Report Manager grouped with Image Manager

Performed Work Status Update (optional)
Report Manager
DSS/OF
RWF Profile
IM/IA
SWF Profile
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Reporting Workflow Grouping

• Report Manager grouped with DSS/OF

Performed Work Status Update, if needed
Report Manager
RWF Profile
IM/IA
DSS/OF
SWF Profile
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Diagnostic Reporting Use Cases

• Predefined report
• Workitem deferred
• Direct report creation
• Interpretation and dictation
• Transcription
• Partial completion
• Verification

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Predefined report

• The user chooses a report from a list of
  pre-configured draft reports

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Task deferred

• The user selects the task and decides not to
  perform it

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Partial Completion

• The user begins the task and then decides that
  this task cannot be completed at this moment

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Verification

• The user may need to correct the report's content
  by dictation