1 2 nd ICT Med Workshop Informatics

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2 nd ICT Med Workshop Informatics in Medical Imaging New Advences & Horizons Alireza Shakibafard MD Shiraz University of Medical Sciences(SUMS)

Medical Imaging

Digital Imaging

Digital Imaging Image or Magic ? ? ?

Analog Images

Analog vs. Digital Image

Digital Image is ready for any 1. Change 2. Storage 3. Transfer

New Paradigm Moving from traditional film-screen(analog) toward electronic media In electronic imaging the functional parts of conventional radiology have been separated: Image Capture , Storage & Display

Digital System Film Developed And Fixed Detector Reading Digital Processing Stored PACS Viewed Display QC of the digital systems is an additional requirement – in addition to the usual x-ray performance tests

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Image Characteristics Each pixel is assigned a numeric value (bit depth) that represents a shade of gray based on the attenuation characteristics of the volume of tissue imaged

Medical Imaging Advanced Applications

Multiplanar Navigation

MIP

Conventional PACS Archiving Media Hospital Diagnostic Modality PACS Server Archiving Device

Modern View on PACS is the “Imaging” part of Healthcare Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS. The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone. Technological basis: “PACS rides many horses” from web -based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.

Historical Evolution 80 -ties: MODALITY PACS = CT & MRI 80 -ties radiologists, advanced 3 D systems. 90 ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective? ? >2000: Enterprise-PACS+RIS+PACS = film-less >2000 hospitals. >2007: Newest achievements: Multi-site PACS using >2007 MPI (Master Patient Index) to allow the patient’s access on all sites Hospitals will skip historical steps and adopt to state of the art PACS and HIS.

Parallel evolution of all PACS 2012 functions 1980 PICTURES Archiving Communication 2 D tapes ATM, video Represent 5 D datasets SAN/NAS/grids Internet/web/ Wifi Systems Hardware + show an image Functionality+ knowledge

3 Patient arrives 1 Study ordered and scheduled 14 2 HIS Report transcription ADT 4 Order/schedule status notification 15 RIS Report status notification 9 Modality 7 Report 13 Connectivity Manager Workflow Management Study status notification 12 Report approval Modality worklist 5 Order/schedule status notification 10 a 16 Verification Report status notification PACS QC Pre-fetching (images) 6 10 8 11 Image store Diagnostic review and report dictation Patient is examined 17 Images to long term archive 1 Ob Images wavelet compressed by curator 19 In hospital, Out hospital Distribution Non diagnostic review

Information systems in the hospital workflow HIS (Hospital Information System) Central administration and financial system of the hospital Keeps the central patient registration patient identification holds the demographic data RIS (Radiology Information System) Dedicated radiology information system, taking care of exam ordering exam planning study reporting passing billing related information not automatically included not available for every country Holds the study information PACS (Picture Archiving and Communication System) Dedicated system for archiving and communication of study related images Communicates with the outside world HIS HL 7 RIS HL 7 Connectivity Manager DICOM PACS

Information exchange standards HL 7 (Health Level 7) Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services. E. g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, … DICOM (Digital Imaging and Communication in Medicine) DICOM is a standard, to enable efficient and flexible integration and communication of image data between components (modalities, printers, storage, databases, …) in a medical network However: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant

Translate HIS/RIS messages (e. g. HL 7) to DICOM PACS Connectivity Services (Connectivity Manager) PV 1||E|TRAUMA|A||||^DOE ^JOHN^W. ^DR. ^|||WAITING ROOM RIS ? ? ? CM Do you speak DICOM ?

Image acquisition Objective • Consolidation of image data information provided by multiple sources • Multi-modality (MRI, CT, Ultrasound…) • Multi-Vendor How ? • DICOM gateway : Paxport (for non DICOM modalities) • Film scanner

Image data storage and archiving • Storage (. dcm files) • Type of media (disks, UDO, LTO) • Everything on line solutions, nearline, off-line • Data compression • Data availability

PACS Architecture RIS HIS Internal & External Clients Application Server Connectivity Manager Workflow Manager Curator Modality Database Archive Server

Web Viewer Webserver At Modality PACS Viewing Station

PACS and Network Workstation 1 Workstation 2 …. . Hub Switch Workstations RAID CD/DVD Robot Archive

PACS Beyond Radiology Other Types of Images: Vascular Angiography Cardiac Angiography Echocardiography Obstetric Ultrasound Medical Photography Retinal Imaging Colposcopy / Cytology…. . May be more of a RIS Issue than PACS

Imaging Informatics New Advances

Imaging Informatics Laboratory

The Bottom Line • • Modern Image Processing Automated CAD with interpretation and reporting Portable medical records – perhaps imbedded in patient Integrated RIS-PACS-HIS through I. T. Robotic imaging Molecular Imaging Image guided chemotherapy and gene therapy ………….

Take Home Point: Beyond Bytes & Bits : Healthcare IT ; When needed , Where needed Integrated & Enterprise

Take Home Point: Healthcare IT ; Beyond one person , one department , one …. . , it is across … It needs collaboration , communication & decision making

THANK YOU FOR YOUR NICE ATTENTION