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Key Image Notes Evidence Documents Simple Image & Numeric Report Access to Radiology Information Key Image Notes Evidence Documents Simple Image & Numeric Report Access to Radiology Information IHE Vendors Workshop 2006 Rita Noumeir, Ph. D. , Softmedical 3/19/2018 1

Abstract / Scope Sharing of Imaging Information across health enterprises Imaging Information includes Ø Abstract / Scope Sharing of Imaging Information across health enterprises Imaging Information includes Ø extensive sets of DICOM instances including images, evidence documents and presentation states Ø diagnostic reports provided in a "for display" form Ø selection of diagnostically significant images associated with the report content 2

Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise B Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise B PACS B Radiology-to-radiology Radiology-to. Physicians PACS A Physician Office Radiology Enterprise A 3

Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise B Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise B Cross. Enterprise Registry PACS B Patient Id= 3547 F 45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B • Report 2/18/2005 : Chest Xray A • Study 2/18/2005 : Chest Xray A PACS A Physician Office Radiology Enterprise A 4

Physicians and Systems within a Regional Health Network - Routine Imaging Referral Regional Health Physicians and Systems within a Regional Health Network - Routine Imaging Referral Regional Health Information Network Radiology Enterprise B Register Imaging Information for sharing Cross. Enterprise Registry Patient Id= 3547 F 45 • Report 5/21/1998 : CT Head B Query for • Study 5/21/1998 : CT Head B Documents Physician Office Prior imaging Reports & Register Imaging Studies Information for sharing Radiology Enterprise A 5

Physicians and Systems within a Regional Health Network - Routine Imaging Referral Regional Health Physicians and Systems within a Regional Health Network - Routine Imaging Referral Regional Health Information Network Radiology Enterprise B Register Imaging Information for sharing Cross. Enterprise Registry Register Imaging Information for sharing Notification of Doc Availability Physician Office Radiology Enterprise A 6

Physicians and Systems within a Regional Health Network for a Routine Imaging Referral Regional Physicians and Systems within a Regional Health Network for a Routine Imaging Referral Regional Health Information Network Prior Imaging Report & Study Radiology Enterprise B Patient Id= 3547 F 45 • Report 5/21/1998 : CT Head B Cross- • Study 5/21/1998 : CT Head B Enterprise • Report 2/18/2005 : Chest Xray A Registry • Study 2/18/2005 : Chest Xray A Query for documents Notification of Doc Availability Imaging Report & Study Physician Office Radiology Enterprise A 7

Value Proposition Imaging component of the Electronic Health Record: Shared imaging Record, in a Value Proposition Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc. Effective means to contribute and access imaging documents across health enterprises. Ø Without XDS-I, access to the radiology report across health enterprises is difficult Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems. Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest Ø with the same mechanisms used to query other documents 8

Value Proposition Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images Value Proposition Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain. Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report) Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches. 9

XDS-I Dependencies XDS-I depends on IT Infrastructure Cross. Enterprise Document Sharing (XDS) Same Actors XDS-I Dependencies XDS-I depends on IT Infrastructure Cross. Enterprise Document Sharing (XDS) Same Actors as in XDS Ø Document Source Ø Document Consumer Ø Document Registry Ø Document Repository Added extension to support imaging data (images and reports) 10

XDS-I Actors and Transactions Patient Identity Source Patient Identity Feed Document Registry Query Documents XDS-I Actors and Transactions Patient Identity Source Patient Identity Feed Document Registry Query Documents Document Consumer Register Document Set Document Source Image Manager Image Archive Provide & Register Document Set Document Repository Retrieve Document Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve 11

XDS-I New Transaction requirements XDS Actors: Ø Document Consumer • at least one Retrieve XDS-I New Transaction requirements XDS Actors: Ø Document Consumer • at least one Retrieve (DICOM C-Move or WADO) Ø Document Source • Provide and Register Document Set Radiology Actors Ø Image Manager / Image Archive • WADO Retrieve 12

XDS-I Options Document Source must support at least one of the following options: Ø XDS-I Options Document Source must support at least one of the following options: Ø Extensive Set of DICOM Instances Ø PDF Report Ø Text Report Ø Multipart Text/PDF Report 13

Sharing of Extensive DICOM Instance Set 14 Sharing of Extensive DICOM Instance Set 14

Document Registry Register Manifest Query Registry DICOM Manifest Reference to image 1 Reference to Document Registry Register Manifest Query Registry DICOM Manifest Reference to image 1 Reference to image 2 Manifest Reference to image 3 Document Repository Retrieve Manifest Retrieve Images DICOM Manifest Reference to image 1 Reference to image 2 Manifest Clinical IT Reference to image 3 System Clinical Encounter 15

Sharing of Extensive DICOM Instance Set The shared Document is a manifest Ø a Sharing of Extensive DICOM Instance Set The shared Document is a manifest Ø a Key Object Selection DICOM Instance Image Manager/Image Archive is required Ø to ensure that the referenced images from within a published manifest are available to be retrieved Document Source is responsible Ø for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the manifest) 16

Sharing of Imaging Report 17 Sharing of Imaging Report 17

Header: Radiology Report Type: OB / Gyn Text Report …. . Findings: BPD PDF Header: Radiology Report Type: OB / Gyn Text Report …. . Findings: BPD PDF Report. . . …. . Text +PDF Report Impressions: Gestational Age . . . Radiology system Report Source 18

Document Registry Register Report Query Registry Document Repository Report Retrieve Report Header: Report Radiology Document Registry Register Report Query Registry Document Repository Report Retrieve Report Header: Report Radiology Report Type: Radiology system Report Source Findings: OB / Gyn …. . BPD. . . Clinical IT …. . System Impressions: Gestational Clinical Encounter Age . . . 19

Sharing of Report The shared Report Document format is Ø PDF, Text, or multipart Sharing of Report The shared Report Document format is Ø PDF, Text, or multipart PDF + Text A report can Ø embed selected images in its PDF format Ø include fully resolved hyperlinks (interactively clickable) that point to the selected images Document Source is responsible Ø formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document Source is required Ø to ensure that image references are valid links 20

XDS-I Actors / Grouping Sharing of an Extensive DICOM set Ø Document Source shall XDS-I Actors / Grouping Sharing of an Extensive DICOM set Ø Document Source shall be grouped with an Image Manager/Image Archive Sharing of a report that references selected images from previously published extensive DICOM set Ø Document Source can be grouped with a Document Consumer 21

Linking Report to Complete Set of Images Document Registry Submission Set Document Entry t Linking Report to Complete Set of Images Document Registry Submission Set Document Entry t or ep R y st ud ife St an M Document Repository 22

Linking Report to Complete Set of Images Document Registry Submission Set 1 Document Entry Linking Report to Complete Set of Images Document Registry Submission Set 1 Document Entry Submission Set 2 Document Entry t or ep R y st ud ife St an M Document Repository 23

Linking Report to Prior Images and Prior Report Document Registry Submission Set 1 Document Linking Report to Prior Images and Prior Report Document Registry Submission Set 1 Document Entry Submission Set 2 Document Entry Submission Set 3 Document Entry Submission Set 4 Document Entry t or ep R y st ud ife St an M r io rt Pr epo R dy tu r S st io ife Pr an M Document Repository 24

Linking Report to Selected Images Header: Radiology Report Type: Findings: OB / Gyn …. Linking Report to Selected Images Header: Radiology Report Type: Findings: OB / Gyn …. . BPD. . . …. . Gestational Age . . . WADO URI Link to image Relevant Image Radiology system Report Source 25

XDS-I Metadata Radiology specific Ø Acquisition Modality (e. g. CT, MR) Ø Anatomic Region XDS-I Metadata Radiology specific Ø Acquisition Modality (e. g. CT, MR) Ø Anatomic Region (e. g. Arm, Elbow, Hand) Ø Requested procedure (e. g. MRI Knee with contrast) Query example Ø find all “CT of the Head” of patient John Doe for the last 2 years 26

More information…. IHE Web site: http: //www. ihe. net s? on ti es Technical More information…. IHE Web site: http: //www. ihe. net s? on ti es Technical Frameworks u Q Technical Framework Supplements http: //www. himss. org/IHE http: //www. rsna. org/IHE http: //www. acc. org/quality/ihe. htm – Trial Implementation Non-Technical Brochures : Ø Calls for Participation Ø IHE Fact Sheet and FAQ Ø IHE Integration Profiles: Guidelines for Buyers Ø IHE Connect-a-thon Results Ø Vendor Products Integration Statements 27