DICOM,HL7,RIS,PACS

ARogue’sGalleryofAcronymsOr

AnIntrotoImagingInformatics

SEAAPMSymposiumApril2014

DICOM,HL7,RIS,PACS

KevinL.Junck,PhDProfessorofRadiology

ChiefofRadiologyInformaticsUABHealthSystemkjunck@uabmc.edu

LearningObjectives

1)tounderstandtheelectronicflowofinformationthroughouttheradiologyexaminationincludingsystemsbothupstreamanddownstreamwhichinteractwiththeimagingmodality.

2)toreviewtheworkofAAPMTaskGroupNumber248– InteroperabilityEvaluationforImagingModalityAcceptanceTesting.

HighAltitude

MyLevel

MyLevel

Who’sOnFirst?

RadiologyTechnologists

Radiologictechnologistsarethemedicalpersonnelwhoperformdiagnosticimagingexaminationsandadministerradiationtherapytreatments.

Radiologictechnologistswhoperformimagingexaminationsareresponsibleforaccuratelypositioningpatientsandensuringthataquality diagnosticimageisproduced.

RadiologyTechnologists

QualityManagementTechnologistsusestandardizeddatacollectionmethods,informationanalysistoolsanddataanalysismethodstomonitorthequalityofprocessesandsystems intheradiologydepartment.Theyperformprocessorqualitycontroltests,assessfilmdensity,monitortimeraccuracyandreproducibilityandidentifyandsolveproblemsassociatedwiththeproductionofmedicalimages.

Source:http://www.asrt.org

ImagingInformatics

“Medicalimaginginformaticsisa multidisciplinaryfieldthatintersectswiththebiologicalsciences,healthservices,informationsciences,medicalphysics,andengineering.

ImagingInformatics

Imaginginformaticstoucheseveryaspectoftheimagingchainfromimagecreationandacquisition,toimagedistributionandmanagement,toimagestorageandretrieval,toimageprocessing,analysisandunderstanding,toimagevisualizationanddatanavigation;toimageinterpretation,reporting,andcommunications.Thefieldservesastheintegrativecatalystfortheseprocessesandformsabridgewithimagingandothermedicaldisciplines.

ImagingInformatics

Imaginginformaticsprofessionalsandscientistsspecializinginthisevolvingfieldarepioneersinvolvedattheintersectionofinformationscience,imagingtechnologyandhealthcareandrequireclinicalacumenaswellasexpertunderstandingoftechnology."KatherineP.Andriole,PhD,FSIIMSource:http://siim.org

HealthcareIT

Healthinformatics(alsocalledhealthinformationsystems,healthcareinformatics,healthcareinformatics,medicalinformatics,nursinginformatics,clinicalinformatics,orbiomedicalinformatics)isadisciplineattheintersectionofinformationscience,computerscience,andhealthcare.Itdealswiththeresources,devices,andmethodsrequiredtooptimizetheacquisition,storage,retrieval,anduseofinformationinhealthandbiomedicine.

Source:http://www.Wikipedia.org

MedicalPhysicists

WhatdoMedicalPhysicistsDo?

Medicalphysicistsareconcernedwiththreeareasofactivity:clinicalserviceandconsultation,researchanddevelopment,andteaching.Ontheaveragetheirtimeisdistributedequallyamongthesethreeareas.

Source:http://www.aapm.org

MedicalPhysicists

ClinicalServiceandConsultation…Otherimportantservicesarerenderedthroughinvestigationofequipmentperformance,organizationofqualitycontrolinimagingsystems,designofradiationinstallations,andcontrolofradiationhazards.Themedicalphysicistiscalledupontocontributeclinicalandscientificadviceandresourcestosolvethenumerousanddiversephysicalproblemsthatarisecontinuallyinmanyspecializedmedicalareas.

Who’sOnFirst?

BuyitorBuildit

AAPM‐ IISC

AAPM– TG248

AAPM– TG248

Charge:TodevelopataskgroupreportwhichprovidesthefollowingresourcestotheAAPM,applicabletoallimagingmodalityareas:

AAPM– TG248

1)Recommendationthattheacceptancetestingofimagingmodalitiesincludesend‐to‐endevaluationofimagequalityandimageinformationfromorderingsystemtolong‐termarchiveandallrelevantsystemswheretheimagesareviewed,processedormodified.

AAPM– TG248

2)Backgroundandmotivationforinteroperabilityassessmentwithexamplesidentifyingriskstopatientcarefromincompleteacceptancetesting.3)Suggestionsfortoolsforassessinginteroperability.FurtherdetailswillbedevelopedbytheTGincreatingthereport,withabetterexaminationofwhatwouldbeausefulroleforthemodalityphysicistsandwhatresourcesareavailabletothem.

Interoperability

Interoperability

TG248ReportIntroductionThefunctionalityofadiagnosticimagingsystemoftenextendsbeyondtheacquisitionconsoleanddependsoninteroperabilitywithahostofothersystemssuchasRIS,PACS,post‐processingsoftware,treatmentplanningsoftware,andclinicalviewers.InteroperabilitymightbeassuredbyavendorinanIHE(IntegratingtheHealthCareEnterprise)IntegrationStatement,andperhapscontractuallyagreedtoaspartofapurchase.Orthevendormayassumenoresponsibilityforinteroperabilityandleavevalidationtotheend‐usertoensurethattheequipmentisreadyforclinicaluse.

TG248ReportIntroduction

Ineithercase,itiswisetounderstandwhatmightgowrong,whattherisksare,andwhataspectsofinteroperabilityaredesirabletovalidateaspartofequipmentacceptancetesting.Thegoaloftheacceptancetestingcanbeviewedintwoparts:1)toensurethattheequipmentmeetsorexceedsthespecificationsprovidedbythemanufactureraspartofthepurchaseprocess.2)Tovalidatethatasystemisreadyforclinicaluse.Oftenitistheroleofaphysicisttobethefinalsign‐offinregardtobothoftheseacceptancetestinggoals.

TG248ReportIntroduction

Troubleshootingandoptimizingtheimagingchainmayrequireateameffortonthepartofthephysicist,serviceengineer,PACSsystemadministrator,technologistandotherstakeholders.Eachoftheseindividualswillhavespecialknowledgeoftheworkflow,thedataflowandofthepossiblefactorsthatcouldaffectimagequalityandinformationintegrityatdifferentpointsintheimagingchain.Themedicalphysicistshouldhaveanunderstandingofthevariablesthatcanaffecttheimagebetweenacquisitionanddisplay,andtoknowwheretogoforadditionalassistanceinordertoisolatethesourceofimagequalityorinformationintegrityproblems.

TeamLead

DICOM

ServiceClasses– “verbs”– Part4StorageStorageCommitmentQuery/RetrieveModalityWorklistModalityPerformedProcedureStepPrinting

ModalityWorklist

Beforewegenerateanimage,wewanttolinkpatientdemographicinformationtotheimage– who’simageisit?

AservicetypicallyprovidedbythePACS.HoweveritisasnapshotofthedataprovidedbytheRISviaHL7.

PACSvRIS

PACS– Picturescommunicationswithmodality

RIS– ReportsandOrderscommunicationswithpeople(physicians,

technologists)

PACSvRIS

PACSBrokerReceivesHL7fromRISTranslatesintoSQLcallsforPACSdatabaseRespondstomodalityrequestsforworklists

ModalityWorklist Configuration

Placeordersforyourmodalitydotheyshowup?

doyougetordersthatarenotforyourarea?

wanttohaveaminimallisttoavoidwrongselection,butmusthavewhattheuserneeds.

ModalityWorklist

Errortypoinname/MRN/accessionnumber

pickwrongsetofInformationfromlist

We’vereducedtheerrorrate,buttheerrorsaremoredifficulttocatch.

ModalityWorklist Information

Placeordersforyourmodalitywhatinformationispresent?Name,Gender,DOBAccessionNumber,Dateofexam,Typeof

exam– criticalifyouhavemultipleexamsforsamepatient.

doesexam“falloff”listwhencancelled?whenacquired?

ProcedureCodeMapping

Tietheexambeingperformedtoviewsorprotocolsonthemodality.

ChestPAandLateral– modalitymaystepthetechnologistthroughacquiringthetwoimagesneededforthisexam.

enablesdefaulttechniquesandimageprocessingparameters

maybedonebyvendor’sapplicationsspecialist

DICOM

ServiceClasses– “verbs”StorageStorageCommitmentQuery/RetrieveModalityWorklistModalityPerformedProcedureStepPrinting

Storage

UseModalityWorklist withadedicatedtestpatienttobeabletosendimagestoPACS.

Exception– matchingofimagesagainstorders.

ImageProcessing– doesitlookright?ImageAnnotations– aretheythere?Physicalmeasurements– pixelsvsmm?

Storage

ImageManipulations:Window– level

Flip/rotate

Invert

EdgeEnhancement

Storage

Locationmarkers– orientation

Storage

Networkperformance

Sendtoalllocations‐ configuration

Storage

ImageOverlay

Storage

Non‐imageimagesStructuredreportDosereport

Storage

Errorcorrection

Emergencydataentry

DowntimeproceduresRISPACSNetwork

HL7

HealthLevel7www.hl7.org

HL7anditsmembersprovideaframework(andrelatedstandards)fortheexchange,integration,sharing,andretrievalofelectronichealthinformation.Thesestandardsdefinehowinformationispackagedandcommunicatedfromonepartytoanother,settingthelanguage,structureanddatatypesrequiredforseamlessintegrationbetweensystems.HL7standardssupportclinicalpracticeandthemanagement,delivery,andevaluationofhealthservices,andarerecognizedasthemostcommonlyusedintheworld.

HL7StartBlockMSH|^~\&|HNAMN|RADNET|PACS|UABHS|20140428101734||ORM^O01|Q1017569306T1090564180|X|2.3PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||19000101090200|U||U|RADINFOTESTPT^/BADADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999)999‐9999||UNK|U|OTH|648392053252||||NH|||0PV1|1|I|UC~UABC~KRD^^^UC^^^UC~UABC|3|||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||17|UC~UABC~KRD|||1||||O|3252||||||||||||||||||||UC|||||20130909124000|20130923235959ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||20140428101730|||WRITTENORDER^Written|411234561^Tester^Kelly^^^^^^^^^^EXTERNALIDOBR|1|1685047828^HNAM_ORDERID||CD:51536620^MAMammogramDigitalBilateral||||||||CD:312689^312689|||RadType&Rad Type|9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID||||00000MA20140010066^HNA_ACCN~30784024^HNA_ACCNID~5905455^HNA_PACSID|CD:185639490|20140428101730||Mammography|||1^^0^20140428101700^^Today|||Ambulatory|^testEndBlock

HL7

MSH|^~\&|HNAMN|RADNET|PACS|UABHS|20140428101734||ORM^O01|Q1017569306T1090564180|X|2.3

MSH– messageheaderMSH3and4:SendingApplication/Facility– HNAMN/RADNETMSH5and6:ReceivingApplication/Facility– PACS/UABHSMSH7:Date/TimeofMessageMSH9:MessageType

ORM– orderORU‐ result

HL7

PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||19000101090200|U||U|RADINFOTESTPT^/BADADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999)999‐9999||UNK|U|OTH|648392053252||||NH|||0

PID– PatientIdentificationPID3– PatientIdentifierPID5– PatientNamePID7– PatientDOBPID8– GenderPID18– FinancialAccountNumber

HL7

PV1|1|I|UC~UABC~KRD^^^UC^^^UC~UABC|3|||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||17|UC~UABC~KRD|||1||||O|3252||||||||||||||||||||UC|||||20130909124000|20130923235959

PV1– PatientVisitPV12– PatientClassPV13– PatientLocationPV17– AttendingDoctor

HL7

ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||20140428101730|||WRITTENORDER^Written|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID

ORC– OrderCommonInformationORC1– OrderControlCode/StatusORC10– EnteredBy

HL7

OBR|1|1685047828^HNAM_ORDERID||CD:51536620^MAMammogramDigitalBilateral||||||||CD:312689^312689|||RadType&Rad Type|9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID||||00000MA20140010066^HNA_ACCN~30784024^HNA_ACCNID~5905455^HNA_PACSID|CD:185639490|20140428101730||Mammography|||1^^0^20140428101700^^Today|||Ambulatory|^test

OBR– ObservationRequestOBR2– PlacerOrderNumberOBR4– UniversalServiceIDOBR20– FillerField1

DICOM

DICOM— DigitalImagingandCommunicationsinMedicine— istheinternationalstandardformedicalimagesandrelatedinformation(ISO12052).Itdefinestheformatsformedicalimagesthatcanbeexchangedwiththedataandqualitynecessaryforclinicaluse.DICOMisimplementedinalmosteveryradiology,cardiologyimaging,andradiotherapydevice(X‐ray,CT,MRI,ultrasound,etc.),andincreasinglyindevicesinothermedicaldomainssuchasophthalmologyanddentistry.Withtensofthousandsofimagingdevicesinuse,DICOMisoneofthemostwidelydeployedhealthcaremessagingstandardsintheworld.ThereareliterallybillionsofDICOMimagescurrentlyinuseforclinicalcare.Sinceitsfirstpublicationin1993,DICOMhasrevolutionizedthepracticeofradiology,allowingthereplacementofX‐rayfilmwithafullydigitalworkflow.MuchastheInternethasbecometheplatformfornewconsumerinformationapplications,DICOMhasenabledadvancedmedicalimagingapplicationsthathave“changedthefaceofclinicalmedicine”.

DICOM

Referenceshttp://dicom.nema.org

Part3– InformationObjectDefinitions– nounsPart4– ServiceClasses‐ verbsPart6– DataDictionaryPart14– GrayscaleStandardDisplayFunction

DICOM

InformationObjectdefinition– noundataobjectwhichcontainsattributeswhich

describethecompletesetofdataneededtodefineanimage.

someportionsaremodalityspecific,othersarecommonamongstIODs.

DICOM

InformationObjectdefinition– nounpatient:name,MRN,DOB,genderexam:accessionnumber,typeofexam,

orderingphysician,dateofscanacquisition:kVp,slicethickness,vendorof

scanner,imagenumber,seriesnumber

DICOM

ServiceObjectPair(SOP)classtakeoneservice(verb)andpairitupwith

oneobject(noun)MRStorageSOPclassCTStorageSOPclassCTPrintSOPclass

DICOM

StorageClasstworoles

UserProvider

Storageclass– useristhesenderandtheprovideristhereceiver

DICOM

UniqueIdentifier(UID)stringofnumberswhichuniquelyidentifies

somethingSOPClassCTImageStorage1.2.840.10008.5.1.4.1.1.2Study2.16.840.1.114151.4.1615.41755.4913.13414138Series1.2.840.113704.1.111.1772.1398716689.10Image1.2.840.113704.1.111.8980.1398716775.102112