DICOM, HL7, RIS, PACS · 2017-03-01 · HL7 Health Level 7 HL7 and its members provide a framework...
Transcript of DICOM, HL7, RIS, PACS · 2017-03-01 · HL7 Health Level 7 HL7 and its members provide a framework...
DICOM,HL7,RIS,PACS
ARogue’sGalleryofAcronymsOr
AnIntrotoImagingInformatics
SEAAPMSymposiumApril2014
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