Dr Keith FoordConsultant Radiologist,

East Sussex Hospitals,

United Kingdom

www.esht.nhs.uk

keith.foord@esht.nhs.uk

Complete Integration of RIS into PACS: Dream or Reality?

History 1970-2001

• 1970s – First RIS systems– To manage departmental workflows and store information

• Late 1980s/early 1990s – First operational PACS– But did not link information in RIS with images

• Mid 1990-2001 - Image centric PACS with RIS interfaces

• Incompatible communication protocols forced ‘Brokers’• Image centric – PACS image DB has to be additionally populated

with information INTRODUCED to the system• Some RIS functions have to be duplicated in PACS• Problems with correlation of RIS & PACS data - requires

administrator intervention to correct

History 2001+

• RIS centric PACS– The RIS is prime and controls information flows,

including images– Simplifies information management– RIS becoming integrated – integrated Brokers or

‘Brokerless’– IHE integration profiling– Provides DICOM Modality Worklist (MWL) directly

to modalities– Uses DICOM Modality Performed Procedure Step

(MPPS) – if supported by both modality and RIS

Communication issues between IS databases, PACS and modalities

PACS

HL7 i/for ‘Gateway’

HIS RIS

HL7/DICOMI/f = PACS Broker

HL71 HL72

HL72

DICOM

DICOMDICOM

03/10/01Keith D. Foord

Oct. 01 2003Foord, Keith D.

SPF

SPFModality

Many RIS vendors have provided Uni-directional data to PACS via a PACS Broker. Data not sent back to RIS to update fields related to the exam.

If RIS does not support DICOM MWL or modality does not support MWLDemographic data must be entered manually at modality – high risk of errors.

Errors manually corrected at the Archive or QA station,Reducing productivity and delaying availability of images. If not corrected images ‘orphaned’ and not available.

Unidirectional RIS/PACS

Unidirectional RIS/PACS I/fwithout Modality DICOM MWL

RIS PACS Broker

Non – MWL Modality

Modality QA station

HL7

Reporting Workstation

Archive

DICOM minus MWL

DICOM data, no MWLManual correction of data to match

RIS dataIf not done up to 20% of studies are ‘orphaned’

Manual input of data. Prone

to error

Unidirectional RIS/PACS I/fwith Modality DICOM MWL

RIS PACS Broker

MWL Modality

HL7

Reporting Workstation

Archive

DICOMData incl MWL

Data on start/finish exam, procedure changes, resource utilisation, number of images and series in study if sent back to RIS enhance QA, increase productivity and allow full integration into Integrated Clinical Systems.

To do this both RIS and Modality must support not just MWL but also DICOM Modality Performed Procedure Step (MPPS)

Bi-directional RIS/PACS

Bi-directional RIS/PACS I/fwith DICOM MWL and Modality Performed Procedure

Step installed in both RIS and Modality

RISMWL/MPPS PACS Broker

MWL/MPPS Modality

HL7 +

Reporting Workstation

Archive

DICOM

DICOM

DICOM +

HL7

Integrated RIS/PACS with DICOM MWL and Modality Performed Procedure

Step installed in both RIS and Modality

RIS/PACSInternal HL7- DICOM

& DICOM – HL7transactions

MWL/MPPS Modality

Reporting Workstation

Archive

DemographicsMWL MPPS

DICOMGeneral Purpose Worklist

(if provided allows choice Of WS independent

of PACS Vendor)

PACS companies which haveacquired RIS company products.Still basic brokering, but added internal HL7/DICOM transactions.

RIS PACS

Internal Transactions

Broker

Voice

De-novo combined RIS-PACS products.Some internal interfacing plusInternal HL7/DICOM transactions.

RIS PACS

Internal Transactions

Voice

Different vendors with all the HL7/DICOM transactions in RIS withina ‘PACS integration module’

RIS

PACSInternal Transactions

Voice

Incorporated into the report are captured images of key findings (which can be exploded to full screen presentation), structured diagnosis information, recorded audio, the ability to sort findings by anatomy or priority, to view prior findings associated with the corresponding patient and hyperlinks to related information.

      

DICOM SR – is an ‘envelope’, but within this useful structure is available.

User decides how much structure to use and controls with templates the type of content, if it is mandatory or optional and modes of expression

Structured reporting

Link Features to Description

New nodulesuperimposedwith rightfourth rib

Free air

10% Pneumothorax

Cavitation

Structured reporting

David Clunie

Development Director, Imaging Products

ComView Corporation – Paper at SPIE, 2001

Structured reporting

With an old non HL7 RIS – forget it

With an old HL7 Brokered RIS – limited

With a new HL7(IHE) RIS - very nearly a reality with a PACS integration module

- this allows freedom to choose best RIS and best (IHE) PACS

With a same vendor combined RIS-PACS – internal HL7/DICOM transactions

….But what about the modalities, DICOM MWL and MPPS?

Don’t forget the need to integrate the HIS and Integrated Clinical Systems too!

Complete Integration of RIS into PACS: Dream or Reality?

With thanks to Dr Jan SchillingbeekWith thanks to Dr Jan Schillingbeek

RIS PACS

Internal Transactions

Broker

Voice

HISEPR

HIS

Access to HIS

No access to HIS Extern callPaper document

General Scheduler

Order placed

Request

RIS

OrderCommunication

Part I: Administration

Order filledAnalogue request

available as scanned image

Analogue request

DICOM ModalityWorklist

PACS

Image manager +

archive

Long-termArchive

RISOrder filled

Modality

Display station

DS

Prefetching

Prefetched images

PACSModality

Imagemanager +

archive

RIS

Registration

Part II: Image production

Order filled

Listed

StartedArrived

Finished

DS

-MPR-MIP-Volume Rendering

-Access to HIS-Access to RIS-Access to EPR

Part III: Reporting

- Speech recognition

-Desktop integration:1 mouse &

1 keyboard

PACSPart IV: Distribution

Imagemanager +

archive

RISreport

DS

Webserver Paperprint

URL

EPRElectronic Patient Record

Billing

Report

print

CD

Complete Integration of RIS into PACS: Dream or Reality?

DEFINITELY POSSIBLE !