IHE Workshop – June 2006What IHE Delivers 1 Kevin O’Donnell Toshiba Medical Systems Evidence...

1IHE Workshop – June 2006 What IHE Delivers

Kevin O’DonnellKevin O’Donnell

Toshiba Medical SystemsToshiba Medical Systems

Evidence Documents ProfileEvidence Documents Profile

2IHE Workshop – June 2006IHE Workshop – June 2006

Evidence DocumentsEvidence DocumentsProblemProblem

Cardiology is measurement intensive

More and more modalities and workstations provide digital measurements

More and more sites are doing electronic reporting

… to improve efficiency, turnaround time and reduce errors

Current “state of the art”?

-> Screen dump a paper report

Introduces multiple unnecessary error points: A series of numbers that could be misread, misspoken, misheard and

mistyped Introduces additional unnecessary effort Introduces additional unnecessary delay


Evidence DocumentsEvidence DocumentsProblemProblem

Other popular kludges Measurements handwritten onto a worksheet which is

later dictated / transcribed Measurements output to a printer port and intercepted

by an application that scrapes the values Measurements recorded as a screen capture then

later OCR (optical character recognition) extracts numbers and label strings

… brittle solutions


Evidence DocumentsEvidence DocumentsScopeScope

Covers creation, storage and retrieval of evidence documents

Evidence documents contain coded observations such as measurements, procedure logs, CAD results, etc.

Evidence Documents are not Diagnostic Reports

Evidence Documents are: Inputs to the interpretation process (like images) Generally created, managed and used entirely inside

Cardiology/Radiology Dept

Diagnostic Reports are: Outputs from the interpretation process Generally created inside Cardiology/Radiology and distributed outside


Evidence DocumentsEvidence DocumentsScopeScope

Creation:

Generally Acquisition Modality or workstation (aka Evidence Creator) Generally created during acquisition or post-processing workflow Creator supports appropriate SR objects/templates

Storage:

Stored and Committed to “Image” Manager/Archive

Retrieval:

Retrieved by “Image Display” May be retrieved for presentation/interpretation with images, for further

processing, and/or for insertion into electronic reports Image Display may be grouped with a Report Creator


Evidence DocumentsEvidence DocumentsUse CaseUse Case

Electronic Distribution of measurements, Electronic Distribution of measurements, CAD and other observationsCAD and other observations

Evidence Document Evidence Document StoredStored

Storage CommitmentStorage Commitment

Query / RetrieveQuery / Retrieve

…..

Findings:

Image Refs.:

Header:

Report Type: Echo

EF

…..WallMotion


Interpretation

Simple Image & Simple Image & Numeric ReportNumeric Report

Evidence Evidence DocumentsDocuments

…..

Findings:

Image Refs.:

Header:

Report Type: Echo

EFWall……..

Cardiology Report

Impressions:

...

Key Image NotesKey Image Notes

…..

Findings:

Image Refs.:

Header:

Report Type: Echo

EF

…..WallMotion


Evidence DocumentsEvidence DocumentsImage ReferencesImage References

Echocardiography Measurement

Patient: Doe, John Technologist: der Payd, N

Measurements:

Mitral valve diameter 3.1cm

- shown in image at [ ]

Ventricular length, diastolic 5.97 cm

- shown in image at [ ]

Ventricular volume, diastolic 14.1 ml

- inferred from [ ]

- inferred from VLZ algorithm


Evidence DocumentsEvidence DocumentsValue propositionValue proposition

Measurements are managed in same study folder as images

Data is structured and uses coded concepts and vocabulary

Coded data can be searched, processed, databased (locally, national registry), …

Avoids detour through “paper-space” extra handling, delay and potential loss of paper additional effort and errors


Evidence DocumentsEvidence DocumentsTechnical BasisTechnical Basis

Based on: DICOM Structured Report (SR) Objects Storage Commitment Query/Retrieve

Addresses creation/distribution of the content

Scheduling and progress reporting could easily be supported by also implementing an appropriate IHE workflow profile


Evidence DocumentsEvidence DocumentsCath Evidence OptionCath Evidence Option

Acquisition Modalities / Evidence Creators:

Shall support one or more of the following DICOM Objects: Enhanced SR Comprehensive SR Procedure Log

Shall use one or more of the following templates: 3001 Procedure Log 3202 Ventricular Analysis 3213 Quantitative Arterial Analysis 3250 Intravascular Ultrasound 3500 Hemodynamics

Image Displays:

Shall unambiguously render ALL of the above Includes providing visual emphasis for measurements flagged “abnormal” Support of the templates is implicit in support of the DICOM Objects Displays may optimize display for the templates


Evidence DocumentsEvidence DocumentsEcho Evidence OptionEcho Evidence Option

Acquisition Modalities / Evidence Creators:

Shall support one or more of the following DICOM Objects: Enhanced SR Comprehensive SR

Shall use one or more of the following templates: 5100 Vascular Ultrasound 5200 Echocardiography

Image Displays:

Shall unambiguously render ALL of the above Includes providing visual emphasis for measurements flagged “abnormal” Support of the templates is implicit in support of the DICOM Objects Displays may optimize display for the templates


Evidence DocumentsEvidence DocumentsCath & Echo Evidence OptionsCath & Echo Evidence Options

Specific guidance provided on Completion Flag (0040,A491), E.g.: “Complete” requires the contents be attested/verified by an

identified user “Complete” means content includes all significant measurements

in the scope of the root Concept Name of the document A Requested Procedure may have multiple documents, each

covering a separate scope/topic

Specific guidance provided on Normality Flag (Template 3100) Allows flagging of measurements as Abnormal (high, low)


Evidence DocumentsEvidence Documents

Other Templates: 3900 CT/MR Cardiovascular Analysis 4000 Mammography CAD 4100 Chest CAD 4200 Breast Imaging Report 5000 OB-Gyn Ultrasound Report


Example Transaction FlowExample Transaction Flow

Image Display/Evidence Creator

Department System Scheduler/ Order Filler

Modality Procedure Step Completed [RAD-7]


ImageManager/

PPS Manager

Retrieve Images [CARD-4]

Modality Procedure Step In Progress [CARD-1]

Modality Procedure Step In Progress [CARD-1] Perform/Update

Measurements & Analysis

Modality Images/ Evidence Stored [CARD-2]

Storage Commitment [CARD-3]

Image Display

Query Images [RAD-14]Query Evidence [RAD-44]Retrieve Images [CARD-4]

Acquisition Modality


Perform Acquisition & Measurements



Query Images [RAD-14]Query Evidence [RAD-44]

Image Display/Evidence Creator

Department System Scheduler/ Order Filler



ImageManager/

PPS Manager

Retrieve Images [CARD-4]

Modality Procedure Step In Progress [CARD-1]

Modality Procedure Step In Progress [CARD-1] Perform/Update

Measurements & Analysis


Storage Commitment [CARD-3]

Image Display

Query Images [RAD-14]Query Evidence [RAD-44]Retrieve Images [CARD-4]

Acquisition Modality


Perform Acquisition & Measurements



Query Images [RAD-14]Query Evidence [RAD-44]

IHE Workshop – June 2006What IHE Delivers 1 Kevin O’Donnell Toshiba Medical Systems Evidence...

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Transcript of IHE Workshop – June 2006What IHE Delivers 1 Kevin O’Donnell Toshiba Medical Systems Evidence...