1September, 2005 What IHE Delivers

What’s New in IHE 2006What’s New in IHE 2006

Rita Noumeir Ph.D.Rita Noumeir Ph.D.

SoftmedicalSoftmedical

IHE Radiology Technical and Planning CommitteesIHE Radiology Technical and Planning Committees

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IHE Radiology ActivitiesIHE Radiology Activities

New Supplements in 2006New Supplements in 2006 Import Reconciliation Workflow (IRWF) Integration Profile Import Reconciliation Workflow (IRWF) Integration Profile Image Fusion (FUS) Integration Profile Image Fusion (FUS) Integration Profile Mammography Image (MAMMO) Integration ProfileMammography Image (MAMMO) Integration Profile Nuclear Medicine Image (NMI) Integration Profile with Nuclear Medicine Image (NMI) Integration Profile with

Cardiac OptionCardiac Option

Demonstration RSNA 2006Demonstration RSNA 2006 Cross-Enterprise Document Sharing for Imaging (XDS-I) Cross-Enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE)Teaching File and Clinical Trial Export (TCE)

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IHE IT Infrastructure ActivitiesIHE IT Infrastructure Activities

New Supplements in 2006New Supplements in 2006 Cross-enterprise Document Media Interchange (XDM) Cross-enterprise Document Media Interchange (XDM) Cross-enterprise Document Reliable Interchange (XDR) Cross-enterprise Document Reliable Interchange (XDR) Cross-enterprise Sharing of Scanned Documents (XDS-SD) Cross-enterprise Sharing of Scanned Documents (XDS-SD) Patient Identifier Cross-Reference and Patient Demographic Query Patient Identifier Cross-Reference and Patient Demographic Query

HL7 V3 (PIX/PDQ V3)HL7 V3 (PIX/PDQ V3) Registry Stored Query Transaction for Cross-Enterprise Document Registry Stored Query Transaction for Cross-Enterprise Document

Sharing Profile Sharing Profile Retrieve Form for Data Capture (RFD)Retrieve Form for Data Capture (RFD)

New White Papers in 2006New White Papers in 2006 White Paper: Cross Community Information Exchange including White Paper: Cross Community Information Exchange including

Federation of XDS Affinity Domains Federation of XDS Affinity Domains White Paper: Cross-Enterprise User Authentication (XUA) White Paper: Cross-Enterprise User Authentication (XUA) White Paper: Cookbook for the Security Section of IHE ProfilesWhite Paper: Cookbook for the Security Section of IHE Profiles

Interoperability Showcase at HIMSS 2007Interoperability Showcase at HIMSS 2007

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IHE Patient Care CoordinationIHE Patient Care Coordination

New Supplements in 2006New Supplements in 2006 Basic Patient Privacy Consents (BPPC)Basic Patient Privacy Consents (BPPC) Emergency Department Referral (EDR)Emergency Department Referral (EDR) Exchange of Personal Health Record Content Exchange of Personal Health Record Content

(XPHR) (XPHR) Pre-procedure History and Physical (PPHP)Pre-procedure History and Physical (PPHP)

Interoperability Showcase at HIMSS 2007Interoperability Showcase at HIMSS 2007

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IHE Cardiology ActivitiesIHE Cardiology Activities

New Supplements in 2006New Supplements in 2006 Implantable Device Cardiac Observations Profile Implantable Device Cardiac Observations Profile

(IDCO) (IDCO) Stress Testing Workflow Integration Profile Stress Testing Workflow Integration Profile

(STRESS)(STRESS) Patient Demographics Query: Urgent Implantable Patient Demographics Query: Urgent Implantable

Device Cardiac Identification Content Profile Device Cardiac Identification Content Profile (PDQ-IDC) (PDQ-IDC)

Demonstration at ACC 2007 Demonstration at ACC 2007

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IHE Lab ActivitiesIHE Lab Activities

New Supplements in 2006New Supplements in 2006 Sharing Laboratory Reports (XD*-LAB) Sharing Laboratory Reports (XD*-LAB) Laboratory Tests Code SetLaboratory Tests Code Set

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IHE New DomainsIHE New Domains

IHE Eye Care - AAOIHE Eye Care - AAO Eye Care Workflow (EYECARE) Eye Care Workflow (EYECARE) Charge Posting (CHG) Charge Posting (CHG) Eye Care Evidence Documents (ECED)Eye Care Evidence Documents (ECED)

IHE Radiation Oncology - ASTROIHE Radiation Oncology - ASTRO RT Objects Integration ProfileRT Objects Integration Profile

IHE Patient Care Devices - ACCEIHE Patient Care Devices - ACCE Device Enterprise Communication (DEC)Device Enterprise Communication (DEC)

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IHE Emerging DomainsIHE Emerging Domains

IHE PathologyIHE Pathology

IHE EndoscopyIHE Endoscopy

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Import Reconciliation Import Reconciliation Workflow Profile (IRWF)Workflow Profile (IRWF)

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Import Reconciliation WorkflowImport Reconciliation WorkflowUse Case – External Acquisition/ReadUse Case – External Acquisition/Read

Radiology Enterprise A

Radiology Enterprise B

Provider A

Radiology Site B

PACS A

Portable Data Creator Patient Data

2. Radiology Site B creates portable media with patient images and/or Reports

1. Provider A orders External Radiology Procedure

3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read.

4. Study Results sent to Provider

Radiologist

PDI Disk

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Radiology Enterprise B

Radiology Enterprise A

PACS B

Portable Data Creator

Patient Data

2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information.

1. Request for Patient’s case data to be transferred from Enterprise A to B.

3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive.

4. Patient Data is now associated with B’s electronic health record system.

Import Reconciliation WorkflowImport Reconciliation WorkflowUse Case – Patient Referral/TransferUse Case – Patient Referral/Transfer

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Import Reconciliation WorkflowImport Reconciliation WorkflowProblemProblem

Physical LimitationsPhysical Limitations

Security/Administrative: no CD drive in medical workstationsSecurity/Administrative: no CD drive in medical workstations

Logistical LimitationsLogistical Limitations

Portable Data may include different user interfaces in viewers, Portable Data may include different user interfaces in viewers, some viewers don’t worksome viewers don’t work

The clinician’s need to archive images temporary or permanent The clinician’s need to archive images temporary or permanent can’t be fulfilledcan’t be fulfilled

Images not available in Radiology PACS for comparison or second-Images not available in Radiology PACS for comparison or second-opinion consultopinion consult

Data LimitationsData Limitations

Patient not registered in the HIS Patient not registered in the HIS

Patient not registered in the RISPatient not registered in the RIS

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Import Reconciliation WorkflowImport Reconciliation WorkflowRequirementsRequirements

Patient Patient must be registered in the HIS must be registered in the HIS Patient Demographics from the Enterprise must be Patient Demographics from the Enterprise must be

used to reconcile imported dataused to reconcile imported data

Import may be a Import may be a Scheduled OrderScheduled Order Order information may be used to schedule the import Order information may be used to schedule the import Order information may be used to reconcile imported Order information may be used to reconcile imported

datadata

Import may be Import may be UnscheduledUnscheduled

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Import Reconciliation WorkflowImport Reconciliation Workflow

Scheduled Import OptionScheduled Import Option

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Import Reconciliation WorkflowImport Reconciliation WorkflowScheduled Import Transaction DiagramScheduled Import Transaction Diagram

RISRIS

ImporterImporter

PACSPACSRISRIS

Modality Worklist QueryModality Worklist Query

Imported Objects StorageImported Objects Storage

Storage CommitmentStorage Commitment

MPPS ManagerMPPS Manager

MPPSMPPS

Images from external Source: i.e. CDImages from external Source: i.e. CD

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Import Reconciliation WorkflowImport Reconciliation Workflow

Unscheduled Import OptionUnscheduled Import Option

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Import Reconciliation WorkflowImport Reconciliation WorkflowScheduled Import Transaction DiagramScheduled Import Transaction Diagram

PDQ PDQ SupplierSupplier

ImporterImporter

PACSPACS

Patient Demographics QueryPatient Demographics Query

Imported Objects StorageImported Objects Storage

Storage CommitmentStorage Commitment

MPPS ManagerMPPS Manager

MPPSMPPS

Images from external Source: i.e. CDImages from external Source: i.e. CD

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Image Fusion Profile (FUS)Image Fusion Profile (FUS)

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Image Registration and FusionImage Registration and Fusion

•Translate

•Rotate Rigid Registration

•Scale

•Warp- optional (Deformable Registration)

•Fuse

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Image Fusion- General Use CaseImage Fusion- General Use Case

Tech acquires two series of Tech acquires two series of images. images.

Tech reconstructs images, Tech reconstructs images, performs registration, and performs registration, and stores results.stores results.

Workstation presents fused view Workstation presents fused view based on full image data for based on full image data for Radiologist or Oncologist. Radiologist or Oncologist.

PACS Display shows Fused PACS Display shows Fused views to Referring Physicianviews to Referring Physician

CTCT MRMR

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Fusion- The Integration ProblemFusion- The Integration Problem

Results not readily transferable between systemsResults not readily transferable between systems Proprietary or inconsistent implementations Proprietary or inconsistent implementations Lack of guidanceLack of guidance

Results presented on different systems may not Results presented on different systems may not appear the same. appear the same.

Systems must correctly handle issues such as Systems must correctly handle issues such as Identifying and retrieving the right datasets Identifying and retrieving the right datasets Matching data between single-slice and multi-slice Matching data between single-slice and multi-slice

datasetsdatasets Performing spatial translationsPerforming spatial translations Rendering the fused displayRendering the fused display

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Fusion- The Integration SolutionFusion- The Integration Solution

A collection of DICOM objects exists to A collection of DICOM objects exists to address the problem. address the problem.

Their use is constrained and clarified to Their use is constrained and clarified to avoid misinterpretation and promote avoid misinterpretation and promote compatibilitycompatibility. .

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Spatial Registration ObjectSpatial Registration Object

Not required for already-registered Not required for already-registered PET-CT data from a hybrid scanner PET-CT data from a hybrid scanner

SROImage 1

Image 2

Transformation

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Blending Presentation StateBlending Presentation State

Image 1

Image 2

SRO

Transformation BPS

Window – 1

Window – 2

Color Table

Transparency

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Load CT and PET imagesLoad CT and PET images

Align images (automatically or Align images (automatically or manually) and fuse with desired manually) and fuse with desired blending factorblending factor

Store the alignment, including Store the alignment, including

Registration object Registration object Blending State (defining the blending Blending State (defining the blending

factor, window levels and factor, window levels and referencing all other objects) referencing all other objects)

Storage can be on PACS or disk. Storage can be on PACS or disk. Images do not need to be stored if Images do not need to be stored if already stored.already stored.

Fusion- PreparationCTCTCTCT

PETPETPETPET

Registration Registration ObjectObject

Blending State

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Blending state can be searched and Blending state can be searched and retrieved from PACS retrieved from PACS Can be used to retrieve the image data Can be used to retrieve the image data

and the alignment automatically. and the alignment automatically. User selects a Blending state. User selects a Blending state. Automatically load referenced objects.Automatically load referenced objects.

Alignment applied, PET re-sampled to Alignment applied, PET re-sampled to CT and displayed fused automatically .CT and displayed fused automatically .

Display is required to provide Display is required to provide Scrolling through volumeScrolling through volume Adjustment of fusion blending and Adjustment of fusion blending and

window levelswindow levels MPR MPR Side-by-side displaySide-by-side display

Fusion- Display

CTCTCTCTPETPETPETPET

Registration Registration ObjectObject

Blending State

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Nuclear Medicine Image Nuclear Medicine Image ProfileProfile

with Cardiac Option (NMI)with Cardiac Option (NMI)

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

Click and move mouse down to adjust window level, right to adjust window center

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Cardiac Viewing SuboptimalCardiac Viewing Suboptimal

If sent as If sent as Short axisShort axis Images not Images not

displayed in a displayed in a useful format.useful format.

If sent as screen snapshotsIf sent as screen snapshots(ie, static Secondary Capture)(ie, static Secondary Capture) Can’t separately adjust stress and rest imagesCan’t separately adjust stress and rest images Can’t view gated cineCan’t view gated cine

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Image DisplayImage Display

Scale “intelligently” to avoid Scale “intelligently” to avoid presenting postage-stamp size NM presenting postage-stamp size NM imagesimages

Allow user to select different Allow user to select different vectors/framesets of complex multi-vectors/framesets of complex multi-frame imagesframe images

Allow user to separately adjust intensity for Allow user to separately adjust intensity for different framesets (eg, phases) in the different framesets (eg, phases) in the same “image”same “image”

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ACC NM Display ExampleACC NM Display ExampleShort axisShort axis

Horizontal LongHorizontal Long

Vertical LongVertical Long

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ACC NM Display ExampleACC NM Display ExampleShortShort

HorizontalHorizontal

VerticalVertical

Stress

Rest

Stress

Rest

Stress

Rest

Stress

Rest

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Result Screen Export OptionResult Screen Export Option

Wednesday 4:15-5:00Wednesday 4:15-5:00

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Mammography Image (MAMMO)Mammography Image (MAMMO)

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Hanging Protocol DifferencesHanging Protocol DifferencesExample Preferred LayoutExample Preferred Layout

Hanging protocol determined by:Hanging protocol determined by:

View Type (i.e. CC vs. MLO)View Type (i.e. CC vs. MLO)

Specialty View Type (i.e. Spot, Mag)Specialty View Type (i.e. Spot, Mag)

Laterality Laterality

Patient OrientationPatient Orientation

R CCR CC L CCL CC

L MLOL MLOR MLOR MLO

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Variances in FFDM Vendor DataVariances in FFDM Vendor DataDetector Size ExampleDetector Size Example

RR RRLL LL

RR LL

Prior Exam fromPrior Exam fromVendor A’s systemVendor A’s system

RR LL

Typical “Fit to Viewport” effectTypical “Fit to Viewport” effect

Current Exam fromCurrent Exam fromVendor B’s systemVendor B’s systemDifferent resolutionDifferent resolutionDifferent pixel matrixDifferent pixel matrix

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Printing ConsiderationsPrinting ConsiderationsTrue SizeTrue Size

Precision of <2% errorPrecision of <2% error

10in x12in10in x12inFilm sizeFilm size

8inx10in8inx10inFilm sizeFilm size

Film size vs. Detector SizeFilm size vs. Detector Size

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Printing ConsiderationsPrinting ConsiderationsPositioning-minimal borders at chestwallPositioning-minimal borders at chestwall

Centered images canCentered images cancreate large borders create large borders at chestwallat chestwall

Image offset with Image offset with chestwall side having chestwall side having minimal bordersminimal borders

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Mammography Image IntegrationMammography Image IntegrationValue propositionValue proposition

Helps meet desire to have multiple FFDM Helps meet desire to have multiple FFDM vendors and use any vendor’s workstation for vendors and use any vendor’s workstation for diagnosisdiagnosis

Ensures that FFDM modalities provide Ensures that FFDM modalities provide adequate information to facilitate downstream adequate information to facilitate downstream applicationsapplications

Ensures systems support required data Ensures systems support required data objects for interoperabilityobjects for interoperability

Defines image display and printing operations Defines image display and printing operations required for effective and efficient diagnosesrequired for effective and efficient diagnoses

Tuesday 1:15-2:00Tuesday 1:15-2:00

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