Transcript Managing the Acquisition Workflow with DICOM

DICOM INTERNATIONAL
CONFERENCE & SEMINAR
October 9-11, 2010
Rio de Janeiro, Brazil
Managing the Acquisition Workflow
Nikolaus Wirsz, PhD
SIEMENS AG – Healthcare Sector
Member of the DICOM Standards Committee and
Working Group Ten - Strategic Advisory
Managing the
Acquisition Workflow
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Introduction
Modality Worklist
Modality Performed Procedure Step
Storage Commitment
Instance Availability Notification
Conclusions
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Introduction
• DICOM Constructs
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Information Object Definitions (IOD): Images, Evidence Documents
Service Class Specifications: Storage, Query/Retrieve, …
Data Structures and Semantics
Message Exchange
…
… to support
– User Tasks
– Interactions Between Systems
– Process Steps in the Diagnostic Chain
… and improve clinical processes:
– Acquisition Workflow
– Post-Processing Workflow
– Reporting Workflow
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The Acquisition Workflow
• Sustain & Optimize Process Tasks
in the Radiology / Imaging Department
Data Entry
Procedure Scheduling
Image Acquisition
Procedure Tracking
Image Storage Management
Image
Management
(PACS)
Instance Availability Notification
• Unobstructed Information Flow
Workflow Management
“Assembling the Puzzle”
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• Key DICOM Services for
Acquisition Workflow Support
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Registration
Order Entry
Scheduling
Tracking
Modality Worklist
Modality Performed Procedure Step
Storage with Storage Commitment
Instance Availability Notification
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Modality Worklist
Departmental
Information System
(RIS)
Image
Acquisition
Modality
Storage & Storage Commitment
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2 Performed Procedure Step
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1 Modality Worklist (MWL)
• Provide Demographics, Procedure and Schedule Details to the Modality
• Modality (SCU) Queries the RIS (SCP) 1a
• Query Matching Key Attributes
– Date / Time of Procedure
– Modality Type (e.g. CT)
– Station AE Title (a specific Device)
Departmental
Information System
– Patient Name / ID
(RIS)
– Accession # (identifies an Imaging Order)
– Requested Procedure ID
–…
1b Results: C-FIND Resp.
1a Query: C-FIND Req.
Image
Acquisition
Modality
• Query Examples
– Today‘s Worklist
– CT Procedures Worklist
– CT Room 1 Worklist
– John Doe‘s Procedures of a Chest Imaging Order
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1 Modality Worklist (MWL)
• RIS (SCP) Returns Query Results to Modality (SCU) 1b
– Null (No Match)
– One or More Worklist Entries
• Worklist Entry (Unit of Service) =
Scheduled Procedure Step (SPS)
1b Results: C-FIND Resp.
• Query Return Key Attributes
– Patient Data
• Name, ID, Demographics
• Allergies, Special Conditions
Departmental
Information System
(RIS)
– Scheduling Information
• Date / Time
1a Query: C-FIND Req.
Image
Acquisition
Modality
– Procedure Information
• Description, Protocol Codes
• Contrast & Medication Administration
– Order Information
• Accession #, Study UID
• Requesting Physician
– ...
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1 Modality Worklist (MWL)
• Deployment of the Modality Worklist Service
– Modalities Query & Receive Worklists from RIS 1a 1b
– Modality Displays Worklist to Operator
– Operator Selects a Worklist Entry (SPS) to Perform
– Acquisition of Images
(Based on SPS Details)
– Insert Patient & Procedure Data
Departmental
Information System
into the Image Header
(RIS)
• Benefits of Using the Modality Worklist
1b Results: C-FIND Resp.
1a Query: C-FIND Req.
Image
Acquisition
Modality
– Eliminate Redundant Data Capture
– Avoid Error-Prone Manual Tasks
– Facilitate Data Consistency:
Unambiguous Association of Images to Proper Patient / Procedure
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2 Modality Performed
Procedure Step (MPPS)
• Feedback Acquisition Data to Scheduling System (RIS)
• Modality (SCU) Sends Acquisition Information to the RIS (SCP)
• Tracking of Modality Procedure Status
– IN PROGRESS: MPPS N-CREATE 2a
– COMPLETED:
MPPS N-SET 2b
– DISCONTINUED: MPPS N-SET
(incl. Reason for Discontinuation)
• Logging of Procedure Related Data
Departmental
Information System
(RIS)
Image
Acquisition
Modality
– Identification Attributes:
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Accession #
SPS ID
Patient Name / ID / Demographics
...
2a MPPS IN PROGRESS: N-SET
2b MPPS COMPLETED: N-CREATE
– List (Series) of Images
– Protocol Codes for the Actually Performed Acquisition
– Materials Used (Chemicals, Supplies)
– Radiation Dose Exposure Values
– ...
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2 Modality Performed
Procedure Step (MPPS)
• MPPS Use Cases (according to IHE)
Simple Case
SPS
Unscheduled Case
SPS
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0
results
in
1
results
in
1
PPS
PPS
1
Append Case
SPS
1
results
in
1
1
SPS
Group Case
SPS
SPS
1
1
PPS
PPS*
Modality Worklist
Departmental
Information System
(RIS)
*appended
results
in
1
Image
Acquisition
Modality
PPS
1
2 Performed Procedure Step
• Benefits of Using MPPS
– Keeping Schedules Up-to-date
– Better Management of Resources
– Gather Information Required for Billing
– Trigger for Subsequent Processes: Post-Processing, Reporting
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3 Storage with
Storage Commitment
• Secure Ownership and Safekeeping of Clinical Results
– PACS Notifies Modality of Success (or Failure) :
N-EVENT-REPORT 3c
Image
Acquisition
Modality
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3c Confirm Storage Commitment: N-EVENT-REPORT
– Modality Issues Storage Commitment Request to PACS:
N-ACTION 3b including List of Instances to Retain
3b Request Storage Commitment: N-ACTION
– Modality Transmits Images (or other Objects) to PACS:
C-STORE Operations for Images 3a
3a Transfer Images: C-STORE
• Modality (SCU) Requests
Storage Commitment from PACS (SCP)
Image
Management
(PACS)
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3 Storage with
Storage Commitment
• Benefits of Using Storage Commitment
– Confidence in a Dependable Storage of Clinical Evidence
Image
Management
(PACS)
– Avoid Unnecessary Re-Examinations
(Reduce Radiation Exposure)
– Modality can Remove Images from Local Storage and
Re-Use Available Space for Exams to Follow
Image
Acquisition
Modality
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3c Confirm Storage Commitment: N-EVENT-REPORT
• Network Troubles
• Storage Breakdowns
3a Transfer Images: C-STORE
– Avoid Loss of Clinical Information due to
3b Request Storage Commitment: N-ACTION
– Eliminate Double-Check / Manual Confirmation Time
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4 Instance Availability
Notification (IAN)
• Inform about Availability of Image Data
• PACS (SCU) Notifies the RIS (SCP) that 4
Images are Available for Retrieval & Use
– List of Instances (Images)
– Location (Retrieve SCP) of Images
– Availability Status
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Image
Management
(PACS)
Instance Availability Notification: N-CREATE
Online
Nearline
OffLine
Unavailable
• Use of IAN to Initiate
Subsequent Processes
Departmental
Information System
(RIS)
– Post-Processing
– Interpretation / Reporting
– Distribution of Images to Other Locations
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4 Instance Availability
Notification (IAN)
• Benefits of Using Instance Availability Notification
– In-Time Notification Avoids Excessive Queries
for the Whereabouts of Images
– Completion of Acquisition Workflow:
Ready-to-Use Results
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Image
Management
(PACS)
Instance Availability Notification: N-CREATE
– Enable Transition to the Next Process
Steps of the Imaging Workflow
– Allow for Timely Preparations of
Tasks & Resource Allocation for
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Additional Procedures
Post-Processing
Reporting
Patient Transfer / Discharge
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Departmental
Information System
(RIS)
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Integrating the
Healthcare Enterprise
IHE Scheduled Workflow (SWF) Integration Profile
– includes Acquisition Workflow Management –
• Interoperability Frameworks for
Implementing and Deploying
Standards-Based (HL7 & DICOM)
Integrated Solutions
Evidence Processing
Report Generation
Interpretation
Reviewing
Workstation
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• IHE Integration Profiles
– Interoperability Building Blocks to
Solve Specific Integration Issues:
e.g. Workflows
– Packages of DICOM / HL7 Services:
e.g. Scheduled (Acquisition) Workflow
(SWF) Integration Profile
Image
Management
(PACS)
Instance Availability Notification
Hospital
Information System
(HIS)
Workflow Management
• Registration
• Order Entry
• Scheduling
• Tracking
Patient Registration
Order Management
Results Processing
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Storage & Storage Commitment
• Forum (Organization) for Advancing
Integration in Clinical Practice
Modality Worklist
Departmental
Information System
(RIS)
Image
Acquisition
Modality
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2 Performed Procedure Step
Refer to: IHE Radiology Technical Framework Vol. I – Scheduled Workflow (SWF) Integration Profile
http://www.IHE.net/Technical_Framework/
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Conclusions
• DICOM Services for Acquisition Workflow Management
– Improve Interoperability of Imaging Equipment
– Ensure Data Consistency
Image
Management
(PACS)
– Facilitate Reliable Data Management
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Instance Availability Notification
– Better Quality of
Imaging Services
Workflow Management
• Registration
• Order Entry
• Scheduling
• Tracking
1
Modality Worklist
Departmental
Information System
(RIS)
Image
Acquisition
Modality
Storage & Storage Commitment
– Improve Process Efficiency
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2 Performed Procedure Step
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References
http://medical.NEMA.org/DICOM
http://www.HL7.org/
http://www.IHE.net/
Thank you for your attention !
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