Transcript radiologist-clinician.v1.0

Collaboration between the
Referring Clinician and the
Radiologist
DICOM WG10 April, 2004,
Kamakura
IHE White Paper: External View
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DICOM WG10 Kamakura April, 2004
page 2
Main external Process
patient
order
Radiology
patient
Acquisition
Reporting
result
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DICOM WG10 Kamakura April, 2004
page 3
IHE Actors / Transactions
modality
radiologist
Acquisition
Modality
patient
HIS
IMAGINGImage Display
images
AcquiReporImage Mgr /
•PACS
Archive
•Workstations
Performed
Report ting
sition
Procedure Step
•Modalities Creator
Manager
status updat.
scheduling
order
Order
Placer
Department
System Scheduler
– Order Filler –
HIS
report
Enterprise
RIS Dept Mgt
Radiology
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patient
Report
Manager
DICOM WG10 Kamakura April, 2004
resultsReport
Repository
page 4
Main Internal process
modality
patient
Acquisition
radiologist
images
Reporting
patient
status updat.
scheduling
order
report
Radiology Dept Mgt
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DICOM WG10 Kamakura April, 2004
results
page 5
Scenario 3 and 4
modality worklist
Selected Images
print
print
RIS
stor
e
Qn
R
interpretation
sen
d
acquisition
Images
Evidence Docts
Presentation States
Narrative
Info Only
print + mail
/ fax / e-mail
Electronic Report
quer
y
transcription
prin
t
stor
e
store>burn
interpretation
Electronic Report
Image
Repository
stor
e
Qn
R
PACS
approval
print
Report
Repository
store>burn
Images
Evidence Documents
Presentation States
burn CD
Film
network
DICOM
optional
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DICOM WG10 Kamakura April, 2004
manual
HL7/other
page
6
Scenario 5 & 6
CIS
Note:
Alternative Approach IHE Web Service
Retrieve Specific Information for Display
Retrieve Document for Display
Store
Store
Q/R
Q/R
Relevant
RelevantPatient
Patient
InformationQuery
InformationQuery
Gateway
HL7
Interface
Financial
Information
Repository
Images
Evidence Documents
Presentation States
Store
Store
Acquisition Control
Quality Control
Postprocessing
ED Creation
Clinical
Information
Repository
Postprocessing
Dictation
Interpretation
Direct Report Creation
ED/Report Verification
Store
Store
Q/R
Q/R
Export:
Images
Evidence Documents
Imaging Reports
IIS
Report
Repository
Image
Repository
PACS
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FIS
Web
Interface
DICOM WG10 Kamakura April, 2004
Web
Interface
WADO
Web Client
Clinician Access
WADO
DICOM
Interface
Web
Gateway
Q/R
Q/R
page 7
Context
• Digital imaging and communications in
Radiology is relatively mature
• Clinicians have more and more access to
digital equipment (PC, Web, emerging
EPR/EMR)
• Communication channels are available
(Intranet, Internet, CD/DVD)
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DICOM WG10 Kamakura April, 2004
page 8
Limitations of DICOM
•
•
•
•
•
•
Order / prescription enriching diagnosis
Report display and « push »
Significant images selection
Access to images and reports
Multi-domain patient identification
Collaboration on images and reports (for the
mid term future)
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DICOM WG10 Kamakura April, 2004
page 9
Order / prescription
• Orders « managed » by HL7 but its
radiology specific content has to be mapped
to DICOM
• Lack of structured content (CPOE, JJ17xx)
• New Structured Prescription, retrieved by
interpretation WS?
• If defined, to be integrated in SR
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DICOM WG10 Kamakura April, 2004
page 10
Report
• The main result waited by the clinician
• A « push mode » has to be defined
• A mapping on CDA has to be defined, to be
managed as other documents by clinicians
• A « presentation mode » has to be defined
(stylesheet to PDF?) to replace the paper
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DICOM WG10 Kamakura April, 2004
page 11
Significant images
• Crucial problem of selection, required for
saving clinician time and largely under done
by radiologists for saving their time
• Highlighted by large CT and MR, even on
CD distribution of images
• Requires to defined a « push mode » of a set
of selected images/objects
• By default, action close to the « print » one
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DICOM WG10 Kamakura April, 2004
page 12
Access to images and reports
• Clinician are more and more manipulating
DICOM objects but DICOM protocol can not
reach them easily
• Extension of WADO kind mechanisms for:
– Querying DICOM objects (IHE ITI RID kind);
– "Set of objects" retrieval (example a series or a KOS
referring a list of images);
– "Left part" of the URI (using Namespaces for solving
the problem "transposition" of the references between
different contexts);
– Refining the access to only a part of the DICOM object,
either a set of Tags for example, or a part of the image
or the sequence (beyond the single frame number).
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DICOM WG10 Kamakura April, 2004
page 13
Multi-domain patient identification
• How far DICOM shall take into account the
multi-domain patient identification?
• Analyze the impact of the DomainID
extension of the Patient Header (CPxx)
• Typical use case on short term: reload of
DICOM CD in another radiology
department, with patient reconciliation
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DICOM WG10 Kamakura April, 2004
page 14