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DICOM,HL7, RIS,PACS ARogue’sGalleryofAcronyms Or AnIntrotoImagingInformatics SEAAPMSymposiumApril2014 DICOM,HL7, RIS,PACS KevinL.Junck,PhD ProfessorofRadiology ChiefofRadiologyInformatics UABHealthSystem [email protected] LearningObjectives 1)tounderstandtheelectronicflowofinformation throughouttheradiologyexaminationincluding systemsbothupstreamanddownstreamwhich interactwiththeimagingmodality. 2)toreviewtheworkofAAPMTaskGroupNumber 248– InteroperabilityEvaluationforImagingModality AcceptanceTesting. HighAltitude MyLevel MyLevel Who’sOnFirst? RadiologyTechnologists Radiologictechnologistsarethemedicalpersonnel whoperformdiagnosticimagingexaminationsand administerradiationtherapytreatments. Radiologictechnologistswhoperformimaging examinationsareresponsibleforaccuratelypositioning patientsandensuringthataquality diagnosticimageis produced. RadiologyTechnologists QualityManagementTechnologists usestandardizeddatacollectionmethods,informationanalysis toolsanddataanalysismethodstomonitorthequalityofprocesses andsystems intheradiologydepartment.Theyperformprocessor qualitycontroltests,assessfilmdensity,monitortimeraccuracy andreproducibilityandidentifyandsolveproblemsassociatedwith theproductionofmedicalimages. Source:http://www.asrt.org ImagingInformatics “Medicalimaginginformaticsis a multidisciplinaryfieldthatintersectswiththe biologicalsciences,healthservices,information sciences,medicalphysics,andengineering. ImagingInformatics Imaginginformaticstoucheseveryaspectoftheimaging chainfromimagecreationandacquisition,toimage distributionandmanagement,toimagestorageand retrieval,toimageprocessing,analysisand understanding,toimagevisualizationanddata navigation;toimageinterpretation,reporting,and communications.Thefieldservesastheintegrative catalystfortheseprocessesandformsabridgewith imagingandothermedicaldisciplines. ImagingInformatics Imaginginformaticsprofessionalsand scientistsspecializinginthisevolvingfieldare pioneersinvolvedattheintersectionof informationscience,imagingtechnologyand healthcareandrequireclinicalacumenaswell asexpertunderstandingoftechnology." KatherineP.Andriole,PhD,FSIIM Source:http://siim.org HealthcareIT Healthinformatics(alsocalledhealthinformation systems,healthcareinformatics,healthcare informatics,medicalinformatics,nursinginformatics, clinicalinformatics,orbiomedicalinformatics)isa disciplineattheintersectionofinformationscience, computerscience,andhealthcare.Itdealswiththe resources,devices,andmethodsrequiredtooptimize theacquisition,storage,retrieval,anduseofinformation inhealthandbiomedicine. Source:http://www.Wikipedia.org MedicalPhysicists WhatdoMedicalPhysicistsDo? Medicalphysicistsareconcernedwiththree areasofactivity:clinicalserviceand consultation,researchanddevelopment,and teaching.Ontheaveragetheirtimeis distributedequallyamongthesethreeareas. Source:http://www.aapm.org MedicalPhysicists ClinicalServiceandConsultation …Otherimportantservicesarerenderedthrough investigationofequipmentperformance,organization ofqualitycontrolinimagingsystems,designof radiationinstallations,andcontrolofradiation hazards.Themedicalphysicistiscalleduponto contributeclinicalandscientificadviceandresourcesto solvethenumerousanddiversephysicalproblemsthat arisecontinuallyinmanyspecializedmedicalareas. Who’sOnFirst? BuyitorBuildit AAPM‐ IISC AAPM– TG248 AAPM– TG248 Charge: Todevelopataskgroupreportwhichprovides thefollowingresourcestotheAAPM, applicabletoallimagingmodalityareas: AAPM– TG248 1)Recommendationthattheacceptance testingofimagingmodalitiesincludesend‐to‐ endevaluationofimagequalityandimage informationfromorderingsystemtolong‐term archiveandallrelevantsystemswherethe imagesareviewed,processedormodified. AAPM– TG248 2)Backgroundandmotivationfor interoperabilityassessmentwithexamples identifyingriskstopatientcarefrom incompleteacceptancetesting. 3)Suggestionsfortoolsforassessing interoperability.Furtherdetailswillbe developedbytheTGincreatingthereport, withabetterexaminationofwhatwouldbea usefulroleforthemodalityphysicistsandwhat resourcesareavailabletothem. Interoperability Interoperability TG248ReportIntroduction Thefunctionalityofadiagnosticimagingsystemoften extendsbeyondtheacquisitionconsoleanddepends oninteroperabilitywithahostofothersystemssuchas RIS,PACS,post‐processingsoftware,treatment planningsoftware,andclinicalviewers. InteroperabilitymightbeassuredbyavendorinanIHE (IntegratingtheHealthCareEnterprise)Integration Statement,andperhapscontractuallyagreedtoaspart ofapurchase.Orthevendormayassumeno responsibilityforinteroperabilityandleavevalidation totheend‐usertoensurethattheequipmentisready forclinicaluse. TG248ReportIntroduction Ineithercase,itiswisetounderstandwhatmightgo wrong,whattherisksare,andwhataspectsof interoperabilityaredesirabletovalidateaspartof equipmentacceptancetesting.Thegoalofthe acceptancetestingcanbeviewedintwoparts:1)to ensurethattheequipmentmeetsorexceedsthe specificationsprovidedbythemanufactureraspartof thepurchaseprocess.2)Tovalidatethatasystemis readyforclinicaluse.Oftenitistheroleofaphysicistto bethefinalsign‐offinregardtobothoftheseacceptance testinggoals. TG248ReportIntroduction Troubleshootingandoptimizingtheimagingchainmayrequirea teameffortonthepartofthephysicist,serviceengineer,PACS systemadministrator,technologistandotherstakeholders.Each oftheseindividualswillhavespecialknowledgeoftheworkflow, thedataflowandofthepossiblefactorsthatcouldaffectimage qualityandinformationintegrityatdifferentpointsintheimaging chain.Themedicalphysicistshouldhaveanunderstandingofthe variablesthatcanaffecttheimagebetweenacquisitionanddisplay, andtoknowwheretogoforadditionalassistanceinordertoisolate thesourceofimagequalityorinformationintegrityproblems. TeamLead DICOM ServiceClasses– “verbs”– Part4 Storage StorageCommitment Query/Retrieve ModalityWorklist ModalityPerformedProcedureStep Printing ModalityWorklist Beforewegenerateanimage,wewanttolink patientdemographicinformationtotheimage – who’simageisit? AservicetypicallyprovidedbythePACS. Howeveritisasnapshotofthedataprovided bytheRISviaHL7. PACSvRIS PACS– Pictures communicationswithmodality RIS– ReportsandOrders communicationswithpeople(physicians, technologists) PACSvRIS PACSBroker ReceivesHL7fromRIS TranslatesintoSQL callsforPACSdatabase Respondstomodality requestsforworklists ModalityWorklist Configuration Placeordersforyourmodality dotheyshowup? doyougetordersthatarenotforyourarea? wanttohaveaminimallisttoavoidwrong selection,butmusthavewhattheuserneeds. ModalityWorklist Error typoinname/MRN/accessionnumber pickwrongsetofInformationfromlist We’vereducedtheerrorrate,buttheerrorsare moredifficulttocatch. ModalityWorklist Information Placeordersforyourmodality whatinformationispresent? Name,Gender,DOB AccessionNumber,Dateofexam,Typeof exam– criticalifyouhavemultipleexamsfor samepatient. doesexam“falloff”listwhencancelled? whenacquired? ProcedureCodeMapping Tietheexambeingperformedtoviewsor protocolsonthemodality. ChestPAandLateral– modalitymaystep thetechnologistthroughacquiringthetwo imagesneededforthisexam. enablesdefaulttechniquesandimage processingparameters maybedonebyvendor’sapplications specialist DICOM ServiceClasses– “verbs” Storage StorageCommitment Query/Retrieve ModalityWorklist ModalityPerformedProcedureStep Printing Storage UseModalityWorklist withadedicatedtest patienttobeabletosendimagestoPACS. Exception– matchingofimagesagainstorders. ImageProcessing– doesitlookright? ImageAnnotations– aretheythere? Physicalmeasurements– pixelsvsmm? Storage ImageManipulations: Window– level Flip/rotate Invert EdgeEnhancement Storage Locationmarkers– orientation Storage Networkperformance Sendtoalllocations‐ configuration Storage ImageOverlay Storage Non‐imageimages Structuredreport Dosereport Storage Errorcorrection Emergencydataentry Downtimeprocedures RIS PACS Network HL7 HealthLevel7 www.hl7.org HL7anditsmembersprovideaframework(andrelated standards)fortheexchange,integration,sharing,andretrievalof electronichealthinformation.Thesestandardsdefinehow informationispackagedandcommunicatedfromonepartyto another,settingthelanguage,structureanddatatypesrequired forseamlessintegrationbetweensystems.HL7standardssupport clinicalpracticeandthemanagement,delivery,andevaluationof healthservices,andarerecognizedasthemostcommonlyusedin theworld. HL7 StartBlock MSH|^~\&|HNAMN|RADNET|PACS|UABHS|20140428101734||ORM^O01|Q1017569306T1090564180|X|2.3 PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||19000101090200|U||U|RADINFOTEST PT^/BADADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999)999‐9999||UNK|U|OTH| 648392053252||||NH|||0 PV1|1|I|UC~UABC~KRD^^^UC^^^UC~UABC|3|||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~ 9500^Universal^Provider^^^^^^^^^^EXTERNALID|||17|UC~UABC~KRD|||1||||O|3252|||||| ||||||||||||||UC|||||20130909124000|20130923235959 ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|411234561^Tester^Kelly^^^^^^ ^^^^EXTERNALID||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provide r^^^^^^^^^^EXTERNALID|||20140428101730|||WRITTENORDER^Written|411234561^Tester^ Kelly^^^^^^^^^^EXTERNALID OBR|1|1685047828^HNAM_ORDERID||CD:51536620^MAMammogramDigitalBilateral||||||| |CD:312689^312689|||RadType&Rad Type|9500^Universal^Provider^^^^^^^^^^DOCNBR~~~ 9500^Universal^Provider^^^^^^^^^^EXTERNALID||||00000MA20140010066^HNA_ACCN~30784 024^HNA_ACCNID~5905455^HNA_PACSID|CD:185639490|20140428101730||Mammography|||1^^ 0^20140428101700^^Today|||Ambulatory|^test EndBlock HL7 MSH|^~\&|HNAMN|RADNET|PACS|UABHS|20 140428101734||ORM^O01|Q1017569306T10 90564180|X|2.3 MSH– messageheader MSH3and4:SendingApplication/Facility– HNAMN/RADNET MSH5and6:ReceivingApplication/Facility– PACS/UABHS MSH7:Date/TimeofMessage MSH9:MessageType ORM– order ORU‐ result HL7 PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||1900010 1090200|U||U|RADINFOTESTPT^/BAD ADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999) 999‐9999||UNK|U|OTH| 648392053252||||NH|||0 PID– PatientIdentification PID3– PatientIdentifier PID5– PatientName PID7– PatientDOB PID8– Gender PID18– FinancialAccountNumber HL7 PV1|1|I|UC~UABC~KRD^^^UC^^^UC~UABC|3|||9500^Universal ^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^ ^^^^^^^^EXTERNALID|||17|UC~UABC~KRD|||1||||O|3252|||||| ||||||||||||||UC|||||20130909124000|20130923235959 PV1– PatientVisit PV12– PatientClass PV13– PatientLocation PV17– AttendingDoctor HL7 ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|4 11234561^Tester^Kelly^^^^^^^^^^EXTERNALID||9500^Univers al^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^ ^^^^^^^^^EXTERNALID|||20140428101730|||WRITTEN ORDER^Written|411234561^Tester^Kelly^^^^^^^^^^EXTERNA LID ORC– OrderCommonInformation ORC1– OrderControlCode/Status ORC10– EnteredBy HL7 OBR|1|1685047828^HNAM_ORDERID||CD:51536620^MA MammogramDigitalBilateral||||||||CD:312689^312689|||Rad Type&Rad Type|9500^Universal^Provider^^^^^^^^^^DOCNBR ~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID||||0000 0MA20140010066^HNA_ACCN~30784024^HNA_ACCNID~59054 55^HNA_PACSID|CD:185639490|20140428101730||Mammograp hy|||1^^0^20140428101700^^Today|||Ambulatory|^test OBR– ObservationRequest OBR2– PlacerOrderNumber OBR4– UniversalServiceID OBR20– FillerField1 DICOM DICOM— DigitalImagingandCommunicationsinMedicine— isthe internationalstandardformedicalimagesandrelatedinformation(ISO 12052).Itdefinestheformatsformedicalimagesthatcanbeexchanged withthedataandqualitynecessaryforclinicaluse.DICOMis implementedinalmosteveryradiology,cardiologyimaging,and radiotherapydevice(X‐ray,CT,MRI,ultrasound,etc.),andincreasinglyin devicesinothermedicaldomainssuchasophthalmologyanddentistry. Withtensofthousandsofimagingdevicesinuse,DICOMisoneofthe mostwidelydeployedhealthcaremessagingstandardsintheworld. ThereareliterallybillionsofDICOMimagescurrentlyinuseforclinical care.Sinceitsfirstpublicationin1993,DICOMhasrevolutionizedthe practiceofradiology,allowingthereplacementofX‐rayfilmwithafully digitalworkflow.MuchastheInternethasbecometheplatformfornew consumerinformationapplications,DICOMhasenabledadvanced medicalimagingapplicationsthathave“changedthefaceofclinical medicine”. DICOM References http://dicom.nema.org Part3– InformationObjectDefinitions– nouns Part4– ServiceClasses‐ verbs Part6– DataDictionary Part14– GrayscaleStandardDisplayFunction DICOM InformationObjectdefinition– noun dataobjectwhichcontainsattributeswhich describethecompletesetofdataneededto defineanimage. someportionsaremodalityspecific,others arecommonamongstIODs. DICOM InformationObjectdefinition– noun patient:name,MRN,DOB,gender exam:accessionnumber,typeofexam, orderingphysician,dateofscan acquisition:kVp,slicethickness,vendorof scanner,imagenumber,seriesnumber DICOM ServiceObjectPair(SOP)class takeoneservice(verb)andpairitupwith oneobject(noun) MRStorageSOPclass CTStorageSOPclass CTPrintSOPclass DICOM StorageClass tworoles User Provider Storageclass– useristhesenderandthe provideristhereceiver DICOM UniqueIdentifier(UID) stringofnumberswhichuniquelyidentifies something SOPClass CTImageStorage1.2.840.10008.5.1.4.1.1.2 Study2.16.840.1.114151.4.1615.41755.4913.13414138 Series1.2.840.113704.1.111.1772.1398716689.10 Image1.2.840.113704.1.111.8980.1398716775.102112
