Standard Protocols In

Dr. Ahmed Alsharef Farah

Dr. Ahmed Alsharef Farah 1 Imaging Informatics:

• Imaging informatics, also known as radiology informatics or medical imaging informatics, is a subspecialty of biomedical informatics that aims to improve the efficiency, accuracy, usability and reliability of medical imaging services within the healthcare enterprise.

Dr. Ahmed Alsharef Farah 2 • Imaging informatics touches every aspect of the imaging chain: Image creation and acquisition. Image distribution and management. Image storage and retrieval. Image processing, analysis. Image visualization. Image interpretation, reporting, and communications.

Dr. Ahmed Alsharef Farah 3 Industry Standards:

• Earlier, transmission of textual or image data across network used to be very difficult because the differences in the operating system and the application environment. • To facilitate free flow of information across modalities and networks in health care industry standards have been developed.

Dr. Ahmed Alsharef Farah 4 • By this way, images and data can be handled in an organized manner. • Currently: (HL7) is the industry standard for the transmission of textual information. Digital Imaging and Communications in Medicine (DICOM) is the industry standard for the image data and communication protocols.

Dr. Ahmed Alsharef Farah 5 Health Level 7 Imaging Integration

Dr. Ahmed Alsharef Farah 6 HL7 (Health Level Seven International):

• HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications. • HL7 and related standards provide a framework for the exchange, integration, sharing, and retrieval of electronic health information.

Dr. Ahmed Alsharef Farah 7 • These standards define how information is packaged and communicated from one party to another, setting the language, structure and data types required for integration between systems. • HL7 standards support clinical practice and the management, delivery, and evaluation of health services, and are recognized as the most commonly used in the world.

Dr. Ahmed Alsharef Farah 8 HL7 - plays an important role in the following areas:

1. Patient identity: Management, exchange of demographic data, and patient information. 2. Patient registration and location tracking: Admission, discharge, and transfer of the patient.

Dr. Ahmed Alsharef Farah 9 3. Order entry: Imaging order place and file management, imaging order workflow management. 4. Results reporting: Results and document management messages, (DICOM Structured Reporting) DICOM SR, and Clinical Document Architecture (CDA).

Dr. Ahmed Alsharef Farah 10 DICOM

Dr. Ahmed Alsharef Farah 11 DICOM:

• DICOM: Digital Imaging and Communications in Medicine. • Is the international standard for medical images and related information. • It defines the formats for medical images that can be exchanged with the data and quality necessary for clinical use.

Dr. Ahmed Alsharef Farah 12 • Digital imaging and communications in medicine (DICOM): It is a standard for handling, storing, printing, and transmitting information in medical imaging. It is also necessary to standardize the format of images and communication protocols used in imaging so as to facilitate flow of information across the hospital.

Dr. Ahmed Alsharef Farah 13 It was developed together by American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA) to promote exchange of information among various equipments. This was aimed to integrate various equipment used in radiology such as radiography machines, CT scanners, MRI, printers, digitizers, etc. with PACS.

Dr. Ahmed Alsharef Farah 14 • The first version was released in 1985 and it was called as ACR-NEMA version 1. • Later in 1988, the second version namely ACR-NEMA 2.0 was also released with enhancements. • In 1992, a newer version was released with major improvements and it was named as DICOM 3.0.

Dr. Ahmed Alsharef Farah 15 • DICOM is implemented in almost every Radiology (X-ray, CT, MRI, ultrasound, etc.), Cardiology imaging, and Radiotherapy device, and increasingly in devices in other medical domains such as Ophthalmology and Dentistry.

Dr. Ahmed Alsharef Farah 16 Key Concepts

Data format:

DICOM groups information into data sets. That means that a file of a chest x-ray image, for example, actually contains the patient ID within the file, so that the image can never be separated from this information by mistake. This is similar to the way that image formats such as JPEG can also have embedded to identify and describe the image.

Dr. Ahmed Alsharef Farah 17 Image display:

To promote identical grayscale image display on different monitors and consistent hard-copy images from various printers, the DICOM committee developed a lookup table to display digitally assigned pixel values.

Dr. Ahmed Alsharef Farah 18 To use the DICOM Grayscale Standard Display Function (GSDF), images must be viewed (or printed) on devices that have this lookup curve or on devices that have been calibrated to the GSDF curve.

Dr. Ahmed Alsharef Farah 19 Services:

DICOM consists of services, most of which involve transmission of data over a network.

Dr. Ahmed Alsharef Farah 20 Store:

The DICOM Store service is used to send images or other persistent objects (structured reports, etc.) to a picture archiving and communication system (PACS) or workstation.

Dr. Ahmed Alsharef Farah 21 Query/Retrieve:

This enables a workstation to find lists of images or other such objects and then retrieve them from a picture archiving and communication system.

Dr. Ahmed Alsharef Farah 22 Modality Worklist:

The DICOM Modality Worklist service provides a list of imaging procedures that have been scheduled for performance by an image acquisition device (sometimes referred to as a modality system).

Dr. Ahmed Alsharef Farah 23 The items in the worklist include relevant details about the subject of the procedure (patient ID, name, sex, and age), the type of procedure (equipment type, procedure description, procedure code) and the procedure order (referring physician, accession number, reason for exam).

Dr. Ahmed Alsharef Farah 24 An image acquisition device, such as a CT scanner, queries a service provider, such as a RIS, to get this information which is then presented to the system operator and is used by the imaging device to populate details in the image data.

Dr. Ahmed Alsharef Farah 25 Prior to the use of the DICOM Modality Worklist service, the scanner operator was required to manually enter all the relevant details. Manual entry is slower and introduces the risk of misspelled patient names, and other data entry errors.

Dr. Ahmed Alsharef Farah 26 Modality Performed Procedure Step:

A complementary service to Modality Worklist, this enables the modality to send a report about a performed examination including data about the images acquired, beginning time, end time, and duration of a study, dose delivered, etc.

Dr. Ahmed Alsharef Farah 27 It helps give the radiology department a more precise handle on resource (acquisition station) use. Also known as MPPS, this service allows a modality to better coordinate with image storage servers.

Dr. Ahmed Alsharef Farah 28 Print:

The DICOM Print service is used to send images to a DICOM Printer, normally to print an “X-Ray” film. There is a standard calibration to help ensure consistency between various display devices, including hard copy printout.

Dr. Ahmed Alsharef Farah 29 Integrating the Healthcare Enterprise

Dr. Ahmed Alsharef Farah 30 What is IHE ?

• It is an initiative by the healthcare industry to improve the way computer systems share information. • IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.

Dr. Ahmed Alsharef Farah 31 Integration Goal:

• Improve the efficiency and effectiveness of clinical practice by: Improved Information Flow. Advanced Multi-System Functions.

Dr. Ahmed Alsharef Farah 32 • Currently we have:

DICOM to exchange imaging data. HL7 to exchange order and lab results data. • IHE aims to facilitate the integration of data between systems. • IHE defines the use of subsets of DICOM and HL7 standards – it is not a standard itself.

Dr. Ahmed Alsharef Farah 33 How does this help ?

• Improves integration and interoperability:

Integration – disparate systems share info. reducing multiple data entry. Interoperability – two systems can carry out a task effectively e.g. both systems have two fields for first and second name. Simplifies workflow.

Dr. Ahmed Alsharef Farah 34 Scheduled Workflow Profile

report report Registration Report Report Repository HIS patient Diagnostic Film information Workstation Light box images PACS retrieved

Orders Placed procedure scheduled Image Manager Film Prefetch any relevant & Archive Folder examination orders prior studies Acquisition modality Modality images Orders Filled worklist stored RIS Acquisition completed Acquisitionacquisition Film completedin-progress Images Modality printed Dr. Ahmed Alsharef Farah 35 Dr. Ahmed Alsharef Farah 36