Information Technology in Radiology

IntroductionRadiology

Information TechnologyApplication of Information Technology to Radiology

Conclusion

Dr. Adegbenga Ismail

Rays & Waves Radiology Clinic

October 30, 2014

Dr. Adegbenga Ismail Information Technology in Radiology

Conclusion

Table of Contents

1 Introduction

2 Radiology

3 Information Technology

4 Application of Information Technology to Radiology

5 Conclusion

Conclusion

Radiology

Definition Medical specialty that uses imaging to diagnosediseases [Wikipedia]

Fundamental Concerns Just two things:

1 Image acquisition2 Interpretation of Images viz-a-viz Disease states

Conclusion

Radiology

Definition Medical specialty that uses imaging to diagnosediseases [Wikipedia]

Fundamental Concerns Just two things:

1 Image acquisition2 Interpretation of Images viz-a-viz Disease states

Conclusion

Information Technology

Definition Application of Computers and Telecommunicationsequipment to store, retrieve, transmit and manipulatedata, often in the context of a business or otherenterprise [Wikipedia]

Fundamental Concern Automation

Conclusion

Information Technology

Definition Application of Computers and Telecommunicationsequipment to store, retrieve, transmit and manipulatedata, often in the context of a business or otherenterprise [Wikipedia]

Fundamental Concern Automation

Conclusion

Modalities

Sound Ultrasound

X-rays Radiography, Fluoroscopy and ComputedTomography

Magnets Magnetic Resonance Imaging

Sub-atomic particles Nuclear Medicine, and Positron EmissionTomography

Conclusion

Modalities

Sound Ultrasound

Conclusion

Modalities

Sound Ultrasound

Conclusion

Modalities

Sound Ultrasound

Conclusion

Modalities

Hardware Typical Configuration: Client – Server Architecture:

Server + Dedicated Multi-modality viewingWork-stationServer + General-purpose PC

Networks 1GB or faster ethernet hardware. Fast routers.Implementations:

Local Area NetworkWide Area NetworkVirtual Private Network

Conclusion

Modalities

Hardware Typical Configuration: Client – Server Architecture:

Server + Dedicated Multi-modality viewingWork-stationServer + General-purpose PC

Networks 1GB or faster ethernet hardware. Fast routers.Implementations:

Local Area NetworkWide Area NetworkVirtual Private Network

Conclusion

Modalities

Software Stored Instructions and procedures. DICOM is theunderlying protocol

Server + Fat client Server and Dedicated Client:

ConQuest DICOM-server +k-PACS image-viewerOsirix Server + OsirixImage-viewer

Server + Thin client Server and Web browser

Clear Canvas Image Server +Web-browserOrthanc Server + Web-browser

Conclusion

Radiology already involves an intense use of Science,Technology and Information. Can Computers,Tele-communication and Information systems still add value?

Conclusion

Applications

Computed Radiography Computerized Radiography

Picture Archiving and Communication System (PACS) Provideseconomical storage of, and convenient access to,images from multiple modalities.

Radiology Information System (RIS) Computerized database usedto store, manipulate and distribute patientradiological data and imagery.

Conclusion

Applications

Conclusion

Applications

Conclusion

Applications

Teleradiology Transmission of radiological images from onelocation to another for the purpose of sharing studieswith other radiologists and physicians.

Voice Recognition System Translation of spoken words into text

Computer-aided Diagnosis Pattern-recognition softwares highlightsuspicious areas on images, and draws the attentionof the radiologist to suspicious areas

Decision Support Systems Particularly useful in assisting decisionfor appropriate Imaging and follow-up Imaging

Conclusion

Applications

Conclusion

Applications

Conclusion

Applications

Conclusion

Computed Radiography

Combines four steps involved in radiographic film developmentinto just one step:

Developer A base (alkali) and metal solution used inreducing ionized silver bromide crystals onradiographic films to black metallic silver crystals

Stopper A glacial acetic acid solution used to neutralizeany excessive development of the film

Fixer Solution used to preserve radiographic imageover time

Rinsing and Drying Dry off water to allow film to be reported

Using a laser scanner to directly acquire images from aphotostimulable phospor imaging plate

Conclusion

Computed Radiography

Combines four steps involved in radiographic film developmentinto just one step:

Developer A base (alkali) and metal solution used inreducing ionized silver bromide crystals onradiographic films to black metallic silver crystals

Stopper A glacial acetic acid solution used to neutralizeany excessive development of the film

Fixer Solution used to preserve radiographic imageover time

Rinsing and Drying Dry off water to allow film to be reported

Using a laser scanner to directly acquire images from aphotostimulable phospor imaging plate

Conclusion

Picture Archiving and Communication System

Uses the DICOM standard to acquire images and data fromdifferent HL7-compliant radiological imaging modalities

Stores images on RAIDs. RAID 5 in particular

Makes images available to reporting radiologists and cliniciansover high-speed broadband networks

Same image is simultaneously available over a LAN, a WANor the internet for reporting and clinical decision making

Long term storage is ensured by periodic off-site back-ups

Provides fast image retrieval and redundant image availability

Conclusion

Radiologic Information System

Specialized instance of a Health Information Systemaddressing the peculiar needs of a radiology department

One-time input of patient data such as: name, age, gender,registration number etc

Patient data can also be acquired from a hospital-wide HIS

Can Communicate via a Dicom Modality Work-list withimaging equipments [Grainger & Allison, 2008]

Same patient data can be linked with multiple images fromdifferent imaging modalities

Reduces clerical errors by eliminating multiple entry of samepatient information in different imaging equipment

Conclusion

Teleradiology

Images transmitted over broadband networks to off-sitereporting radiologist

Enables off-site reporting of radiological images

Enables virtual Multi-disciplinary Team Meetings

Emerging area of Tele-education

Conclusion

Teleradiology

Conclusion

Teleradiology

Conclusion

Teleradiology

Conclusion

Voice Recognition System

Seeks to automate stenography

Typical Reporting Work-flow:Radiologist’s Dictation ⇒ Secretary ⇒ Typed Report

Automated Reporting Work-flow:Radiologist’s Dictation ⇒ Voice Recognition Software ⇒Computerized Report [Grainger & Allison, 2008]

Faster

Report is instantly verified and signed by radiologist author

Interfaces with the RIS and PACS

Conclusion

Faster

Conclusion

Faster

Conclusion

Faster

Conclusion

Faster

Conclusion

Faster

Conclusion

Computer-aided Diagnosis (CADx)

Uses pattern recognition to identify disease patterns in images

Machine learning technology is utilized to optimize algorithm

Images compared with anatomic databank of normal andabnormal images

Uses Artificial Neural Network and Bayesian statistics inanalyzing images for probability of disease[Stivaros et al, 2010]

Technology also used in Computer-aided Simple Triage(CAST)

Supplements and assists, not replace, human evaluation

Conclusion

Figure: Typical Neural Network

Conclusion

Figure: Simple Bayesian Network

Conclusion

Figure: Complex Bayesian Network for Mammography

Conclusion

Decision Support Systems

Uses bayesian statistics to make a weighted combination of:

Evidence in peer-reviewed publications

Information from Domain Experts

National Specialty Guidelines

Patient Information in the HIS

To Make Appropriate Imaging Requests

Conclusion

Figure: Typical Decision Support System

Conclusion

Aimed at Automating the work of a Radiology BenefitManager

Assists clinicians in making appropriate Evidence-based Imageordering

Increasingly being used by radiologists in making informedimaging recommendations

More objective and transparent replacement of the job of aRadiology Benefit Manager [ACR-RBMA, 2011]

Conclusion

To What End?

Machinery . . . will facilitate and abridge labour [Smith, 1776]

Conclusion

To What End?

Increased Efficiency and Productivity

Increased Revenue

Conclusion

Increased Productivity

What difference does automation make in productivity?

What is the difference in productivity between a manualworker and an automated worker?

A mathematical metaphor:

Lazy Manual worker: ⇒ 0.2365 = 0Efficient Manual worker: ⇒ 0.99365 = 0.026Automated Worker: ⇒ 1.01365 = 37.78

Conclusion

Increased Revenue

Directly from the Increased Productivity

From accreted Value.

Data Client DatabaseData Image Repositories

Conclusion

Increased Revenue

Directly from the Increased Productivity

From accreted Value.

Data Client DatabaseData Image Repositories

Conclusion

References

Wikipedia

http://en.wikipedia.org/wiki/Radiology

Wikipedia

http://en.wikipedia.org/wiki/Information technology

Stivaros SM, Gledson A, Nenadic G, Zeng XJ, Keane J, Jackson A.

Decision support systems for clinical radiological practice – towards thenext generation.

Br J Radiol. 2010 Nov;83(995):904-14. doi: 10.1259/bjr/33620087.Review.

PMID:20965900 [PubMed - indexed for MEDLINE]

Adam Smith (1776)

An Inquiry into the Nature and Causes of the Wealth of Nations

http://www2.hn.psu.edu/faculty/jmanis/adam-smith/wealth-nations.pdf12(3), 45 – 678.

Conclusion

References

ACR-RBMA Best Practices Guidelines on Radiology Benefits ManagementPrograms (2011)

http://www.rbma.org/uploadedFiles/RBMA Web site/Advocacy/Advocacy Payer Relations/ACR-RBMA%20Best%20Practices%20for%20Radiology%20Benefits%20Management%20Programs.pdf

Grainger & Allison’s Diagnostic Radiology (5th edition).

Section 1, Chapter 1

Churchill Livingstone, Elsevier

Conclusion

Thank You For Listening

Conclusion

Questions

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