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DICOM, HL7, RIS, PACS A Rogue’s Gallery of Acronyms Or An Intro to Imaging Informatics SEAAPM Symposium April 2014
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DICOM, HL7, RIS, PACS · 2017-03-01 · HL7 Health Level 7 HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of

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Page 1: DICOM, HL7, RIS, PACS · 2017-03-01 · HL7 Health Level 7 HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of

DICOM,HL7,RIS,PACS

ARogue’sGalleryofAcronymsOr

AnIntrotoImagingInformatics

SEAAPMSymposiumApril2014

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DICOM,HL7,RIS,PACS

KevinL.Junck,PhDProfessorofRadiology

[email protected]

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LearningObjectives

1)tounderstandtheelectronicflowofinformationthroughouttheradiologyexaminationincludingsystemsbothupstreamanddownstreamwhichinteractwiththeimagingmodality.

2)toreviewtheworkofAAPMTaskGroupNumber248– InteroperabilityEvaluationforImagingModalityAcceptanceTesting.

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HighAltitude

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MyLevel

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MyLevel

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Who’sOnFirst?

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RadiologyTechnologists

Radiologictechnologistsarethemedicalpersonnelwhoperformdiagnosticimagingexaminationsandadministerradiationtherapytreatments.

Radiologictechnologistswhoperformimagingexaminationsareresponsibleforaccuratelypositioningpatientsandensuringthataquality diagnosticimageisproduced.

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RadiologyTechnologists

QualityManagementTechnologistsusestandardizeddatacollectionmethods,informationanalysistoolsanddataanalysismethodstomonitorthequalityofprocessesandsystems intheradiologydepartment.Theyperformprocessorqualitycontroltests,assessfilmdensity,monitortimeraccuracyandreproducibilityandidentifyandsolveproblemsassociatedwiththeproductionofmedicalimages.

Source:http://www.asrt.org

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ImagingInformatics

“Medicalimaginginformaticsisa multidisciplinaryfieldthatintersectswiththebiologicalsciences,healthservices,informationsciences,medicalphysics,andengineering.

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ImagingInformatics

Imaginginformaticstoucheseveryaspectoftheimagingchainfromimagecreationandacquisition,toimagedistributionandmanagement,toimagestorageandretrieval,toimageprocessing,analysisandunderstanding,toimagevisualizationanddatanavigation;toimageinterpretation,reporting,andcommunications.Thefieldservesastheintegrativecatalystfortheseprocessesandformsabridgewithimagingandothermedicaldisciplines.

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ImagingInformatics

Imaginginformaticsprofessionalsandscientistsspecializinginthisevolvingfieldarepioneersinvolvedattheintersectionofinformationscience,imagingtechnologyandhealthcareandrequireclinicalacumenaswellasexpertunderstandingoftechnology."KatherineP.Andriole,PhD,FSIIMSource:http://siim.org

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HealthcareIT

Healthinformatics(alsocalledhealthinformationsystems,healthcareinformatics,healthcareinformatics,medicalinformatics,nursinginformatics,clinicalinformatics,orbiomedicalinformatics)isadisciplineattheintersectionofinformationscience,computerscience,andhealthcare.Itdealswiththeresources,devices,andmethodsrequiredtooptimizetheacquisition,storage,retrieval,anduseofinformationinhealthandbiomedicine.

Source:http://www.Wikipedia.org

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MedicalPhysicists

WhatdoMedicalPhysicistsDo?

Medicalphysicistsareconcernedwiththreeareasofactivity:clinicalserviceandconsultation,researchanddevelopment,andteaching.Ontheaveragetheirtimeisdistributedequallyamongthesethreeareas.

Source:http://www.aapm.org

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MedicalPhysicists

ClinicalServiceandConsultation…Otherimportantservicesarerenderedthroughinvestigationofequipmentperformance,organizationofqualitycontrolinimagingsystems,designofradiationinstallations,andcontrolofradiationhazards.Themedicalphysicistiscalledupontocontributeclinicalandscientificadviceandresourcestosolvethenumerousanddiversephysicalproblemsthatarisecontinuallyinmanyspecializedmedicalareas.

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Who’sOnFirst?

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BuyitorBuildit

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AAPM‐ IISC

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AAPM– TG248

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AAPM– TG248

Charge:TodevelopataskgroupreportwhichprovidesthefollowingresourcestotheAAPM,applicabletoallimagingmodalityareas:

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AAPM– TG248

1)Recommendationthattheacceptancetestingofimagingmodalitiesincludesend‐to‐endevaluationofimagequalityandimageinformationfromorderingsystemtolong‐termarchiveandallrelevantsystemswheretheimagesareviewed,processedormodified.

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AAPM– TG248

2)Backgroundandmotivationforinteroperabilityassessmentwithexamplesidentifyingriskstopatientcarefromincompleteacceptancetesting.3)Suggestionsfortoolsforassessinginteroperability.FurtherdetailswillbedevelopedbytheTGincreatingthereport,withabetterexaminationofwhatwouldbeausefulroleforthemodalityphysicistsandwhatresourcesareavailabletothem.

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Interoperability

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Interoperability

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TG248ReportIntroductionThefunctionalityofadiagnosticimagingsystemoftenextendsbeyondtheacquisitionconsoleanddependsoninteroperabilitywithahostofothersystemssuchasRIS,PACS,post‐processingsoftware,treatmentplanningsoftware,andclinicalviewers.InteroperabilitymightbeassuredbyavendorinanIHE(IntegratingtheHealthCareEnterprise)IntegrationStatement,andperhapscontractuallyagreedtoaspartofapurchase.Orthevendormayassumenoresponsibilityforinteroperabilityandleavevalidationtotheend‐usertoensurethattheequipmentisreadyforclinicaluse.

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TG248ReportIntroduction

Ineithercase,itiswisetounderstandwhatmightgowrong,whattherisksare,andwhataspectsofinteroperabilityaredesirabletovalidateaspartofequipmentacceptancetesting.Thegoaloftheacceptancetestingcanbeviewedintwoparts:1)toensurethattheequipmentmeetsorexceedsthespecificationsprovidedbythemanufactureraspartofthepurchaseprocess.2)Tovalidatethatasystemisreadyforclinicaluse.Oftenitistheroleofaphysicisttobethefinalsign‐offinregardtobothoftheseacceptancetestinggoals.

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TG248ReportIntroduction

Troubleshootingandoptimizingtheimagingchainmayrequireateameffortonthepartofthephysicist,serviceengineer,PACSsystemadministrator,technologistandotherstakeholders.Eachoftheseindividualswillhavespecialknowledgeoftheworkflow,thedataflowandofthepossiblefactorsthatcouldaffectimagequalityandinformationintegrityatdifferentpointsintheimagingchain.Themedicalphysicistshouldhaveanunderstandingofthevariablesthatcanaffecttheimagebetweenacquisitionanddisplay,andtoknowwheretogoforadditionalassistanceinordertoisolatethesourceofimagequalityorinformationintegrityproblems.

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TeamLead

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DICOM

ServiceClasses– “verbs”– Part4StorageStorageCommitmentQuery/RetrieveModalityWorklistModalityPerformedProcedureStepPrinting

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ModalityWorklist

Beforewegenerateanimage,wewanttolinkpatientdemographicinformationtotheimage– who’simageisit?

AservicetypicallyprovidedbythePACS.HoweveritisasnapshotofthedataprovidedbytheRISviaHL7.

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PACSvRIS

PACS– Picturescommunicationswithmodality

RIS– ReportsandOrderscommunicationswithpeople(physicians,

technologists)

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PACSvRIS

PACSBrokerReceivesHL7fromRISTranslatesintoSQLcallsforPACSdatabaseRespondstomodalityrequestsforworklists

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ModalityWorklist Configuration

Placeordersforyourmodalitydotheyshowup?

doyougetordersthatarenotforyourarea?

wanttohaveaminimallisttoavoidwrongselection,butmusthavewhattheuserneeds.

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ModalityWorklist

Errortypoinname/MRN/accessionnumber

pickwrongsetofInformationfromlist

We’vereducedtheerrorrate,buttheerrorsaremoredifficulttocatch.

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ModalityWorklist Information

Placeordersforyourmodalitywhatinformationispresent?Name,Gender,DOBAccessionNumber,Dateofexam,Typeof

exam– criticalifyouhavemultipleexamsforsamepatient.

doesexam“falloff”listwhencancelled?whenacquired?

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ProcedureCodeMapping

Tietheexambeingperformedtoviewsorprotocolsonthemodality.

ChestPAandLateral– modalitymaystepthetechnologistthroughacquiringthetwoimagesneededforthisexam.

enablesdefaulttechniquesandimageprocessingparameters

maybedonebyvendor’sapplicationsspecialist

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DICOM

ServiceClasses– “verbs”StorageStorageCommitmentQuery/RetrieveModalityWorklistModalityPerformedProcedureStepPrinting

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Storage

UseModalityWorklist withadedicatedtestpatienttobeabletosendimagestoPACS.

Exception– matchingofimagesagainstorders.

ImageProcessing– doesitlookright?ImageAnnotations– aretheythere?Physicalmeasurements– pixelsvsmm?

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Storage

ImageManipulations:Window– level

Flip/rotate

Invert

EdgeEnhancement

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Storage

Locationmarkers– orientation

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Storage

Networkperformance

Sendtoalllocations‐ configuration

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Storage

ImageOverlay

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Storage

Non‐imageimagesStructuredreportDosereport

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Storage

Errorcorrection

Emergencydataentry

DowntimeproceduresRISPACSNetwork

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HL7

HealthLevel7www.hl7.org

HL7anditsmembersprovideaframework(andrelatedstandards)fortheexchange,integration,sharing,andretrievalofelectronichealthinformation.Thesestandardsdefinehowinformationispackagedandcommunicatedfromonepartytoanother,settingthelanguage,structureanddatatypesrequiredforseamlessintegrationbetweensystems.HL7standardssupportclinicalpracticeandthemanagement,delivery,andevaluationofhealthservices,andarerecognizedasthemostcommonlyusedintheworld.

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HL7StartBlockMSH|^~\&|HNAMN|RADNET|PACS|UABHS|20140428101734||ORM^O01|Q1017569306T1090564180|X|2.3PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||19000101090200|U||U|RADINFOTESTPT^/BADADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999)999‐9999||UNK|U|OTH|648392053252||||NH|||0PV1|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|20130923235959ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||20140428101730|||WRITTENORDER^Written|411234561^Tester^Kelly^^^^^^^^^^EXTERNALIDOBR|1|1685047828^HNAM_ORDERID||CD:51536620^MAMammogramDigitalBilateral||||||||CD:312689^312689|||RadType&Rad Type|9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID||||00000MA20140010066^HNA_ACCN~30784024^HNA_ACCNID~5905455^HNA_PACSID|CD:185639490|20140428101730||Mammography|||1^^0^20140428101700^^Today|||Ambulatory|^testEndBlock

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HL7

MSH|^~\&|HNAMN|RADNET|PACS|UABHS|20140428101734||ORM^O01|Q1017569306T1090564180|X|2.3

MSH– messageheaderMSH3and4:SendingApplication/Facility– HNAMN/RADNETMSH5and6:ReceivingApplication/Facility– PACS/UABHSMSH7:Date/TimeofMessageMSH9:MessageType

ORM– orderORU‐ result

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HL7

PID|1|2738161|2738161||HSISTEST^RADINFO^FOUR||19000101090200|U||U|RADINFOTESTPT^/BADADDRESS^BIRMINGHAM^AL^35222^USA^^^JEFFE|JEFFE|(999)999‐9999||UNK|U|OTH|648392053252||||NH|||0

PID– PatientIdentificationPID3– PatientIdentifierPID5– PatientNamePID7– PatientDOBPID8– GenderPID18– FinancialAccountNumber

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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– PatientVisitPV12– PatientClassPV13– PatientLocationPV17– AttendingDoctor

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HL7

ORC|NW|1685047828^HNAM_ORDERID|||||||20140428101700|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID||9500^Universal^Provider^^^^^^^^^^DOCNBR~~~9500^Universal^Provider^^^^^^^^^^EXTERNALID|||20140428101730|||WRITTENORDER^Written|411234561^Tester^Kelly^^^^^^^^^^EXTERNALID

ORC– OrderCommonInformationORC1– OrderControlCode/StatusORC10– EnteredBy

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HL7

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~30784024^HNA_ACCNID~5905455^HNA_PACSID|CD:185639490|20140428101730||Mammography|||1^^0^20140428101700^^Today|||Ambulatory|^test

OBR– ObservationRequestOBR2– PlacerOrderNumberOBR4– UniversalServiceIDOBR20– FillerField1

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DICOM

DICOM— DigitalImagingandCommunicationsinMedicine— istheinternationalstandardformedicalimagesandrelatedinformation(ISO12052).Itdefinestheformatsformedicalimagesthatcanbeexchangedwiththedataandqualitynecessaryforclinicaluse.DICOMisimplementedinalmosteveryradiology,cardiologyimaging,andradiotherapydevice(X‐ray,CT,MRI,ultrasound,etc.),andincreasinglyindevicesinothermedicaldomainssuchasophthalmologyanddentistry.Withtensofthousandsofimagingdevicesinuse,DICOMisoneofthemostwidelydeployedhealthcaremessagingstandardsintheworld.ThereareliterallybillionsofDICOMimagescurrentlyinuseforclinicalcare.Sinceitsfirstpublicationin1993,DICOMhasrevolutionizedthepracticeofradiology,allowingthereplacementofX‐rayfilmwithafullydigitalworkflow.MuchastheInternethasbecometheplatformfornewconsumerinformationapplications,DICOMhasenabledadvancedmedicalimagingapplicationsthathave“changedthefaceofclinicalmedicine”.

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DICOM

Referenceshttp://dicom.nema.org

Part3– InformationObjectDefinitions– nounsPart4– ServiceClasses‐ verbsPart6– DataDictionaryPart14– GrayscaleStandardDisplayFunction

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DICOM

InformationObjectdefinition– noundataobjectwhichcontainsattributeswhich

describethecompletesetofdataneededtodefineanimage.

someportionsaremodalityspecific,othersarecommonamongstIODs.

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DICOM

InformationObjectdefinition– nounpatient:name,MRN,DOB,genderexam:accessionnumber,typeofexam,

orderingphysician,dateofscanacquisition:kVp,slicethickness,vendorof

scanner,imagenumber,seriesnumber

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DICOM

ServiceObjectPair(SOP)classtakeoneservice(verb)andpairitupwith

oneobject(noun)MRStorageSOPclassCTStorageSOPclassCTPrintSOPclass

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DICOM

StorageClasstworoles

UserProvider

Storageclass– useristhesenderandtheprovideristhereceiver

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DICOM

UniqueIdentifier(UID)stringofnumberswhichuniquelyidentifies

somethingSOPClassCTImageStorage1.2.840.10008.5.1.4.1.1.2Study2.16.840.1.114151.4.1615.41755.4913.13414138Series1.2.840.113704.1.111.1772.1398716689.10Image1.2.840.113704.1.111.8980.1398716775.102112

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DICOM & HL7: Integration of Imaging and Information Systems

Category: Documents
DICOM, PACS and DICOM, PACS and Veterinary Radiology ...

DICOM, PACS and DICOM, PACS and Veterinary Radiology ...

Category: Documents
Behind the Image DICOM, PACS and Veterinary Radiology · Image DICOM, PACS and ... –typically will have DICOM print and workflow services (modality worklist) as well ... • Breed

Behind the Image DICOM, PACS and Veterinary Radiology ·...

Category: Documents
X-PACS and X-Referral -a standards update- · 2013. 11. 30. · Ringholm bv learn * share * connect Standards evolve.. • X-PACS, X-Referral – IHE XDS, HL7 CDA, DICOM • New developments

X-PACS and X-Referral -a standards update- · 2013. 11....

Category: Documents