Collaboration between the Referring Clinician and the Radiologist
Collaboration between the Referring Clinician and the Radiologist DICOM WG 10 April, 2004, Kamakura emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004
IHE White Paper: External View emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 2
Main external Process patient order Radiology patient Acquisition Reporting result emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 3
IHE Actors / Transactions modality radiologist Acquisition Modality patient HIS IMAGINGImage Display images Acqui. Repor. Image 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 RIS Dept Mgt Radiology emmanuel. cordonnier@etiam. com patient Report Manager DICOM WG 10 Kamakura April, 2004 Enterprise results. Report Repository 4
Main Internal process modality patient Acquisition radiologist images Reporting patient status updat. scheduling order report Radiology Dept Mgt emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 results 5
Scenario 3 and 4 modality worklist Selected Images print RIS stor e sen d acquisition Images Evidence Docts Presentation States print + mail / fax / e-mail Qn. R interpretation Narrative Info Only Electronic Report quer y transcription Report Repository Electronic Report Image Repository stor e Qn. R print PACS approval stor e store>burn print interpretation store>burn Images Evidence Documents Presentation States burn CD Film network optional emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 manual DICOM HL 7/other 6
Scenario 5 & 6 emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 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) emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 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) emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 9
Order / prescription • Orders « managed » by HL 7 but its radiology specific content has to be mapped to DICOM • Lack of structured content (CPOE, JJ 17 xx) • New Structured Prescription, retrieved by interpretation WS? • If defined, to be integrated in SR emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 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 emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 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 emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 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). emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 13
Multi-domain patient identification • How far DICOM shall take into account the multi-domain patient identification? • Analyze the impact of the Domain. ID extension of the Patient Header (CPxx) • Typical use case on short term: reload of DICOM CD in another radiology department, with patient reconciliation emmanuel. cordonnier@etiam. com DICOM WG 10 Kamakura April, 2004 14
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