September, 2005What IHE Delivers 1 Whats New in IHE 2006 Rita Noumeir Ph.D. Softmedical IHE Radiology Technical and Planning Committees

2 IHE Radiology Activities New Supplements in 2006 Import Reconciliation Workflow (IRWF) Integration Profile Import Reconciliation Workflow (IRWF) Integration Profile Image Fusion (FUS) Integration Profile Image Fusion (FUS) Integration Profile Mammography Image (MAMMO) Integration Profile Mammography Image (MAMMO) Integration Profile Nuclear Medicine Image (NMI) Integration Profile with Cardiac Option Nuclear Medicine Image (NMI) Integration Profile with Cardiac Option Demonstration RSNA 2006 Cross-Enterprise Document Sharing for Imaging (XDS-I) Cross-Enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE) Teaching File and Clinical Trial Export (TCE)

3 IHE IT Infrastructure Activities New Supplements in 2006 Cross-enterprise Document Media Interchange (XDM) Cross-enterprise Document Media Interchange (XDM) Cross-enterprise Document Reliable Interchange (XDR) Cross-enterprise Document Reliable Interchange (XDR) Cross-enterprise Sharing of Scanned Documents (XDS-SD) Cross-enterprise Sharing of Scanned Documents (XDS-SD) Patient Identifier Cross-Reference and Patient Demographic Query HL7 V3 (PIX/PDQ V3) Patient Identifier Cross-Reference and Patient Demographic Query HL7 V3 (PIX/PDQ V3) Registry Stored Query Transaction for Cross-Enterprise Document Sharing Profile Registry Stored Query Transaction for Cross-Enterprise Document Sharing Profile Retrieve Form for Data Capture (RFD) Retrieve Form for Data Capture (RFD) New White Papers in 2006 White Paper: Cross Community Information Exchange including Federation of XDS Affinity Domains White Paper: Cross Community Information Exchange including Federation of XDS Affinity Domains White Paper: Cross-Enterprise User Authentication (XUA) White Paper: Cross-Enterprise User Authentication (XUA) White Paper: Cookbook for the Security Section of IHE Profiles White Paper: Cookbook for the Security Section of IHE Profiles Interoperability Showcase at HIMSS 2007

4 IHE Patient Care Coordination New Supplements in 2006 Basic Patient Privacy Consents (BPPC) Basic Patient Privacy Consents (BPPC) Emergency Department Referral (EDR) Emergency Department Referral (EDR) Exchange of Personal Health Record Content (XPHR) Exchange of Personal Health Record Content (XPHR) Pre-procedure History and Physical (PPHP) Pre-procedure History and Physical (PPHP) Interoperability Showcase at HIMSS 2007

5 IHE Cardiology Activities New Supplements in 2006 Implantable Device Cardiac Observations Profile (IDCO) Implantable Device Cardiac Observations Profile (IDCO) Stress Testing Workflow Integration Profile (STRESS) Stress Testing Workflow Integration Profile (STRESS) Patient Demographics Query: Urgent Implantable Device Cardiac Identification Content Profile (PDQ-IDC) Patient Demographics Query: Urgent Implantable Device Cardiac Identification Content Profile (PDQ-IDC) Demonstration at ACC 2007

6 IHE Lab Activities New Supplements in 2006 Sharing Laboratory Reports (XD*-LAB) Sharing Laboratory Reports (XD*-LAB) Laboratory Tests Code Set Laboratory Tests Code Set

7 IHE New Domains IHE Eye Care - AAO Eye Care Workflow (EYECARE) Eye Care Workflow (EYECARE) Charge Posting (CHG) Charge Posting (CHG) Eye Care Evidence Documents (ECED) Eye Care Evidence Documents (ECED) IHE Radiation Oncology - ASTRO RT Objects Integration Profile RT Objects Integration Profile IHE Patient Care Devices - ACCE Device Enterprise Communication (DEC) Device Enterprise Communication (DEC)

8 IHE Emerging Domains IHE Pathology IHE Endoscopy

9 Import Reconciliation Workflow Profile (IRWF)

10 Import Reconciliation Workflow Use Case – External Acquisition/Read Radiology Enterprise A Radiology Enterprise B Provider A Radiology Site B PACS A Portable Data Creator Patient Data 2. Radiology Site B creates portable media with patient images and/or Reports 1. Provider A orders External Radiology Procedure 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Radiologist PDI Disk

11 Radiology Enterprise B Radiology Enterprise A PACS B Portable Data Creator Patient Data 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patients radiology information. 1. Request for Patients case data to be transferred from Enterprise A to B. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive. 4. Patient Data is now associated with Bs electronic health record system. Import Reconciliation Workflow Use Case – Patient Referral/Transfer

12 Import Reconciliation Workflow Problem Physical Limitations Security/Administrative: no CD drive in medical workstations Security/Administrative: no CD drive in medical workstations Logistical Limitations Portable Data may include different user interfaces in viewers, some viewers dont work Portable Data may include different user interfaces in viewers, some viewers dont work The clinicians need to archive images temporary or permanent cant be fulfilled The clinicians need to archive images temporary or permanent cant be fulfilled Images not available in Radiology PACS for comparison or second- opinion consult Images not available in Radiology PACS for comparison or second- opinion consult Data Limitations Patient not registered in the HIS Patient not registered in the HIS Patient not registered in the RIS Patient not registered in the RIS

13 Import Reconciliation Workflow Requirements Patient must be registered in the HIS Patient Demographics from the Enterprise must be used to reconcile imported data Patient Demographics from the Enterprise must be used to reconcile imported data Import may be a Scheduled Order Order information may be used to schedule the import Order information may be used to schedule the import Order information may be used to reconcile imported data Order information may be used to reconcile imported data Import may be Unscheduled

14 Import Reconciliation Workflow Scheduled Import Option

15 Import Reconciliation Workflow Scheduled Import Transaction Diagram RIS Importer PACS RIS Modality Worklist Query Imported Objects Storage Storage Commitment MPPS Manager MPPS Images from external Source: i.e. CD

16 Import Reconciliation Workflow Unscheduled Import Option

17 Import Reconciliation Workflow Scheduled Import Transaction Diagram PDQ Supplier Importer PACS Patient Demographics Query Imported Objects Storage Storage Commitment MPPS Manager MPPS Images from external Source: i.e. CD

18 Image Fusion Profile (FUS)

19 Image Registration and Fusion Translate Rotate Rigid Registration Scale Warp- optional (Deformable Registration) Fuse

20 Image Fusion- General Use Case Tech acquires two series of images. Tech reconstructs images, performs registration, and stores results. Workstation presents fused view based on full image data for Radiologist or Oncologist. PACS Display shows Fused views to Referring Physician CTMR

21 Fusion- The Integration Problem Results not readily transferable between systems Proprietary or inconsistent implementations Proprietary or inconsistent implementations Lack of guidance Lack of guidance Results presented on different systems may not appear the same. Systems must correctly handle issues such as Identifying and retrieving the right datasets Identifying and retrieving the right datasets Matching data between single-slice and multi-slice datasets Matching data between single-slice and multi-slice datasets Performing spatial translations Performing spatial translations Rendering the fused display Rendering the fused display

22 Fusion- The Integration Solution A collection of DICOM objects exists to address the problem. Their use is constrained and clarified to avoid misinterpretation and promote compatibility.

23 Spatial Registration Object Not required for already-registered PET-CT data from a hybrid scanner SRO Image 1 Image 2 Transformation

24 Blending Presentation State Image 1 Image 2 SRO Transformation BPS Window – 1 Window – 2 Color Table Transparency

25 Load CT and PET images Align images (automatically or manually) and fuse with desired blending factor Store the alignment, including Registration object Blending State (defining the blending factor, window levels and referencing all other objects) Storage can be on PACS or disk. Images do not need to be stored if already stored. Fusion- PreparationCT PET Registration Object Blending State

26 Blending state can be searched and retrieved from PACS Can be used to retrieve the image data and the alignment automatically. User selects a Blending state. Automatically load referenced objects. Alignment applied, PET re-sampled to CT and displayed fused automatically. Display is required to provide Scrolling through volume Adjustment of fusion blending and window levels MPR Side-by-side display Fusion- DisplayCT PET Registration Object Blending State

27 Nuclear Medicine Image Profile with Cardiac Option (NMI)

28 General NM Viewing Suboptimal NMPACS

29 General NM Viewing Suboptimal NMPACS

30 General NM Viewing Suboptimal Click and move mouse down to adjust window level, right to adjust window center

31 Cardiac Viewing Suboptimal If sent as Short axis Images not displayed in a useful format. Images not displayed in a useful format. If sent as screen snapshots (ie, static Secondary Capture) Cant separately adjust stress and rest images Cant view gated cine

32 Image Display Scale intelligently to avoid presenting postage-stamp size NM images Allow user to select different vectors/framesets of complex multi- frame images Allow user to separately adjust intensity for different framesets (eg, phases) in the same image

33 ACC NM Display Example Short axis Horizontal Long Vertical Long

34 ACC NM Display Example Short Horizontal Vertical Stress Rest Stress Rest Stress Rest Stress Rest

35 Result Screen Export Option Wednesday 4:15-5:00

36 Mammography Image (MAMMO)

37 Hanging Protocol Differences Example Preferred Layout Hanging protocol determined by: View Type (i.e. CC vs. MLO) View Type (i.e. CC vs. MLO) Specialty View Type (i.e. Spot, Mag) Specialty View Type (i.e. Spot, Mag) Laterality Laterality Patient Orientation Patient Orientation R CC L CC L MLO R MLO

38 Variances in FFDM Vendor Data Detector Size Example R R L L R L Prior Exam from Vendor As system RL Typical Fit to Viewport effect Current Exam from Vendor Bs system Different resolution Different resolution Different pixel matrix Different pixel matrix

39 Printing Considerations True Size Precision of <2% error 10in x12in Film size 8inx10in Film size vs. Detector Size

40 Printing Considerations Positioning-minimal borders at chestwall Centered images can create large borders at chestwall Image offset with chestwall side having minimal borders

41 Mammography Image Integration Value proposition Helps meet desire to have multiple FFDM vendors and use any vendors workstation for diagnosis Ensures that FFDM modalities provide adequate information to facilitate downstream applications Ensures systems support required data objects for interoperability Defines image display and printing operations required for effective and efficient diagnoses Tuesday 1:15-2:00

42