1. Collaboration between the Referring Clinician and the Radiologist DICOM WG10 April, 2004, Kamakura

2. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 2 IHE White Paper: External View

3. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 3 Main external Process Radiology order result Acquisition Reporting patient

4. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 4 IHE Actors / Transactions report results Radiology Dept Mgt patient modality Acqui- sition radiologist Repor- ting order scheduling images patient status updat. Department System Scheduler – Order Filler – Order Placer Acquisition Modality Performed Procedure Step Manager Image Mgr / Archive Image Display Report Creator Report Manager Enterprise Report Repository RIS HIS IMAGING PACS Workstations Modalities

5. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 5 report results Radiology Dept Mgt patient modality Acqui- sition radiologist Repor- ting order scheduling images patient status updat. Main Internal process

6. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 6 Image Repository Image Repository PACS stor e Qn R store- >burn stor e Qn R and 4 Scenario 3 acquisition interpretation burn CD print interpretation transcription prin t store- >burn stor e modality worklist print Report Repository RIS approval quer y sen d print + mail / fax / e-mail print + mail / fax / e-mail print manual network DICOM HL7/other optional Narrative Info Only Images Evidence Docts Presentation States Selected Images Electronic Report Images Evidence Documents Presentation States Film

7. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 7 Scenario 5 & 6

8. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 8 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)

9. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 9 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)

10. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 10 Order / prescription Orders « managed » by HL7 but its radiology specific content has to be mapped to DICOM Lack of structured content (CPOE, JJ17xx) New Structured Prescription, retrieved by interpretation WS? If defined, to be integrated in SR

11. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 11 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

12. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 12 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

13. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 13 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).

14. emmanuel.cordonnier@etiam.com DICOM WG10 Kamakura April, 2004 page 14 Multi-domain patient identification How far DICOM shall take into account the multi-domain patient identification? Analyze the impact of the DomainID extension of the Patient Header (CPxx) Typical use case on short term: reload of DICOM CD in another radiology department, with patient reconciliation