Analytic Workflow in Radiology: From Images to Reports
Dig into the analytic workflow in radiology from acquiring images to generating reports, featuring topics like basic worklists, procedure steps, and system interfaces. Learn about IHE Profiles and explore key terms in radiology informatics.
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THE DICOM 2013 INTERNATIONAL CONFERENCE & SEMINAR March 14-16 Bangalore, India Analytic Workflow: From Images to Reports Lawrence Tarbox, Ph.D. Mallinckrodt Institute of Radiology Washington University in St. Louis Research Assistant Professor of Radiology St. Louis, Missouri, USA WG-5, WG-10, WG-14 (Chair), WG-18, WG-23 (chair), WG-27
Analytic Workflow: From Images to Reports Outline Workflow Related Service Classes Relationship to IHE and HL-7 Base Workflow Workflow Variants Application Hosting Conclusions References (if any) Contact info of Presenter L. Tarbox - Analytic Workflow: From Images to Reports
Workflow Related Service Classes Basic Worklist Lists of what needs to be done Modality and General Purpose Variants Procedure Step Records what was done Modality and General Purpose Variants Unified Procedure Step Replacement for General Purpose Variants Storage Commitment Instance Availability Notification L. Tarbox - Analytic Workflow: From Images to Reports
Relationship to IHE and HL-7 DICOM defines interface between acquisition/imaging equipment and IT systems Archives HIS/RIS HL-7 defines interfaces between IT systems IHE outlines how it all works together L. Tarbox - Analytic Workflow: From Images to Reports
The best way to learn about workflow is to read the IHE Profiles! L. Tarbox - Analytic Workflow: From Images to Reports
IHE = Integration Profiles Each IHE Profile describes a clinical information need or workflow scenario documents how to use standards (e.g. HL7, DICOM, ...) to accomplish it Systems that implement the same Profile address a need in a mutually compatible way Hundreds of products support one or more IHE Radiology Profiles. 4/19/2025 6
Important Terms Actor An abstract name for a system Transaction A well defined communication of a message from a source actor to a destination actor Modality queries for a worklist, or Modality stores images to an Image Manager Option An extra feature in an Integration Profile Not required, but you might find it important 4/19/2025 7
Examples of Actors Acquisition Modality A system that acquires and creates medical images while a patient is present, e.g., a Computed Tomography scanner or Nuclear Medicine camera. ADT Patient Registration A system responsible for adding and/or updating patient demographic and encounter information. Department System Scheduler/Order Filler A department-based information system (for instance, Radiology .) that provides functions related to the management of orders received . Image Manager A system that provides functions related to safe storage and management of evidence objects. It also accepts/commits dose data and supports query/retrieve. 4/19/2025 8
Options by Example First car I drove: 1963 Ford Galaxy coupe Air conditioning was an option We did not purchase the option You do not need options to have a car, but The options might improve your driving experience 4/19/2025 9
An Integration Profile : A Set of Actors Exchanging Transactions Department System Scheduler/ Department System Scheduler/ Order Filler Order Filler Image Manager/ PPS Manager PPS Manager Image Manager/ Order Placer Placer Order Acquisition Modality Modality Acquisition ADT ADT Use cases Process Flows Register J.Doe Register J.Doe Patient Registration [RAD-1] Registration [RAD-1] Patient Placer Order Management Placer Order Management New [RAD-2] New [RAD-2] One or the other methods of creating an One or the other methods of creating an order is used order is used Filler Order Management - New [RAD-3] New [RAD-3] Filler Order Management - Schedule Schedule Procedure Procedure Procedure Procedure Scheduled [RAD-4] Scheduled [RAD-4] Actors Transactions Query Modality Worklist [RAD-5] Query Modality Worklist [RAD-5] Perform Acquisition Acquisition Perform Modality Procedure Step In Progress [CARD-1] [CARD-1] Modality Procedure Step In Progress Modality Procedure Step In Progress [CARD-1] [CARD-1] Modality Procedure Step In Progress Filler Order Mgmt - Status Update [RAD-3] Update [RAD-3] Filler Order Mgmt - Status Modality Procedure Step Completed [RAD-7] [RAD-7] Modality Procedure Step Completed Modality Procedure Step Completed [RAD-7] [RAD-7] Modality Procedure Step Completed Patient Reconciliation Patient Reconciliation Filler Order Mgmt - Status Filler Order Mgmt - Status Update [RAD-3] Update [RAD-3] J.Doe -> J.Doe -> J.Smith J.Smith ADT ADT Patient Update/ Merge [RAD-12] Merge [RAD-12] Patient Update/ Patient Update/ Patient Update/ Merge [RAD-12] Merge [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Placer Order Management [RAD-2] Filler Order Management [RAD-3] Placer Order Management [RAD-2] Filler Order Management [RAD-3] For each transaction: Std referenced Options specified Mapping required Order Placer Order Placer DSS/ Order Filler DSS/ Order Filler Procedure Scheduled [RAD-4] Patient Update [RAD-12] Procedure Scheduled [RAD-4] Patient Update [RAD-12] Procedure Updated [RAD-13] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Procedure Updated [RAD-13] Instance Availability Notification [RAD-49] Instance Availability Notification [RAD-49] Evidence Creator Creator Evidence Image Display Image Display Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Query Images [RAD-14] Retrieve Images/Evidence [CARD-4] Query Images [RAD-14] Retrieve Images/Evidence [CARD-4] Storage Storage Modality Image/Evidence Modality Image/Evidence Stored [CARD-2] Stored [CARD-2] Performed Procedure Step Manager Step Manager Performed Procedure Commitment Commitment [CARD-3] [CARD-3] Image Manager Manager Image Image Archive Archive Image Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Storage Storage Modality Image/Evidence Stored [CARD-2] Stored [CARD-2] Modality Image/Evidence Commitment Commitment [CARD-3] [CARD-3] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Acquisition Acquisition Modality Modality Query Modality Worklist [RAD-5] Query Modality Worklist [RAD-5] 10 4/19/2025 10
Where Can We Improve Workflow? Is the request communicated effectively from the referring physician to the technologist? to the radiologist reading the study? Did the technologist perform the procedure or substitute a different one? Does the patient have priors? Do I have all of the images and data? Are the images safely stored on the PACS (can we delete from the modality)? 4/19/2025
Actors in Scheduled Workflow ADT Patient Registration Order Placer Department System Scheduler/Order Acquisition Modality Image Manager MPPS Manager Image Display Evidence Creator 4/19/2025 12
Registration HIS patient information Diagnostic Workstation PACS images retrieved Orders Placed procedure scheduled Prefetch any relevant prior studies Image Manager & Archive examination orders Acquisition Modality modality worklist images stored acquisition completed Orders Filled RIS acquisition in-progress completed acquisition Modality HIMSS/RSNA Vendor Workshop, April 2003
Send Request to Order Filler (RIS) 1: ADT Order Placer ADT 2: Order 1: ADT Order Filler 4/19/2025 14
In the Previous Slide (1: ADT) is shorthand for Radiology Transaction 1 ADT tells both Order Placer and Order Filler patient information (common patient ID, demographics) (2: Order) Order Placer (HIS) informs Order Filler (RIS) of request from physician 4/19/2025 15
Schedule the Procedure 4: Schedule Order Filler Image Manager 5: Worklist Query Acquisitio n Modality 4/19/2025 16
Where Are We Now? (4: Schedule) is a push to the Image Manager Image Manager locates relevant priors based on a consistent patient identifier Image Manager could set up a reading worklist (5: Worklist Query) is a pull by the modality Technologist does not have to type demographics The requested procedure is visible right on the console No second RIS terminal is needed 4/19/2025 17
Bonus Points !!! Assisted Acquisition Protocol Setting Option Modality translates worklist codes to a protocol Technologist can accept protocol or select a different one Modality will inform RIS/PACS of what was performed using coded system 4/19/2025 18
Where Can We Improve Workflow? Is the request communicated effectively from the referring physician to the technologist? to the radiologist reading the study? Did the technologist perform the procedure or substitute a different one? Does the patient have priors? Do I have all of the images? Are the images safely stored on the PACS (can we delete from the modality)? 4/19/2025
Acquire Images, Alert the Media!! 6, 7: MPPS 8: Store Images Acquisitio n Modality Image Manager 10: Commit 6, 7: MPPS Order Filler 4/19/2025 20
In the Previous Slide (6,7: MPPS) Modality tells what procedure was performed Modality sends a list of images (8: Store Images) Standard DICOM push (10: Commit) Modality: Image Manager, do you take responsibility for these images? Image Manager: I do 4/19/2025 21
Where Can We Improve Workflow? Is the request communicated effectively from the referring physician to the technologist? to the radiologist reading the study? Did the technologist perform the procedure or substitute a different one? Does the patient have priors? Do I have all of the images? Are the images safely stored on the PACS (can we delete from the modality)? 4/19/2025
View Images 14: Query Images 16: Retrieve Image Display Image Manager 4/19/2025 23
Image Display Can retrieve priors and display with current images If the display is integrated with the RIS or PACS, it will have access to MPPS data Requested procedure Performed procedure List of all images acquired 4/19/2025 24
Where Can We Improve Workflow? Is the request communicated effectively from the referring physician to the technologist? to the radiologist reading the study? Did the technologist perform the procedure or substitute a different one? Does the patient have priors? Do I have all of the images? Are the images safely stored on the PACS (can we delete from the modality)? 4/19/2025
Other IHE Workflow Profiles Mammography Cardiology Image-Enabled Office ECG Import Reconciliation Post Acquisition Workflow Variants on a common theme L. Tarbox - Analytic Workflow: From Images to Reports
Application Hosting Separate the provision of infrastructure from the application. Infrastructure providers (Hosting Systems) concentrate on the movement and storage of data and results, and on workflow management. Application providers concentrate on the processing and analysis of that data, providing results back to the infrastructure. Minimize the reinvention of the wheel . L. Tarbox - Analytic Workflow: From Images to Reports
One App, Many Hosts Portable applications that plug into any host that implements the standardized socket Standard API Commercial Vendor #1 Commercial Vendor #2 Unix, Mac, PC Internet Server
Benefits of Application Hosting Users Want one workstation that supports any needed functionality Want to pick and choose any application to run on that workstation regardless of who created that application IT Administrators Tired of changing infrastructure to accommodate new workstations simply to add functionality Application Developers Do not have time to customize applications for each of the workstations available in the market from dozens of vendors Workstation Vendors Want to expand their list of offered applications beyond those in the base workstation without incurring extra development effort
References http http://dicom.nema.org ://dicom.nema.org/ / http://www.HL7.org/ http://www.HL7.org/ http://www.IHE.net/ http://www.IHE.net/ L. Tarbox - Analytic Workflow: From Images to Reports
Author Contacts Lawrence Tarbox, Ph.D. tarboxl@mir.wustl.edu 510 South Kingshighway Boulevard St. Louis, MO 63110 USA Thank you for your attention ! L. Tarbox - Analytic Workflow: From Images to Reports
