Collaboration between the Referring Clinician and the Radiologist

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Collaboration between the Referring Clinician and
the Radiologist

• DICOM WG10 April, 2004, Kamakura

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IHE White Paper External View
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Main external Process
Radiology
Acquisition Reporting
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IHE Actors / Transactions
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Main Internal process
Radiology Dept Mgt
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Scenario 3
modality worklist
Selected Images
print
print
store
print mail / fax / e-mail
interpretation
send
acquisition
Electronic Report
Electronic Report
NarrativeInfo Only
Images Evidence Docts Presentation States
query
transcription
print
approval
burn CD
store-gtburn
Images Evidence Documents Presentation States
print
Film
interpretation
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Scenario 5 6
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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)

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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)

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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

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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

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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

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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).

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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