MIR 2002

1
Berthold Wein,Dept. Diagnostic
RadiologyUniversity Hospital Aachen

• The Clinical Benefits of IHE
• The first 7 IHE Integration Profiles,
• for a Better Practice

2
Selected Problems (Overview)

• Seamless workflow
• Data consistency
• Image presentation
• Spiral CT examinations
• Information distribution
• Image notification
• Parametric access to images and reports

3
Workflow

• Most critical issue in a Radiology Environment
• Inter- or corrupted information chain
• Paper based informations -gt multiple re-entry of
  data
• Different non adapted subsystems dont cooperate
• Error correction takes huge amount of time
• Stale information
• Brandnew information not known (cancellation,
  change)
• Status update information
• Exam registered, finished, archived, reported,
  delivered

4
IHE Integration Profiles
Workflow
5
IHE Scheduled Workflow in Radiology
RIS
PACS Archive

• A Closed Loop
• Update IS Scheduling
• Match Procedure with Order
• Support Billing Based on MPPS
• Avoid Reading Incomplete Procedures

6
Data Consistency

• Trauma patient
• Manual wrong data entry at the modality
• System crashed
• VIP person

7
IHE Integration Profiles
8
Image presentation

• Viewing on different monitors / systems
• Ensuring print quality outside of the department
• Radiologist discussing images with remote
  physicians
• Capture image manipulation to avoid redundant
  work (coronal CT, MR reading, etc.)

9
IHE Integration Profiles
10
Consistent Presentation of Images
Referring Physician or Reviewing Radiologist
Reporting Radiologist
Presentation State
Presentation LUT
Grayscale Standard
11
Re-arranging Series

• CT/MR Head bone / brain separation
  (external/internal)
• CR Foot/ankle - hand/wrist
• E.g., lateral image of foot shared between AP of
  ankle and AP of foot
• DR Trauma patient AP / Lat re-grouping
• I.e., do all the Aps then rotate the patient once
  then do Lats
• MR MRI/MRA
• To be viewed and billed separately
• IR Diagnostic run and therapeutic run
• Performed contemporaneously, viewed/billed
  separately
• US Abdomen and kidneys / retroperitoneum
• and lymphnodes

12
IHE Integration Profiles
13
IHE Presentation of Grouped Procedures
Requested ProcedureCHEST
Requested ProcedureABDOMEN
RIS / PACS
14
Information distribution

• Therapy related imaging
• Radiation therapy
• Computer assisted surgery (orthopaedic,
  neurosurgery, ...)
• Secure image distribution within the enterprise
  and to the outside world

15
IHE Integration Profiles
16
Access to Radiology Information

• Providing Access to Radiology Information
• Internally to Radiology
• From Other Departments Surgery, Oncology,
  Pediatrics, etc.

DICOM Based Transactions
17
Image notification

• Flag images within a huge CT-series
• Informations from radiographer to radiologist
• Dedicated image descriptions
• ....

18
IHE Integration Profiles
19
Different notes on different images
Same note on different images
20
Parametric access to images and reports

• Discussion
• Comparison is made to the prior study of
  11.04.1999. The left paratracheal lymph node
  (image 8, image 11) now measures 2.5x2.7x3.1 cm
  increasing from 2.0x2.1x2.6 previously. No other
  mediastinal, upper abdominal or axillary
  adenopathy is identified. No focal pulmonary
  lesions are seen. The yadda, yadda, yadda are
  normal.
• Impression
• Worsening left paratracheal adenopathy.
• Signature

21
IHE Integration Profiles
22
Pattern Simple Image Numeric Report
Simply Adds Measurements to Simple Image Reports
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Simple ImageandNumeric Reports
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IHE Year 4 Integration Profiles
25
Clinical Benefits by IHE

• The power of IHE to improve productivity and
  reduce errors is really great
• Clinical workflow will re-gain resources
• Systems connectivity increases
• gt Daily work will become worthwhile again