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2 nd ICT Med Workshop

Informatics in Medical Imaging New Advences & Horizons. 2 nd ICT Med Workshop. Alireza Shakibafard MD Shiraz University of Medical Sciences(SUMS). Medical Imaging. Digital Imaging. Digital Imaging. Image or Magic ???. Analog Images. Analog vs. Digital Image. Analog. Digital.

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2 nd ICT Med Workshop

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  1. Informatics in Medical Imaging New Advences & Horizons 2nd ICT Med Workshop AlirezaShakibafard MD Shiraz University of Medical Sciences(SUMS)

  2. Medical Imaging

  3. Digital Imaging

  4. Digital Imaging Image or Magic ???

  5. Analog Images

  6. Analog vs. Digital Image Analog Digital AD Conversion For computer viewing For human viewing

  7. Digital Image is ready for any Change Storage Transfer

  8. New Paradigm Moving from traditional film-screen(analog) toward electronic media In electronic imaging thefunctional parts of conventional radiology have been separated: • Image Capture , Storage & Display

  9. Digital System Film Developed And Fixed Viewed Display Detector Reading Digital Processing Stored PACS QC of the digital systems is an additional requirement – in addition to the usual x-ray performance tests

  10. Each pixel is assigned a numeric value (bit depth)that represents a shade of gray based on the attenuation characteristics of the volume of tissue imaged Image Characteristics

  11. Medical Imaging Advanced Applications

  12. Multiplanar Navigation

  13. MIP

  14. ArchivingMedia DiagnosticModality PACSServer ArchivingDevice Conventional PACS Hospital

  15. Modern View on PACS • PACS is the “Imaging” part of Healthcare Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS. • The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone. • Technological basis: “PACS rides many horses” from web-based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.

  16. Historical Evolution • 80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems. • 90ties:departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective?? • >2000: Enterprise-PACS+RIS+PACS = film-less hospitals. • >2007: Newest achievements: Multi-site PACS using MPI (Master Patient Index) to allow the patient’s access on all sites • Hospitals will skip historical steps and adopt to state of the art PACS and HIS.

  17. Parallel evolution of all PACS functions 19802012 PICTURES Archiving Communication Systems Represent 5D datasets SAN/NAS/grids Internet/web/ Wifi Functionality+ knowledge 2D tapes ATM, video Hardware + show an image

  18. Patient arrives 3 Study ordered and scheduled 1 Report approval 14 12 Report transcription ADT 2 15 4 Report status notification HIS RIS 13 Order/schedule status notification Report Workflow Management Connectivity Manager 9 Study status notification 7 5 Modality worklist Order/schedule status notification Report status notification 10a 16 Verification PACS Modality QC Pre-fetching (images) 6 11 Diagnostic review and report dictation 10 Image store 8 Patient is examined 17 Images to long term archive 1Ob Images wavelet compressed by curator 19 Non diagnostic review In hospital, Out hospital Distribution

  19. Information systems in the hospital workflow HIS • HIS (Hospital Information System) • Central administration and financial system of the hospital • Keeps the central patient registration • patient identification • holds the demographic data • RIS (Radiology Information System) • Dedicated radiology information system, taking care of • exam ordering • exam planning • study reporting • passing billing related information • not automatically included • not available for every country • Holds the study information • PACS (Picture Archiving and Communication System) • Dedicated system for archiving and communication of study related images • Communicates with the outside world HL7 RIS HL7 Connectivity Manager DICOM PACS

  20. Information exchange standards • HL7 (Health Level 7) • Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services. E.g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, … • DICOM (Digital Imaging and Communication in Medicine) • DICOM is a standard, to enable efficient and flexibleintegration and communication of image data between components(modalities, printers, storage, databases, …) in a medical network However: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant

  21. RIS PV1||E|TRAUMA|A||||^DOE^JOHN^W.^DR.^|||WAITING ROOM Do you speak DICOM ? CM PACS Connectivity Services (Connectivity Manager) Translate HIS/RIS messages (e.g. HL7) to DICOM ???

  22. Consolidation of image data information provided by multiple sources • Multi-modality (MRI, CT, Ultrasound…) • Multi-Vendor • DICOM gateway : Paxport (for non DICOM modalities) • Film scanner Image acquisition Objective How ?

  23. Image data storage and archiving • Storage (.dcm files) • Type of media (disks, UDO, LTO) • Everything on line solutions, near-line, off-line • Data compression • Data availability

  24. PACS Architecture Internal & External Clients RIS Database Application Server HIS Archive Server Connectivity Manager Workflow Manager Curator Modality

  25. PACS Viewing Station At Modality Web Viewer Webserver

  26. PACS and Network Workstation 1 Workstation 2 SERVER Hub Switch SERVER ….. Workstations CD/DVD Robot RAID Archive

  27. PACS Beyond Radiology • Other Types of Images: • Vascular Angiography • Cardiac Angiography • Echocardiography • Obstetric Ultrasound • Medical Photography • Retinal Imaging • Colposcopy / Cytology….. • May be more of a RIS Issue than PACS

  28. Imaging Informatics New Advances

  29. Imaging Informatics Laboratory

  30. The Bottom Line • Modern Image Processing • Automated CAD with interpretation and reporting • Portable medical records – perhaps imbedded in patient • Integrated RIS-PACS-HIS through I.T. • Robotic imaging • Molecular Imaging • Image guided chemotherapy and gene therapy • ………….

  31. Take Home Point: Beyond Bytes & Bits : Healthcare IT ; When needed , Where needed Integrated & Enterprise

  32. Take Home Point: • Healthcare IT ; • Beyond one person , one department , one ….. , it is across … • It needs collaboration , communication & decision making

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