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Rita Noumeir, Ph.D. Professor University of Quebec

Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I) Access to Radiology Information (ARI) Retrieve Information for Display (RID). Rita Noumeir, Ph.D. Professor University of Quebec. Abstract / Scope. Sharing of Imaging Information across health enterprises

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Rita Noumeir, Ph.D. Professor University of Quebec

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  1. Distributing Images: Cross-enterprise Document Sharing for Imaging (XDS-I) Access to Radiology Information (ARI)Retrieve Information for Display (RID) Rita Noumeir, Ph.D. Professor University of Quebec

  2. Abstract / Scope • Sharing of Imaging Information across health enterprises • Imaging Information includes • extensive sets of DICOM instances including images, evidence documents and presentation states • diagnostic reports provided in a "for display" form • selection of diagnostically significant images associated with the report content

  3. Sharing Radiology Reports and Imagesin a Regional Health Information Network Regional Health Information Network Radiology Enterprise B PACS B Radiology-to-radiology Radiology-to-Physicians PACS A Physician Office Radiology Enterprise A

  4. Sharing Radiology Reports and Imagesin a Regional Health Information Network Regional Health Information Network Radiology Enterprise B PACS B • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B • Report 2/18/2005 : Chest Xray A • Study 2/18/2005 : Chest Xray A Cross-Enterprise Registry PACS A Physician Office Radiology Enterprise A

  5. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Register Imaging Information for sharing Priorimaging Reports & Studies Register Imaging Information for sharing Query for Documents Regional Health Information Network Radiology Enterprise B Cross-Enterprise Registry • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B Physician Office Radiology Enterprise A

  6. Physicians and Systems within a Regional Health Network - Routine Imaging Referral Register Imaging Information for sharing Register Imaging Information for sharing Notification of Doc Availability Regional Health Information Network Radiology Enterprise B Cross-Enterprise Registry Physician Office Radiology Enterprise A

  7. Physicians and Systems within a Regional Health Network for a Routine Imaging Referral Prior Imaging Report & Study Query for documents Notification of Doc Availability Imaging Report & Study Regional Health Information Network Radiology Enterprise B • Patient Id= 3547F45 • Report 5/21/1998 : CT Head B • Study 5/21/1998 : CT Head B • Report 2/18/2005 : Chest Xray A • Study 2/18/2005 : Chest Xray A Cross-Enterprise Registry Physician Office Radiology Enterprise A

  8. Value proposition • Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc. • Effective means to contribute and access imaging documents across health enterprises. • Without XDS-I, access to the radiology report across health enterprises is difficult • Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems. • Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest • with the same mechanisms used to query other documents

  9. Value proposition • Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager. • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain. • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report) • Document Content Neutral: Document content is processed only by source and consumer IT systems. • Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

  10. XDS-I Dependencies • XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS) • New Actors • Imaging Document Source • Imaging Document Consumer (should be grouped with Document Consumer) • Same Actors as in XDS • Document Consumer • Document Registry • Document Repository • Added extension to support imaging data (images and reports)

  11. XDS-I Actors and Transactions Patient Identity Source Patient Identity Imaging Document Consumer Feed Query Document Documents Document Consumer Registry Register Document Set Retrieve Provide & Register Document Document Set Document Imaging Document Source Repository Retrieve Images Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve

  12. XDS-I New Transaction requirements • XDS-I Actors: • Imaging Document Consumer • at least one Retrieve ( [RAD-55], [RAD-16], [RAD-17], [RAD-27], [RAD-31] [RAD-35]) • Imaging Document Source • Provide and Register Document Set [RAD-54] • WADO Retrieve [RAD-55] • Retrieve Images [RAD-16], Retrieve Presentation States [RAD-17] Retrieve Reports [RAD-27], Retrieve Key Image Note [RAD-31], Retrieve Evidence Documents [RAD-45] • XDS Actors • Document Repository • Provide and Register Document Set [RAD-54]

  13. Options • Imaging Document Source must support at least one of the following options: • Extensive Set of DICOM Instances • PDF Report • NEW Text Report wrapped in a CDA Document • NO Text option • NO multipart Text / PDF option

  14. Sharing of Extensive DICOM Instance Set

  15. Register Manifest Query Registry DICOM Manifest DICOM Manifest Retrieve Manifest Reference to image 1 Reference to image 1 Reference to image 2 Reference to image 2 Reference to image 3 Reference to image 3 Retrieve Images Manifest Manifest Manifest Manifest Manifest Clinical IT System Clinical Encounter Document Registry Document Repository

  16. Sharing of Extensive DICOM Instance Set • The shared Document is a manifest • a Key Object Selection DICOM Instance • title : manifest • Imaging Document Source is required • to ensure that the referenced images from within a published manifest are available to be retrieved • Imaging Document Source is responsible • for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances referenced within the manifest)

  17. Sharing of Imaging Report

  18. Radiology Report Header: Report Type: OB / Gyn BPD ….. ... Findings: ….. Gestational Impressions: Age ... Text wrapped into CDA Report PDF Report Radiology system Report Source

  19. Register Report Query Registry Radiology Report Header: Report Type: OB / Gyn BPD Retrieve Report ….. ... Findings: ….. Gestational Impressions: Age Report Report Report ... Clinical IT System Clinical Encounter Document Registry Document Repository Radiology system Report Source

  20. Sharing of Reports • The shared Report Document format is • PDF, Text wrapped in a CDA • A report can • embed selected images in its PDF format • include fully resolved hyperlinks (interactively clickable) that point to the selected images • Imaging Document Source is responsible • for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document • Imaging Document Source is required • to ensure that image references are valid links

  21. XDS-I Actors / Grouping • No specific grouping requirement on Imaging Document Source, however: • Imaging Document Source is responsible of ensuring published images in a manifest are available to be retrieved • Imaging Document Consumer shall be grouped with a Document Consumer

  22. Linking Report to Complete Set of Images SubmissionSet DocumentEntry DocumentEntry Study Manifest Report Document Registry Document Repository

  23. Linking Report to Complete Set of Images SubmissionSet 1 SubmissionSet 2 DocumentEntry Report Study Manifest Document Registry DocumentEntry Document Repository

  24. Linking Report to Prior Images and Prior Report SubmissionSet 3 SubmissionSet 1 SubmissionSet 2 SubmissionSet 4 DocumentEntry DocumentEntry DocumentEntry Prior Study Manifest Prior Report Report Study Manifest Document Registry DocumentEntry Document Repository

  25. Linking Report to Selected Images BPD ... ….. Radiology Report Header: Report Type: OB / Gyn ….. Findings: Gestational WADO URI Link to image Age ... Relevant Image Radiology system Report Source

  26. XDS-I Metadata • Radiology specific • Acquisition Modality (e.g. CT, MR) • Anatomic Region (e.g. Arm, Elbow, Hand) • Requested procedure (e.g. MRI Knee with contrast) • Query example • find all “CT of the Head” of patient John Doe for the last 2 years

  27. Access to Radiology Information

  28. Access to Radiology InformationAbstract /Scope • Provides access to radiology information within the rest of the hospital (e.g., ER, OR, cardiology, oncology, etc) • Images, evidence documents, presentation states, key image notes, structured radiology reports • Query and retrieve based model • Multiple Sources Option • Allows user access to distributed Radiology information • One user’s action, queries to multiple sources, consolidation of results.

  29. Access to Radiology Information constraints • DICOM Query/ Retrieve • Defines Matching keys for response filtering by Image Manager/Archive • Defines Return keys to be requested by Image Display • Defines Returned attributes supported by Image Manager/Archive in query responses • Defines Returned attributes required to be displayed on Image Display

  30. Retrieve Information for Display

  31. Retrieve Information for display Summary of Laboratory Reports Summary of Radiology Reports Summary of Cardiology Reports Summary of Surgery Reports Summary of Intensive Care Reports Summary of Emergency Reports Summary of Discharge Reports List of Allergies List of Medications Persistent Document Standards: HTTP, Web Service XHTML, PDF, JPEG, CDA Retrieve Specific Info for Display [11] Information Source Display Retrieve Document for Display [12] Summary of All Reports Summary of Prescriptions Types ofRequests

  32. Parameter Name REQ Description RequestType R requestType specifies what type of information shall be retrieved. This parameter shall always be valued. patientID R This attribute identifies the subject of the results being queried for. Its value shall include identification of assigning authority. lowerDateTime O Used to constrain the earliest date/time of creation of information. upperDateTime O Used to constrain the latest date/time of creation of information. MostRecentResults R The numeric value that indicates the number of most recent results to be included into the response, i.e., 1 indicates to provide the latest result. Query Keys – Transaction [11]Retrieve Specific Information for Display

  33. Parameter Name REQ Description RequestType R This parameter is required to have a value of “DOCUMENT”. DocumentUID R PreferredContentType R Identifies document’s UID as known to both actors. This parameter is required to identify the preferred format: JPEG. PDF, CDA L1 that the document is to be provided (as MIME content type). Query Keys – Transaction [12]Retrieve Document for Display

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