Collaboration between the Referring Clinician and the Radiologist

1. Collaboration between the Referring Clinicianand the Radiologist DICOM WG10 April, 2004, Kamakura

2. IHE White Paper: External View DICOM WG10 Kamakura April, 2004

3. patient patient order result Main external Process Radiology Acquisition Reporting DICOM WG10 Kamakura April, 2004

4. Enterprise Report Repository modality Order Placer radiologist Report Manager Report Creator Image Display • IMAGING • PACS • Workstations • Modalities Acqui-sition Repor-ting Department System Scheduler – Order Filler – patient patient Image Mgr / Archive status updat. HIS HIS scheduling Performed Procedure Step Manager report Acquisition Modality order Radiology Dept Mgt RIS results images IHE Actors / Transactions DICOM WG10 Kamakura April, 2004

5. modality radiologist Acqui-sition Repor-ting patient patient status updat. scheduling report order results images Main Internal process Radiology Dept Mgt DICOM WG10 Kamakura April, 2004

6. RIS and 4 Report Repository Image Repository PACS QnR store QnR store store->burn network DICOM optional manual HL7/other Scenario 3 modality worklist Selected Images print print store print + mail / fax / e-mail interpretation send acquisition Electronic Report Electronic Report Images Evidence Docts Presentation States NarrativeInfo Only query transcription print approval burn CD store->burn Images Evidence Documents Presentation States print Film interpretation DICOM WG10 Kamakura April, 2004

7. Scenario 5 & 6 DICOM WG10 Kamakura April, 2004

8. 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) DICOM WG10 Kamakura April, 2004

9. 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) DICOM WG10 Kamakura April, 2004

10. 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 DICOM WG10 Kamakura April, 2004

11. 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 DICOM WG10 Kamakura April, 2004

12. 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 DICOM WG10 Kamakura April, 2004

13. 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). DICOM WG10 Kamakura April, 2004

14. 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 DICOM WG10 Kamakura April, 2004