Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Nuclear Medicine Image - NM Dr. Jerry Wallis (SNM) IHE Radiology Technical Cmte Kevin O’Donnell (Toshiba Corp.) Co-Chair, IHE Radiology Planning Cmte IHE Europe Participants' Workshop

2. Nuclear Medicine Image - NM Charge Posting Presentation of Grouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage NMImage Consistent Present-ation of Images EvidenceDocs Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow Basic Security IHE Europe Participants' Workshop

3. NM Image – The Problem • DICOM NM objects are different and support in products is inconsistent • NM clinical display practices are different and support in products is inconsistent • Clinical Analysis Programs are used extensively (particularly for Cardiology), but no support for distribution and display of those Result Screens • NM Users are not adept at getting these requirements accurately included in RFPs • Vendors (especially of general purpose systems) are not adept at accurately representing their support for such features IHE Europe Participants' Workshop

4. Understood by dedicated NM systems Often Misunderstood by general storage and display systems Multiframe Dynamic Anterior Posterior Multi-energy NM Image Format NM Image • Image vectors IHE Europe Participants' Workshop

5. NM Image NM PACS IHE Europe Participants' Workshop

6. NM Image NM PACS IHE Europe Participants' Workshop

7. NM Image Click and move mouse down to adjust window level, right to adjust window center IHE Europe Participants' Workshop

8. NM – The Solution • New Profile • for Users to request and Vendors to claim • No New Actors or Transactions • Additional requirements on existing actors and transactions • Two New Options • New Informative Text in Vol. 1 • Clarifications of NM Workflow mapping to SWF • Explanation of NM Data • Explanations of NM Clinical Display concepts • New Normative Text in Vol. 2 • <See Following Slides> • Connectathon to help test and confirm IHE Europe Participants' Workshop

9. NM – Actors and Transactions IHE Europe Participants' Workshop

10. NM Image Profile • Acquisition Modalities (Modality Images Stored [8]) • Create NM objects as specified (additional attribute & vector handling) • Include specific codes in Cardiac studies • Evidence Creators (Creator Images Stored [18]) • Create NM objects as specified (additional attribute & vector handling) • Include specific codes in Cardiac studies • Image Manager/Archives • Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects • Image Displays (Retrieve Images [16]) • Display NM and Secondary Capture (SC & MFSC) Images • Support specified display capabilities IHE Europe Participants' Workshop

11. Result Screen Export Option Provides storage, retrieval and display of Static and Dynamic Result Screens • Based on the following DICOM Objects: • Secondary Capture • Multi-Frame Grayscale Byte Secondary Capture • Multi-Frame True Color Secondary Capture • Evidence Creators • Generate appropriate Secondary Capture objects from any Result Screens created. IHE Europe Participants' Workshop

12. Review Option Adds requirements to the Image Display to allow Review of NM Images • Image Displays • Must additionally support MPR Display, more frames, different series types together, etc. IHE Europe Participants' Workshop

13. PACS  NM Workstation ? • No ! • No filtering • No ROI • No TAC • No renal, lung … processing • No reframing • No cardiac processing IHE Europe Participants' Workshop

14. Image Display • Support separate adjustment of upper and lower window levels • Show multiple cines • Display grayscale and color result screens • Display dynamic result screens • Apply local color tables to grayscale screens • Add color tables to system • Change intensity of grayscale result screens • (strongly recommended) IHE Europe Participants' Workshop

15. Image Display • Must use “intelligent” scaling to avoid presenting postage-stamp size NM images • Just because it was acquired at 64x64 doesn’t mean they want to review it at 64x64 IHE Europe Participants' Workshop

16. Image Display • Must use “intelligent” scaling to avoid presenting postage-stamp size NM images • Must allow the user to select different vectors/framesets of complex multi-frame images • Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image” IHE Europe Participants' Workshop

17. Display Formats • Grid display • One image set • Fit display • Multiple image sets • Comparison display • Multiple image sets IHE Europe Participants' Workshop

18. Multiple Cines IHE Europe Participants' Workshop

19. Multiple Cines IHE Europe Participants' Workshop

20. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements IHE Europe Participants' Workshop