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Managing the Acquisition Workflow

Learn about the key DICOM services and worklist integration for managing the acquisition workflow in the radiology/imaging department, improving clinical processes and ensuring efficient information flow.

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Managing the Acquisition Workflow

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  1. Managing the Acquisition Workflow Nikolaus Wirsz, PhD Siemens HealthcareMember of the DICOM Standards Committee and Working Group Ten – Strategic Advisory

  2. Managing theAcquisition Workflow • Introduction • Modality Worklist • Modality Performed Procedure Step • Storage Commitment • Instance Availability Notification • Conclusions DICOM International Conference & Seminar

  3. Introduction • DICOM Constructs • Information Object Definitions (IOD): Images, Evidence Documents • Service Class Specifications: Storage, Query/Retrieve, … • Data Structures and Semantics • Message Exchange • … … to support • User Tasks • Interactions Between Systems • Process Steps in the Diagnostic Chain … and improve clinical processes: • Acquisition Workflow • Post-Processing Workflow • Reporting Workflow DICOM International Conference & Seminar

  4. Image Management (PACS) 4 Instance Availability Notification • Workflow Management • Registration • Order Entry • Scheduling • Tracking 1 Modality Worklist Departmental Information System (RIS) Storage & Storage Commitment Image Acquisition Modality 2 Performed Procedure Step 3 The Acquisition Workflow • Sustain & Optimize Process Tasksin the Radiology / Imaging Department • Data Entry • Procedure Scheduling • Image Acquisition • Procedure Tracking • Image Storage Management • Unobstructed Information Flow“Assembling the Puzzle” • Key DICOM Services forAcquisition Workflow Support • Modality Worklist • Modality Performed Procedure Step • Storage with Storage Commitment • Instance Availability Notification DICOM International Conference & Seminar

  5. 1 1a Results: C-FIND Resp. Query: C-FIND Req. 1b Departmental Information System (RIS) Image Acquisition Modality 1a Modality Worklist (MWL) • Provide Demographics, Procedure and Schedule Details to the Modality • Modality (SCU) Queries the RIS (SCP) • Query Matching Key Attributes • Date / Time of Procedure • Modality Type (e.g. CT) • Station AE Title (a specific Device) • Patient Name / ID • Accession # (identifies an Imaging Order) • Requested Procedure ID • … • Query Examples • Today‘s Worklist • CT Procedures Worklist • CT Room 1 Worklist • John Doe‘s Procedures of a Chest Imaging Order DICOM International Conference & Seminar

  6. 1 1b Results: C-FIND Resp. Query: C-FIND Req. 1b Departmental Information System (RIS) Image Acquisition Modality 1a Modality Worklist (MWL) • RIS (SCP) Returns Query Results to Modality (SCU) • Null (No Match) • One or More Worklist Entries • Worklist Entry (Unit of Service) =Scheduled Procedure Step (SPS) • Query Return Key Attributes • Patient Data • Name, ID, Demographics • Allergies, Special Conditions • Scheduling Information • Date / Time • Procedure Information • Description, Protocol Codes • Contrast & Medication Administration • Order Information • Accession #, Study UID • Requesting Physician • ... DICOM International Conference & Seminar

  7. 1 1a 1b Results: C-FIND Resp. Query: C-FIND Req. 1b Departmental Information System (RIS) Image Acquisition Modality 1a Modality Worklist (MWL) • Deployment of the Modality Worklist Service • Modalities Query & Receive Worklists from RIS • Modality Displays Worklist to Operator • Operator Selects a Worklist Entry (SPS) to Perform • Acquisition of Images(Based on SPS Details) • Insert Patient & Procedure Datainto the Image Header • Benefits of Using the Modality Worklist • Eliminate Redundant Data Capture • Avoid Error-Prone Manual Tasks • Facilitate Data Consistency:Unambiguous Association of Images to Proper Patient / Procedure DICOM International Conference & Seminar

  8. 2 2a 2b Departmental Information System (RIS) Image Acquisition Modality 2a MPPS IN PROGRESS: N-SET MPPS COMPLETED: N-CREATE 2b Modality Performed Procedure Step (MPPS) • Feedback Acquisition Data to Scheduling System (RIS) • Modality (SCU) Sends Acquisition Information to the RIS (SCP) • Tracking of Modality Procedure Status • IN PROGRESS: MPPS N-CREATE • COMPLETED: MPPS N-SET • DISCONTINUED: MPPS N-SET(incl. Reason for Discontinuation) • Logging of Procedure Related Data • Identification Attributes: • Accession # • SPS ID • Patient Name / ID / Demographics • ... • List (Series) of Images • Protocol Codes for the Actually Performed Acquisition • Materials Used (Chemicals, Supplies) • Radiation Dose Exposure Values • ... DICOM International Conference & Seminar

  9. 2 1 1 Simple Case SPS PPS 0 1 Unscheduled Case SPS PPS 1 1 Append Case SPS PPS 1 PPS* 1 1 *appended SPS Modality Worklist 1 1 Group Case SPS PPS Departmental Information System (RIS) 1 SPS Image Acquisition Modality resultsin resultsin resultsin resultsin 2 Performed Procedure Step Modality Performed Procedure Step (MPPS) • MPPS Use Cases (according to IHE) • Benefits of Using MPPS • Keeping Schedules Up-to-date • Better Management of Resources • Gather Information Required for Billing • Trigger for Subsequent Processes: Post-Processing, Reporting DICOM International Conference & Seminar

  10. 3 Image Management (PACS) 3a 3b 3c 3b 3a 3c Request Storage Commitment: N-ACTION Transfer Images: C-STORE Confirm Storage Commitment: N-EVENT-REPORT Image Acquisition Modality Storage with Storage Commitment • Secure Ownership and Safekeeping of Clinical Results • Modality (SCU) RequestsStorage Commitment from PACS (SCP) • Modality Transmits Images (or other Objects) to PACS: C-STORE Operations for Images • Modality Issues Storage Commitment Request to PACS: N-ACTION including List of Instances to Retain • PACS Notifies Modality of Success (or Failure) : N-EVENT-REPORT DICOM International Conference & Seminar

  11. 3 Image Management (PACS) 3b 3a 3c Request Storage Commitment: N-ACTION Transfer Images: C-STORE Confirm Storage Commitment: N-EVENT-REPORT Image Acquisition Modality Storage with Storage Commitment • Benefits of Using Storage Commitment • Confidence in a Dependable Storage of Clinical Evidence • Eliminate Double-Check / Manual Confirmation Time • Avoid Loss of Clinical Information due to • Network Troubles • Storage Breakdowns • Avoid Unnecessary Re-Examinations(Reduce Radiation Exposure) • Modality can Remove Images from Local Storage andRe-Use Available Space for Exams to Follow DICOM International Conference & Seminar

  12. 4 4 Image Management (PACS) 4 Instance Availability Notification: N-CREATE Departmental Information System (RIS) Instance Availability Notification (IAN) • Inform about Availability of Image Data • PACS (SCU) Notifies the RIS (SCP) thatImages are Available for Retrieval & Use • List of Instances (Images) • Location (Retrieve SCP) of Images • Availability Status • Online • Nearline • OffLine • Unavailable • Use of IAN to InitiateSubsequent Processes • Post-Processing • Interpretation / Reporting • Distribution of Images to Other Locations DICOM International Conference & Seminar

  13. 4 Image Management (PACS) 4 Instance Availability Notification: N-CREATE Departmental Information System (RIS) Instance Availability Notification (IAN) • Benefits of Using Instance Availability Notification • In-Time Notification Avoids Excessive Queriesfor the Whereabouts of Images • Completion of Acquisition Workflow:Ready-to-Use Results • Enable Transition to the Next ProcessSteps of the Imaging Workflow • Allow for Timely Preparations ofTasks & Resource Allocation for • Additional Procedures • Post-Processing • Reporting • Patient Transfer / Discharge DICOM International Conference & Seminar

  14. IHE Scheduled Workflow (SWF) Integration Profile –includes Acquisition Workflow Management – Integrating the Healthcare Enterprise • Forum (Organization) for AdvancingIntegration in Clinical Practice • Interoperability Frameworks forImplementing and DeployingStandards-Based (HL7 & DICOM)Integrated Solutions • IHE Integration Profiles • Interoperability Building Blocks toSolve Specific Integration Issues:e.g. Workflows • Packages of DICOM / HL7 Services:e.g. Scheduled (Acquisition) Workflow(SWF) Integration Profile Refer to: IHE Radiology Technical Framework Vol. I – Scheduled Workflow (SWF) Integration Profilehttp://www.IHE.net/Technical_Framework/ DICOM International Conference & Seminar

  15. Image Management (PACS) 4 Instance Availability Notification • Workflow Management • Registration • Order Entry • Scheduling • Tracking 1 Modality Worklist Departmental Information System (RIS) Storage & Storage Commitment Image Acquisition Modality 2 Performed Procedure Step 3 Conclusions • DICOM Services for Acquisition Workflow Management • Improve Interoperability of Imaging Equipment • Ensure Data Consistency • Facilitate Reliable Data Management • Improve Process Efficiency • Better Quality ofImaging Services DICOM International Conference & Seminar

  16. References http://medical.NEMA.org/ http://www.HL7.org/ http://www.IHE.net/ Thank you for your attention ! DICOM International Conference & Seminar

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