1Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 MEDT8002 Digital image storage Patient workflow

2Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Ditgital image storage – information Standard image storage format: DICOM >What does that mean? –Raw Data, Raw DICOM, Pure DICOM? –DICOM SR?

3Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 DICOM DICOM: Digital Imaging and Communication in Medicine >Global tandard for exchange of medical information between medical devices >Continuously developed, organized by NEMA ( >Four dimensions of DICOM: – DICOM for Image Management – DICOM for Network Image Transfer – DICOM for Network Printing – DICOM for Media Interchange/Archiving >Covers all modalities (CT, MR, US, PET, X-Ray, …)

4Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 DICOM (cont.) GE Ultrasound uses DICOM as a file format when storing images. DICOM images are stored as pixel-data (i.e. what is displayed on screen) >Still flexibility related to encoding –Color: Monochrome, Monocrhome2, Pallette, RGB and YBR –Compression: none, RLE or JPEG >Cardiac u/s images uses JPEG/YBR

5Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 DICOM (cont.) Measurements/reporting is not a part of the DICOM file format. >Has not been stored earlier >New standard: DICOM SR. Supported for export by GE systems. No systems support import yet.

6Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Raw data Data that are processed trough different calculation steps in order to generate the image on screen. >not part of the DICOM standard, >stored as private data elements in the DICOM file. >DICOM file with raw data: “Raw DICOM” >DICOM File without raw data: “Pure DICOM” >Non-GE systems will ignore the raw data section.

7Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Basic measurements Run/stop loop Adjust replay framerate Step frame by frame Brightness / Contrast Re-size Annotations Raw data – features with Pure DICOM

8Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Color on/off High-quality zoom Change colormap (flow and tissue) TVI -> Strain -> Strain Rate Imaging -> Tracking Variance on/off Angle correct Hor. Sweep (Doppler spectr. & M-Mode) Baseline shift Phys. Trace manipulation Persistance Velocity traces (from TVI) Data size Significant reduction of data size with raw data vs. bitmaps Must use lossy compression for bitmaps, with some degradation of IQ Even more significant for 3D/4D Raw data – features with RawDICOM

9Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Dataflows

10Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Dataflows – overview U/S Workflow Patient record Findings Images Volume sweep – 3D Referrals Billing Mostly DICOM in Rad/ OB No Standard in Card/ Raw Data Server, MiniPACS Hospital IT Patient data Images/ PACS Billing Connection to other Hospitals, Image Centers, Clinics, Insurance, Suppliers HL7 interface U/S Workflow Connect to GE & non-GE CIS/RIS/PACS Enterprise Image Mgt

11Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 HIS V7 Echo Department Hospital Dicom Worklist Dicom Server HL7 HL7* * Export excel file + report to HIS

12Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 HIS V7 Echo Department Hospital Dicom Server Query/ Retrieve HL7 * Images + SR(~60% of M&A) Storage*

13Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 HIS V7 Echo Department Hospital Dicom Worklist Dicom Server HL7 HL7* * EchoServer7, ImageVault3, ImageVault4 GE Server*

14Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 V7 Echo Children Echo Adult Department * Server containing one or more image shares Server* EPPC V7 EchoServer Server*

15Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 V7 Echo Children Echo Adult Hospital * Server containing one or more image shares EPPC V7 ImageVault4 EnterpriseServer Department Workstation

16Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 V7 Echo * Server containing one or more image shares EPPC Other Sacnner EPPC, DICOM share Department

17Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Connectivity Product Overview Low-End Small office / Dept. Mid-Range Echo only High-End Multi-Modality Hosp. Network EchoPAC PC Share EchoPAC PC SW-Only EchoPAC PC Workstation ImageVault 4.0 EchoServer EchoPAC PC Vivid 7 Vivid 3 Vivid 4 Non-GE scanner ImageVault 3.0 Vivid HL7 Gateway HISHIS PACSPACS Vivid 7 XA, CT, MR, NM EchoPAC PC AI DMS WEB Browser

18Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 Workflows

19Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 End-user workflows In-exam (V7) >Protocol based, observations and measurement requirements >Track observations (“notepad” with checkboxes) >Guiding based on normal measurements “Sonographers don’t want to report, but they make observations that directly creates statements.”

20Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 End-user workflows Reading (EPPC, EPPC swo) >Efficiency: “Minimize clicking, maximize overview” –See images and report/statements at the same time –Automate processes: “Stack of unread”, done reading signoff (eg. HL7 export), patient locking –Easy access to trending data (images, measurements, observations –Suggested statements based on observations/measurements. -> Taylor as reading station

21Jens Lien, GE Vingmed Ultrasound Nov 11, 2004 End-user workflows Back-end/admin (EPPC, EPPC swo) >Secondary reports based on statements in report –Billing codes (ICD-9) –Accreditation (CPT) >General data mining