New Advences & Horizons 2nd ICT Med Workshop Informatics in Medical Imaging New Advences & Horizons Alireza Shakibafard MD Shiraz University of Medical Sciences(SUMS)

Medical Imaging

Digital Imaging

Digital Imaging Image or Magic ???

Analog Images

Analog vs. Digital Image AD Conversion For computer viewing For human viewing

Digital Image is ready for any Change Storage Transfer

New Paradigm Image Capture , Storage & Display Moving from traditional film-screen(analog) toward electronic media In electronic imaging the functional parts of conventional radiology have been separated: Image Capture , Storage & Display

Digital System Film Developed And Fixed Detector Reading Digital Processing Stored PACS Viewed Display QC of the digital systems is an additional requirement – in addition to the usual x-ray performance tests

Image Characteristics Each pixel is assigned a numeric value (bit depth) that represents a shade of gray based on the attenuation characteristics of the volume of tissue imaged

Advanced Applications Medical Imaging Advanced Applications

Multiplanar Navigation

MIP

Conventional PACS Hospital Archiving Media Diagnostic Modality Archiving Device PACS Server

Modern View on PACS PACS is the “Imaging” part of Healthcare Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS. The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone. Technological basis: “PACS rides many horses” from web-based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.

Historical Evolution 80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems. 90ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective?? >2000: Enterprise-PACS+RIS+PACS = film-less hospitals. >2007: Newest achievements: Multi-site PACS using MPI (Master Patient Index) to allow the patient’s access on all sites Hospitals will skip historical steps and adopt to state of the art PACS and HIS.

Parallel evolution of all PACS functions 1980 2012 PICTURES Archiving Communication Systems Represent 5D datasets SAN/NAS/grids Internet/web/ Wifi Functionality+ knowledge 2D tapes ATM, video Hardware + show an image

In hospital, Out hospital Distribution Patient arrives 1 Study ordered and scheduled 3 Report transcription 12 HIS RIS Report approval 14 ADT 2 Report 13 Report status notification 15 Order/schedule status notification 4 Workflow Management Connectivity Manager Study status notification 9 Modality worklist 7 Order/schedule status notification 5 Verification 10a Report status notification 16 PACS Modality QC Diagnostic review and report dictation 11 Pre-fetching (images) 6 Image store 10 Patient is examined 8 Images to long term archive 17 Images wavelet compressed by curator 1Ob In hospital, Out hospital Distribution Non diagnostic review 19

Information systems in the hospital workflow HIS (Hospital Information System) Central administration and financial system of the hospital Keeps the central patient registration patient identification holds the demographic data RIS (Radiology Information System) Dedicated radiology information system, taking care of exam ordering exam planning study reporting passing billing related information not automatically included not available for every country Holds the study information PACS (Picture Archiving and Communication System) Dedicated system for archiving and communication of study related images Communicates with the outside world HIS HL7 RIS HL7 Connectivity Manager DICOM PACS

Information exchange standards HL7 (Health Level 7) Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services. E.g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, … DICOM (Digital Imaging and Communication in Medicine) DICOM is a standard, to enable efficient and flexible integration and communication of image data between components (modalities, printers, storage, databases, …) in a medical network However: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant

PACS Connectivity Services (Connectivity Manager) Translate HIS/RIS messages (e.g. HL7) to DICOM RIS PV1||E|TRAUMA|A||||^DOE^JOHN^W.^DR.^|||WAITING ROOM Do you speak DICOM ? CM ???

Image acquisition Objective Consolidation of image data information provided by multiple sources Multi-modality (MRI, CT, Ultrasound…) Multi-Vendor How ? DICOM gateway : Paxport (for non DICOM modalities) Film scanner

Image data storage and archiving Storage (.dcm files) Type of media (disks, UDO, LTO) Everything on line solutions, near-line, off-line Data compression Data availability

PACS Architecture Internal & External Clients RIS Database Application Server HIS Connectivity Manager Archive Server Workflow Manager Curator Modality

Web Viewer Webserver PACS Viewing Station At Modality

….. PACS and Network Hub Switch Archive Workstation 1 Workstation 2 SERVER Hub Switch SERVER ….. Workstations CD/DVD Robot RAID Archive

PACS Beyond Radiology Other Types of Images: Vascular Angiography Cardiac Angiography Echocardiography Obstetric Ultrasound Medical Photography Retinal Imaging Colposcopy / Cytology….. May be more of a RIS Issue than PACS

Imaging Informatics New Advances

Imaging Informatics Laboratory

The Bottom Line Modern Image Processing Automated CAD with interpretation and reporting Portable medical records – perhaps imbedded in patient Integrated RIS-PACS-HIS through I.T. Robotic imaging Molecular Imaging Image guided chemotherapy and gene therapy ………….

When needed , Where needed Integrated & Enterprise Take Home Point: Beyond Bytes & Bits : Healthcare IT ; When needed , Where needed Integrated & Enterprise

Take Home Point: Healthcare IT ; Beyond one person , one department , one ….. , it is across … It needs collaboration , communication & decision making

THANK YOU FOR YOUR NICE ATTENTION