IHE Mammography Face-to-Face meeting July 31 – August 1, 2006 RSNA Headquarters Oak Brook, IL

Current Workflow LMD Actions Clerk / Reception Actions Patient History Protocol Modality Acquisition [Check images with Radiologist] Add/Adjust steps Dismiss patient Push to PACS, CAD, IWS CAD results to PACS, IWS (,AM?!) IWS Q/R comps and hists IHE Mammo display AIM Report Creation Letters and Reports Distribution

LMD Actions –LMD prescribes Screening Mammogram Clerk / Reception Actions –Ward Clerk enters order in OP or OF Patient History capture

Tech Supervisor processes order on OF Tech “starts” procedure on OF (RIS) Tech checks old images and reports Tech gets patient Tech CRUDs “Technologist Observations”

Adjust Protocol AM queries MWL Technologist needs to adjust protocol 1.Delete scheduled procedure steps on modality and/or add 2.Change Requested Procedure on DSS/OF

Modality Acquisition AM acquires detector data AM (MUST? IHE Mammography IP)) creates “FOR PROCESSING” images AM creates one or more sets of “FOR PRESENTATION” images Tech visually inspects image on modality DICOM store “FOR PROCESSING” (optional) and “FOR PRESENTATION” images to IM/IA DICOM Modality performed procedure step DICOM Storage commitment to IM/IA DICOM Storage to CAD and IWS

Current Interpretation Practice (I) Modality Also DICOM Stores to INTREPRETATION WS (IWS) IWS Q/R (manual or auto) from IM/IA –Q/R FOR PRESENTATION –Q/R historicals and other modality and comps. IM/IA or DSS/OF DICOM C-Moves current, historicals to IWS Radiologist on IWS selects case from pull- down menu (SOUP)

Current Interpretation Practice (II) IWS Displays images according to IHE Mammography Integration Profile Display patient history sheet and old reports –Ideally in image application on IWS –Or Separate application IWS (IHE PSA) –Separate application on separate WS (IHE PSA) –No IHE PSA –Paper

Current Interpretation Practice (III) Image Annotation and Markup –Circles, text, etc. –Communicate AIM to technologist –Persistence of AIM site optional Create Report –Same application or different –Same WS or different –Dictate (HT, VR), Macros, S/R References AIM Recall information into IS (manually/PDA)

Letters and Reports Letters to patient and / or physician Reports to patient and / or physician HT into IS –S/R into MIS Finalized in IS Charge posting (IHE Charge Posting) Report transmission –HL7 v2 ASCII message –FAX – –Paper Report visualization –Software application –Paper

Post-processing Use Case CAD 3D segmentation and measurement –Tomosynthesis Multimodality fusion (?IHE fusion) –Mammo/3D US –PEM

Post Processing variants Convert historical FOR PROCESSING images from old software versions to current software version of the same vendor Value added conversion of FOR PROC to FOR PRES off of the modality by same vendor (or licensed third party) Value added post-processing of FOR PRESENTATION

Current CAD workflow (I) AM DICOM stores FPROC and FPRES to (All) CAD CAD assumes study complete (problem) –Timeout –Assoc – mult images – Close Assoc –Sufficient (but not complete) CAD produces –Mammo CAD per IHE Mammo

Current CAD workflow (II) CAD Stores to IWS CAD Stores to PACS CAD Stores to AM ?! IWS probably has all FPRES images IWS probably has all CAD objects IWS drops CAD objects if received before images Rad selects patient from pull-down menu IWS displays images and cad objects

August 1, 2006 Review of consensus MESA testing and Connect-a-thon status Review Deployment handbook Next Steps

Current Workflow LMD Actions Clerk / Reception Actions Patient History Protocol Modality Acquisition [Check images with Radiolgist] Add/Adjust steps Dismiss patient Push to PACS, CAD, IWS CAD results to PACS, IWS (,AM?!) IWS Q/R comps and hists IHE Mammo display AIM Report Creation Letters and Reports Distribution

Proposed Workflow IHE Scheduled Workflow –Optional DICOM store to other destinations –Requested Procedure Complete IHE KIN for “Sticky Notes” IHE Post-Processing Workflow –Optional DICOM store to other destinations IHE Reporting Workflow –Payload TBD Other IHE in effect –PIR, CPI, IRW, ARI, TCFTE, PDI, ATNA, CP QC Workflow Technologist - Radiologist Communication Patient History Capture Technologist Observations Multimodality Display?

This year 1.IHE Reporting Workflow for Mammography 2.IHE Post-Processing Workflow for Mammography –Optional DICOM store to other destinations 3.IHE Scheduled Workflow for Mammography –Optional DICOM store to other destinations –Requested Procedure Complete Next Year 1.Mammography Report Content, Semantics and Encoding 2.Technologist - Radiologist Communication 3.Patient History Capture 4.Technologist Observations 5.Multimodality Display? 6.QC Workflow

QC Workflow MQSA QC Technologist / Image / Clinical QC Resident QC Radiologist QC

Technologist – Radiologist Communication In process checking of images –Near real-time image display –Bidirectional AIM –Communication of procedure steps Post-procedure communications –“next time do …”

Patient History Capture Must be available on IWS Must be available on AM Must be available to EMR Created in EMR? Capture incremental change? ? IHE RID

Technologist Observations Must be available on IWS Must be available on AM AIM –Mark an x,y location in the image –Mark a geometric boundary –Associate a concept with the geometric boundary –Tag Image Features in Images Non-image Observations Graphical Observations No consensus S/R vs GSPS

Multimodality Display Gaps in DICOM object types?

MESA Testing and Connect-a-thon Status Chris Carr, Steven Moore SBI April 2007 DEMO ?

Deployment Handbook Review

Next Steps Options to IHE