Johannes Gutenberg-University Department of Radiology, Mainz, Germany User Success Story prepared by Peter Mildenberger, MD

EEE, Feb Topics Infrastructure ( Hospital / Radiology) Infrastructure ( Hospital / Radiology) IT - responsibilities IT - responsibilities IHE Integration Profiles used IHE Integration Profiles used Further developments Further developments Conclusions Conclusions

EEE, Feb. 2005

University Hospital Mainz and Department of Radiology 1500 beds, ~100 wards 1500 beds, ~100 wards inpatients/year, outpatients inpatients/year, outpatients >30 examination rooms >30 examination rooms ~ 500 exams / d ~ 500 exams / d ~ 15 clinical conferences / d ~ 15 clinical conferences / d RIS since 1988 RIS since 1988 PACS since 1996 (Rad, Neurorad, NUK, Endo, Dent..) PACS since 1996 (Rad, Neurorad, NUK, Endo, Dent..) >30 modalities (e.g. 5 CTs, 5 MRs, 5 CRs, 3 DRs..) >30 modalities (e.g. 5 CTs, 5 MRs, 5 CRs, 3 DRs..) GB / d as new data GB / d as new data ~ 25 TB online (>40 million images) ~ 25 TB online (>40 million images)

EEE, Feb Dept. of Radiology Internal 210 Radiotherapy Ward 401-2b Orthopedics503Surgery 505 Internal701 Departmental Structure CT DL Skelett Ward Thorax US MRT Archive/ Workstation Mammography CT DL Skeletal R ICU Thorax US MRT Skeletal R DL CT DL Skelett ICU Thorax MRT WardRadiotherapy Angiogr. Neuroradiology Angiogr. CT DL Chest Skeletal R

EEE, Feb General IT Concept HIS (Administration) IT Depart in Administration SAP/R3 and IS-H* productive Digital Archive for paperbased files Medical Informatics Microfiche plus Web-Access not available yet! PACS Radiology all DICOM - Objects central server, RAID + long term storage DICOM-Viewer separated workgroup- servers with on demand access productive EPR IT Department in Administration SAP based (IS-H*MED) first pilots (2 of 30 dept) HL7

EEE, Feb The IHE Radiology Workflow Modified according to N. Wisrz, PhD, Siemens X

EEE, Feb Modality Worklist / Performed Procedure Step MPPS with auto- matic transfer of: Exposure Time Total dose Exposure dose Fluoro dose Number frames Fluoro time Number series Exposure Time Total dose Exposure dose Fluoro dose Number frames Fluoro time Number series RIS (gap it!, iSoft) Acq. modality (Integris, PMS) MWL: Name, Date of Birth Accession number UIDs et al. Name, Date of Birth Accession number UIDs et al.

EEE, Feb Pitfalls in conventional documentation Exposure data * incomplete document Diff. in Fluorotime >20%

EEE, Feb. 2005

Consistency and Completeness of Image Archiving RESULT:  ~ images / d  ~ 500 studies / d  manual control takes min / modality  ~ 3h/d for the complete department RESULT:  ~ images / d  ~ 500 studies / d  manual control takes min / modality  ~ 3h/d for the complete department

EEE, Feb Storage Commitment – Push Model Please take responsibility for safekeeping of data O.k., commitment for archiving images permanently PACS (ImageDevices) P A C S Acq modality DVD

EEE, Feb Survey in different Departments (est.) Ophthalmology Ophthalmology Gastroenterology Gastroenterology Urology Urology Cardiology Cardiology Onkology Onkology Dermatology Dermatology Dental Imaging Dental Imaging Total (outside Radiology) Total (outside Radiology)  300 GB / year  250 GB / year  900 GB / year  400 GB / year  750 GB / year  700 GB / year ...  5 TB / year

EEE, Feb Image Sources Radiography, CT, MRT, DSA Radiography, CT, MRT, DSA Sonography Sonography Szintigraphy, PET Szintigraphy, PET Visible Light Visible Light Endoscopy, Ophthalmology, Digital Photography, Microscopic Slides) Endoscopy, Ophthalmology, Digital Photography, Microscopic Slides) Cardiology Cardiology

EEE, Feb PACS Status (outside Radiology) Gastroenterology, Urology, Ophthalmology,... Gastroent. (Viewpoint) Sono 2 Enteroscopy Lapara- scopy Gastroscopy Archive/ Workstations Colography Fundoscopy Dig. Photo Sonogr. RF Sono Dig. Photo Sonogr. Sono 1 Dig. Photo Sono Neurology Sono Angiology PediatricsOphthalmo. Urology ( Sienet) Vascular Center Endocrin.

EEE, Feb Integrated Presentation

EEE, Feb Conclusions flexible implementation, less independant from a vendor flexible implementation, less independant from a vendor MWL, MPPS, StComm improve clinical workflow, data consistency, quality of documentation,... MWL, MPPS, StComm improve clinical workflow, data consistency, quality of documentation,... IHE is a pragmatic model for the clinical scenarios IHE is a pragmatic model for the clinical scenarios IHE profiles should become regular part of RFPs IHE profiles should become regular part of RFPs IHE Process fit also outside Radiology (e.g. Lab., Card.) IHE Process fit also outside Radiology (e.g. Lab., Card.) IHE is NOT a standard, it is beyond !!! IHE is NOT a standard, it is beyond !!! IHE solves daily-life problems by Integration Profiles IHE solves daily-life problems by Integration Profiles

EEE, Feb Using IHE there will be less work for „Consultants“ like this one....