1. Key Image Notes Integration Profile Charles Parisot GE Medical Systems IT Planning and Technical Radiology Committees

2. HIMSS/RSNAApril 2003 Workshop IHE Integration profiles Patient Informa- tion Reconci- liation, Access to Radiology Information Consistent Presentation of Images Basic Security - Evidence Documents Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Key Image Notes

3. HIMSS/RSNAApril 2003 Workshop The radiologist selects Key Images, and creates appropriate Notes. for refering physician In this image you can see the hematoma. Note 2: for refering physician In this image you can see the renal rupture. Note 1: The referring physician views the Key Image Note prepared by radiologist. for refering physician In this image you can see the renal rupture. Note 1: for refering physician In this image you can see the hematoma. Note 2: Results in improved communication between the radiologist and the referring physician

4. HIMSS/RSNAApril 2003 Workshop The radiologist selects Key Images, and creates appropriate Notes. The referring physician views the Key Image Note prepared by radiologist. Results in improved communication between the radiologist and the referring physician for refering physician Hematoma everywhere Note 3: for refering physician In this image you can see the hematoma. Note 3:

5. HIMSS/RSNAApril 2003 Workshop Key Image Notes There is more to teamwork than images and reports With IHE, it is possible to attach « electronic post-it notes» to images to increase informal but critical communication between: – The Technologist and the Radiologist about specific examination events – The Radiologist and the Technologist about image quality issues – The Radiologist and other department clinicians (surgeon, orthopedist,..) – The Radiologist and colleagues about selection of images for conferences – The Radiologist to the Referring Physician, …..etc. Key Image Note Integration Profile provides a simple but cost effective communication mechanism

6. HIMSS/RSNAApril 2003 Workshop Technical Overview Key Image Note Transactions Key Image Note Actor Requirements Use of DICOM Key Object Selection Document

7. HIMSS/RSNAApril 2003 Workshop KIN Participates in the Scheduled Workflow

8. HIMSS/RSNAApril 2003 Workshop Acquisition Modality and Image Creator A Key Image Note references one or more images In a Key Image Note, each image reference may also include a Presentation State. A Key Image Note is created as a DICOM Key Object Selection object. It contains: A Coded Title An optional user comment References to one or more objects (IHE applies it only to images) The Key Object Selection object belongs with the same DICOM study as the images it references. It is not required by IHE to support referencing of images outside of the study. IHE Scheduled Workflow rules may be applied to Key Image Notes (managed by worklist, storage commitment, PPS, etc.)

9. HIMSS/RSNAApril 2003 Workshop Key Image Notes Titles Defined by DICOM Supplement 59. May be extended Context ID 7010 – Key Object Selection Document Title Coding Scheme Designator Code Value Code Meanings DCM113000Of Interest DCM113001Rejected for Quality Reasons DCM113002For Referring Provider DCM113003For Surgery DCM113004For Teaching DCM113005For Conference DCM113006For Therapy DCM113007For Patient DCM113008For Peer Review DCM113009For Research DCM113010Quality Issue The note title defines the semantics of the reason of significance. Notes can be queried by code. The user comments are meant to be informal.

10. HIMSS/RSNAApril 2003 Workshop Image Display Provides user interface to view images « flagged » by Key Image Notes (with optional creator comments). Applies a Presentation State if one is referenced along with image referenced when note is viewed. Allows user to select Key Image Notes from an Image Archive Actor via DICOM Query/Retrieve mechanisms (subset of keys used to query reports). Supports DICOM Key Object Selection Storage

11. HIMSS/RSNAApril 2003 Workshop Key Image Note Is Managed Like Any Other Object Patient Information Study Information Series Information Image Series Information Key Object Selection Series Information Presentation State Series Information Other Composite IODs Patient ID Study Inst. UID Series Inst. UID SOP Inst. UID Key Object Selection placed in "KO" Series in the same Study

12. HIMSS/RSNAApril 2003 Workshop Key Image Notes Query Keys

13. HIMSS/RSNAApril 2003 Workshop IHE Key Image Notes Fits within the normal DICOM structure Like GSPS, a separate object associated with images Very Simple SR structure The way to perform informal but critical communication associated with images

14. HIMSS/RSNAApril 2003 Workshop Questions? Documents Available On the Web at: www.rsna.org/IHEwww.rsna.org/IHE