1. RSNA 2011 Image Sharing Demonstration Transaction Sequence Diagram Nov 21st, 9am CDT, 2011

2. RSNA 2011 Image Sharing Demo 0: Set Up PHR Scenarios: ADT, Order, and “Prior” and new Image Acquisition Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Software: Nuance Report Creator 040: ADT ITI-8 “prior” 060: ORM Clearinghouse Cloud: Life Image Modality: Siemens CT TCE Receiver: MIRC REM Dose Reporter/Register 030: ADT ITI-8 Image Storage/ Image Document Source DSS/OF: Candelis RIS 080: “DICOM C-Store “prior” and aorta images 070: ORM PHR: Dell PHR: itMD PHR: DICOM Grid 001: “Patient” Registers (trigger) 020: ORU; “prior” and Aorta report 010: ORM RAD-4 – prior and aorta 050: ORM RAD-4 -current 110: prior images and report submission 091: “Patient” Request Info (trigger Priors move) 100: DICOM C-Move Prior images 210: For demo, pre-create PHR Account and Demonstrator pulls down Prior images and report 230: Registry Stored Query [ITI-18] 250: Retrieve Document [RAD-69] 240: Retrieve Document Set [ITI-43] Note: “Prior” images and report must NOT be deleted on RIS, PACS, or PHRs since the data and accounts will be reused from demo to demo.

3. RSNA 2011 Image Sharing Demo 1: PHR- Create and Submit Current Images and Report Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage 180: DICOM C-Move Reporting Software: Nuance Report Creator Clearinghouse: Life Image Modality: Siemens CT 120: DMWL for “current” image codes 140: MPPS 170: Give patient the ID Number (trigger) TCE Receiver: MIRC REM Dose Reporter/Register: 190: current Report and Image submission 195: Register DocumentSet Image Storage/ Image Document Source DSS/OF: Candelis RIS 130: DICOM C-Store “current” images/ Dose SR/ Storage Commit 160: HL7 2.3 ORU report 110: Patient arrives At scanner PHR: LifeImage PHR: Dell PHR: itMD PHR: DICOM Grid 150: Launch API From reading worklist;

4. RSNA 2011 Image Sharing Demo 2: PHR Review of Current Case (Note: PHR account created well in advance of “prior” case) Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA DSS/OF/IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Software: Nuance Clearinghouse: Life Image Modality: Siemens CT 210: Patient logs in to PHR Account and uses EdgeServer Token – Exam ID In patientID to pull Current case TCE Receiver: MIRC REM Dose Reporter/Register: Image Storage/ Image Document Source 230: Registry Stored Query [ITI-18] 240: Retrieve Document Set [ITI-43] 250: Retrieve Document [RAD-69] PHR: LifeImage PHR: Dell PHR: itMD PHR: DICOM Grid DSS/OF: Candelis RIS Note: “Current” images and report (only) must be deleted on RIS, PACS, and PHRs after each demo to be reused with existing “priors”.

5. RSNA 2011 Image Sharing Demo 3A: Site to Site Transfer See slide 0: Set up; include Aorta Case also with Prior; not shown here Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA DSS/OF/IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: Local Folder viewer Reporting Software: Nuance Clearinghouse: Life Image Modality: Siemens CT TCE Receiver: MIRC REM Dose Reporter/Register: Image Storage/ Image Document Source 230: Registry Stored Query [ITI-18] 240: Retrieve Document Set [ITI-43] 250: Retrieve Document [RAD-69] DSS/OF: Candelis RIS Edge Server v2: NIBIB/RSNA 220: Trigger?

6. RSNA 2011 Image Sharing Demo 3B: Site to Site Transfer See slide 0: Set up; include Aorta Case also with Prior; not shown here Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA DSS/OF/IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: Local Folder viewer Reporting Software: Nuance Clearinghouse: Life Image Modality: Siemens CT TCE Receiver: MIRC REM Dose Reporter/Register: Image Storage/ Image Document Source 230: Registry Stored Query [ITI-18] 240: Retrieve Document Set [ITI-43] 250: Retrieve Document [RAD-69] DSS/OF: Candelis RIS Edge Server v2 lifeIMAGE 220: Trigger?

7. RSNA 2011 Image Sharing Demo 4: Set Up REM/TCE Scenarios: ADT, Order, and new Image Acquisition Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: RSNA/NIBIB IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Software: Nuance Report Creator 040: ADT ITI-8 “prior” Clearinghouse Cloud: Life Image Modality: Siemens CT TCE Receiver: MIRC REM Dose Reporter/Register 030: ADT ITI-8 Image Storage/ Image Document Source DSS/OF: Candelis RIS 080: “DICOM C-Store “prior” images 070: ORM PHR: Dell PHR: itMD PHR: DICOM Grid 001: “Patient” Registers (trigger) 050: ORM RAD-4 -current 210: For demo, pre-create PHR Account and Demonstrator pulls down Prior images and report 230: Registry Stored Query [ITI-18] 250: Retrieve Document [RAD-69] 240: Retrieve Document Set [ITI-43] Note: “Prior” images and report must NOT be deleted on RIS, PACS, or PHRs since the data and accounts will be reused from demo to demo. 040: ORM RAD-4 -current

8. RSNA 2011 Image Sharing Demo 5: REM/TCE Create and Submit Current Images and Report Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Software: Nuance Report Creator Clearinghouse: Life Image Modality: Siemens CT 120: DMWL for “current” image codes 140: MPPS TCE Receiver: MIRC REM Dose Reporter/Register: Image Storage/ Image Document Source DSS/OF: Candelis RIS 130: DICOM C-Store “current” images/ Dose SR/ Storage Commit 160: HL7 2.3 ORU report 110: Patient arrives At scanner PHR: LifeImage PHR: Dell PHR: itMD PHR: DICOM Grid 150: Launch API From reading worklist; Note: an attendee may want to still see the info Propogated to the PHRs so this should still be an option, Just not part of normal flow for this demo.

9. RSNA 2011 Image Sharing Demo 6: TCE Demo – Trigger is Radiologist viewing images Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA DSS/OF/IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Software: Nuance Report Creator Clearinghouse: Life Image Modality: Siemens CT 410: Export Instances [RAD-53] TCE Receiver: MIRC REM Dose Reporter/Register Image Storage/ Image Document Source 420: review teaching files PHR: LifeImage PHR: Dell PHR: itMD PHR: DICOM Grid DSS/OF: Candelis RIS 400: Radiologist Viewing images At PACS

10. RSNA 2011 Image Sharing Demo 7: REM Demo – PACS Auto-Trigger to send DOSE SRs Geneva: John Perry’s Amazing Demo Tool PIX Mgr Document Registry Document Repository Edge Server: NIBIB/RSNA DSS/OF/IM/IA/TCE Export Select/Mgr: Candelis Image Document Source Document/ Image Document Consumer PHR: LifeImage Reporting Workstation Document Source Clearinghouse: Life Image Modality: Siemens CT 520: Query and Retrieve DOSE [RAD-53] TCE Receiver REM Dose Reporter: Aware Image Storage/ Image Document Source 540: review dose PHR: LifeImage PHR: Dell PHR: itMD PHR: DICOM Grid REM Dose Reporter: Siemens; Upenn Radiance 510: C-Store DOSE SRs REM Dose Reporter: ACR 540: review dose DSS/OF: Candelis RIS 400: PACS Auto resends DOSE SRs to REM Reg Upon reciept of SR From CT scanner