1. DICOM INTERNATIONAL CONFERENCE & SEMINAR October 9-11, 2010 Rio de Janeiro, Brazil Managing the Acquisition Workflow Nikolaus Wirsz, PhD SIEMENS AG – Healthcare Sector Member of theDICOM Standards Committee and Working Group Ten - Strategic Advisory

2. October 9-11, 2010DICOM International Conference & Seminar2 Managing the Acquisition Workflow Introduction Modality Worklist Modality Performed Procedure Step Storage Commitment Instance Availability Notification Conclusions

3. October 9-11, 2010DICOM International Conference & Seminar3 Introduction DICOM Constructs –Information Object Definitions (IOD): Images, Evidence Documents –Service Class Specifications: Storage, Query/Retrieve, … –Data Structures and Semantics –Message Exchange –… … to support –User Tasks –Interactions Between Systems –Process Steps in the Diagnostic Chain … and improve clinical processes: –Acquisition Workflow –Post-Processing Workflow –Reporting Workflow

4. October 9-11, 2010DICOM International Conference & Seminar4 The Acquisition Workflow Sustain & Optimize Process Tasks in the Radiology / Imaging Department –Data Entry –Procedure Scheduling –Image Acquisition –Procedure Tracking –Image Storage Management Unobstructed Information Flow “Assembling the Puzzle” Key DICOM Services for Acquisition Workflow Support 1.Modality Worklist 2.Modality Performed Procedure Step 3.Storage with Storage Commitment 4.Instance Availability Notification Image Management (PACS) Departmental Information System (RIS) Workflow Management Registration Order Entry Scheduling Tracking Modality Worklist 1 Performed Procedure Step 2 Storage & Storage Commitment 3 Instance Availability Notification 4 Image Acquisition Modality

5. October 9-11, 2010DICOM International Conference & Seminar5 Modality Worklist (MWL) Provide Demographics, Procedure and Schedule Details to the Modality Modality (SCU) Queries the RIS (SCP) Query Matching Key Attributes –Date / Time of Procedure –Modality Type (e.g. CT) –Station AE Title (a specific Device) –Patient Name / ID –Accession # (identifies an Imaging Order) –Requested Procedure ID –… Query Examples –Today‘s Worklist –CT Procedures Worklist –CT Room 1 Worklist –John Doe‘s Procedures of a Chest Imaging Order 1 Departmental Information System (RIS) Results: C-FIND Resp. 1b Query: C-FIND Req. 1a Image Acquisition Modality 1a

6. October 9-11, 2010DICOM International Conference & Seminar6 Modality Worklist (MWL) RIS (SCP) Returns Query Results to Modality (SCU) –Null (No Match) –One or More Worklist Entries Worklist Entry (Unit of Service) = Scheduled Procedure Step (SPS) Query Return Key Attributes –Patient Data Name, ID, Demographics Allergies, Special Conditions –Scheduling Information Date / Time –Procedure Information Description, Protocol Codes Contrast & Medication Administration –Order Information Accession #, Study UID Requesting Physician –... 1 1b Departmental Information System (RIS) Results: C-FIND Resp. 1b Query: C-FIND Req. 1a Image Acquisition Modality

7. October 9-11, 2010DICOM International Conference & Seminar7 Modality Worklist (MWL) Deployment of the Modality Worklist Service –Modalities Query & Receive Worklists from RIS –Modality Displays Worklist to Operator –Operator Selects a Worklist Entry (SPS) to Perform –Acquisition of Images (Based on SPS Details) –Insert Patient & Procedure Data into the Image Header Benefits of Using the Modality Worklist –Eliminate Redundant Data Capture –Avoid Error-Prone Manual Tasks –Facilitate Data Consistency: Unambiguous Association of Images to Proper Patient / Procedure 1 1a1b Departmental Information System (RIS) Results: C-FIND Resp. 1b Query: C-FIND Req. 1a Image Acquisition Modality

8. October 9-11, 2010DICOM International Conference & Seminar8 Modality Performed Procedure Step (MPPS) 2 2a 2b Departmental Information System (RIS) Image Acquisition Modality MPPS COMPLETED:N-CREATE 2b 2a MPPS IN PROGRESS:N-SET Feedback Acquisition Data to Scheduling System (RIS) Modality (SCU) Sends Acquisition Information to the RIS (SCP) Tracking of Modality Procedure Status –IN PROGRESS:MPPS N-CREATE –COMPLETED:MPPS N-SET –DISCONTINUED:MPPS N-SET (incl. Reason for Discontinuation) Logging of Procedure Related Data –Identification Attributes: Accession # SPS ID Patient Name / ID / Demographics... –List (Series) of Images –Protocol Codes for the Actually Performed Acquisition –Materials Used (Chemicals, Supplies) –Radiation Dose Exposure Values –...

9. October 9-11, 2010DICOM International Conference & Seminar9 Modality Performed Procedure Step (MPPS) 2 MPPS Use Cases (according to IHE) Benefits of Using MPPS –Keeping Schedules Up-to-date –Better Management of Resources –Gather Information Required for Billing –Trigger for Subsequent Processes: Post-Processing, Reporting Departmental Information System (RIS) Modality Worklist 1 Performed Procedure Step 2 Image Acquisition Modality SPS PPS results in 1 1 Simple CaseUnscheduled Case SPS PPS results in 0 1 Append Case SPS PPS results in 1 1 PPS* 1 *appended Group Case SPS PPS results in 1 1 SPS 1 1

10. October 9-11, 2010DICOM International Conference & Seminar10 Storage with Storage Commitment 3 Secure Ownership and Safekeeping of Clinical Results Modality (SCU) Requests Storage Commitment from PACS (SCP) –Modality Transmits Images (or other Objects) to PACS: C-STORE Operations for Images –Modality Issues Storage Commitment Request to PACS: N-ACTIONincluding List of Instances to Retain –PACS Notifies Modality of Success (or Failure) : N-EVENT-REPORT 3a 3b 3c Image Management (PACS) Image Acquisition Modality 3b Request Storage Commitment: N-ACTION 3c Confirm Storage Commitment: N-EVENT-REPORT 3a Transfer Images: C-STORE

11. October 9-11, 2010DICOM International Conference & Seminar11 Storage with Storage Commitment 3 Benefits of Using Storage Commitment –Confidence in a Dependable Storage of Clinical Evidence –Eliminate Double-Check / Manual Confirmation Time –Avoid Loss of Clinical Information due to Network Troubles Storage Breakdowns –Avoid Unnecessary Re-Examinations (Reduce Radiation Exposure) –Modality can Remove Images from Local Storage and Re-Use Available Space for Exams to Follow Image Management (PACS) Image Acquisition Modality 3b Request Storage Commitment: N-ACTION 3c Confirm Storage Commitment: N-EVENT-REPORT 3a Transfer Images: C-STORE

12. October 9-11, 2010DICOM International Conference & Seminar12 Instance Availability Notification (IAN) 4 Inform about Availability of Image Data PACS (SCU) Notifies the RIS (SCP) that Images are Available for Retrieval & Use –List of Instances (Images) –Location (Retrieve SCP) of Images –Availability Status Online Nearline OffLine Unavailable Use of IAN to Initiate Subsequent Processes –Post-Processing –Interpretation / Reporting –Distribution of Images to Other Locations 4 Image Management (PACS) Departmental Information System (RIS) Instance Availability Notification: N-CREATE 4

13. October 9-11, 2010DICOM International Conference & Seminar13 Instance Availability Notification (IAN) 4 Benefits of Using Instance Availability Notification –In-Time Notification Avoids Excessive Queries for the Whereabouts of Images –Completion of Acquisition Workflow: Ready-to-Use Results –Enable Transition to the Next Process Steps of the Imaging Workflow –Allow for Timely Preparations of Tasks & Resource Allocation for Additional Procedures Post-Processing Reporting Patient Transfer / Discharge Image Management (PACS) Departmental Information System (RIS) Instance Availability Notification: N-CREATE 4

14. October 9-11, 2010DICOM International Conference & Seminar14 Integrating the Healthcare Enterprise Forum (Organization) for Advancing Integration in Clinical Practice Interoperability Frameworks for Implementing and Deploying Standards-Based (HL7 & DICOM) Integrated Solutions IHE Integration Profiles –Interoperability Building Blocks to Solve Specific Integration Issues: e.g. Workflows –Packages of DICOM / HL7 Services: e.g. Scheduled (Acquisition) Workflow (SWF) Integration Profile Refer to:IHE Radiology Technical Framework Vol. I – Scheduled Workflow (SWF) Integration Profile http://www.IHE.net/Technical_Framework/ IHE Scheduled Workflow (SWF) Integration Profile – includes Acquisition Workflow Management –

15. October 9-11, 2010DICOM International Conference & Seminar15 Conclusions DICOM Services for Acquisition Workflow Management –Improve Interoperability of Imaging Equipment –Ensure Data Consistency –Facilitate Reliable Data Management –Improve Process Efficiency –Better Quality of Imaging Services Image Management (PACS) Departmental Information System (RIS) Workflow Management Registration Order Entry Scheduling Tracking Modality Worklist 1 Performed Procedure Step 2 Storage & Storage Commitment 3 Instance Availability Notification 4 Image Acquisition Modality

16. October 9-11, 2010DICOM International Conference & Seminar16 References http://www.HL7.org/ http://www.IHE.net/ Thank you for your attention ! http://medical.NEMA.org/DICOM