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

2. EEE, Feb. 2005 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

3. EEE, Feb. 2005

4. University Hospital Mainz and Department of Radiology 1500 beds, ~100 wards 1500 beds, ~100 wards 53.000 inpatients/year, 190.000 outpatients 53.000 inpatients/year, 190.000 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..) 15 - 20 GB / d as new data 15 - 20 GB / d as new data ~ 25 TB online (>40 million images) ~ 25 TB online (>40 million images)

5. EEE, Feb. 2005 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

6. EEE, Feb. 2005 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

7. EEE, Feb. 2005 The IHE Radiology Workflow Modified according to N. Wisrz, PhD, Siemens X

8. EEE, Feb. 2005 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.

9. EEE, Feb. 2005 Pitfalls in conventional documentation Exposure data *10-100 incomplete document Diff. in Fluorotime >20%

10. EEE, Feb. 2005

14. Consistency and Completeness of Image Archiving RESULT:  ~ 25000 images / d  ~ 500 studies / d  manual control takes 5 - 15 min / modality  ~ 3h/d for the complete department RESULT:  ~ 25000 images / d  ~ 500 studies / d  manual control takes 5 - 15 min / modality  ~ 3h/d for the complete department

15. EEE, Feb. 2005 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

16. EEE, Feb. 2005 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

17. EEE, Feb. 2005 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

18. EEE, Feb. 2005 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.

19. EEE, Feb. 2005 Integrated Presentation

20. EEE, Feb. 2005 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

21. EEE, Feb. 2005 Using IHE there will be less work for „Consultants“ like this one....