M7 Computers in Radiology

COMPUTERS

Integral part of many activities within a Radiology Department

COMPUTERS

Used by different Radiologic Modalities to Acquire, Process & Post Process Imaging Data.

DICOM

Developed by ACR & NEMA

DICOM

A “Cooperative Standard” that allows compatibility between imaging systems, by connectivity of imaging & associated medical equipment's of different vendors

American College of Radiology

ACR

National Electrical Manufacturers Association

NEMA

20

DICOM 2011 Standard is divided into _ parts

PACS

 It enables integration of scanners, servers, workstation, printers, & network hardware from multiple vendors into a

DICOM

Promotes the development of PACS & Image Networking in a LAN & WAN scenario

Radiology

needs DICOM for its uniform set of rules for communication of digital images

DICOM

Provides protocols for integration of image data between modalities, devices and systems

DICOM or any electronic communication

is functionally divisible into a set of layers with each layer performing a defined set of functions

DICOM Service Class

is defined as a group of operations that a user wants to perform on data from a modality.

Print Management Service Class

that deals with printing images on film or paper printer, with flexible film formats

Storage Service Class

that implies "sending" images

Query/Retrieve Service Class

that deals with issues of "find, move and get" SOP (Service Object Pair) Classes.

find

is used to query for images

move and get

are used to commence a transfer

Other Classes of Service

include Verification Service Class, Media storage, Study content notification, Print management, Patient management, Study management, Result management, Modality Performed Procedure Step management States and Structured reporting.

DICOM Conformance

identifies specific DICOM capabilities of an equipment or medical device.

Conformance Statement

allows: “a user to determine which optional components of the DICOM Standard are supported by a particular implementation & what additional extensions or specializations an implementation adds”

Modern radiology

modalities generate an enormous amount of a variety of data.

healthcare standards

To efficiently handle the sizeable data, and to improve workflow efficiency, ___ ____ have been created.

Healthcare Standards

assists the exchange, management and integration of different medical data (including radiology), that supports patient care.

workflow

It is important to understand that Radiology requires more than DICOM for

DICOM, HL7 and IHE

Consequently, 3 Significant Health Care Standards important to a Radiologist are

DICOM

Digital Imaging and Communications in Medicine

IHE

Integrating the Health Enterprise

HL7

Health Level Seven

Integrating the Health Enterprise

An initiative by Healthcare Professionals And Industry to improve the way computer systems in healthcare share information.

Integrating the Health Enterprise

Promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.

DICOM and HL7

Promotes the coordinated use of established standards such as ___ and ___ to address specific clinical needs in support of optimal patient care.

accordance with IHE

Systems developed in ___ ___ __ communicate with one another better, are easier to implement, and enable care providers to use information more effectively

Health Level Seven

Provides protocols for exchange, management and integration of clinical and administrative electronic health data.

Health level seven

is "an all-volunteer, not-for-profit" organization.

1987

(HL7)Formed in ___, the accepted global standard for exchange, integration, sharing and retrieval of electronic health information in hospitals.

global standard

Formed in 1987, the accepted ___ ___ for exchange, integration, sharing and retrieval of electronic health information in hospitals.

A. Improve Care Delivery B. Optimize Workflow C. Reduce Ambiguity D. Enhance Knowledge Transfer

HL7 Mission is to provide standards for interoperability that:

Clinical, Clinical Genomics, Administrative, Clinical Research, Electronic Claims Attachments, Public Health, Personal Health

Wide range of Healthcare Standards:

Health Level "Seven"

has its origins based on a Seven-layer International Organization Of Standards (ISO) Communication Model.

Layers 1-4

Deal with Communication; Comprising Physical, Data Link, Network And Transport Communication Layers.

Layers 5-7

Deal with functions like Session, Presentation & Application.

Highest Level or Seventh Level

is regarded as the Application Level, which deals with the definition of data to be exchanged

Highest Level or Seventh Level

This Level supports varied functions, such as "Security Checks, Participant Identification, Availability Checks, Exchange Mechanism Negotiations and Data Exchange Structuring".

HL7 Standards

are freely implementable, but have a strict copyright.

workflow

It is important to understand that Radiology requires more than DICOM for

DICOM and HL7

Existing standards like ___ and ___ have been established and are in place. These standards lay down that interoperability is possible.

Integrating Information Systems

in Radiology Departments can be complex.

DICOM and HL7

When standards like __ and __ are applied on ground, there are ambiguities and conflicting interpretations.

IHE

steps in to fill a gap between what is theoretically possible and what can be achieved in practice on ground in Radiology Departments.

IHE

solves issues involving "Multiple, Heterogeneous Information Systems" by way of consensus and cooperation between existing healthcare standards agencies.

IHE

It coordinates the use of established standards like DICOM and HL7 but answers issues that remain unresolved within the scope of DICOM and HL7.

Integrating The Healthcare Enterprise

The core strategy of "__ __ __ __" is integrating radiology workflow within a healthcare setup, using existing standards like DICOM and HL7.

IHE

By a "multi-year initiative that creates the framework for integrating applications, systems and settings across the entire healthcare enterprise" the IHE initiative improves workflow

A. Interoperability Problem Identification B. Integration Profile Specification C. Implementation and Testing at Connectathon D. Integration Profile Conformance Statements

IHE accomplishes this by a four stage process:

Consistent presentation of images profile which ensures images are displayed as similarly as physically possible on different displays like film on view box, workstation, or PC

Typical examples of a few successfully implemented IHE Integration Profiles in Radiology Departments include:

KEY IMAGE NOTES PROFILE

which is used for flagging images of Radiologic Procedures

Key Image

is practically useful, for example in a CT Scan of the abdomen, where out of the nearly 200 slices, useful information may be available in only four images.

four images

in a CT Scan of the abdomen, where out of the nearly 200 slices, useful information may be available in only

Flagging

of these four images enables referring clinicians across a PACS to quickly access them, thereby saving time and increasing efficiency

1. Scheduled Work Flow 2. Patient Information Integration Reconciliation 3. Post Processing Workflow, 4. Charge Posting 5. Simple Image And Numeric Reports 6. Presentation Of Grouped Procedures 7. Access To Radiology Information 8. Exception Management Workflow 9. Basic Security 10. Integration Profile

Other IHE Integration Profiles include:

RADIOLOGY

is a ubiquitous healthcare service that derives, processes, offers and distributes data in an electronic format.

DICOM, HL7 and initiatives like IHE

have been created to improve workflow efficiency in a networked radiology department, across a multivendor system environment.

DIGITAL IMAGING

Integral to current Radiology practice, wherein images are acquired, processed, post-processed and displayed, in black and white, gray scale, or colour, using binary numbers.

Digital Imaging in Radiology

The sources of ___ ___ __ ____ are very varied and diverse, when compared with other specialities.

UTZ, CR, DR, CT, MRI

They comprise imaging equipment like

digital camera or scanners, interface hardware connecting devices and computers

input devices like

output devices like

printers, monitors and video projectors.

Pixels, Gray Scale, Bit Depth, Colour & Resolution

Digital Imaging has few important performance parameters like

parameters

These ____ are distinctly different for image acquisition equipment when compared with image output and viewing devices.

WORKSTATION

‘Viewing Boxes ’ of a Modern Radiologist

WORKSTATION

They are at the very core of a Radiologist’s daily work and central to the business of manufacturing medical imaging equipment’s

workstation

The modern radiologist often reads an image at a ____, by manipulating it to extract useful information out of the voluminous dataset of a given patient from a specific modality

Image overload

is another area considered as the single biggest challenge in radiological services.

3D processing

The only method to tame this deluge of image data is to effectively use __ ___ in workstations

Placing and replicating

workstations in every modality, reading room, office, and hospital sites like Ward and ICU is not economically feasible or practical.

Thin and Thick Clients

Fundamental difference between __ and __ __ is based on the location of the software applications

NETWORK

exists when two or more computers are connected together, thereby allowing them to share data, equipment, and other digital electronic resources.

Seamless

Such '____' Workflow features in a Radiology network are made possible by means of a combination of network software and network hardware.

type of a network

The __ __ _ ____gives an idea of the size and its scale in a geographical area.

Personal Area Network

PAN

Local Area Network

LAN

Metropolitan Area Network

MAN

Wide Area Network

WAN

Global Area Network

GAN

LAN

cover a small geographic area, like a Radiology Department or hospital buildings.

LAN

in contrast to WANs, have a much higher data transfer rates, a smaller geographic range, and no dependency on leased telecommunication lines.

Ethernet technology

Most LANs are based on

PICTURE ARCHIVAL & COMMUNICATION SYSTEMS

PACS

PACS

A system for digital storage, transmission and retrieval of radiology images.

PACS

Have both software and hardware components and directly interface with imaging modalities.

Radiology Images.

The PACS System archives & stores

1. Cost Saving 2. Time Saving 3. Access 4. Applications 5.Integration 6. Convergence 7. Data Handling 8. CAD 9. Advanced Analysis 10. Security and Privacy

PACS has multiple advantages over film-based:

A. Computer Aided Diagnosis | CAD B. Data Mining Intelligence C. PACS Connectivity On Mobile Phones

Over the next decade, PACS systems is expected to transform themselves to more intelligent, mobile and secure systems that can incorporate:

TELERADIOLOGY

Refers to the practice of a Radiologist interpreting medical images while not physically present in the location where the images are generated

TELERADIOLOGY

Hospitals, mobile imaging companies, urgent care facilities and even some private practices utilize

a. Efficient transfer of image data b. Accurate representation of the graphic image at the remote site c. Optimal utilization of radiologist time d. Systems and processes leading to an overall increase in Radiologist productivity

TELERADIOLOGY FOCUSES ON:

PACS Workstation and a RIS platform

The technology required for Teleradiology consists of a

PACS Workstation

for imaging viewing and interpretation

RIS platform

for report generation and archival

1. Image Acquisition 2. Image Transfer 3. Image Compression 4. Image Review

Advantages of Teleradiology in Clinical Practice

I. Increasing sub-specialization from an emergency after-hours service to subspecialty practice II. Increasing globalization with integration of more countries III. Greater broadband penetration by emergence of onset of WiMAX and 3G networks IV. Convergence and portability with rapid rise of handheld devices and high end mobile phones. V. Innovative applications, such as real-time telesonography, web-based e-learning and internet education.

Anticipated future trends in Teleradiology include the following:

digital transformation

A __ ___has occurred in the current practice of Radiology and Imaging, by an unprecedented impact of computers.

working knowledge of computers

A ___ ___ __ ____ for a Radiologist will not only facilitate the workflow practices in different modalities in radiology to its full potential, but will also prepare for the further innovations in a digital future

Pixel

It is the smallest sample of an image

Grayscale

images are different from 'black and white' images with a number of shades of gray in between

Grayscale

Range from pure black at weakest intensity to pure white at strongest

Color

For on-screen color in TV and monitors an "additive" RGB model with phosphors is used. A rane of colours is emitted by varying type and intensity of phosphor dots struck

For color printing on a paper a subtractive CYMK model is used. These combine on paper, a filter action absorbing few wavelengths of light while reflecting the remainder into human eye

Spatial Resolution

It describes an ability to distinguish fine spatial and differentiate objects in an image

Spatial Resolution

Increasing the sampling frequency and number of pixels increases resolution but requires large file sizes

Contrast Resolution

It is the amount of grayscale or color differentiation that exists in an image

Contrast Resolution

For Digital image acquisition equipment, it is the number of shades of gray that a detector can capture