&
WHAT NOW & WHAT’S NEXT
Kevin O’Donnell,
Toshiba Medical Research Inst.
Co-Chair, DICOM Standards Cmte.
Member, IHE Radiology Technical Cmte.
DISCLOSURE
Presenter perceives no conflict of interest with this
presentation but discloses being an employee of:
Toshiba Medical Research Institute USA,
a division of Toshiba Medical Systems Corp.
DICOM is the standard for medical imaging.
Widely implemented; basis of DI marketplace
 Managed process (NEMA/MITA)
 International scope (ISO-12052)
 and many pages of detail information…

IHE IN ONE SLIDE

IHE helps vendors implement & test
functions that span multiple systems

Profiles are implementation guides



Connectathons are test events


how to use existing standards
to address a specific problem scenario
managed testing of Profile
implementations
IHE helps users purchase & integrate
multi-system solutions

list required IHE Profile support in RFPs
4
COMMUNICATION STANDARDS
X
x
X
X
Y ?
X
X
X
X
?
?
Y
X
COMMUNICATION STANDARDS
X
X!
LEVEL OF IMPLEMENTATION

product-registry.ihe.net
Integration Statement Database
 IS = specific version of specific product


connectathon-results.ihe.net

Vendor Participation Database
IMAGING WORKFLOW
What Now…

IHE Scheduled Workflow
o
o
o
DICOM Modality Worklist
DICOM Images
DICOM MPPS (Performed Procedure Step)

o

Unscheduled or Modified Procedures
DICOM Storage Commit (turn it on)
IHE Mammography Image
IMAGING WORKFLOW
What’s Next…

DICOM Enhanced CT, MR, XA, PET, 3D US
o
o

Faster
Better Processing
DICOM Multiframe Converted Legacy
o
o
Supplement 157
Addresses Mixed Environment
DICOM MULTI-FRAME CONVERSION
Advanced Modality
Enhanced View
Advanced Workstation
&
&
Classic View
Legacy Modality
Legacy Workstation
IMAGING WORKFLOW
What’s Next…

IHE Scheduled Workflow.b
o
o

HL7 2.5.1
Replaces 2.5.1 Option in SWF
RadLex Playbook (RSNA)
o
Standard codeset for orderables



o
Code:
RPID7
Short Name: CT HEAD ANGIO WO & W IVCON
Long Name: CT HEAD ANGIOGRAPHY WITHOUT THEN WITH IV
CONTRAST
playbook.radlex.org
Confidential
STANDARD PROCEDURE CODES
RSNA
Templates
EMR
Registry
P7
P7
some text: #
Numerical Details
12.2 14.5
11.8
7.6
9.5 10.9
P7
Guidelines
P8
P7
Radlex Playbook
:RPID7- CT HEAD ANGIO
WO & W IVCON
12.2 14.5
9.5 10.9
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Lksdflkjsdfljksdflkjsdf
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P7
some text: #
Numerical Details
12.2 14.5
9.5 10.9
Sdfkljslkjreljwerkljwe
Lksdflkjsdfljksdflkjsdf
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CDA
P7
some text: #
Numerical Details
12.2 14.5
11.8
7.6
9.5 10.9
PACS
RIS
P7
P7
P7
P7->Protocol
12
IMAGING WORKFLOW
What’s Next…

DICOM Protocol Storage (CT)
o

Supplement 121 (WIP)
DICOM Contrast Administration Record
o
Supplement 164 (WIP)
PROTOCOL STORAGE
Defined &
Planned Protocol
SOURCES
Device=Aquilion Series
…
Pat. Pos. : Feet First / Supine
Pat. Instruct : Single Breath
Hold
/ Full Inspiration
…
kVp : 80~140
Slice Thickness : 1.0~2.5mm
Recon. Kernel : Std.
…
Prior Scan
Modality
Protocol Library
Vendor
APPLICATIONS
Semi-auto
Scan Setup
Prior
Comparability
Patient
Positioning
Sharing
Best Practice
Clinical Trial Protocol
or
Clinical Trial
Performed Protocol
Local Standard
Hospital
Best Practice
ACR / RSNA
AAPM
Device=Aquilion ONE
Version=3.0.4
…
Pat. Pos=Feet First / Supine
Pat. Instruct=Given
…
kVp=120
Slice Thickness=1.0mm
Recon. Kernel=FC12
…
Protocol
Backups
Acquisition
Validation
Scan QA /
Troubleshooting
14
RADIATION MANAGEMENT
What Now…
DICOM RDSR (CT, XA, CR, DR, MG)
 IHE Radiation Exposure Monitoring

o

CT Now, Others appearing
Dose Analysis
o
o
o
ACR Dose Registry (2Mil+ studies)
Open Source (Radiance, etc.)
Commercial Packages
IHE RADIATION EXPOSURE MONITORING PROFILE
National Registry
some text: #
Numerical Details
12.2 14.5
Numer
11.8
7.6
12.2 9.5
14.5 10.9
some text: #
Numerical Details
12.2 14.5
11.8
7.6
9.5 10.9
9.5
some text: #
Numerical Details
some 12.2
text: #14.5
Numerical
Details
some 12.2
text:11.8
#14.5 7.6
9.5
10.9
Numerical
11.8 Details
7.6
12.2 9.5
14.5 10.9
some 11.8
text: # 7.6
Numerical
9.5 Details
10.9
12.2 14.5
11.8
7.6
9.5 10.9
10.9
Outlier: #
Performing Phys.
Over Target: 12.2%
Outlier: #
Performing Phys.
Over Target: 12.2%
some text: #
Numerical Details
12.2 14.5
11.8
7.6
9.5 10.9
Outlier: #
Performing Phys.
Over Target: 12.2%
some text: #
Numerical Details
some text:
12.2# 14.5
Numerical
11.8Details
7.6
12.2 14.5
9.5 10.9
11.8
7.6
9.5 10.9
Archive
Dose Information
Reporter
some text: #
Numerical Details
12.2 14.5
11.8
7.6
9.5 10.9
16
RADIATION MANAGEMENT
What’s Next…

DICOM Radiopharmaceutical SR
o

Supplement 159 (WIP)
DICOM Patient Dose SR
o
Supplement TBA
IMAGE DISTRIBUTION
What Now…
DICOM Push/Pull (configure firewalls)
 IHE PDI compliant DICOM CDs
 IHE XDS-I.b

o

Some Canadian DIRs already using
IHE Import Reconciliation Workflow.b
Store
(Fix IDs, Codes
& Demographics)
IMAGE DISTRIBUTION
What’s Next

DICOM WADO-RS
o

DICOM STOW-RS
o

Store Over the Web - RESTful
DICOM QIDO-RS
o

Web Access to DICOM Objects - RESTful
Query – RESTful
IHE Invoke Image Display
MEASUREMENT
What Now…

Ultrasound Measurements
o
o
o

OB/Gyn
Adult Echo
Fetal, Pediatric and Congenital Echo
Record & Dataflow
MEASUREMENT
What’s Next…

Ultrasound Measurements
o
(Simplified) Adult Echo
POST-ACQUISITION WORKFLOW
What’s Next…

IHE Post-Acquisition Workflow
o
o
o
DICOM Unified Procedure Step
DICOM Application Hosting (“DICOM plugins”)
Worklist managed processing

o
Progress notifications


o
Automated & manual
Any interested system
(RIS, Billing, Reading Worklist, Dashboard, Analytics)
Subscription-based
Cancelation requests

With reason & contact
IHE PAWF
Example “Workitem” Tasks:
 3D View Generation
 Computer Aided Detection
 Clinical Applications
 Pre-fetching
 Image Routing
 CD Burning
 Image Importing
 …
REPORTING
What Now…

IHE Consistent Presentation of Images
o
o
DICOM GSDF (Calibration)
DICOM Greyscale Presentation State
REPORTING
What’s Next…

IHE Management of Rad. Report Templates
o
o
o

DICOM Radiology CDA Templates
o

Format for dictation/authoring templates
Vehicle for RSNA Template Library
www.radreport.org
Supplement 155 (WIP)
DICOM Multi-dimensional Presentation States
o
Supplement 156 (WIP)
USEFUL LINKS

DICOM


IHE





dicom.nema.org
www.ihe.net – Technical Frameworks
wiki.ihe.net - (click “Integration Profiles”)
product-registry.ihe.net
connectathon-results.ihe.net
QIBA

qibawiki.rsna.org – Profiles, Project status