integrating the healthcare enterprise -radiation oncology · dicom conformance statement hmmmmmm...
TRANSCRIPT
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Integrating the HealthcareEnterprise
- Radiat ion Oncology -
Bruce Curran, M.S., M.E.Bruce Curra n, M.S., M.E.Department of Radiation OncologyUniversity of MichiganAnn Arbor, MI
Acknowledge ments
• IHE-RO Symposi um @ ASTRO 2006– Mike Vannie r– Jay Cooper– Keith LaPlain
• IHE-RO Technical Commi ttee– ihero tech@aa pm.org
• IHE 2007 Worksh op– http: //www.i he.net
Disclo sure s
• Co-chair, IHE-RO Technical Commi ttee– Funding from ASTRO for participation
• Vice-Chair, DICOM Working Group 7– Funding from AAPM for parti cipation
Outline
• DICOM in Radiation Therapy– Brief History– Scope– Why it doesn ’t work
• IHE– Brief History– Structure and Current Activi ties
• IHE-RO
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• Orig inal ly Developed as AAPM Report #10• “ A Standard Format for Digital Image Exchange ”
• Modified by NCI Particle Intercompar isonContra ct• Used by NCI High Energy Photon External Beam
Contract
• Modified further by NCI Electr on Exte rnalBeam Cont ract
• Ado pted and Significant Exte nded by RTOGQA Center
AAPM / RTOG
• Started as ACR-NEMA– Committee formed in 1983– 1985 - ACR-NEMA V1.0– 1988 - ACR-NEMA V2.0– V1.0 & v2.0 image transfer based on point -to-point
medium.– Version 3, renamed DICOM 3. Used network for image
transfer.
DICOM 3 Histor y
• 1990 - The name was change d to separ atethe standard from the or iginating body
• 1991 - Release of Parts 1 and 8 of DICOM• 1992 - RSNA demonstra tion, Part 8• 1993 - DICOM Parts 1-9 approved, RSNA
demon stration of ALL parts• 1994 - Part 10: Media Storage and File
Format• 1995 - Parts 11,12, and 13 plus Supplements
DICOM 3 History
Part 2 Conformance
Par
t1O
verv
iew
Part 4 Service Class Specifications
Part 3 Information Object Definitions
Part 6 Data Dictionary
Part 5 Data Structure & Encoding
Part 7 MessageExchange
Part 10 Storage Media& File Format
Part 8Network
Part 9Point-to-Point
Part 12 PhysicalMedia Formats
Par
t11
Med
iaS
tora
geA
ppl.
Pro
files
DICOM 3 Struc ture
3
HISHISHIS
ORSurgery
ORORSurgerySurgeryWardsWards
InsuranceInsuranceInsurance
PharmacyPharmacyPharmacyTreatment
(RT)TreatmentTreatment
(RT)(RT)
GeneralPractitioners
GeneralGeneralPractitionersPractitioners
CardiologyCardiologyCardiology ICUICUICU
LaboratoryLaboratoryLaboratory
RadiologyRadiologyRadiology
DICOMDICOM
HL7HL7
e.g.e.g. EDIfactEDIfacte.g.e.g. EDIfactEDIfact
HospitalHospital
TeleradiologyTeleradiologyto clinicsto clinics
PathologyPathologyPathology
Healthcare Standard s
MAGN
ETOM
Inform ation Managemen t System
Stora ge, Query/Ret rieve,Stora ge, Query/Ret rieve,Study Comp onentStudy Comp onent
Query/Retrieve, Patient &Query/Retrieve, Patient &Study Managem entStudy Managem ent
Query/RetrieveQuery/Retriev eResults ManagementResu lts Management
Print ManagementPrint Management
Media ExchangeMedia Exch ange
Li teBox
DICOM App lication Domai n
Radiati on Therapy: Imaging +
• Need for mor e that just Images– Field descr ip tions– Prescription / Fractionation
• Infor mation objec ts “ evolv e”– At simulation , only basic setup
inform ation– Af ter plannin g, fields, doses, …– Verific ation data
Depar tmental Data Flows
MAGNETOM
MAGNETOM
LiteBoxLi teBox
CT MR
DB
R&V / Arch ive
CT Sim RTP LinacSimulator
Image
SS, Plan,Dose
Image,Setup
Image All Image
PlanImage, SS,Plan
SS, Plan,Image
Image
Li teBox
Porta l Imaging
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DICOM RT
• Proposed at RSNA, 1994– Working Group star ted in 1995 as NEMA RT Section
TG– First obj ects approved in 1998
• Ad ded several objects for Radiation Therapy– RT Dose– RT Structur e Set– RT Image– RT Plan– RT Treatment Record(s )
• Since DICOM 3.1, jus t another part of DICOM
• DICOM Part 2 specifies the stru cture of aconformance statemen t
• DICOM does not speci fy a test suite or acompl iance verification mechanism
• All DICOM implementations must besupported by a properly constructedconformance statement
DICOM “ Testing ”
• Implementati on Model which describes theApplic atio n Entities in the implem entatio n
• Detailed specifica tion of each App lication Entity– SOP Classes suppor ted– policies for initiat ion and acceptance of associations
• Presentation Contexts• SOP options• Suppo rted communications protocols• Specializations• Configuration
DICOM Confor mance Statemen t Hmmmmmm
DICOM
The New Yorke r, 7/2007
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DICOM Conform ance Statement
• Allow a user to dete rmine which optionalcompo nents of the DICOM Stand ard aresuppo rted by a particular impleme ntation, andwhat extensio ns or specia lizati ons animplementation adds.
• By comp aring the Conforma nce Statementsfrom two impl ementat ions, a knowl edgeableuser should be able to determine whether or notinterop erability is possible.
The Problems
• DICOM-RT Objects Evolve– Numerous ‘Optio nal ’ Fields– Diffe rent Interpretations– ‘Stale’ Data
• Securit y– HIPPA has heightened awareness of the
need to protect data– Netw ork Protection / Isolat ion
DICOM
• No for mal testing struct ure– Left to the user to examine
manufacturer Conformance Statementsto verify compatib ili ty
– Know ledge necessary to truly verif ycomp atibility is arcane , not easy toacquire or keep current
– Much more difficult for DICOM RTExten sions compar ed to images
What is IHE?
• Standards -based,• Globa l Initiativ e
generating
• Real-wor ld Impl ementa tionsin patient care
“ Defining, testing , and imp lemen tingstandar ds -based in teroperability forEHR’s”
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Why IHE?
• 1970’s—Mainframe Era--$100,000 perinterfac e
• 1990’s—HL7 2.x--$10,000 per interface• 2000’s—IHE Implementation Profiles —
Cheaper than a new pho ne line!
How? IHE Elimi nates Optio nsfound in Publish ed Standards
IHE bri ngs reality to workflo w
Who is IHE?
• IHE is a joint ini tiative among:– American College of Cardiology (ACC)– Radiologica l Society of North America (RSNA)– Healthc are Information Managemen t Systems Society (HIMSS)– GMSIH, HPRIM, JAHIS (laborato ry)– American Soc iety of Opht halm olo gy– American College of Physicians (ACP)– American College of Clinical Engineerin g (ACCE)– And many more ….
• Began in 1997 in Radiology (RSNA) and IT (HIMSS)• Internation al effor t: IHE- Europe and IHE-Asia• Addition al sponsors for Cardiology includi ng ASE, ESC,
ASNC, SCA&I, HRS and more
IHE Organizational StructureMulti -Domain & Multi -National
IHE Organizational StructureIHE Organizational Stru ctureMultiMulti --Domain & MultiDomain & Multi --NationalNational
Participants
contribute
Global Development:Radiology,IT Infra structure,Cardiolo gy,Lab, etc .
Delegates
IHE Europ e
IHE NorthAmerica
IHE Asia/O ceania
Regional &NationalDeploym ent
supervises reports
IHE (Inter national) Strategi c Developm ent Committee
Spons orCo-Chairs
Global
Inter oper abili ty
IHE Domain-relat edPlanning and
Technical Committees
7
Electronic Health Record
Cardiology
Laboratory
Radiology
Oncology
FutureDomains
I HEIT Infrastru cture
14 Integra tion Profil es
5 Integration Profi les
4 Integrati on Profiles
1133 IInntteeggrraatt iioonn PPrrooff ii lleess
Patient CareCoordination
1 Integrati on Profile
Patient CareDevices
PathologyEye Care
IHE 2006IHE 2006 –– Nine Active DomainsNine Active DomainsOver 100 vendors involved worl dOver 100 vendors involv ed world --wide,wide, 5 Technic al Frameworks5 Technical Frameworks
37 Integra tion Profil es, Testing at Connectath ons37 Integrati on Profiles, Testing at Connectathon sDemons trat ions at major confe rences worldDemon strati ons at major conferences world --widewide
15 Ac tive national chap ters on 4 co ntinents15 Active nati onal chapters on 4 con tin ents
IHE Standards -Based Integra tion SolutionsIHE StandardsIHE Standards --Based Integration Soluti onsBased Integration Solu tion s
Professional Societies SponsorshipHealthcare Providers & Software Developers
Healthcare IT StandardsHL7, DICOM, etc.
General IT StandardsIntern et, ISO, etc.
Interoperable Healthcare ITSolution Specifications
IHE Integr ation ProfileInteroperable Healthcare IT
Solution SpecificationsIHE Integration Profile
Interoperable Healthcare ITSolution Specifications
IHE Integration Profi leInteroperable Healthcare IT
Solution SpecificationsIHE Integra tio n Profile
IHEProcess
IHE Integration Profil es
Access to Radiology Inform ation
ConsistentPresentati on
of Images
Sched uled Workflow
Basic Security
-
EvidenceDocumen ts
Key ImageNotes
SimpleImage andNumericReports
Presentationof GroupedProcedures
Post -ProcessingWorkflow
ReportingWorkflow
ChargePostingP
atient
Information
Reconciliation
Proven Standa rds Adop tion Process
IHEIntegrationProfiles B
IHEIntegratio n
Profile A
Easy toIntegrateProd uct s
IHEIHEDemonstrati onDemonstrati on
User Site
RFPRFP
StandardsStandards
IHETechnical
Framewor k
Product IHE Integrati onStatement
IHE Integrat ion Pro files at the heart of IHE :– Detailed selection of standards and optio ns each solving a speci fic
in tegration problem– A growing set of effective prov ider/ softwar e-develo per agreed soluti ons– Vendors can imple ment wit h ROI
IHEIHEConnectConnect --aa--thonthon
ProductWith IHE
IHE Connect -a-thonResul ts
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IHE Technical Frameworks
↑↑
↓ Pt. Registrat ion[RAD-1]↓ Patient Update[RAD-12]
Pt. Registration [RAD-1 ] ↓PatientUpdate[RAD-12] ↓
←PlacerOrderManagement [RAD-2]→Filler Order Management [RAD-3]
ADT
↓ Query Images[RAD-14]↓ RetrieveImages/Evidence[CARD-4]
ImageDisplay
Modality Image/EvidenceStored[CARD-2]
StorageCommitment
[CARD-3]
↓ ProcedureScheduled[RAD-4]
↓ ProcedureUpdated[RAD-13]
←QueryModality Worklist [RAD-5]
PerformedProcedure
StepManager
↑ M odali ty PSin Progress [CARD-1]↑ Modali ty PSCompleted[RAD-7]
→ M odali ty PSin Progress[CARD-1]→ M odali ty PSCompleted[RAD-7]
←Modality PSin Progress[CARD-1]←Modality PSCompleted[RAD-7]
OrderPlacer
AcquisitionModality
ImageManager
ImageArchive
DSS/OrderFiller
↓ PatientUpdate[RAD-12]
Modality Image/EvidenceStored[CARD-2]
StorageCommitment
[CARD-3]
↓↓
EvidenceCreator← Modal ity PSin Progress[CARD-1]
← Modal ity PSCompleted[RAD-7]
InstanceAvai lab ility Not ification [RAD-49]↑
↑↑
↓ Pt. Registrat ion[RAD-1]↓ Patient Update[RAD-12]
Pt. Registration [RAD-1 ] ↓PatientUpdate[RAD-12] ↓
←PlacerOrderManagement [RAD-2]→Filler Order Management [RAD-3]
ADT
↓ Query Images[RAD-14]↓ RetrieveImages/Evidence[CARD-4]
ImageDisplay
Modality Image/EvidenceStored[CARD-2]
StorageCommitment
[CARD-3]
↓ ProcedureScheduled[RAD-4]
↓ ProcedureUpdated[RAD-13]
←QueryModality Worklist [RAD-5]
PerformedProcedure
StepManager
↑ M odali ty PSin Progress [CARD-1]↑ Modali ty PSCompleted[RAD-7]
→ M odali ty PSin Progress[CARD-1]→ M odali ty PSCompleted[RAD-7]
←Modality PSin Progress[CARD-1]←Modality PSCompleted[RAD-7]
OrderPlacer
AcquisitionModality
ImageManager
ImageArchive
DSS/OrderFiller
↓ PatientUpdate[RAD-12]
Modality Image/EvidenceStored[CARD-2]
StorageCommitment
[CARD-3]
↓↓
EvidenceCreator← Modal ity PSin Progress[CARD-1]
← Modal ity PSCompleted[RAD-7]
InstanceAvai lab ility Not ification [RAD-49]↑
Query Modality Worklist [RAD-5]
ADT OrderPlacer
Regist erJ.Doe
AcquisitionModality
PlacerOrderManagement–New [RAD -2]
PatientReconcili ation
DepartmentSystemScheduler/
OrderFi ller
ScheduleProcedure
ProcedureScheduled[RAD-4]
Modalit yProcedureStepCompleted[ RAD-7]J.Doe->
J.Smith
Pat ientUpdate/Merge [RAD-12]
Modality ProcedureStep Completed[RAD-7]
PatientRegistration[RAD-1]
Patient Update/
Merge[RAD -12]
Modalit y ProcedureStep In Progress[CARD-1]
Modality ProcedureStepIn Progress[ CARD-1]
PerformAcquisition
Fill erOrderMgmt - StatusUpdate [RAD -3]
Fill erOrderMgmt - StatusUpdate [RAD -3]
I mageManager/
PPSManager
Filler OrderManagement-New[RAD-3]
Oneor theothermethodsof creatinganorder is used
Query Modality Worklist [RAD-5]
ADT OrderPlacer
Regist erJ.Doe
AcquisitionModality
PlacerOrderManagement–New [RAD -2]
PatientReconcili ation
DepartmentSystemScheduler/
OrderFi ller
ScheduleProcedure
ProcedureScheduled[RAD-4]
Modalit yProcedureStepCompleted[ RAD-7]J.Doe->
J.Smith
Pat ientUpdate/Merge [RAD-12]
Modality ProcedureStep Completed[RAD-7]
PatientRegistration[RAD-1]
Patient Update/
Merge[RAD -12]
Modalit y ProcedureStep In Progress[CARD-1]
Modality ProcedureStepIn Progress[ CARD-1]
PerformAcquisition
Fill erOrderMgmt - StatusUpdate [RAD -3]
Fill erOrderMgmt - StatusUpdate [RAD -3]
I mageManager/
PPSManager
Filler OrderManagement-New[RAD-3]
Oneor theothermethodsof creatinganorder is used
Detailed standards implementationguides
IHE Connectathon
• Open invitation to the SoftwareDeveloper Communi ty
• Advance testing tools (MESA) applie d• Compliance Testi ng organized and
supervi sed by the sponsors of IHE• Thous ands of cross -system tests
perform ed• Produ ct Integratio n Statemen ts
validate d
IH E Connectathon, January 2006••300+ parti cip ants, 120+ systems300+ parti cipan ts, 120+ systems••60+ systems devel opers60+ systems developers••Four Domain s: Cardiology, IT Infrastructure,Four Domains: Cardi ology, IT Infrastructure,
Patient Care Coordinati on, RadiologyPatient Care Coordinati on, Radiology••2800+ monitored test cases2800+ monito red test cases
Request for Proposals (RFPs)• Much easier to speci fy and agree to an IHE
Integration Profil e than detailed technical specs:
– “ Devic e must support IHE Scheduled WorkflowIntegration Profile, and vendor must suppl y anIHE Integrati on Statement. ”
• Software Developer response:
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• Results– Over 3000 attendees visited the HIMSS RHIO Showcase– 37 vendors demonstrated 48 systems– 700 attendees created and tracked their own health record– 63 educational sessions were presented– 5 International delegations– 3 VIP tours– 16 clinical scenarios were demonstrated
IHE-RO
• DICOM WG-7 (Apr il, 2004)– Intr oduc tion to IHE– Discussion on how Radiation Oncol ogy coul d
participat e• NEMA Radiation Therapy Section
– At AAPM 2004, dis cuss ed need to impro veinteroperabili ty in RT
• ASTRO– Board of Directors Proposal, June 2004– Kick -off, ASTRO Annual Meetin g, 2004– First Meeting of IHE-RO PC & TC @ RSNA, 2004– Joint Effort led by ASTRO with AAPM, NEMA, and others
• IHE-RO Technical Committee– First Meeting, January, 2005 w/ DICOM WG-7
IHE-RO
INTEGRATING THE HEALT HCARE ENTERPRISE (IHE) –
RADI ATIO N ONCOLOGY (RO)
Participants in IHE-RO International Atomic Energy
Agency (IAEA)
Impac
Japanese Society for
Therapeutic Radiology and
Oncology (JASTRO)
Miranda Solutions
National Cancer Institute
(NCI)
National Electrical
Manufacturers Association
(NEMA)
Nucletron
Philips
Tomotherapy
Radiological Society of North
America (RSNA)
Siemens
Varian
Advanced Technology Consortium
(ATC)
American Association of Physicists
in Medicine (AAPM)
American College of Radiology
(ACR)
American Society for Therapeutic
Radiology and Oncology (ASTRO)
Association of Radiation
Oncologists of India (AROI)
Canadian Association of Radiation
Oncologists (CARO)
Chinese Society of Radiation
Oncologists (CSRO)
CMS
Egyptian Cancer Society –Radiation
Oncology
Elekta
European Society for Therapeutic
Radiology and Oncology (ESTRO)
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IHE-RO
INTEGRATING THE HEALTHCARE ENTERPRISE (IHE) –
RADIATI ON ONCOLOGY (RO)
Participants in IHE-RO International Atomic Energy
Agency (IAEA)
Impac
Japanese Society for
Therapeutic Radiology and
Oncology (JASTRO)
Miranda Solutions
National Cancer Institute
(NCI)
National Electrical
Manufacturers Association
(NEMA)
Nucletron
Philips
Tomotherapy
Radiological Society of North
America (RSNA)
Siemens
Varian
Advanced Technology Consortium
(ATC)
American Association of Physicists
in Medicine (AAPM)
American College of Radiology
(ACR)
American Society for Therapeutic
Radiology and Oncology (ASTRO)
Association of Radiation
Oncologists of India (AROI)
Canadian Association of Radiation
Oncologists (CARO)
Chinese Society of Radiation
Oncologists (CSRO)
CMS
Egyptian Cancer Society –Radiation
Oncology
Elekta
European Society for Therapeutic
Radiology and Oncology (ESTRO)
Exactly How Does IHE-RO Function?
• Planni ng Commit tee– Identifies information
systems or compone ntsof infor mati on systemsthat produce, manage,or act on informationassociated wi th clinicaland operationalactivities that requir eintegration .
• Techn ical Committee– Identifies and
impl ements standardsfor interactio ns betweenactors that communi catethe requi red informati onthrough stand ards -basedmessages.
ThePCandTC work togethertoPrioritize Efforts,ProposeSolutions,and Eventually Demonstrate Connectivity
- whatdid he justsay?
IHE-RO Basic Inter operabili ty2005-2007 Integr ation Profi le
ImagingStudyContouring
System
SimulationSystem
PlanningWorkstation
RadOncIMS
TreatmentDelivery
TreatmentVerification
IHE-RO Actors
• Proposals circul ating betweenPlanni ng Comm ittee and Techni calComm ittee– Many applica tions combin e actor s
ImageArchive
RTArchive
PatientRegistrarMulti-Media Registration
ContouringReference Point Generation
Prescription EntryBeamPlacer/ Shaper
DoseCalculatorPlan Evaluator
FractionatorReferenceImage Creator
Planning Application
RT SSet
RT Plan G
RT SSet RT Plan
RT Dose ReferenceImages
RT Dose
DICOM
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IHE-RO CT Simulatio n Applic ation
RTArchive
ImageArchive
Multi-Media RegistrationContouring
Reference Point GeneratorBeam Shaper / Placer
Prescription EntryReference Image Creator
Contouring &Beam Editor Application
RT SSet
RT Plan G
DICOM
Reference Images
IHE-RO Treatment Plannin g App licatio n
ImageArchive
RTArchive
Patient RegistrarMulti-Media Registration
ContouringReference Point Generation
Prescription EntryBeam Placer / Shaper
Dose CalculatorPlan Evaluator
FractionatorReference Image Creator
Planning Application
RT SSetRT Plan G
RT SSet RT Plan
RT Dose Reference Images
RT Dose
DICOM
IHE-RO Treatme nt Delivery IHE-RO Techn ical Frameworks
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Actors
• Archive• Contourer• Geometric Planner• Dosi metric Planner• Dose Displa yer
IHE-RO Connectath on 2006
Supporters• Keith La Plain (Varian)• Stuart Swerdl off (IMPAC)• Robyn Watson (ASTRO)• Jamie Gale (ASTRO)• Mike Sul livan (ASTRO)• Amy Kapinus (ASTRO)• Stephen Vastagh (NEMA)
Evaluators• Bruce Curran (U Mich)• Walter Bosch (Wash U ATC)• Chuck Pelizzari (U Chicago)• Philip Devlin (Harvard)
Participan ts• Phillips• Siemens• Nuclet ron• Varian• Elekta• Brainlab• Tomotherapy• CMS• IMPAC
Informa l Connect athon 2006
••25+ particip ants, 9 Vendors, 10+ systems25+ parti cipan ts, 9 Vendors, 10+ systems••95+ monitored test cases95+ monit ored test cases
Infor mal Conne ctatho n 2006
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What’s Next?
• Compositing Dose• Residual Dose Optimization• Multimodality Image Registra tion• On-line Image Review (referen ce image vs.
deli very image)• Off -line Image Review (reference image vs.
deli very image)• Scheduling Treatment Delivery and
Veri fy/Record• Query/Retrieve• Configuration Management
Selected for 2008
Profi le Roadmap
• Initial Implementati on (2005-2007)– RO General Integrati on Profil e
• CT Image Retri eval / Storage• Image Set Contouring• Geometric Plan Definition• Dosimetric Plan Definition• 3D Dose Matrix Viewer
– Reduce Multipli city of Implement ation Paths– Test Tools Contract in place– Connect athon Scheduled (8/25/2007)
• 2008 Profil es– RO Multimodalit y Regis trati on– Treatment Deliver y Workflow
IHE-RO 2006 Connectath on