topic 9 medical imaging informatics - university of winnipeg · basic concepts –roles for...

Kevin Robertson, MBA

Topic 9Medical Imaging Informatics

ACS-2816 Health Information Systems

Winter 2020

Two Questions

2

What is the radiologic process role in the healthcare enterprise?

How information systems support and improve the radiologic process?

Topic 9 Outline

3

Introduction to Imaging Systems in Radiology

Basic Concepts

Historical Development

Current Status

Future Directions

Reading: Biomedical Informatics 4th Ed. Ch 20 p593-p610


4

Digital image is a fundamental data type

Biomedical Imaging Informatics (BII)Study methods for generating, manipulating,

managing, and integrating images in many biomedical applications

BII applies to many fields: Radiology, Pathology, Dermatology, Ophthalmology, Cardiology, etc.


5

Diagnostic Imaging / Radiology Reading StationFigure source: usa.healthcare.siemens.com/medical-imaging-it/radiology-information-systems/syngo-workflow


6Figure source: www.flatpaneldr.com/index.php/category/human-medical-dr/

HighlyDistributedSetting

Issues


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Generic Workflow for Diagnostic Imaging / Radiology Services


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Identification of Potential Problem Areas in the Diagnostic Process

Figure source: Bui A et al (Eds), Medical Imaging Informatics, Springer 2010, Figure 1.2, p5

Topic 9 Outline

9


Basic Concepts


Current Status

Future Directions

Basic Concepts

10

Roles for Imaging

The Radiologic Process

Image Management and Display

Integration with Other Healthcare Systems

Basic Concepts – Roles for Imaging

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Detection and diagnosis

Treatment planning

Image-guided treatment

Assessment of response

Estimation of prognosis

Medical communication and education

Research

Basic Concepts – Roles for Imaging: Detection and Diagnosis

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Image primary useDetection of medical abnormalitiesDiagnostic purposes

Wide variety of imaging proceduresComputer Tomography (CT),Magnetic-resonance imaging (MRI),Ultrasound (US),X-rays, etc.

Basic Concepts – Roles for Imaging: Detection and Diagnosis

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Rudimentary idea behind using x-rays as a means to create medical images

Figure source: Bui A et al (Eds), Medical Imaging Informatics, Springer 2010, Figure 2.2, p18


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Treatment planning





Research

Basic Concepts – Roles for Imaging: Treatment Planning

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Assists assessment of patient’s healthDisease progression,Treatment response, and/orPrognosis estimation

E.g. Ultrasound to assess fetal size, growth and development

E.g. Computer tomography (cross section view) to assist approach for surgery


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Treatment planning





Research

Basic Concepts – Roles for Imaging: Image-Guided Treatment

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Images can provide real-time guidance

Manipulation and haptic (touch) feedback important

E.g. Endoscopic and minimally invasive surgery

E.g. Surgical Theatre at U of Michigan

http://www.imris.com/news-articles/visius-surgical-theatre-at-university-of-michigan


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Treatment planning





Research

Basic Concepts – Roles for Imaging: Medical Communication

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Images visualized concurrently with reports and discussions of interpretations

Communicating images essential in telemedicine (e.g. teleradiology, tepathology, teledermatology, etc.) for remote

Viewing

Interpretation

Consultation

Basic Concepts – Roles for Imaging: Education

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Images essential in medical education and training

Images utilized inCase libraries,Tutorials,Atlases,3-D models,Quiz libraries, etc.


21


Treatment planning





Research

Basic Concepts – Roles for Imaging: Research

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Imaging support medical research activities

E.g. Quantitative study of morph metrics (i.e. growth and development)

E.g. Functional mapping of the human brain activity

Figure source: See link at http://psychcentral.com/lib/what-is-functional-magnetic-resonance-imaging-fmri

http://psychcentral.com/lib/what-is-functional-magnetic-resonance-imaging-fmri

Basic Concepts

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Roles for Imaging




Basic Concepts – The Radiologic Process

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Radiology is engaged in all aspects of the healthcare process: detection & diagnosis -> treatment -> follow-up -> prognosis assessment

Primary function is the acquisition and analysis of medical images

Radiologists play a direct role in clinical-problem solving and diagnostic planning

Basic Concepts – The Radiologic Process

25 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 4th Edition, Figure 20.5, p599

Basic Concepts

26

Roles for Imaging




Basic Concepts – Image Management and Display

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Introduction

Image Acquisition

Storage Requirements

Image Transmission

Standardization

Display Capabilities

Cost

Basic Concepts – Image Management and Display: Introduction

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Storage and retrieval of images for a given exam Challenge as healthcare delivery is dispersed

PACS – Picture-Archiving and Communication System RIS – Radiology Information System Role of technology

High-resolution acquisition High capacity storage High-speed networks, Internet Standardization of formats (i.e. DICOM), data compression Database management systems Workstation design


29

Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Image Acquisition

30 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 18.2, p633


31

Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Storage Requirements

32 Table source: Shortliffe et al, ‘Biomedical Informatics’, 4th Edition, Table 20.1, p600

Modality Image size (pixels)

Images/exam Exam Size (MB)

Computer/DigitalRadiography

5M 3 29

CT 262,144 500 250

MRI 65,536 500 63

Ultra Sound 262,144 50 25

Mammography 20M 4 153

Interventional/Fluro 1M 50 100

Nuclear Medicine 16,384 25 1


33

Mary is expecting a baby and goes to see her obstetrician to find out how her baby is developing. Her obstetrician does an US for 30 minutes to assess the baby’s development. How much laptop storage her obstetrician needs for the baby’s US?

Assumptions: US generates 60 frames / minute, 1 MB = 1024 KB,

1 KB = 1024 B, 1 B = 8 bits

Each frame takes (512 x 512 pixel/frame) x 8 bits/pixel = 256 KB / frame

In one minute, 256 KB/frame x 60 frame/min = 15360 KB/min

In a 30 minutes study, we have 15360 KB/min x 30 min = 460800 KB

= 450 MB


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Storage requirements increasing due to higher resolution imaging, larger number of images per study and increase in number of studies performed

Data compression Lossless compression Lossey compression (no negative impact to source)

Storage access time

Key images vs total archiving

Storage hierarchies


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Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Image Transmission

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LANs and WANs enough to support simultaneous viewing across the enterprise (local and remote)

Network configuration and planning according to data patterns and use, and

Data compression

→ Image transmission time


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Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Standardization

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TCP/IP network protocol

DICOM (Digital Imaging and Communication in Medicine) application protocolEnsures all image data can be recognized and

interpreted by any node in the network

HL7 (Health Level 7) application protocolEnsures all systems can exchange operational

information


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Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Display Capabilities

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Workstation key for PACS use Radiologist workflow and operation

Comparison multiple images Flexibility in viewing, image manipulation Reshuffling images Zooming in on a specific area, measuring

Each modality has specific display requirements E.g. Mammography needs high resolution for

micro-calcification detection


41 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 18.3, p640

Some Workstation Display Alternatives


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Physical layout Monitor size Viewing distance Image size

Ergonometric factors Luminance Orientation Kinds of controls Quality of user interface


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Introduction

Image Acquisition


Image Transmission

Standardization


Cost

Basic Concepts – Image Management and Display: Costs

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Viewing stations

Reading stations

Clinical stations, web-based stations

Network & storage infrastructure

Modalities

PACS / RIS

Human resources / workflows

Basic Concepts

45

Roles for Imaging




Basic Concepts – Integration with Other Healthcare Systems

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Images need to be integrated in the care delivery workflow and its associated data

As healthcare practice becomes more distributed, image distribution changes

HIS need both vertical and horizontal integration

Open architectures and standards facilitate integration, challenge with legacy systems

Basic Concepts – Integration with Other Healthcare Systems: RIS

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Radiology Information Systems Examination scheduling and performance evaluation Patient registration Radiologists review and analysis of studies Report management and distribution Billing services Quality services (e.g. turnaround time, wait times) Inventory control and preventive maintenance

RIS implemented stand alone or as a component of HIS

PACS must be integrated with RIS and HIS

Topic 9 Outline

48


Basic Concepts


Current Status

Future Directions

Historical Development – Evolution of Image Management into PACS/RIS

49

In the 80’s, researchers realized that work was needed to develop infrastructure Image acquisition from several modalities Storage of image data schemes (long and short

term) Data transmission (local and remote) Workstation display for reading and review

(radiology and clinical) Integration with RIS and HIS Distribution of reports and key images / studies

Topic 9 Outline

50


Basic Concepts


Current Status

Future Directions

Current Status – Image Management

51

PACS Smooth coupling of exam interpretation and

clinical information including old reports Dictation systems integrated at reading

workstations (SpeechQ) Better resolution for studies’ modalities

Teleradiology (Telehealth) Remote access across the distributed network Data compression

Indexing and Image retrieval

Current Status – Information Systems Integration

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PACS, HIS and RIS integration HIS – RIS link for transfer of patient

demographics, billing, and report information RIS – PACS link for image management Better resolution for studies’ modalities

Referring physician image and report distribution support

DICOM and HL7 role ‘Integrating the Healthcare Enterprise’ (IHE)

initiative role (www.ihe.net)

Current Status – IS Integration –IHE Profiles: Scheduled Workflow

53 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Scheduled_Workflow

http://wiki.ihe.net/index.php?title=Scheduled_Workflow

Current Status – IS Integration –IHE Profiles: Patient Info. Reconciliation

54 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Patient_Information_Reconciliation

http://wiki.ihe.net/index.php?title=Patient_Information_Reconciliation

Current Status – IS Integration –IHE Profiles: Post-Processing Workflow

55 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Post-Processing_Workflow

http://wiki.ihe.net/index.php?title=Post-Processing_Workflow

Current Status – IS Integration –IHE Profiles: Reporting Workflow

56 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Reporting_Workflow

http://wiki.ihe.net/index.php?title=Reporting_Workflow

Current Status – IS Integration –IHE Profiles: Access to Radiology Info

57 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Access_to_Radiology_Information

http://wiki.ihe.net/index.php?title=Access_to_Radiology_Information

Current Status – IS Integration – IHE Profiles: Teaching File & Clinical Trial Exp.

58 Figure source: IHE link at http://wiki.ihe.net/index.php?title=Teaching_File_and_Clinical_Trial_Export

http://wiki.ihe.net/index.php?title=Teaching_File_and_Clinical_Trial_Export

Topic 9 Outline

59


Basic Concepts


Current Status

Future Directions

Future Directions for Imaging Systems

60

Computational & networking capabilities improve image processing functionalities

Modalities with higher spatial, contrast and temporal resolution (3D, 4D)

Widespread access to images and reports, enterprise integration

Content based retrieval

Future Directions for Imaging Systems

61

HL7 / DICOM compliance

Sophisticated GUI (3D, 4D)

Better speech recognition

Database management, image data mining & image data analytics tools

Better image guided tools (e.g. surgery, therapy)

Two Questions

62

What is the radiologic process role in the healthcare enterprise?

How information systems support and improve the radiologic process?

topic 9 medical imaging informatics - university of winnipeg · basic concepts –roles for...

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