Informatics I - The digital breast image interoperability and management

Transcription

1 Informatics I - The digital breast image interoperability and management Alain Gauvin Montebello,

2 DICOM HL7 VARIABLE Orders, demography, (HL7 ORM, ADT) Images + metadata (dicom storage) Modality 1 RIS GW ARCHIVE Modality 2 Results+orders (HL7 ORU+ORM) HIS Orders, demography, scheduling (HL7 ORM, ADT, SIU) Parsed data DB PACS Modality 3

3 DICOM Digital Communication in Medicine Sponsored by ACR and NEMA 1993: emergence of TCP/IP and ethernet Initially for radiology and nuc med images, now for other images, non-image objects and other DICOM 3.0 DICOM evolves incrementally Completely free

4 Service-object pair (SOP class) Service and object STORAGE («C-STORE») is main focus Object is the information set: Image object definition (IOD), type of image

5 Network role in DICOM («direction» of exchange) SCU: Storage class user Initiates communication, ex modality SCP: Storage class provider Exposes communication port, waits for contact SOP classes can be supported as SCU, SCP, or both

6 6

7 Evolution of DICOM New functionality come as «supplement» Describe changes to be made to chapters to support new type of exchange When/is adopted, DICOM chapters modified Correction proposals (CP), for modification/adddition/clarificaiton

8 DICOM tags GROUP ELEMENT EVEN = DICOM ODD = PRIVATE

9 IOD structure patient Module Information Entity General Study General Series Patient Study Frame of reference General equipment General Image Image Plane Contrast Bolus Image Pixel Image Overlay Plane VOI LUT SOP Common 9

10 DICOM infostructure SOP Class Service Object (IOD) Information entities Module Sequence Tag

11 SOP classes, mammo Digital Mammography X-Ray Image Storage- For Presentation/Processing Mammography CAD SR Storage Breast Tomosynthesis Image Storage Breast Projection X-Ray Image Storage - For Presentation/Processing

12 DICOM tags: DBT

13 DICOM tags: DBT (middle)

14 DICOM tags: DBT (bottom)

15 Private tags Typically carry some proprietary metadata Otherwise «normal» DICOM data, as mobile Can be added by modality or downstream In some cases, complementary image data, ex. echocardio «raw» data More extreme, carries and conceals the main function of the image data, ex. tomosynthesis

16 Private tags: SCO

17 17 Association negatiation

18 18 To store one image

19 Compression Lossless: compression-decompression results in the exact same matrix as originally Lossy: not Ratio: 2-5 lossless, 10+, lossy Despite efforts, lossy has not real acceptance classes can be supported as SCU, SCP, or both DICOM transport accomodates compression through choice of transfer syntax

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21 DICOM conformance Evaluated using a DICOM conformance statement (DCS): compulsory document SOP classes supported in the most important element Role (SCU or SCP) is typically expected Harder to drill further down, more easily done via IHE conformance

22 22 Table of content of DICOM DCS

23 DICOM tools DICOM header viewer: ex. Rubo Basic viewer, many free TCP port tester, ex. scanport Anonymizer, many free TCP/IP sniffer and DICOM protocol decoder, Wireshark

24 HL7 Main protocol in hospitals ADT (demo and encounters), orders, results, scheduling Used by RIS and PACS

25 Exemple de message MSH ^~\& CLINA ABCD ADT^A03 MSGID1048 P 2.4<cr> EVN A <cr> PID ^7^M11 TREMBLAY^PIERRE^A^SR Y <cr> PV1 I<cr> PDA Y ^WELBY^MARCUS^R^^DR<cr> 25

26 Integrating the health care enterprise (IHE) Aims at supporting enterprise workflow with interoperability between systems (actors) Workflow expressed in terms of different uses cases Achieves interoperability using existing protocols (DICOM, HL7 ) but not a protocol Proposes sequencing of communication, coercing of transactions, software behavior

27 IHE building blocks Domain: clinical activity Integration profile: type of workflow targeted for improvement Actors: participating clinical systems Transactions:

28 Other IHE domains Cardiology Pathology/laboratory Infrastructure Radiation oncology Eye care Dental Pharmacy.

29 IHE infostructure Integration profile (IP) IHE domain Radiology Digital Breast Tomosynthesis (DBT) Actors (ch 1) Mammography unit Transactions (ch 2 and 3) RAD-16 Description (ch 1) Use cases Options Projection images. Software behavior Calculation of distance DICOM+ constraints Use of image

30 Assembling a profile System 1 Actor Actor System 2 Actor Actor Actor Profile X Actor System 3

31 Mammo image IP Evidence creator Image display Storage commitment [10] Evidence document stored [43] Image manager Modality images stored [8] Image archive Storage commitment [10] Query images [14] Retrieve images [16] Query evidence documents [44] Retrieve evidence documents [45] Acquisition modality

32 Radiology mammo profiles Mammography image (MAMMO) Stereotactic mammography image (SMI) Digital breast tomosynthesis (DBT) Mammography acquisition workflow (MAWF)

33 Digital breast tomosynthesis BT SOP class has been around for 7 or 8 years With DBT profile, BT SOP class will be used for: Actual tomo stack Slab images (MIP or mean) Generated 2D images With DBT profile, the new BP SOP class is used for «raw» tomo images stack, as DBT option Opens door to outsourcing of reconstruction

34 2 other profiles of interest

35 Consistant presentation of images (CPI) Supports storage of markups and other image transformations In mammography, ROI s are of particular interest Screening centers: produce GSPS, diagnostic center must display them Also specify need for viewing on calibrated monitors with grayscale display function (GSDF)

36 Radiation exposure monitoring Incresingly supported (REM) Bears considerable potential to physicist work Could bring other dimension to radiation dose assessment and control

37 IHE conformance «IHE integration statement» Describes the actors supported by the system for each supported profile Provides the options supported by the system for each actor or each profile Tested during connectathons, see IHE registry Often software version dependant

38 IHE integration statement IHE INTEGRATION STATEMENT IHE Integration Statement Date 01 Jan 2014 Vendor Product Name Version Super vendor Super mammo 1.2.x.x This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below: Integration Profiles Implemented Actors Implemented Options Implemented Scheduled Workflow Image Display None Access to Radiology Information Image Display None Consistent Time Time Client None Consistent Presentation of Images Print Composer None Mammography Acquisition Workflow Evidence Creator None Image Display Partial View Print Composer None Mammography Image Evidence Document Image Display None Portable Data for Imaging Portable Media Creator Portable Media Importer Image Display Print Composer None None None None

39 Storage DBT increases storage consumption Projection images should generally be avoided

40 PACS and mammography PACS supports «Image display» and Image manager/archive actors of MAMMO Same for other breast imaging profiles, or at least for the DICOM part (quickly evolving) 2 x 5+ megapixel displays, or 10+ megapixel displays RIS integration for visualising external forms Supports CPI and REM

41 Other integration issues Antivirus exclusions Patient health information acquisition and storage Access security

42 Conclusion Modality technology hand in hand with IT IT integration integral part of realizing benefits Physicists mastery of it is key the evolution of the profession