1jens lien, ge vingmed ultrasound nov 11, 2004 medt8002 digital image storage patient workflow
TRANSCRIPT
1 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
MEDT8002
Digital image storagePatient workflow
2 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Ditgital image storage – information
Standard image storage format: DICOM
> What does that mean?– Raw Data, Raw DICOM, Pure DICOM?– DICOM SR?
3 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
DICOM
DICOM: Digital Imaging and Communication in Medicine
> Global tandard for exchange of medical information between medical devices
> Continuously developed, organized by NEMA (http://medical.nema.org/)
> Four dimensions of DICOM:– DICOM for Image Management– DICOM for Network Image Transfer– DICOM for Network Printing– DICOM for Media Interchange/Archiving
> Covers all modalities (CT, MR, US, PET, X-Ray, …)
4 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
DICOM (cont.)
GE Ultrasound uses DICOM as a file format when storing images.
DICOM images are stored as pixel-data (i.e. what is displayed on screen)> Still flexibility related to encoding
– Color: Monochrome, Monocrhome2, Pallette, RGB and YBR
– Compression: none, RLE or JPEG
> Cardiac u/s images uses JPEG/YBR
5 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
DICOM (cont.)
Measurements/reporting is not a part of the DICOM file format.
> Has not been stored earlier
> New standard: DICOM SR. Supported for export by GE systems. No systems support import yet.
6 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Raw data
Data that are processed trough different calculation steps in order to generate the image on screen.
> not part of the DICOM standard,
> stored as private data elements in the DICOM file.
> DICOM file with raw data: “Raw DICOM”
> DICOM File without raw data: “Pure DICOM”
> Non-GE systems will ignore the raw data section.
7 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
• Basic measurements• Run/stop loop• Adjust replay framerate• Step frame by frame• Brightness / Contrast• Re-size• Annotations
Raw data – features with Pure DICOM
8 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
• Color on/off• High-quality zoom• Change colormap (flow and tissue)• TVI -> Strain -> Strain Rate Imaging ->Tracking• Variance on/off• Angle correct• Hor. Sweep (Doppler spectr. & M-Mode)• Baseline shift• Phys. Trace manipulation• Persistance• Velocity traces (from TVI)
Data size• Significant reduction of data size with raw data vs. bitmaps• Must use lossy compression for bitmaps, with some degradation of IQ• Even more significant for 3D/4D
Raw data – features with RawDICOM
9 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Dataflows
10 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Dataflows – overview
U/S Workflow•Patient record•Findings•Images •Volume sweep – 3D•Referrals •Billing
•Mostly DICOM in Rad/ OB
•No Standard in Card/ Raw Data
• Server, MiniPACS
Hospital IT•Patient data•Images/ PACS•Billing•Connection to other Hospitals, Image Centers, Clinics, Insurance, Suppliers
•HL7 interface U/S
WorkflowConnect to GE
& non-GE
CIS/RIS/PACSEnterprise Image Mgt
11 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
HIS
V7
Echo
Department
Hospital
Dicom Worklist
Dicom ServerHL7
HL7*
* Export excel file + report to HIS
12 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
HIS
V7
Echo
Department
Hospital
Dicom Server
Query/
Retrieve
HL7
* Images + SR(~60% of M&A)
Storage*
13 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
HIS
V7
Echo
Department
Hospital
Dicom Worklist
Dicom ServerHL7
HL7*
* EchoServer7, ImageVault3, ImageVault4
GE Server*
14 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
V7
Echo Children
Echo Adult
Department
* Server containing one or more image shares
Server*EPPC
V7
EchoServer
Server*Server*
Server*
15 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
V7
Echo Children
Echo Adult
Hospital
* Server containing one or more image shares
EPPC
V7
ImageVault4
EnterpriseServer
Department Workstation
16 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
V7
Echo
* Server containing one or more image shares
EPPC
Other Sacnner
EPPC, DICOM share
Department
17 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Connectivity Product Overview
Low-End
Small office /Dept.
Mid-Range
Echo only
High-End
Multi-ModalityHosp. Network
EchoPAC PC ShareEchoPAC PCSW-Only EchoPAC PC
Workstation
ImageVault 4.0EchoServer
EchoPAC PC
Vivid 7
Vivid 3
Vivid 4
Non-GE scanner
ImageVault 3.0
Vivid HL7 Gateway
HISHISHISHIS
PACSPACSPACSPACS
Vivid 7
XA, CT, MR, NMXA, CT, MR, NMXA, CT, MR, NMXA, CT, MR, NM
EchoPAC PC
AI1000 + DMS
WEB Browser
18 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
Workflows
19 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
End-user workflows
In-exam (V7)
> Protocol based, observations and measurement requirements
> Track observations (“notepad” with checkboxes)
> Guiding based on normal measurements
“Sonographers don’t want to report, but they make observations that directly creates statements.”
20 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
End-user workflows
Reading (EPPC, EPPC swo)
> Efficiency: “Minimize clicking, maximize overview”– See images and report/statements at the same time– Automate processes: “Stack of unread”, done reading
signoff (eg. HL7 export), patient locking– Easy access to trending data (images, measurements,
observations– Suggested statements based on
observations/measurements.-> Taylor as reading station
21 Jens Lien, GE Vingmed UltrasoundNov 11, 2004
End-user workflows
Back-end/admin (EPPC, EPPC swo)
> Secondary reports based on statements in report– Billing codes (ICD-9)– Accreditation (CPT)
> General data mining