1jens lien, ge vingmed ultrasound nov 11, 2004 medt8002 digital image storage patient workflow

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