RSNA 2013 - RC326 - Quantitative Imaging: A Revolution in Evolution (In Association with the Society for Imaging Informatics in Medicine)

Vendors provide easy tools to perform quantitative imaging but the question is how reliable and repeatable this quantification is. 

Many clinical examples can already be listed where quantitative imaging is used in clinical practice. Such as carotid stenosis, coronary artery stenosis, calcium scoring, pulmonary nodules, renal donor evaluation, liver and tumor volumetry, brain perfusion, emphysema quantification. 

Each of these show good results in literature and could be applied in clinical practice.

However, the question is whether the numbers we get out of the software are usefull and what is reality. Different vendors provide different results in the same patient and even within one software system measurements are influenced by postprocessing choices but also by decisions during the acquisiiton. 

One of the things that can be done to get proper quantification we should provide reference datasets.

QIBA is ran by a group of stakeholders to improve quantitative imaging. They define profiles to get precise, repeatable measurements. QIBA has setup a imaging data warehouse (QIDW) including standard datasets that can be used to validate quantitative imaging algorithm.

The QIDW is free, open source, modular software based on MIDAS.

In conclusion tagging of the image data in radiology is essential to allow computers to work with the information. The quantification is part of this tagging. Developments like AIM are trying to cover this and allow export in XML or DICOM SR, however current PACSs and EMRs do not yet support these kind of measurement. When the storage and data mining of all the information available in the images becomes possible it will provide the key information to get to personalized diagnosis and treatment.

RSNA 2013 - ICIA24 - using IHE profiles to plan for medical imaging

Top five forces to medical imaging are defined to be:

1. Cost reduction

2. Daunting PACS migration

3. Silos of imaging sources

4. Complexity of effective image sharing

5. Leverage health IT best practices

The road to effective image sharing by implementing Vendor Neutral Archive (VNA) taking care of access consolidation. Access consolidation requirements are:

1. Integrated clinical systems

2. Portability

3. Scalable

4. Extensible

5. Content accessible

IHE profiles are there to break the vendor neutral consolidation barriers.

IHE XDS provides the profiles to allow content (vendor) neutral archive. Several profiles are defined to describe the required capabilities within an XDS affinity domain such as PIX (patient identity cross referencing) , BPPC (basic patient privacy and concent) and XUA (cross enterprise user authentication).

The XDS environment can be setup as a federated, centralized or hybrid environment.

RSNA 2013 - ICII23 - 3D printing: bridging the gap between theory and practice

In an interesting session the prerequistes for 3D printing were shown as well as an overview of the available techniques for 3d printing. One clear message was that the integration into the normal workflow is not achieved as of yet. Furthermore, reimbursement of 3D printing is not available yet thus hampering its wide scale application.

Basically great potential was show for 3d printing in education, training, intervention planning, and evalution using patient specific phantoms for for example flow measurement. Although 3d printing is not yet into mainstream in radiology and medicine the near future will show an increased use of this new feature.

RSNA 2013 - VSIN21 - radiology informatics series: mobile computing devices

Mobile is the single largest disruptive technology for the next decade. While desktop PCs are reducing in number the number of tablets is rising steadily. The number of smartphones is exploding right now showing an enormous increase (half of the facebook users are mobille only).

Eighty percent of smartphones shipped today are running android. This shows that android is starting to takeover apple iOS. This is also shown in tablets where android is also more sold nowadays than the iPad while the iPad currently still is the most used tablet based on network traffic measurements.

In terms of security, android shows a higher number of malware apps than apple iOS. Also in terms of enterprise security policies, VPN handling, etc, iOS is way ahead of android with for example enterprise single sign on and VPN per app.

The iOS first approach to develop an app seems to be the way to go in radiology because of the wider acceptance and use of apple devices.

To develop an app the steps to take are identify concept, user interface design, programming, construct app, and finally polish the app.

RSNA 2013 - RC126 - Health IT tools to Improve quality and safety in radiology

A crucial point in quality metrics is the choice of the right measures. These measures should be selected such that they can be used to identify problems, not making the department look good. Metrics that are repeatedly in range should be droppen since they are not providing information to improven. The national quality forum can help to identify the radiology measures for quality. However they only include 2 dedicated radiology metrics.

Employee engagement is very important to succesfully improve quality. An example was given showing that metrics were used to stimulate radiologists to meet them by connecting the number of metrics met to a financial reward. This worked remarkably showing a much better quality performance after this reward was implemented.

Another vital part of quality improvement is root cause analysis. Just recording problems and fixing them does not improve quality, taking the time to get to the root cause and solving it does.

RSNA 2013 Preview

We are presenting a number of posters and orals from our group at the RSNA 2013 in Chicago later this year. Some of the topics made it to Auntminnie.

Check out the coverage at the AuntMinnie website:

Caution should be used with DICOM data deidentification

and

Before migrating your PACS, do a test run

HIMSS Europe 2013 Amsterdam - Closing Keynote: Assessing and AdvancingEHR System Usability

Zariukian stated usability to be an underexposed topic in HealthIT. Form, fit and function are important in usability. Form is the shape, size, mass, the 'look' of a product. Fit is ability physically interface, connect, integrate. Function is the action the product is designed to perform. Usability affects how we think, feel and act. By examples and backgrounds, Zaroukian clearly showed the importance of usability to get HealthIT accepted and used both by patients and professionals. With good usability It is easier to do the thing right and it is easier to do the right thing. The meaningfull use projects in he US has shown a struggle of physicians to use EHRs requiring extensive training. Specific problems were system wait times for busy clinicians and new abilities that seemed to be "bolted on" and not integrated properly. 

HIMSS published a document on usabilty of the EMR in 2009, accessible at 

http://www.himss.org/files/HIMSSorg/content/files/himss_definingandtestingemrusability.pdf

Below you can find the official information and abstract from the program

Closing Keynote: Assessing and Advancing EHR System Usability

Michael H. Zaroukian, MD, PhD, FACP, FHIMSS Vice President and CMIO, Sparrow Health System

Abstract
Physicians, nurses and other clinicians are responsible for gathering, recording, analyzing and acting on health information in electronic health record (EHR) systems. Assessing and advancing EHR usability is important to clinician productivity, satisfaction and best use of clinical information systems to improve healthcare quality, safety, efficiency and value. In the closing keynote, a HIMSS Board member and practicing physician informaticist, will give his perspective on EHR usability challenges and opportunities, as well as strategies and tools for evaluating and improving the usability of EHR systems.

HIMSS Europe 2013 Amsterdam - SA7: Update and New Developments on IHE

Parisot presented in the update and new developments of IHE. One of the main messages from his presentation was that interoperability will never be turnkey magic, but always involve hard work. IHE is growing into new domains, new paradigms, adoption at national and regional level, enhancing deployment support, benefits for profile based interoperablity better understood. The challenge in getting IHE working is not in the writing of the profiles and produce the corresponding documents but in the deployment and use of the profiles. To support this open source test tooling (Gazelle) is available from IHE to test for IHE profiles and setup quality management for test plans. The tools are available for eHealth projects and vendors through IHE services.

Parisot also stated that the mobile world poses a large problem that every app is a silo on itself resulting in thousands of apps that can be used by the patient that are not connected and do not allow data sharing. Therefore, patients will have to use tens of apps to get all their required information. IHE is developing IHE profiles for mHealth to have app compatibility such that the user can choose te app and connect to required hospitals and other healthcare providers (IHE-MHD profile). Mhealth = IHE + HL7 + DICOM. A major challenge here is still authentication and determination of the identity of the user. 

 below you can find the official information and abstract from the programme

SA7: Update and New Developments on IHE

New Developments in IHE: Mobile Health, Device Connectivity and eHealth Projects Services

Charles Parisot, Manager Architecture and Standards, IHE Europe Stearing Committee, France

Abstract
Integrating the Healthcare Enterprise has established a solid reputation in providing standards-based interoperability specification, IHE profiles that are proven, tested at Connectathon and widely adopted by the market and eHealth projects around the world. This presentation will provide an overall update of IHE profiles adoption world-wide, focusing on the recent profiles targeting specifically mobile Health, and home and hospital medical devices interoperability. It will conclude with the increased attention by IHE to offer its open interoperability test tools along with supporting services that greatly facilitate hospital and regional eHealth project deployment.

HIMSS Europe 2013 Amsterdam - SA6: Success Story from IHE Netherlands

Cross enterprise document sharing (XDS) in the Neterlands is discussed. Some exmples of possible pitfalls and problems based on experience in both regional and national (screening) infrastructures are:

Problem: lost documents because of discrepency in descriptions and lack of uniformity

Solution: standarization in coding (SNOMED, ICD-10) resulting in a Dutch standard metadataset. Role codes are also standardized.

Problem: security and privacy

Solution: ATNA secure node actor or secure application actor. Timestamp consistency

Problem: how to deal with patient consent?

Solution: no definite solution yet, ongoing discussion

Below the official information and abstracts are provided below

SA6: Success Story from IHE Netherlands

XDS in the Netherlands: Possibilities and Experiences of Implementing Cross-Institutional Collaboration

Piet-Hein Zwaal, Partner, Medical PHIT, The Netherlands

Abstract
IHE Cross-Enterprise Document Sharing (XDS) allows authorized health care providers to electronically collect, store, manage, distribute and view patient documents, reports and images entirely in digital format. XDS networks are the building blocks that facilitate sharing and make the information an integral part of longitudinal patient records regardless of where the images or reports are acquired or created.

Several diagnostic imaging & document XDS deployments has been carried out in the Netherlands. These networks are separated into two different groups. The first group is the regional sharing of documents and images for patients between hospitals. The second group is the XDS infrastructures, which support the Dutch screening operations. Experiences of setting up 4 networks will be discussed.

All the Dutch projects involved the integration of different EHR, Picture Archiving and Communication Systems.

In implementing the different XDS networks, obstacles were found along the way. Some of them were technological in nature, and could be addressed directly. However, it was found that many obstacles are a mix of organisational and technical reasons.

This talk will explain the implementation outcomes and successful steps in realising XDS networks. One of those steps can be lowering the technical barriers and organisational barriers to starting with a focused use-case. Another could be starting with less interoperability from the beginning only to facilitate the organisational cooperation. Also new re-use and possibilities of combining XDS networks will be discussed.

HIMSS Europe 2013 Amsterdam - SA5: Success Story IHE France

The presentation showed that getting to a national personal health record is a long term project that took years of preparation and experimenting (started in 2002). The health records is nationwide and products can obtain a compatibility certificate when they are proven to connect to the central system properly. The architecture of the personal health record is based on IHE profiles. The compatibilty certification has three levels: create, read and write. 123 IT products are already compatible with the system (including EMR, IHE interface, ambulatory physician softwares, lab information systems).

Both patients and healthcare providers have a smartcard allowing access to the sytem for identification and authentication. Patients have an internet account with a single use password deliverd to their mobile phone to access their own data.

In France, the DMP account is optional for the patient. It will be created together with a healthcare provider. The patient grants permission for access by physicians, departments or institutions. All information is available to the patient but it is possible to lock certain information until after a certain event. For example, if bad news is included in a report, the report can be blocked until after a personal consult with the patient.

By now about 380,000 patients have a record which is still modest but shows a steady growth. This modest usage is partly explained by the fact that no public marketing campain was undertaken yet.

Below, the official information and abstract from the program are provided

SA5: Success Story IHE France

The French PHR: The Creation, Usage and Lessons Learnt With a National e-Health Record

Francois Macary, Responsible for Semantic Interoperability, ASIP Santé, France

Abstract
This presentation summarizes the different steps in the national Personal Health Record project (DMP in French stands for PHR): regulation and legal adaptations, standardization activities, design of the framework, build of the solution, promotion and support towards healthcare providers and health IT vendors, certification of the interoperability of Health IT solutions. The presentation shows the interactions that this project has had back and forth with IHE all along the way, and draws some lessons and perspectives for the future.