RSNA: Vendor Neutral Archiving

One of the buzzwords on the RSNA that many companies are using is VNA (Vendor Neutral Archiving). With vendor neutral archiving, the storage is taken care off in a cloud oriented architecture. Any image can be stored into the VNA secure and consolidated regardless of the vendor of the data producing entity (e.g. A PACS).
Advantages can be found in easy sharing of images between healthcare institutes, but also in the fact that PACS replacement can be achieven easier since all data is available in the VNA.

A whitepaper on VNA is availble from Carestream Health

RSNA: iPad for review... But is it calibrated?

During this RSNA again a lot of vendors are showing iPad based viewing of medical imaging. In most cases advocated to be for review only and not for primary diagnosis. However, even for review the quality of the images displayed should be uncompromised. However, internal setting of the level of backlight of the iPad itself and external light sources heavily influence the quality of the image displayed.

BARCO has developed a calibration tool for the iPad called Medical QAWeb Mobile which allows a visual callibration and QA of tablets used for medical imaging viewing. A demo version can be downloaded from the Apple iTunes store. It basically involves tapping a couple of shapes on the screen to determine visibility of certain greylevels.

RSNA: IHE Image Sharing Demo

During RSNA, the IHE has an image sharing demo demonstrating the application of IHE profiles with a large number of different vendors that connect to each other and RSNA software.

In this demonstration they show how IHE can be employed to enhance clincal care by sharing information under patient control using personal health records. Doing this improves radiation safety and facilitates radiological research and aducation by appropriate sharing of images and related data.

Implementing the IHE profiles should also reduce costs by eliminating the need of publishing paper and CDs or DVDs both for patient care and clinical research.

For links to the documentation related to this demonstration see my earlier, pre-RSNA post on this topic.

RSNA: Radiology reporting

The RSNA informatics group is standardizing radiology reporting by making a report template library. this uses expert consensus, standard formats, rich functionality and all in XML. Their aim is to provide these templates on a webpage where a radiologist can visit an 'online shop' with macros, select the templates of interest and put them in a shopping cart. Subsequently, the templates can be downloaded and used in the local speach recognition system.

Using this a more consistent reporting can be achieved and reporting speed increases with effective macros.

The full database now contains over 140 templates that are freely available in text and XML.

RSNA: Decoding the Alphabet Soup

The RSNA is involved in many informatics activities and projects including IHE, MIRC, and RadLex. During this session more information on these activities is provided.

The tools are all developed part of the RSNA and freely available from the RSNA website.

MIRC is the RSNA teaching file system. Besides the system itself, the MIRC workgroup also developed other tools. CTP (clinical trial processor) can be used for data transfer for clinical trials including high level anonymization and firewall penetration.

A new, 2011, version of MIRC was shown which includes a rewrite of the software and also has a new and improved interface. One of the new possibilities are the 'shopping cart' to select cases for conferences.

RadLex is an encoding system which is complementing the existing coding systems including radiology oriented terms. In RadLex imaging methods (playbook) and diagnosis are included. The first version of the playbook for CT was launched this RSNA.

RSNA: Practical Informatics for the Practicing Radiologist

This session was organized in conjunction with the Society for Imaging Informatics in Medicine (SIIM).

Keith Dreyer presented on meaningful use where the transition has to be made from a department centered EHr to a patient centered EHR with acces to any information of a patient from any location. Driving forces are consumerism with technology advances and the informed patients, but also economics where the demand is on decrease of healthcare costs. In radiology this means either reducing the cost of imaging or reducing the amount of imaging. A third driving force is quality (image intepretation and report, image access).

The thing that is wrong with a RIS is that it is departmental centric, the RIS should be fully integrated with the EHR. Interaction with requesting physicians and patients must be improved.

In PACS the trends are towards Vendor Neutral Archive (VNA) with standards based archiving and cloud storage. Image display should move to storage independent web/mobile access. Image management should not focus on PACS or RIS based but patient centric.

New technologies that are playing a major role in future radiology informatics are:

• Cloud computing
• Mobile computing
• Healthcare innovations (clinical decision support, personal health records)

RSNA: Improving resident report evaluation by web-based integration into the attending sign-off process

A group from New York presented on a system to improve the learning of residents. They stated that many times, the residents write a report, but one on one review with their supervisor is not always possible. The resident will see the supervisors corrections later on which decreases the learning value. They developed a seperatentool into their reading process adding a simple form for the supervisor to identify whether there were changes or not and somenmore details what was changed and what the consequences would be. This does not only provide more information for the residents but it also gives insight in the strengths and weaknesses of specific residents. A very interesting and valuable development.

Another group from Philadelphia did a similar study. However they provided the residents with a text changes comparison tool with their own report and the supervisors report. In these report the changes are marked. Residents can look at their last 100 report in a side by side comparison. This group also implemented a feedback form into thei PACS. This form is used by the supervisor to comment on a preliminary report of a resident using a guided form. The resident will receive an e-mail with the comments and links to the report and data through PACS and RIS webviewers.

RSNA: Informatics Education and Research

A mixed session with very different presentations on informatics.

First presentation from Leipzig, Germany about CT guided tumour ablation. A consortium of institutions developed a patient specific liver tumor ablation simulation. Clinical evaluation still has to be performed.

Next two presentations by our group from Groningen, the Netherlands on the use of the RSNA informatics tools in clinical studies and anonymization tools. One of these were also highlighted by AuntMinnie. Both studies show how to accurately implement anonymization into clinical setting.

Presentation four by a group from Baltimore, USA covered AIM and RadLex which should take care of standardization in clincal radiology reporting. Image base annotations are used to enable an intelligent atlas to facilitate the review of anatomy.

Other topics included were on reporting and e-learning. See the first link on this page for all presentations and abstracts of this session.

IHE Image sharing demonstration during RSNA

During RSNA from November 27 until December 2 of this year, the IHE organises several demonstrations on image sharing and other topics. The handout for the IHE image sharing demonstration can be found here. Detailed information about all the different demonstrations and activities on IHE and related initiativen from RSNA informatics can be found here.

German hospital achieves highest level of Electronic Patient Record according to HIMSS Analytics Europe

HIMSS Analytics Europe has granted level 7 of the european EMRAM (Electronic Medical Record Adoption Model) awards to the University Hospital Hamburg-Eppendorf in Germany. They are the first hospital in Europe to achieve this highest possible level. The hospital is running the electronic patient record Soarian of Siemens Healthcare. The European EMRAM model is a modified version of the American EMRAM adapted to the specific demands of European healthcare institutions. The German hospital achieved level 6 early 2011 and now they are at level 7. This level means that they not only work fully paperless internally, but that patient information is also exchanged digitally to other healthcare providers and insurance companies.

This achievement shows that the exchange of patient information is definately possible and should be advocated. Although a European report earlier this year showed that the exchange of data digitally between healthcare institutions is still far from widespread in the European Union, the trend is definately in this direction and hopefully examples like this will inspire decision makers and IT managers of other hospitals to 'dare' to go fully digital.

Also see the announcement in Zorgvisie (in Dutch): Zorgvisie - Duits ziekenhuis behaalt hoogste EPD-niveau met Soarian