Benefits of the DICOM modality performed procedure step

Development and Implementation of a Semi-Automated Workflow for Point-of-Care Ultrasound Billing and Documentation Within an Electronic Health Record

Point-of-care ultrasound (POCUS) is widely used for both diagnostic and therapeutic purposes. With its many advantages, including ease of use, real-time multisystem assessment, affordability, availability, and accuracy, it has been adopted by all medical specialties. Despite its advantages, the lack of standard workflow and automated billing solutions makes it difficult to launch a comprehensive POCUS program. In this work, we describe how we created and implemented an efficient standardized EHR-based workflow for POCUS that has been used across multiple division and settings within our organization.

AUTOMATIC ACQUISITION OF CT RADIATION DOSE DATA: USING THE DIAGNOSTIC REFERENCE LEVEL FOR RADIATION DOSE OPTIMIZATION

The present work describes that we try to construct a system that collects dose information that performed CT examination from multiple facilities and unified management. The results of analysis are compared with other National diagnostic reference level (DRL), and the results are fed back to each facility and the cause of the abnormal value is investigated for dose optimization. Medical information collected 139 144 tests from 33 CT devices in 13 facilities. Although the DRL of this study is lower than that of Japan DRL, it was higher than the DRL of each country. When collecting all the examination, it is thought that the variation of the dose due to the error other than the intended imaging site is large. In future, we should continue to collect information in order to DRL renewal and we also think that it is desirable to collect information on physique and detailed scan region as well.

Real-Time Patient Radiation Dose Monitoring System Used in a Large University Hospital

Radiation dose monitoring in medical imaging examination areas is mandatory for the reduction of patient radiation exposure. Recently, dose monitoring techniques that use digital imaging and communications in medicine (DICOM) dose structured reports (SR) have been introduced. The present paper discusses the setup of a radiation dose monitoring system based on DICOM data from university hospitals in Korea. This system utilizes the radiation dose data-archiving method of standard DICOM dose SR combined with a DICOM modality performed procedure step (MPPS). The analysis of dose data based on a method utilizing DICOM tag information is proposed herein. This method supports the display of dose data from non-dosimeter-attached X-ray equipment. This system tracks data from 62 pieces of equipment to analyze digital radiographic, mammographic, mobile radiographic, CT, PET-CT, angiographic, and fluorographic modalities.

Development of Diagnostic Reference Levels Using a Real-Time Radiation Dose Monitoring System at a Cardiovascular Center in Korea

Digital cardiovascular angiography accounts for a major portion of the radiation dose among the examinations performed at cardiovascular centres. However, dose-related information is neither monitored nor recorded systemically. This report concerns the construction of a radiation dose monitoring system based on digital imaging and communications in medicine (DICOM) data and its use at the cardiovascular centre of the University Hospitals in Korea. The dose information was analysed according to DICOM standards for a series of procedures, and the formulation of diagnostic reference levels (DRLs) at our cardiovascular centre represents the first of its kind in Korea. We determined a dose area product (DAP) DRL for coronary angiography of 75.6 Gy cm(2) and a fluoroscopic time DRL of 318.0 s. The DAP DRL for percutaneous transluminal coronary intervention was 213.3 Gy cm(2), and the DRL for fluoroscopic time was 1207.5 s.

Dose monitoring using the DICOM structured report: assessment of the relationship between cumulative radiation exposure and BMI in abdominal CT

AIM

To perform a systematic, large-scale analysis using the Digital Imaging and Communication in Medicine structured report (DICOM-SR) to assess the relationship between body mass index (BMI) and radiation exposure in abdominal CT.

MATERIALS AND METHODS

A retrospective analysis of DICOM-SR of 3121 abdominal CT examinations between April 2013 and March 2014 was performed. All examinations were conducted using a 128 row CT system. Patients (mean age 61 ± 15 years) were divided into five groups according to their BMI: group A <20 kg/m(2) (underweight), group B 20-25 kg/m(2) (normal weight), group C 25-30 kg/m(2) (overweight), group D 30-35 kg/m(2) (obese), and group E > 35 kg/m(2) (extremely obese). CT dose index (CTDIvol) and dose-length product (DLP) were compared between all groups and matched to national diagnostic reference values.

RESULTS

The mean CTDIvol and DLP were 5.4 ± 2.9 mGy and 243 ± 153 mGy.cm in group A, 6 ± 3.6 mGy and 264 ± 179 mGy.cm in group B, 7 ± 3.6 mGy and 320 ± 180 mGy.cm in group C, 8.1 ± 5.2 mGy and 375 ± 306 mGy.cm in group D, and 10 ± 8 mGy and 476 ± 403 mGy.cm in group E, respectively. Except for group A versus group B, CTDIvol and DLP differed significantly between all groups (p<0.05). Significantly more CTDIvol values exceeded national diagnostic reference values in groups D and E (2.1% and 6.3%) compared to group B (0.5%, p<0.05).

CONCLUSION

DICOM-SR is a comprehensive, fast, and reproducible way to analyse dose-related data at CT. It allows for automated evaluation of radiation dose in a large study population. Dose exposition is related to the patient's BMI and is increased by up to 96% for extremely obese patients undergoing abdominal CT.

[Construction and usefulness of the dose management system using DICOM radiation dose structured report (Dose SR) in angiography]

The International Commission on Radiological Protection recommends diagnostic reference levels (DRL) in each radiological examination for justification and optimization of patients' dose in medicine. The aim of our study was to propose the dose management system by utilizing dose information in diagnostic X-ray radiation dose structured report (Dose SR) in The Digital Imaging and Communications in Medicine to optimize radiation dose in institutions. Our dose management system is able to organize dose information obtained from various angiography systems and CTs. It is possible to provide this information to operators for justification and optimization of patient dose. Our system would be useful for the estimation of organ dose and could be used for the determination of local DRL (LDRL) for each radiological practice. In addition, the optimization became possible to compare LDRL with national DRL.

[Current reporting in radiology : what will happen tomorrow?]

CLINICAL/METHODICAL ISSUE

Reporting in radiology faces considerable changes in the near future that will be influenced by a broader understanding of the task and increasing technological possibilities.

STANDARD RADIOLOGICAL METHODS

Until now a radiological report could be regarded as a text phrased by a radiologist after viewing imaging data.

METHODICAL INNOVATIONS

New solutions will be accessed by advances in visualization of large datasets, in extracting, analyzing, and communicating metadata as well as by improved integration and interpretation of clinical information.

PERFORMANCE

Virtual reality, texture analysis, growing networks, semantic annotation, data mining and context based presentation have the potential to extensively change the everyday working routine.

ACHIEVEMENTS

Although many of these developments are still in a laboratory phase, the impact on the process of reporting can already be predicted.

PRACTICAL RECOMMENDATIONS

As the leading community in information analysis and technology, radiology as a subject should strive to lead and shape these impending changes.

[Registration and monitoring of radiation exposure from radiological imaging]

Strategies for reducing radiation exposure are an important part of optimizing medical imaging and therefore a relevant quality factor in radiology. Regarding the medical radiation exposure, computed tomography has a special relevance. The use of the integrating the healthcare enterprise (IHE) radiation exposure monitoring (REM) profile is the upcoming standard for organizing and collecting exposure data in radiology. Currently most installed base devices do not support this profile generating the required digital imaging and communication in medicine (DICOM) dose structured reporting (SR). For this reason different solutions had been developed to register dose exposure measurements without having the dose SR object.Registration and analysis of dose-related parameters is required for constantly optimizing examination protocols, especially computed tomography (CT) examinations based on the latest research results in order to minimize the individual radiation dose exposure from medical imaging according to the principle as low as reasonably achievable (ALARA).

Radiology interpretation process modeling

Information and communication technology in healthcare promises optimized patient care while ensuring efficiency and cost-effectiveness. However, the promised results are not yet achieved; the healthcare process requires analysis and radical redesign to achieve improvements in care quality and productivity. Healthcare process reengineering is thus necessary and involves modeling its workflow. Even though the healthcare process is very large and not very well modeled yet, its sub-processes can be modeled individually, providing fundamental pieces of the whole model. In this paper, we are interested in modeling the radiology interpretation process that results in generating a diagnostic radiology report. This radiology report is an important clinical element of the patient healthcare record and assists in healthcare decisions. We present the radiology interpretation process by identifying its boundaries and by positioning it on the large healthcare process map. Moreover, we discuss an information data model and identify roles, tasks and several information flows. Furthermore, we describe standard frameworks to enable radiology interpretation workflow implementations between heterogeneous systems.