Imaging Technology News - January/February 2009 - (Page 20)

> > special report Imaging Loop continued from page 17 information throughput, not just what goes on in radiology. we’re doing in the radiology department is to look at total information throughput. The clock doesn’t start or stop in radiology, which a lot of these measures do. What good is it to have a patient scanned in two seconds if I don’t read the study for four hours? We have to look at the entire loop and optimize at every stage of the game and like I said the clock doesn’t start and stop in the radiology department. It starts when the physician first decides that imaging might contribute to the patient care and only ends when that same physician gets my report or some other message from me with the result that hopefully can contribute to patient management. The concept of the loop is that it begins not in radiology; the loop begins and ends with the patient. Closing that loop is the purpose of this project. The whole goal of this is to optimize the total Optimization focus ITN: What are some of the areas that need optimizing? Dr. Chang: The whole purpose of closed loop imaging is to optimize the entire sequence. For the first time, we will look at all parts of this imaging cycle. Not just the ones in the radiology reading rooms, not just the ones in the imaging suite, but the whole process. We have to improve the accuracy and quality of what we do. Another axis is safety: reducing dose and improving what we do with respect to contrast. Closed loop imaging will optimize the set up electronically – treating the scanners and injectors as IT devices driven by the protocoling tool. Bottlenecks ITN: The study is designed to remove inefficiency at all points within the imaging loop. What are some of the major bottlenecks and non-essential steps in the imaging loop? Dr. Chang: The initial bottlenecks in the past were in the reading room because of PACS, RIS and integration of speech recognition. Yet the real bottleneck within radiology is in the scanning area. A perfect example is protocol. Many of us use protocol sheets. To be optimal, you need two people to take that protocol sheet and do the right thing in the imaging suite — a radiologists who knows what needs to be done and who can communicate that to an engineer to set up the scanner. But we have neither of those people. We have a technologist who we expect to play the role of a radiologist and an engineer at the same time and translate that into the protocol of the scanner and the injector. This takes a very long time because there are so many parameters in an MR scanner or an injector. Sometimes we will simplify the protocol – instead of 20 things we could do, we’ll reduce it to three to reduce the complexity and the set-up time. The goal of the closed loop imaging trial is to have my cake and eat it too – I don’t care how complex a protocol is, it will get set up perfectly – both the injector and the scanner – and without negatively impacting efficiency. The only way to do this is to treat for the first time the modality as an IT device. For the first time we have to view the scanning devices themselves as IT devices that have to be integrated. So the system will automatically extract the lab values, the pathology reports, the history – not just get the requisition but get the clinical context from the EMR. Not requiring me to go to the EMR directly – it gives me a Web page that says here are the cases that need to be protocoled, here is the information right at my fingertips to allow me to use the right protocol. Step two, identify the patient. The technologist is wasting time trying to identify the patient. So when the patient comes in with an RFID tag, the patient is automatically identified, the scanner automatically knows who it is, automatically checks the electronic protocol, and transmits that protocol in a language that the scanner and injector can understand natively – and set itself up. Now the technologist doesn’t have to do the busy work. So one of the aspects of this closed loop imaging is to optimize the set-up electronically – treating the scanners and injectors as IT devices driven by the protocoling tool. The closed imaging loop will include Medrad and their contrast injector system. They have all Web services. ITN: What other steps will be automated? Dr. Chang: Another step involves automating the postacquisition workflow. The technologist is spending many minutes Cardiology PACS Integration Can Be Seamless Successful Integration is ‘System Critical’ setting up the postacquisition workflow – getting the thin slices set up, then manually pushing to 3D workstations. The more time that takes means we can’t scan the next patient, throughput is negatively impacted and it also increases the risk of error. The next step is to build integrated coordination to allow the sufficient provisioning of resources, not just in the scanning suite but improve the overall coordination. We have to have a more efficient view of the overall operational coordination of who we scan or how we scan them. We need to give to the technologist or supervisor a tool or dashboard that lists all of our inpatients, and all of our outpatients, and then when we select that patient it automatically knows 15 minutes into the study to call for the next patient, call for transport, have the patient in the waiting room to start taking contrast. Another part of this closed loop imaging initiative is to enhance the kinds of synchronous and asynchronous mechanisms we have to communicate to doctors. An asynchronous tool is a text messaging or tickler files that automatically notify the physician when there is an urgent result. We want systems to make sure there is a safety net. That’s basically closed loop imaging. We have to take a total view of what goes on in radiology. We have to improve the bottlenecks, the bottlenecks in the scanning suite, the bottlenecks in communication, the bottlenecks in how to order. Join us on February 19th, 2009 at 10:00 a.m. - 10:45 a.m. CST Register on ITNonline.net Today! Radiology PACS vendors are offering socalled integrated solutions. However, this integration will not necessarily always go as smoothly as expected. Who Should Attend: If you are considering purchasing a cardiology PACS or integrating a cardiology system with an existing radiology PACS, don’t miss this ‘system critical’ Webcast. Faculty: Christopher Oropeza, Enterprise Imaging Administrator, The Heart Hospital Baylor Plano Richard Sanders, RN, Cath Lab Manager, The Heart Hospital Baylor Plano Lori Crissup, RN, Cardiology IT Specialist, The Heart Hospital Baylor Plano Moderator: Herman Oosterwijk, President of OTech and renowned PACS Consultant and Trainer Building on SOA ITN: What healthcare language or standard will be used? Dr. Chang: We have chosen for the first step to use the DICOM modality list because you have the provision to send the protocol. It is intensely under-leveraged. We have seen in our initial results, in order to drill down and improve the efficiency of the set-up automatically, we need to give the scanner more detail. So we are using service-oriented architecture (SOA) and Web services to do the same thing, and Philips has that architecture. That is one of the differentiating features Philips provides. Here’s why I’m an advocate of SOA. In the world of SOA, view it as an organism. What we are building is a workflow engine that can take as services and orchestrate this complexity. If I got an RFID signal that a patient just came through the scanner, that information is sent to the scanner, the protocoler and the injector. ITN: Is that why PACS will turn into a service? Dr. Chang: Exactly. Everything is a service. So the first step is to expose everyone of these resources: PACS, 3D, modalities, RIS, EMR, CPOE, all of these things, as services. Web-services is the spinal chord and SOA is the brain. That’s what closed loop imaging is based on – SOA. Closed loop imaging is an ongoing methodology that looks at the entire loop to improve efficiency, while optimizing quality and while optimizing safety – we have to have our cake and eat it too. special report > J a n / F e b 2 0 0 9 http://new.reillycomm.com/imaging/special-report-b.php http://www.ITNonline.net http://www.ITNonline.net

Table of Contents Feed for the Digital Edition of Imaging Technology News - January/February 2009

Imaging Technology News - January/February 2009 Contents IMRT Imaging RT Solutions for Troublesome Tumors PACS Radiology to Close the Imaging Loop Will Web-Based PACS Take Over? Is CT Dose Under Control? The Best in Digital Mammography Breast Biopsy Systems MX Series Monitors Provide University of Pennsylvania Quality Assurance Reduce Waste to Raise Revenue

Imaging Technology News - January/February 2009

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