Imaging Imaging Informatics Informatics • BioMedical Informatics • Imaging Informatics Richard H. Wiggins, III, MD, CIIP, FSIIM – PACS Department of Radiology, Otolaryngology, – SR Head and Neck Surgery, and BioMedical Informatics – RIS University of Utah Health Sciences Center Salt Lake City, Utah Imaging Informatics Imaging Informatics • Radiologist perspective • Radiologist perspective – What is important to the radiologist? – What is important to the radiologist? – What makes me more efficient? Imaging Informatics Imaging Informatics • BioMedical Informatics • Radiologist perspective • Imaging Informatics – What is important to the radiologist? – PACS – What makes me more efficient? – SR • PACS? – RIS • SR?
BioMedical Informatics Imaging Informatics • What is informatics? • What is informatics? – The study of the processes involved in the – The study of the processes involved in the collection, categorization, and distribution collection, categorization, and distribution of data, particularly with reference to of BioMedical data, particularly with computer data reference to computer BioMedical data BioMedical Informatics Methods, Techniques, and Theories Basic Research Public Bio- Imaging Clinical Health informatics Informatics Informatics Informatics Applied Research Imaging Informatics Imaging Informatics • Image generation • Image generation • Image management – Generating the images – Digitizing if necessary • Image manipulation • Image integration
Imaging Informatics Imaging Informatics • Image generation • Image generation • Image management • Image management – Storing • Image manipulation – Transmitting – Preprocessing – Displaying – Postprocessing – Retrieving – Organizing Imaging Informatics Radiologic Process • Image generation • Clinician desires radiologic study • Image management • Procedure requested and scheduled • Image manipulation • Procedure performed • Image integration • Radiologist reviews images – Combining images with other data • Radiologist creates report • Quality control and workflow monitoring • Continuing education and training SIIM 2015 Creating the Image Enabled Enterprise
SIIM 2015 SIIM 2015 Program was developed using the SIIM core knowledge domains Quality: Imaging Informatics Imaging Informatics • Image generation • Modalities – Plain Film • Image management • Conventional • Image manipulation Tomography • Fluoroscopy • Image integration • Angiography – Cross-sectional imaging • CT • MRI • USG – Nuclear medicine Imaging Informatics X-Rays • Neuroradiology • Discovered in 1895 – Wilhelm Conrad Roentgen • Cardiothoracic – Current caused fluorescent screen to • Gastrointestinal glow • Genitourinary • Similar to light and radio waves • Ultrasound – Electromagnetic radiation • Musculoskeletal – High energy and short wavelength • Pediatrics – Energy blocked by dense tissue • Bones – less energy passes through - • Interventional white • Woman’s imaging • Lungs – more energy passes through - black • Nuclear medicine
Plain Film Radiography Radiology Modalities • Computed radiography – 2048 X 2560 – 12 Bits / pixel – 2 Bytes / pixel – 10.5 MB / image Radiology Modalities Imaging Modalities • Digital Mammography • Digital Fluoroscopy – 3000 X 3000 – 1024 X 1024 – 16 Bits / pixel – 8 Bits / pixel – 2 Bytes / pixel – 1 Bytes / pixel – 20 - 40 MB / image – 1 MB / image Reconstruction Methods Radiology Modalities • Angiography – 1923 • Digital subtraction angiography (DSA) – Digital subtraction angiography (DSA) – 1024 X 1024 – 8 Bits / pixel – 1 Bytes / pixel – 1 MB / image
Reconstruction Methods Radiology Modalities • Computed Tomography – 1974 • Computed tomography (CT) – 512 X 512 – Hours to acquire a slice – 12 Bits / pixel – Days to reconstruct a single image – 2 Bytes / pixel – 0.5 MB / image Radiology Modality Radiology Modality • Magnetic resonance imaging (MRI) • Magnetic resonance imaging (MRI) – Intense, uniform magnetic field – Radiofrequency pulse – Nuclei return to original state – Emit detectable radiofrequency signal Radiology Modality Radiology Modality • Magnetic resonance imaging (MRI) • Nuclear Medicine – 512 X 512 – Radioactive isotope chemically attached – 16 Bits / pixel to biologically active compound – 2 Bytes / pixel – 0.5 MB / image
Radiology Modality Radiology Modality • Nuclear Medicine • Ultrasound – 128 X 128 – Echosonography – 8 Bits / pixel – High-frequency waves – 1 Byte / pixel – 2D images – 0.016 MB / image Higher Dimensionality Radiology Modality • Ultrasound • Ultrasound – 3D images – 512 X 512 – 8 Bits / pixel – 1 Bytes / pixel – .26 MB / image Image Parameters Image Parameters Bytes/ Images/ Modality Contrast Spatial Temporal Data/ Modality Pixels Data/Study Resolution Resolution Resolution Study Pixel Study CR 2048 X 2560 2 3 31.4 MB CR Low High Low 31.4 MB CT 512 X 512 2 100 52 MB CT High Moderate High 52 MB MRI 512 X 512 2 300 157 MB MRI High Moderate Moderate 157 MB USG 512 X 512 1 30 8 MB USG Low Moderate High 8 MB NM 128 X 128 1 30 0.5 MB NM Low Low Moderate 0.5 MB
Image Parameters Changes in Radiology? • Data overload – How many images reviewed per study? Modality Radiation Portability Physiology Cost • 1994 – 1,500 images/day CR Moderate Moderate No Moderate • 2002 – 16,000 images/day • 2006 – 80,000 images/day CT Moderate No No (Yes) High MRI None No (Low) Yes High USG None High No Low Moderate Moderate Yes Moderate NM Imaging Informatics Imaging Informatics • BioMedical Informatics • Image generation • Imaging Informatics • Image management – PACS • Image manipulation – SR • Image integration – RIS Image Management Image Management • Environmental Design for Viewing and • Environmental Design for Viewing and Interpreting Images Interpreting Images • The Human Computer Interface • The Human Computer Interface • Work Flow Processes that Ensure Data • Work Flow Processes that Ensure Data Integrity Integrity • Import and Export Images • Import and Export Images
Environmental Design for Ergonomics Viewing and Interpreting Images • Ergonomics • United States Department of Labor – Occupational Safety and Health • Environmental factors Administration • Room layout physical considerations Ergonomics Ergonomics • Good working positions – Neutral body positioning • Joints are naturally aligned • Reduces stress and strain • Reduces risk of musculoskeletal disorder https://www.osha.gov/SLTC/etools/computerworkstations/ Ergonomics Environmental Factors • Sitting still for long periods is bad • Lighting problems – Make small adjustments to position • Glare problems – Stretch • Ventilation problems – Get up and walk around
Environmental Factors Environmental Factors • Lighting problems: • Lighting problems: – Bright lights shining on PACS monitors – Bright light sources behind PACS monitors washes out images and increases eye strain creates contrast problems – Solutions: – Solutions: • Place lights parallel to line of sight • Blinds or drapes to eliminate bright outside light – Horizontal blinds for north/south windows • Install light diffusers • Supplemental light sources – CRT displays: 20 - 50 foot-candles of light – LCD monitors: 50 – 70 foot-candles of light Environmental Factors Environmental Factors • Lighting problems: • Lighting problems: – Bright light sources behind PACS monitors – Bright light sources behind PACS monitors creates contrast problems creates contrast problems – Solutions: – Solutions: • Blinds or drapes to eliminate bright outside light • Blinds or drapes to eliminate bright outside light – Horizontal blinds for north/south windows • Use indirect or light shielding – Vertical blinds for east/west windows Image Management The Human Computer Interface • Environmental Design for Viewing and • EMR/RIS/PACS/SR Interpreting Images • Usability • The Human Computer Interface • Key image selection and image annotation • Work Flow Processes that Ensure Data • Input devices Integrity • Display devices • Import and Export Images
Imaging Informatics PACS • BioMedical Informatics • Picture Archival and • Imaging Informatics Communications System – PACS – SR – RIS PACS PACS • Picture • Components – All types of medical images – Acquisition devices • CT, MRI, USG, digitizers • Archival – Networks – Short and long term storage with rapid – Display devices (monitors) retrieval – Storage devices (archives, servers) • Communications • Standards – Sending data between devices – Platforms and communication • Systems • DICOM, HL-7 – Multiple networked devices PACS PACS • Easier interpretation and comparison of • Fewer patient exam delays studies • Better report turnaround time • Faster and more accurate diagnosis for • Improved patient/physician satisfaction patients • Immediate access from any location to • Images enhanced and transmitted more comprehensive images and reports easily • Enhanced patient safety through process • Reduction in lost or misplaced films automation • Facilitation of timely remote peer consultation • Lower film and chemical costs • Higher radiology productivity • Decreased film storage space requirements
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