Key Image Notes

Integration Profile

Charles Parisot
GE Medical Systems IT
Planning and Technical Radiology Committees
 IHE Integration profiles
Scheduled Workflow
Patient Charge
Informa- Posting
-
tion
Reconci- Presentation Post- Reporting
liation of Grouped Processing
Workflow
, Procedures Workflow

Key Image Simple

Consistent
Evidence Notes Image and
Presentation
Documents Numeric
of Images
Reports

Access to Radiology Information

Basic Security
HIMSS/RSNA April 2003 Workshop
The radiologist selects
Key Images, and creates
appropriate Notes.
Note 1:
for refering physician
In this image you can
see the renal rupture.
Note 2:
for refering physician
In this image you can
see the hematoma.
HIMSS/RSNA April 2003 Workshop
The referring physician
views the Key Image Note
prepared by radiologist.
Note 1: Note 2:
for refering physician for refering physician
In this image you can In this image you can
see the renal rupture. see the hematoma.
Results in improved
communication between
the radiologist and the
referring physician
The radiologist selects The referring physician
Key Images, and creates views the Key Image Note
appropriate Notes. prepared by radiologist.
Note 3:
Note 3:
for refering physician
for refering physician In this image you can
Hematoma everywhere see the hematoma.

Results in improved
communication between
the radiologist and the
HIMSS/RSNA April 2003 Workshop
referring physician
 Key Image Notes
 There is more to teamwork than images and reports
 With IHE, it is possible to attach « electronic post-it notes»
to images to increase informal but critical communication
between:
– The Technologist and the Radiologist about specific examination events
– The Radiologist and the Technologist about image quality issues
– The Radiologist and other department clinicians (surgeon, orthopedist,..)
– The Radiologist and colleagues about selection of images for conferences
– The Radiologist to the Referring Physician, …..etc.

Key Image Note Integration Profile provides a simple but

cost effective communication mechanism

HIMSS/RSNA April 2003 Workshop

 Technical Overview
 Key Image Note Transactions

 Key Image Note Actor Requirements

 Use of DICOM Key Object Selection

Document

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KIN Participates in the Scheduled Workflow
Order Filler

6: Modality PPS in Progress 4: Procedure Scheduled

7: Modality PPS Completed 11: Image Availability Query
20: Creator PPS in Progress 12: Patient Update
21: Creator PPS Completed 13: Procedure Update

Image Creator Image Display

20: Creator PPS in Progress
21: Creator PPS Completed
Storage 18: Creator Image Stored 14: Query Images
Performed Commitment: 10 19: Creator Pres. State Stored 15: Query Pres. States
Procedure Step 29: Store Key Image Notes 16: Retrieve Images
Manager 17: Retrieve Pres. States
30: Query Key Image Notes
Image Image 31: Retrieve Key Image Notes
Manager Archive
6: Modality PPS in Progress
7: Modality PPS Completed
20: Creator PPS in Progress
21: Creator PPS Completed 8: Modality Image Stored
9: Modality Pres. State Stored
Storage 29: Store Key Image Notes
Commitment: 10
6: Modality PPS in Progress
7: Modality PPS Completed
Acquisition
Acquisition
Modality
5: Modality Worklist Modality
HIMSS/RSNA
Provided April 2003 Workshop
 Acquisition Modality and
Image Creator
 A Key Image Note references one or more images
 In a Key Image Note, each image reference may also include a
Presentation State.
 A Key Image Note is created as a DICOM Key Object Selection
object. It contains:
 A Coded Title
 An optional user comment
 References to one or more objects (IHE applies it only to images)
 The Key Object Selection object belongs with the same DICOM
study as the images it references. It is not required by IHE to
support referencing of images outside of the study.
 IHE Scheduled Workflow rules may be applied to Key Image
Notes (managed by worklist, storage commitment, PPS, etc.)

HIMSS/RSNA April 2003 Workshop

 Key Image Notes Titles
Defined by DICOM Supplement 59. May be extended
The note title Context ID 7010 – Key Object Selection Document
defines the TitleCoding Scheme Code Value
semantics of Designator Code Meanings
DCM 113000 Of Interest
the reason of DCM 113001 Rejected for Quality Reasons
significance. DCM 113002 For Referring Provider
Notes can be DCM 113003 For Surgery

queried by DCM 113004 For Teaching

DCM 113005 For Conference
code.
DCM 113006 For Therapy
The user DCM 113007 For Patient

comments are DCM 113008 For Peer Review

DCM 113009 For Research
meant to be
DCM 113010 Quality Issue
informal.
HIMSS/RSNA April 2003 Workshop
 Image Display
 Provides user interface to view images « flagged »
by Key Image Notes (with optional creator
comments).
 Applies a Presentation State if one is referenced
along with image referenced when note is viewed.
 Allows user to select Key Image Notes from an
Image Archive Actor via DICOM Query/Retrieve
mechanisms (subset of keys used to query
reports).
 Supports DICOM Key Object Selection Storage

HIMSS/RSNA April 2003 Workshop

 Key Image Note Is Managed Like Any
Other Object
Patient ID
Patient
Information

Study
Study Inst. UID
Information

Series Inst. UID

Series Series Series Series
Information Information Information Information

SOP Inst. UID

Image Presentation Key Object Other
State Selection Composite IODs

Key Object Selection placed in "KO" Series

in the same Study

HIMSS/RSNA April 2003 Workshop

 Key Image Notes Query Keys
Attribute Name Tag Query Keys Matching Query Keys Return
SCU SCP SCU SCP
Content Date (0008,0023) O O O R+
Content Time (0008,0033) O O O R+
Observation DateTime (0040,A032) O O O R+
Referenced Request Sequence (0040,A370) O O R+ R+
>Study Instance UID (0020,000D) O O R+* R+
>Accession Number (0008,0050) O O R+ R+
>Requested Procedure ID (0040,1000) O O R+ R+
>Requested Procedure Code (0032,1064) O O O R+
Sequence
>>Code Value (0008,0100) O O O R+
>>Coding Scheme Designator (0008,0102) O O O R+
>>Coding Scheme Version (0008,0103) O O O R+
>>Code Meaning (0008,0104) O O O R+
Concept Name Code Sequence (0040,A043) R+ R+ R+ R+
>Code Value (0008,0100) R+ R+ R+ R+
>Coding Scheme Designator (0008,0102) R+ R+ R+ R+
>Coding Scheme Version (0008,0103) O O O R+
>Code Meaning (0008,0104) O O R+ R+

HIMSS/RSNA April 2003 Workshop

 IHE Key Image Notes
 Fits within the normal
DICOM structure
 Like GSPS, a separate
object associated with
images
 Very Simple SR
structure
The way to perform informal but critical
communication associated with images
HIMSS/RSNA April 2003 Workshop
 Questions?
Documents Available On the Web at:

www.rsna.org/IHE

HIMSS/RSNA April 2003 Workshop