Basic Image Review - Detailed Proposal

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1. Proposed Workitem: Basic Image Review Profile

  • Proposal Editor: Kevin O'Donnell
  • Editor: David Clunie
  • Domain: Radiology (incl. all image viewing subspecialties)

Summary

Functionality gaps, poor interfaces and excessive variability between basic image viewers is frustrating clinicians and obstructing patient care.

A Basic Image Review profile could require compliant image displays to support certain display behaviors and control capabilities.

AMA/ACR/ACC/AANS/AAOS have formally expressed their frustration and patient safety concerns on this issue to the imaging vendors represented by NEMA/MITA and went to the extent of developing a draft viewer specification.

The above physician groups agreed to adopt IHE PDI as the preferred solution for image media compatibility, and are ready to participate in the IHE process as an alternative to pushing their own specification. The work proposed here is similar to that done for the Mammography Image profile.


2. The Problem

It is common practice for imaging facilities to distribute images on CDs and for receiving physicians to review those images with the viewer often bundled onto the CD.

Physicians have increasingly been expressing frustration that all too often:

  • the viewer does not successfully run
  • the viewer does not successfully load the images
  • functions critical to review are missing from the viewer
  • the viewer on the CD has Yet Another GUI in which the operation of basic functions is non-obvious

The impact is delayed care, inaccessible information, and poor use of valuable clinician time.

The radiologist may seldom, if ever, use the viewer on the CDs created by their institution and may be unaware of the pain suffered by the clinicians. So the ultimate user of the CDs has problems, while the purchaser the CD burner is satisfied, meaning the critical feedback is not effectively communicated to the vendor of the system.

3. Key Use Case

Referring Clinician Review

A referring clinician reviews an imaging study (DICOM images) somewhere other than a radiology reading station.

The referring clinican is often a primary care physician, but may also include neurosurgeons, cardiologists, orthopedic surgeons, oncologists, and other specialists.

The clinician should be able to perform all "basic image review" functions.

The availability and operation of those functions should be "readily apparent".

Here is a link to the AMA requirements document

Patient Viewing

As a secondary use case, also consider that patients may use the viewer, although this is less critical.

4. Standards & Systems

Relevant Systems:

  • Media Creators
  • Basic Image Review Applications

Relevant Standards:

  • DICOM Media
  • IHE PDI


5. Technical Approach

Broadly, a new Basic Image Review Profile would require Image Display actors to support certain display behaviors similar to what was done in the Mammography Image Profile.


  • Potentially the solution is a Basic Image Review Profile which places requirements on Media Creators and Image Display actors.


Existing actors

  • Image Display (definitely)
  • Media Creator (possibly)

New actors

None


Existing transactions

One approach would be to add behaviors to the Image Stored transaction which would be required for Image Display actors claiming to support the Basic Image Review profile.

New transactions (standards used)

An possibly better approach would be to introduce a new Display Image transaction (arguably between the display and the user) with the required behaviors could be created.

The advantage would be that it could be used regardless of whether the image was pushed, pulled, acquired, imported from a CD or loaded from a local drive.


Impact on existing integration profiles

None required. Display oriented profiles might consider adopting the extra Image Stored behaviors as optional behaviors, or the Display Image transaction as an optional transaction.

New integration profiles needed

One new profile proposed. See Technical Approach summary above.


Breakdown of tasks that need to be accomplished

<A list of tasks would be helpful for the technical committee who will have to estimate the effort required to design, review and implement the profile.>


6. Support & Resources

  • The AMA, ACR, ACC, AANS, DRG, and RANZCR have all specifically identified this as a significant issue for them
    • Several members of those organizations have expressed interest or been identified to participate in the meetings where the profile is developed
      • Dr. Katarzyna Macura
      • Dr. Peter Carmel
      • Dr. Charles Rosen
      • Dr. Gaby Weissman
    • AMA, ACR, ACC and AANS are preparing to declare IHE PDI as being the Standard of Care for distributing images on media and look forward to further productive work with IHE

Demonstrations

Two venues have already been proposed for promotion/demonstration:

  • AANS 2009 - April 30-May 2 San Diego - 8000 physicians
  • AMA 2009 - late June - 1200 delegates - could sponsor a demo and provide feedback

Most likely these events would involve promoting the draft specification and perhaps doing a product survey/pre-test of existing products (as has been done for NucMed, Mammo and some others) to give vendors a heads up and to get a sense of how close we are. A demo of Connectathon tested products could be done the following year.


7. Risks

<List technical or political risks that will need to be considered to successfully field the profile.>

8. Open Issues

  • Put the requirements in Image Stored, or in a new Display Image, or somewhere else?
  • Issue: Specifying what to achieve VERSUS how to do it
  • Some would like to specify icons and GUI elements
    • Problem: May unnecessarily disallow valid implementations, which might be better
  • Others would like to specify broad behaviors and things like "must be readily apparent"
    • Problem: May requires human evaluation which may be subjective
  • There is some interest in ACR to be involved in the evaluation of systems implementing the profile
  • AMA prepared the document linked in the use cases as a starting point


Issue: Should we address office review workflow

  • E.g. provide recommendations to set up your own viewer and have office staff pre-load images from patients
  • Offices which do not think about this find CDs painful because of the loading time of the application and data


Issue: Report Review

  • the reviewer is often also interested in the accompanying Radiology Report (if any)
  • the Profile work should include reviewing what is covered in IHE Displayable Reports and IHE Portable Data for Imaging and decide if some guidance and/or additional specification would be appropriate
  • DRPT documents PDF-based reports
  • PDI allows for reports on the CD
  • Basic Image Review is intended to be complementary to PDI


9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

  • 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

David Clunie
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