Add Image Repository to SWF/XDS-I - Detailed Proposal

1. Proposed Workitem: Diagnostic Imaging Repository Actor

• Proposal Editor: David Heaney, David.Heaney@mckesson.com
• Domain: Radiology

Summary

The existing Radiology Technical Framework Profiles do not specify what Profiles a regional Diagnostic Imaging Repository (DI-r) should support or how such a system should actually support them. This makes it difficult for both prospective buyers of such systems and implementers to know what Standards related features should be supported and how.

IHE already leverages the existing HL7 and DICOM Standards to define how a local PACS, Image Manager/Archive, should manage Scheduled Workflow. In addition, XDS-I makes it clear how XDS infrastructure can be used to federate existing local PACS. However these existing Profiles do not make it clear how a DI-r should support these existing Profiles and the corresponding Standards they are based on.

This Work Item proposes to solve these issues by modifying the existing IHE SWF and XDS-I Profiles so that contain a new DI-r Actor. New Transactions would be added between the appropriate existing Actors of these Profiles and the new DI-r Actor.

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

Enterprise and regional long term archives for diagnostic imaging are being deployed.

Such architectures involve transactions between local PACS and a regional long term archive, with both types of systems normally being considered Image Manager 'actors'.

However, IHE does not define such transactions and does not clearly describe the role of such a Diagnostic Imaging Repository Actor. There are no Image Manager to Image Manager transactions defined in the framework. It is also not clear which Profile Actors should be supported by the local PACS as opposed to the regional archive. For example, does the regional archive have to support Scheduled Workflow transactions, and if so as what Actor and how should it manage the multiple ordering 'contexts'? Also, which XDS-I Profile Actors should the local PACS and regional archive support?

Vendors are running into issues when trying to deploy such systems, or integrate their local PACS products.

3. Key Use Case

A group of hospitals each have local PACS, and possibly other dedicated Image Managers for Mammography, Cardiology, etc.

The PACS systems are in turn connected to a regional central archive.

The regional central archive is then expected to support integration with XDS-based infrastructure.

To prospective customers it is ambiguous which IHE Profiles such a regional archive should support and how.

4. Standards & Systems

DICOM

IHE XDS-I

5. Discussion

A lot of experience has been gained by those working on deploying such regional archives, both in connecting them with local PACS and also with integrating them into XDS-I based infrastructure. Such knowledge could be leveraged to define exactly which Profiles and Actors such a regional archive should support.

For example, one fundamental decision would be whether a regional archive should be 'DICOM only' or also support HL7-based Scheduled Workflow transactions. I believe experience from Canadian deployments (based on the Infoway blueprint) have shown that support for HL7 transactions is required.

This Work Item is certainly related to the Object Change Management and Data Retention Work Items in that we would want to define how a Diagnostic Imaging Repository 'actor' would support these new Profile transactions. However, even if these other new Work Items are not approved it would still be worthwhile to define the manner in which this new Imaging Repository 'actor' would support existing Profiles such as Scheduled Workflow and XDS-I. So this Work Item is not dependent on these other two related ones being approved. v

5. Technical Approach

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<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

<If a phased approach would make sense indicate some logical phases. This may be because standards are evolving, because the problem is too big to solve at once, or because there are unknowns that won’t be resolved soon.>

Existing actors

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New actors

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Existing transactions

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New transactions (standards used)

<Describe possible new transactions (indicating what standards would likely be used for each. Transaction diagrams are very helpful here. Feel free to go into as much detail as seems useful.>

Impact on existing integration profiles

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New integration profiles needed

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Breakdown of tasks that need to be accomplished

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6. Support & Resources

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7. Risks

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8. Open Issues

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9. Tech Cmte Evaluation

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

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA

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