Image Management Enhancements - Brief Proposal

1. Proposed Workitem: Image Management Enhancements

• Proposal Editor:

Christopher Lindop, Christopher.Lindop@ge.com

David Heaney, david.heaney@mckesson.com

Genady Knizhnick, genady.knizhnik@agfa.com

• Editor: <Name of candidate Lead Editor for the Profile, if known>
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiology

2. The Problem

A key issue for deployment of systems relying upon XDS-I based infrastructure surrounds the manner in which systems should deal with data synchronization issues. The IHE XDS-I Profile does not explicitly define how to update values specified in a DICOM SOP Instance after it has been published. Added complexity arises when implementing the Canada Infoway Architecture for XDS-I deployment because it specifies the use of a Digital Imaging Repository (DI-R) for long term archiving of all DICOM SOP Instances. This raises questions of how local PACS acting as Image Manager / Archive Actors should interact with a DI-R in cases where it is necessary to delete, modify, or replace archived SOP Instances. The IHE Canada XDS Implementation Group has been working on developing solutions for these issues. The following approaches have been adopted:

Where possible, existing IHE Scheduled Workflow exception handling mechanisms, Patient Information Reconciliation, Import Reconcilliation Workflow and XDS mechanisms will be used. For example, PIR, and PIX/PDQ will be used for managing patient demographic updates, merging patients, etc. Where necessary, the IHE Technical Framework may need to be clarified for use cases where it is ambiguous how local updates should be conveyed to the XDS Infrasctructure (such as for PIR).

Key Image Notes with Document Title of “Rejected for Patient Safety” to indicate which referenced image SOP Instances should be deleted due to errors in their DICOM information should be used to delete and replace DICOM SOP Instances that have already been exported to a regional archive. The same mechanism should be used if SOP Instances have already been posted to the regional Registry/Repository.

3. Key Use Case

When an image or image set in an archive, is determined necessary to be modified, deleted or replaced, there needs to be a mechanism to perform this action.

Key Image Notes with Document Title of “Rejected for Patient Safety” to indicate which referenced image SOP Instances is a method that could be applied when images exist in an archive that would subsequently be deleted or superceded/replaced. A set of images that will replace a previous set could be imported using IRWF.

4. Standards & Systems

• IHE Integration Profile IRWF
• IHE Integration Profile MAWF

• DICOM

5. Discussion

The need for this capability in Canada is 1Q, 2009.

This work is fairly complete already in piecework components throughout the technical framework today with the inclusion of IRWF, XDS-I, XDS, SWF, PIR, and PIX/PDQ.

The bulk of the new functionality will be to copy the MAWF capability to remove images from an archive to a profile that fits this scenario. IRWF and SWF both could be likely candidates. I recceomend this to be performed in a CP.

The bulk of this proposal is to do the analysis for comprehensive workflow of replace and delete of images sets located in an image archive. As part of the analysis, there may be several CP's which will need to be written.

I reccomend the work to be entirely CP driven and not a new profile.