Rad Tech Minutes 2023-11-13-17

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Monday, November 13, 2023

Attendees: Andrei Leontiev (Visage), Wim Corbijn, (Philips), Chris Melo, (Philips), Ana Kostadinovska (Philips), Steve Nichols (GE), Antje Schroeder (Siemens), John Paulette (Rad AI), Kinson Ho (Tempus), Kevin O'Donnell (Canon), Sean Doyle (Hyperfine), Natalia Farish (ACR), Brian Bialecki (ACR), Chris Roth M.D., David Kwan (Insygnia), Lynn Felhofer (RAD TPM), TeRhonda McGee (RSNA), Jaime Dulkowski (RSNA), Chris Carr (RSNA)

Guests: Rob Ferre M.D., Rachel Liu M.D. (ACEP), Kevin Little (OSU)

  • A1: 8:45am-9:00am Administrative Time
  • S0: 9:00am-9:30am: Agenda work plan review
  • S1: 9:30am-10:30am: ACEP POCUS update (Steve Nichols)
    • See these slides: ACEP EBIW POCUS Workflow Update
    • This working group will continue to meet weekly; currently working on use cases, will especially like to consult with IHE as Vol 2 transactions will be identified to be used in the workflow. Steve and Kevin will continue to keep IHE RAD updated on progress. We can anticipate scheduling consultation tcons in the future with IHE RAD Tech.
  • S2: 10:45am-12:15pm: Maintenance
    • See full list of Maintenance topics
    • From Top Ten list:
      • CP-RAD-475 Extensions to RAD-107 for IMR (Kinson) - we reviewed and updated the content. This CP is approved as Completed and ready for ballot, pending updates agreed to during discussion
      • CP-RAD-523-03 Clarify display of DBT images (Steve) - we updated the text to clarify the requirements in a different section. This CP is approved as Completed and ready for ballot,
      • CP-RAD-501 WIA – RAD-129 fix in Expected Actions (Steve) - we reviewed and updated the content. Steve will make the recommended edit to the Enterprise Identity Table in RAD-14; we will review those updates this week to prepare this for ballot.
    • Other CPs ready for committee review:
      • CP-RAD-479-01 - RAD-60 - update reason codes reference to DICOM (Lynn) - reviewed and approved as Completed pending update to rationale.
  • A2: 1:15pm-1:30pm: Maintenance
    • Other CPs ready for committee review:
      • CP-RAD-463 - Add RDSR Display option in REM (Kevin) - status update: This is now separated into 2 CPs, including CP-RAD-525 Add EMR Extract option in REM. These 2 CPs remain Assigned & Kevin will bring back to RAD Tech for review in the future.
      • CP-RAD-496-01 - Missing arrow in SWF.b actor/transaction diagram (Lynn) - reviewed, updated, and approved as Completed.
  • S3: 1:30pm-3:00pm: Imaging Diagnostic Report (IDR)
    • Discussion of IDR use cases
    • During initial profile development, the most recent version of IDR will be kept in this folder in google drive. (Note: google drive is used for doc storage, NOT for editing)
    • Later, it is anticipated that this content will become a FHIR IG developed in this Github repository at https://github.com/IHE/RAD.IDR
  • S4: 3:15pm-4:45pm: Reject Analysis (RAM)
  • A3: 4:45pm-5:00pm: Administrative Time

Tuesday, November 14, 2023

Attendees: Andrei Leontiev, David Kwan, Wim Corbijn, Ana Kostadinovska, Brian Bialecki, Sean Doyle, Antje Schroeder, Wim Corbijn, Kinson Ho, Steve Nichols, Kevin O'Donnell, John Paulett, Yasunari Shiokawa-san (Salt, IHE-J), Jaime Dulkowski, TeRhonda McGee, Lynn Felhofer

Guests: David Goyard, Stephane, Nicolas Dehouck (Incepto), Natalua Farish, Kevin Little

  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-10:30am: Appropriateness of TID 1500 for AI Results (Antje, Sean)
    • Refer to this presentation with notes from Antje
    • Sean pointed out the issue encoding with being unable to encode classification (i.e. confidence, certainty...) of findings within TID 1500. Oncology has use cases that can inform this work for us. Kevin noted that AI cannot necessarily apply a certainty value to a finding, but AI can report how close the current result is to its training set. The AIR profile has open issue #34 with an initial write-up on this topic. We will likely need to convene a working group to address this.
    • Brian questioned whether using TID 1500 is the right solution; perhaps consider using FHIR R5 Observation / ImagingSelection, instead. There was some discussion of this future direction, but Andrei asked that that discussion of this future consideration be deferred and that we spend the time i this session specifically on how to get guidance for current challenges on encoding AI results in TID 1500.
    • David G. reported that they have chosen DICOM SR for encoding AI Results because a goal is to have the AI output in the PACS. The problem they have encountered that the PACS will not accept and enable viewing and editing of the SR content. Brian noted that an additional challenge is when there are many AI-related SRs in the PACS, which are relevant for the radiologist.
    • Sean reported that the main challenge workflow issue
    • Antje recommended perhaps making the TID 4xxx (Mammo CAD SR) templates more general.
    • Kevin pointed to the AI Result Tree encoding specification and examples in the AIR Profile
    • Encoding of results status -- Kevin pointed to Open Issue #32 in AIR.
    • Examples:
      • Sean pointed out that good examples are really valuable. He suggested a Github repository of examples.
      • Antje said targeted examples that demonstrate key features (AI outputs / primitives) would be good to produce.
    • Post discussion actions to address. Create ad-hoc working groups to address these topics.:
      • Looking into alternatives for derived measurements (temporal, spacial)
      • Flavors of certainty
      • Workflow (accept...reject...). Perhaps keep a library of patterns of usage of AI algorithms.
      • Be sure to engage with the AIGI task force in Europe (Marc Kammerer and others)
      • Bring this topic up at the RAD meeting at RSNA. For future RAD Tech meetings, include an update from these working groups as a sub-topic for maintenance.
  • S2: 10:45am-12:15pm: Imaging Diagnostic Report (IDR)
      • Discuss and add details to the Concepts section in Vol e
      • Discussion of HL7 V2 export option (see notes in IDR open issue #2). We will provide guidance in the profile in a hybrid environment section in Vol 1 concepts, but not a named option.
  • A2: 1:00pm-1:30pm: Administrative Time
    • Connectathon-related...
      • Summary of RAD testing at 2023 Connectathon
      • 2024 Connectathons: Feb 19-23 @ RSNA Headquarters in Oak Brook and June 3-7 in Trieste, Italy
  • S3: 1:30pm-3:00pm: Reject Analysis
    • Discussion of Open Issues in the document
    • Work on actor requirements
  • S4: 3:15pm-4:45pm: Imaging Diagnostic Report (IDR)
  • A3: 4:45pm-5:00pm: Administrative Time

Wednesday, November 15, 2023

Attendees: John Paulett, Kevin O'Donnell, Andrei Leontiev, Steve Nichols, Ana Kostadinovska, Wim Corbijn, Antje Schroeder, Kinson Ho, David Kwan, Kevin O'Donnell, Lynn Felhofer, Yasunari Shiokawa-san (Salt), Jaime Dulkowski, TeRhonda McGee, Chris Carr

Guests: Jason Malobicky (Rad AI), Natalua Farish, Charles Parisot, Kevin Little Clinical consult guests: Raym Geis, David Koff, Chris Roth, Seth Berkowitz, Adam Flanders, Tarik Alkasab

  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-10:30am: Imaging Diagnostic Report (IDR)
    • Discussion of Vol 1 concepts with focus on the structure of the FHIR resources
  • S2: 10:45am-12:45pm: Maintenance
    • Review New Submitted CPs
      • Discussion of the WIA/WIC option for XCA-I (Steve, Charles)
    • Review / update Assessment of RAD profiles for promotion or retirement
      • TO DO for RAD Tech -- communicate candidate FT profiles to national deployment committees as a 'last call' for CPs
      • Include review of (old) criteria on the wiki for Final Text Process and retirement
      • Discussion -- how to help new audience consumer RAD profiles. WIKI content is too technical for this audience. C
    • If time, see Thurs maintenance topics
  • A2: 1:00pm-1:30pm: Administrative Time
  • S3: 1:30pm-2:45pm: Imaging Diagnostic Report (IDR)
    • Working through use cases
  • S4: 3:00pm-4:00pm: Imaging Diagnostic Report (IDR) - Clinical Consult
  • S5: 4:00pm-4:30pm: Checkpoint assessment: Reject Analysis
    • Review of effort estimate sheet
    • End-of-meeting checkpoint -- see notes that follow:

Profile Name: Reject Analysis

  • Describe gaps in Use Case coverage
    • None really.
  • Review ALL "uncertainty points" in the evaluation. Is there a resolution plan for each?
    • Yes.
  • Do the effort points in the evaluation still seem right?
    • Feels good.
  • Did the Breakdown of Tasks accurately reflect the work? What extra tasks arose?
    • Matched well. Added consideration of un-reject; Split Reject and Quality into two use cases
  • Describe unresolved technical issues/tasks
    • Nothing major
  • Describe potential practical issues
    • Seems OK
  • Review the open issue list. Does it feel complete
    • Yes
  • Which open issues feel most risky; what other risks exist?
    • Have tentative or closed resolutions for all
  • How is the work fitting in the allocated bandwidth? (Time to spare? Just right? Things were left undone?)
    • Time to spare this meeting
  • How does the scope feel? (Room to expand? Just right? Pretty ambitious?)
    • Feels right.
  • If you had to reduce scope, what would you drop?
    • Other modality quality code lists (will take what we can get with not too much fuss)
  • Have the promised resources manifested?
    • Yes
  • What tasks would benefit from additional expertise?
    • Other modality codes - Kevin will check with relevant AAPM Cmtes, Kevin O will check with DICOM WG (and maybe MITA)
  • What vendors are engaged for each actor? Record how many.
    • Reporter - Canon, Siemens,
    • Analyzer - GE
    • IM/IA - Visage, GE, Philips
  • Was the profile where it needed to be at the start of the Kickoff meeting (See "Kickoff Meeting" above), if not what was the gap
    • Basically
  • Was the profile where it needed to be at the end of the Kickoff meeting, if not what was the gap
    • Basically
  • How many tcons would you like between now and the PC Prep Meeting?
    • Pretty good shape. Any issues can probably be brought to the Feb meeting.

Thursday, November 16, 2023

Attendees: Kinson Ho, David Kwan, Andrei Leontiev, Kevin O'Donnell, Sean Doyle, Wim Corbijn, Ana Kostadinovska, Antje Schroeder, John Paulett, Lynn Felhofer, Chris Carr, Jaime Dulkowski, TeRhonda McGee

Guests: Charles Parisot, Natalua Farish

  • A1: 8:45am-9:00am Administrative Time
    • Photo of (most of) the group
  • S1: 9:00am-10:30am: Imaging Diagnostic Report (IDR)
    • Working through the Observation resource in the context of IDR
  • S2: 10:45am-12:15pm: Maintenance
    • From top ten list:
      • CP-RAD-423-05 IOCM unreject (Steve)
      • CP-RAD-527-00 Add WADO-RS named option to XDS-I (Charles, Lynn) and CP-RAD_526 XDS-I Vol 1 template updates - review of both CPs; input from committee for last changes prior to balloting both
  • S3: 1:30pm-3:00pm: Administrative & Maintenance
    • From top ten list:
      • CP-RAD-501-05 WIA – RAD-129 - additional Enterprise Identity attributes - ensure readiness for ballot (Steve) - discussed; need more review of table contents
    • Other CPs
      • CP-RAD-513-02 SWF.b: Clarify Intermittently Modality behavior in RAD-10 Storage Commitment (Steve, Sean) - detailed discussion; the CP remains assigned to Steve for additional work
  • S4: 3:15-4:45pm Imaging Diagnostic Report (IDR)
    • Work through a sample report and consider how it might be encoded in IDR.
  • A3: 4:45pm-5:00pm: Administrative Time
    • Prioritize unfinished maintenance
      • From top ten list:
      • CP-RAD-501-05 WIA – RAD-129 - additional Enterprise Identity attributes - ensure readiness for ballot (Steve) - discussed; need more review of table contents
        • CP-RAD-523-04-clarify-DBT-image-scrolling - ensure readiness for ballot (Steve)
        • CP-RAD-475-04 RAD-107 WADO-RS Retrieve: Add retrieve rendered images message pair (Lynn) - one TCQ:
      • Continue assessment of RAD profiles for FT or deprecation
      • Review IID promotion-to-FT details

Friday, November 17, 2023

Attendees: Kinson Ho, John Paulett, Andrei Leontiev, Kevin O'Donnell, David Kwan, Yasunari Shiokawa-san (Salt, IHE-J), Wim Corbijn, Antje Schroeder, Lynn Felhofer, TeRhonda McGee

Guests:

  • A1: 8:30am-9:00am Administrative Time
    • Tcon scheduling
  • S1: 9:00am-10:15am Imaging Diagnostic Report (IDR)
    • Work through simple and highly-structured nd OB-advanced example reports in the context of IDR
  • A2: 10:15pm - 10:45 Checkpoint assessment for IDR
  • S2: 10:45am-12:15pm Maintenance
    • From top ten list:
      • CP-RAD-523-04-clarify-DBT-image-scrolling - ensure readiness for ballot (Steve)
      • CP-RAD-501 Enterprise Identity (Steve)
      • CP-RAD-526 / 527 - XDS-I CPs (Lynn) - last look before ballot
    • Finalize content and timing of next CP ballot
      • Link to Completed folder on google drive
      • List as of Nov 16:
        • CP-RAD-347 XDS-I.b Volume 1 Cleanup
        • CP-RAD-475 RAD-107 WADO-RS Retrieve: Add retrieve rendered images message pair
        • CP-RAD-479 RAD-60 - update reason codes reference to DICOM
        • CP-RAD-490 Update Vol 1x and 2 for RESTful transport in Submit Does Information RAD-63
        • CP-RAD-496 SWF.b - missing arrow in actor/transaction diagram
        • CP-RAD-501 WIA – RAD-129 - additional Enterprise Identity attributes
        • CP-RAD-522 MAP: Update outdated references in transactions
        • CP-RAD-524 Add missing triggers for RAD-108
        • CP-RAD-526 Update XDS-I to align with Vol 1 template
        • CP-RAD-527 Addition of WADO-RS as an option for image retrieve in XDS-I
      • Ballot timeline:
        • Ballot announcement sent:
        • Ballot comments/votes due:
        • Ballot comment resolution tcon:
    • Review / update Top Ten CP list
    • Continue assessment of RAD profiles for FT or deprecation
    • Review IID Final Text Evaluation

Profile Name: Imaging Diagnostic Report

  • Describe gaps in Use Case coverage
    • (a bit hard to say. It's a big space)
    • We DID do a first pass through each of the Creation, Storage, Presentation, Processing.
    • The example reports are helpful and sort of Use Case.
  • Review ALL "uncertainty points" in the evaluation. Is there a resolution plan for each?
    • Have been doing a good job of working through the UP topics (but in general, the points might have been estimated a touch low).
      • Should figure out where to model our learning curve on new stuff. It's a bit Complexity because we slow down and think, but maybe uncertainty becase we discuss a lot if not "debate"
    • Certainly residual uncertainty (nature of this kind of Profile)
      • Review/comprehension of WG20 work will likely need more effort
      • Will likely revisit some UP when we have a clearer technical solution documented and honed in on our "good examples"
      • Didn't have the Content Def skeleton, but we did talk about the information reasonably so we can start that work.
  • Do the effort points in the evaluation still seem right?
    • Mostly good for what's there, but we will have pages of Concept section that isn't really accounted for here
  • Did the Breakdown of Tasks accurately reflect the work? What extra tasks arose?
    • Matched well. (so far)
    • Probably a few extra discussions (see concept section topics)
  • Describe unresolved technical issues/tasks
    • (Fog of War)
    • Level of sophistication of coding some of the content - how do we package, organize
    • DiagReport Root vs Composition Root
    • TODO Go through draft for tagged issue topics
  • Describe potential practical issues
    • (Whew)
    • Wild and woolly marketplace with many players.
    • What are implementers willing to try and do (would be nice to have more implementers providing feedback on this - recruit & PC)
    • In terms of the use cases, not too bad.
  • Review the open issue list. Does it feel complete
    • TODO Need to migrate flagged issues throughout the text up to the OI list.
    • It's a good list, but expect there to be more that arise
  • Which open issues feel most risky; what other risks exist?
    • Moderate risk in several places, but no severe risks.
    • Hard to review because scattered in document
    • Scope Creep is a Risk. Will continue labelling and setting boundaries.
  • How is the work fitting in the allocated bandwidth? (Time to spare? Just right? Things were left undone?)
    • Pretty well. We used the time effectively. But it's a big piece of work.
  • How does the scope feel? (Room to expand? Just right? Pretty ambitious?)
    • Pretty good? The scope creep limiting seems on target and the result feels impactful.
    • Balancing informative vs normative is also a good tool but we need to stay attentive.
  • If you had to reduce scope, what would you drop?
    • (Large piece of work, haven't thought through this yet, and it's a skeleton so all the pieces aren't visible yet)
    • Maybe shift balance to more informative
    • Might not know until we have more concrete text in place
  • Have the promised resources manifested?
    • Yes, wonderful participation, and the Clinical Consult Hour was productive and will continue.
  • What tasks would benefit from additional expertise?
    • More reporting vendors and EMR vendors in general. Clinician support will continue to be needed
  • What vendors are engaged for each actor? Record how many.
  • Was the profile where it needed to be at the start of the Kickoff meeting (See "Kickoff Meeting" above), if not what was the gap
    • Would have been nice to have more concrete skeleton content (e.g. basic encoding guidance for many resources) - Bandwidth limits.
  • Was the profile where it needed to be at the end of the Kickoff meeting, if not what was the gap
    • Great content. Will be a lot of work to pull together.
    • Volume 1 would have been good to have laid out. (Bandwidth)
  • How many tcons would you like between now and the PC Prep Meeting?
    • At least two
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