XDR-I - Detailed Proposal

1. Proposed Workitem: XDR-I

• Proposal Editor: Chris Lindop
• Editor: Chris Lindop
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiology

2. Summary

Currently, Imaging has no payload which would allow for the push of images outside of an enterprise environment. IHE ITI has a transport protocol called XDR which serves well for non-imaging payloads. It is compatible with the Security and Privacy protocols developed by the IHE ITI domain. The XDS-I.b protocol breaks the content profile into 2 components. The first component is designed essential as a notification of where to pull the content. Usage of the XDR transport protocol should not require this notification/pull architecture, but just the push model. It should remove the requirement for a source to be a cross enterprise source of Images.

The value for this capability would allow for a less sophisticated system to be a source of images. An XDR-I image source could be as low cost as a workstation. Additional value could be to use the XDR-I webservices as an XDS-I.b proxy with a regional XDS-I.b source. Currently, when an XDS-I.b Image Document Source provides & register images on behalf of a local facility, there is no mechanism to provide feedback to the originating source. This would allow for an XDS-I.b Image document source to use the response of the XDR transport services to provide success or failure status back to the originatting source of the images.

3. Key Use Case

The potential use cases can be fairly robust.

1) A Clinical outpatient facility providing images to a shared image repository.

This is the case where a clinical facility with diagnostic imaging systems would like to provide an acquired image set to a shared image repository via reliable webservices messaging.

2 Sending images and other clinical documents to a referring clinician without the use of CD media.

In this case, a clinical facility with diagnostic imaging systems may have additional documents (a Radiology Report, for example)and would like to provide the images and documents to a a referring physician via reliable webservices messaging.

3 Connecting a Hospital or Clinical practice PACS to a Regional Repository that is an XDS-I.b Image Document Source.

As in the Canadian National Health Infoway Blueprint and other regional projects around the globe, the hospitals and other clinical institutions share a regional image repository that also functions as an XDS-I.b Image Document Source. The source which aquires the images, provides the images to the regional image repository with a reliable message transaction. The regional imge repository would provide and register the manifest to an XDS.b Registry/Repository. As part of the response back to the source. the regional repositoy would include the XDS-I.b transaction results.

4 Submitting images for a clinical trial

A clincal facility enrolled in a clinical trial would transfer the images and additional clinical information using reliable messaging.

5 Submitting Dose reports to a National registry.

A clincal facility enrolled in a National Dose Registry would transfer the dose reports and additional clinical information using reliable messaging.

4. Standards and Systems

Existing Standards

1. ITI XDR
2. RAD XDS-I.b
3. RAD REM
4. RAD TCE

Existing Systems

1. Workstations
2. Acquisition Modalities
3. PACS and Enterprise Archives
4. Regional PACS and Archives
5. Regional and Enterprise RIS
6. Dose and Clinical Trial Registries

5. Technical Approach

<This section can be very short but include as much detail as you like. The Technical Committee will flesh it out when doing the effort estimation.>

<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

<Indicate what existing actors could be used or might be affected by the profile.>

New actors

<List possible new actors>

Existing transactions

<Indicate how existing transactions might be used or might need to be extended.>

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

<Indicate how existing profiles might need to be modified.>

New integration profiles needed

<Indicate what new profile(s) might need to be created.>

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

This fullfills a gap in the XDS-I.b current Canadian Health Inforway Blueprint. provides synergy

<List groups that have expressed support for the proposal and resources that would be available to accomplish the tasks listed above.>

7. Risks

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

8. Open Issues

<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>

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):

• XX% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

Chris Lindop

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