Practical Imaging Informatics: Foundations and Applications for PACS Professionals

Description

Attention SIIM Members: a special discount is available to you; please log in to the SIIM website at www.siim.org/pii or call the SIIM office at 703-723-0432 for information on how you can receive the SIIM member price. Imaging Informatics Professionals (IIPs) have come to play an indispensable role in modern medicine, and the scope of this profession has grown far beyond the boundaries of the PACS. A successful IIP must not only understand the PACS itself, but also have knowledge of clinical workflow, a base in several medical specialties, and a solid IT capability regarding software interactions and networking. With the introduction of a certification test for the IIP position, a single source was needed to explain the fundamentals of imaging informatics and to demonstrate how those fundamentals are applied in everyday practice. Practical Imaging Informatics describes the foundations of information technology and clinical image management, details typical daily operations, and discusses rarer complications and issues. Practical Imaging Informatics Practical Imaging Informatics Contents Contributors Introduction The Evolution of the Imaging Informatics Professional Who Should Read This Book The Organization of This Book Medical Imaging Modalities and Digital Images 1.1 Introduction 1.1.1 Special Aspects of Medical Images 1.1.2 Medical Imaging Terminology 1.2 Diagnostic Imaging Modalities 1.2.1 Projection Radiography 1.2.2 Fluorography 1.2.3 Computed Tomography (CT) 1.2.4 Magnetic Resonance Imaging (MRI) 1.2.5 Nuclear Medicine and Positron Emission Tomography (PET) 1.2.6 Ultrasound 1.2.7 Visible Light 1.3 Digital Images 1.3.1 Definition 1.3.2 Digital Image Formation 1.3.3 Image Quality Factors Suggested Reading Self-Assessment Questions Computers and Networking 2.1 Introduction 2.2 Computers 101 - Hardware 2.2.1 Hardware Elements of Computers 2.3 Computers 101 - Software 2.3.1 Computer Operating System 2.3.2 Application Software 2.3.3 Low-Level Programming Language 2.3.4 High-Level Programming Language 2.4 Computer Networking 2.4.1 Physical (Hardware) Networking Components 2.4.2 Network Switches 2.4.3 Network Protocols 2.4.4 Data Packets 2.5 Client-Server Architecture 2.6 Database Applications Self-Assessment Questions Introduction to PACS 3.1 Introduction: Rationale and Goals for PACS 3.2 Core Components of a Modern Digital Radiology Department 3.2.1 Radiology Information System 3.2.2 PACS Core 3.2.3 PACS Broker 3.2.4 Diagnostic Workstations 3.2.5 Nonradiologist Access to Radiology Studies and Reports 3.3 Core Workflow Elements to be Supported by PACS and the Informatics Team 3.4 New Professional Roles Necessitated by PACS 3.4.1 PACS Administrator 3.4.2 Image Service Representatives 3.4.3 PACS Systems Analyst 3.4.4 Clinical Outreach and User Training 3.5 Value-Added Adjuncts to the Practice of Radiology, Made Possible by PACS 3.5.1 Programmed Peer Review 3.5.2 Asynchronous Communication Tools 3.5.3 Integration of Nighthawk Wet Readings 3.5.4 Electronic Teaching Files 3.5.5 Regional Sharing of PACS Functionality: Shared Archive 3.5.6 Advanced Visualization Technologies 3.5.7 Site-to-Site Transfer of DICOM Exams Self-Assessment Questions Modalities and Data Acquisition 4.1 Introduction 4.2 Acquisition Devices in Diagnostic Radiology 4.2.1 Digital Radiography and Digital Mammography Projection Imaging 4.2.2 Digital Fluoroscopy and Interventional Radiology 4.2.3 Computed Tomography (CT) 4.2.4 Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) 4.2.5 Ultrasound 4.2.6 Nuclear Medicine (also known as Molecular Imaging) 4.2.7 Other Areas of Image Acquisition 4.3 Installation/Integration of Modalities with PACS and RIS 4.3.1 Network Subnets for Modalities 4.3.2 Quality Control of Diagnostic Imaging Equipment - What Tests? How Often? 4.4 Conclusion Suggested Reading Self-Assessment Questions Workflow Steps in Radiology 5.1 Introduction 5.2 Documentation and Process Flow 5.3 Key Steps of Radiology Workflow 5.3.1 Radiologist Workflow Steps 5.3.2 Technologist Workflow Steps 5.3.3 Referring Clinician Workflow Steps 5.3.4 Other Personnel with Critical Workflow 5.4 IHE Workflow Models 5.5 Goals of Workflow Analysis 5.6 Summary Self-Assessment Questions Standards and Interoperability 6.1 Introduction 6.2 Information Technology Standards Relevant to Imaging 6.2.1 Internet Standards 6.2.2 Digital Imaging and Communications in Medicine (DICOM) 6.2.3 Health Level Seven (HL7) 6.2.3.1 HL7 Version 3 6.3 Interoperability 6.3.1 Integrating the Healthcare Enterprise (IHE) Suggested Reading Self-Assessment Questions Viewing Images 7.1 Introduction 7.2 Human Perception Basics 7.3 Display Hardware Basics 7.4 Display Software Considerations 7.5 Human-Computer Interface Suggested Reading Self-Assessment Questions Image Postprocessing and Volume Rendering 8.1 Introduction 8.2 Image Filtering 8.2.1 Histogram Manipulation 8.2.2 Enhancement 8.2.3 Frequency Filtering 8.2.4 Noise Reduction 8.2.5 Practical Considerations 8.3 Segmentation 8.3.1 Basics 8.3.2 Morphological Operators 8.3.3 Classification 8.4 Registration 8.4.1 Transforms 8.4.2 Similarity Metrics 8.4.3 Optimization 8.5 3D Visualization 8.5.1 Volume Data and Its Grid Structure 8.5.2 Projection Rendering 8.5.2.1 Multi-planar Reconstruction (MPR) 8.5.2.2 Maximum Intensity Projection (MIP) 8.5.3 Surface Rendering 8.5.4 Direct Volume Rendering Suggested Reading Self-Assessment Questions Image Distribution 9.1 Introduction 9.2 Functional Requirements and Technology Strategies 9.2.1 Functional Requirements 9.2.2 Technology Strategies for Image Distribution 9.3 Infrastructure Considerations 9.3.1 Archive/Web Server 9.3.2 Network 9.3.3 Client Hardware and Software 9.4 Specific Workflow Considerations 9.4.1 ED/Trauma 9.4.2 Operating Room 9.4.3 Specialty Clinics 9.4.4 Teleradiology (Primary Interpretation) 9.4.5 Advanced Visualization 9.4.6 CD/DVD Import/Export Self-Assessment Questions Reporting and Dictation 10.1 Introduction 10.2 Newer Reporting Methods 10.2.1 Speech Recognition 10.2.1.1 Vendor Evaluation 10.2.1.2 Training and Applications - Initial and Ongoing 10.2.1.3 Speech Recognition Models 10.2.1.4 Problem Solving 10.2.1.5 Navigation 10.2.2 Structured Reporting 10.2.2.1 Training and Learning Curve 10.2.3 Macros and Templates 10.2.4 Interoperability - Interfaces and Integration 10.2.4.1 RIS Interface 10.2.4.2 PACS Integration 10.3 Lexicons 10.3.1 Current Lexicons 10.3.2 RadLex 10.3.2.1 The RadLex Project - RSNA’s Solution to the Problem 10.3.2.2 Promising Features of RadLex 10.3.2.3 Hierarchy of RadLex 10.3.2.4 RadLex Format 10.3.2.5 Ontologies 10.3.2.6 Role of RadLex in Structured Reporting Suggested Reading Self-Assessment Questions Customer Relations 11.1 Customer Groups and Their Concerns 11.1.1 Radiologists 11.1.2 Clinicians 11.1.3 Technologists 11.1.4 Hospital IT 11.1.5 Hospital Personnel 11.1.6 Vendors 11.1.7 Patients 11.2 Tools of the Trade 11.2.1 Documentation and Education 11.2.2 Ticket and Issue Tracking 11.2.3 Proactive System Monitoring 11.3 Last Thoughts Self-Assessment Questions User Training 12.1 Introduction 12.2 Assessing the Need 12.3 Design and Development 12.4 Implementation 12.5 Evaluation 12.6 Follow-Up Suggested Reading Self-Assessment Questions Quality Assurance for Medical Imaging 13.1 Introduction 13.2 QA of Digital Imaging 13.2.1 Errors in a Digital Imaging System 13.2.2 False Sense of Security 13.2.3 Errors Inside and Outside the Digital World 13.2.4 Consequences of Well-Known Errors 13.3 Processes and Products in the Imaging Department 13.3.1 Report Is the Product; Images Are Auxiliary 13.3.2 Process Mapping 13.4 Measurable Indicators of Quality of Imaging Services 13.4.1 Availability and Quality of Images and Reports 13.4.2 Physical Aspects of Image Quality 13.4.3 Ionizing Radiation Dose 13.4.4 Electronic Display Quality 13.4.5 Repeated Images 13.4.6 Discrepancies in Demographic and Exam Information 13.4.7 Misidentification 13.5 Mechanisms for Improving Performance in the Digital Department 13.5.1 Selection of Indicators and Action Limits 13.5.2 Timeline Analysis 13.5.3 Reject Analysis 13.5.4 Reliability Analysis 13.5.5 Radiologist Image Critique 13.5.6 Training and Orientation 13.5.7 Service Support 13.6 Roles and Responsibilities for QA 13.6.1 Radiologic Technologist 13.6.2 Imaging Informatics Professional 13.6.3 Medical Physicist 13.6.4 Radiologist 13.6.5 Radiology Administrator 13.6.6 QA Committee Suggested Reading Self-Assessment Questions Data Storage and Disaster Recovery 14.1 Philosophy of Storing Electronic Protected Health Information (ePHI) 14.1.1 Enterprise Storage Versus Departmental Silos of Storage 14.1.2 Responsibility of Storage Management 14.1.3 Economics of Storage Management 14.2 Datacenters 14.2.1 Tier Rating of Datacenters 14.3 Types of Medical Data 14.3.1 Variable Content Files (VCF) 14.3.2 Fixed Content Files (FCF) 14.4 Storage Requirements for ePHI 14.4.1 Health Information Portability and Accountability Act (HIPAA) 14.4.2 Storage Requirements for Clinical Studies 14.5 Retention and Destruction Requirements for ePHI 14.5.1 Retention Requirements for ePHI 14.5.2 Film Screen and Digital Mammograms 14.5.3 Destruction Requirements for ePHI 14.6 Storage Technology 14.6.1 Types of Storage Media 14.6.2 Storage Management Infrastructure and Hardware 14.6.3 Storage Management Software 14.7 Compression of Medical Images 14.7.1 Reasons for Compressing FCF 14.7.2 Lossless Compression 14.7.3 Lossy Compression 14.8 Disaster Recovery (DR) and Business Continuance (BC) 14.8.1 General 14.8.2 Options for DR 14.8.3 Fundamentals of BC 14.8.4 Backup and DR for VCF 14.8.5 Backup and DR for FCF 14.8.6 Justifying the Cost of DR and BC 14.9 Migration of Medical Images and Related Data 14.9.1 Reasons for Migrating Data 14.9.2 Factors that Impact Data Migration 14.9.3 Data that Must be Migrated for a PACS 14.9.4 Who Will Migrate Data? 14.9.5 Impact on Clinical Operations 14.9.6 Economics of Data Migration 14.9.7 Mitigating Future Data Migration Problems Self-Assessment Questions Downtime Procedures and Departmental Policies 15.1 Introduction 15.2 Downtime Considerations and Types 15.3 Policies and Procedures 15.4 Minimizing Downtime 15.4.1 Planning at Multiple Levels 15.4.2 Business Continuance and Disaster Recovery Suggested Reading Self-Assessment Questions Reading Room Design 16.1 Introduction 16.2 Challenges of Reading Room Design 16.2.1 Educating the Design Team 16.2.2 Room Enclosure 16.2.3 Lighting 16.2.4 Acoustics 16.2.5 Ergonomics 16.2.6 Connectivity 16.2.7 Thermal Comfort Self-Assessment Questions Workflow Testing and Workflow Engineering 17.1 Introduction 17.2 Workflow Testing 17.2.1 How to Test 17.2.2 Who to Test 17.2.3 When to Test 17.3 Workflow Engineering 17.3.1 Workflow Enhancements 17.3.2 Workflow Bottlenecks Self-Assessment Questions Policy Management and Regulatory Compliance 18.1 Introduction 18.2 HIPAA 18.2.1 Overview 18.2.2 Title II: Administrative Simplification 18.2.3 State, Local, and Organizational Regulations 18.3 MQSA 18.3.1 Overview 18.3.2 Accreditation, Certification, and Inspection 18.3.3 Requirements 18.3.4 Digital Mammography 18.4 Imaging Informatics Professional Certification 18.4.1 Overview 18.4.2 Certification Exam Requirements 18.4.3 Certification Exam Preparation Self-Assessment Questions Billing and Coding 19.1 Introduction 19.2 Terminology and Standards 19.3 Required Practices 19.3.1 CPT Codes 19.3.2 ICD9 Codes 19.4 Information Transfer Suggested Reading Self-Assessment Questions Economics of PACS and Related Systems 20.1 Introduction 20.2 Defining ‘‘Value’’ from Information Technology Investments 20.3 Return on Investment 20.3.1 ROI Components 20.3.2 Total Cost of Ownership 20.3.3 Measuring Benefits 20.3.4 Creating the Financial Return on Investment (ROI) Analysis 20.4 Completing the Business Case 20.5 Financing PACS and Other IT Expenditures Suggested Reading Self-Assessment Questions PACS Readiness 21.1 Introduction 21.2 Assessment 21.2.1 Items to Assess 21.2.1.1 Workload 21.2.1.2 Workflow 21.2.1.3 Imaging Equipment 21.2.1.4 Information Systems: The RIS 21.2.1.5 IHE Profiles 21.2.1.6 Other Information Systems: Advanced Visualization 21.2.1.7 Key Considerations if You Have Advanced Visualization Systems 21.2.1.8 Information Systems: Teleradiology and On-Call Support 21.2.1.9 Information Systems: miniPACS 21.2.1.10 Key Considerations for miniPACS in PACS Readiness 21.2.1.11 Information Systems: Desktop Computing - Why Is This Important for PACS Readiness? 21.2.1.12 IT Infrastructure: Communications Network - Key Questions and Considerations for PACS Readiness 21.2.2 Personnel 21.3 Change Management 21.3.1 Training Issues 21.3.2 Record Keeping and History 21.3.2.1 Important Aspects of Maintaining Systems’ Histories 21.3.3 Getting Help 21.3.3.1 Main Decision Points for Getting External Help 21.4 Summary Suggested Reading Self-Assessment Questions Choosing a Vendor 22.1 PACS: Making a Decision Based on Needs 22.2 Developing an Appropriate Business Plan 22.3 Contents of an Effective Request for Proposal (RFP) 22.3.1 Goals and Objectives of the Radiology Department and the Healthcare Enterprise 22.3.2 General Information About the Healthcare Enterprise 22.3.3 Operational and Workflow Information About Radiology and Other Departments with Access to PACS 22.3.4 Technical and Hardware Requirements of the Organization 22.4 Review of Responses to RFP 22.5 Site Visits 22.6 Negotiation of Terms and Conditions Self-Assessment Questions Acceptance Testing 23.1 Introduction 23.2 Interfaces and Modalities 23.2.1 System Integration and Interfaces 23.2.2 Modality Integration 23.3 PACS Component Testing 23.3.1 Image Storage and Archive 23.3.2 Workstation Functionality 23.3.3 PACS Monitor Testing 23.4 Conclusion Self-Assessment Questions Working with Vendors 24.1 Introduction 24.2 Vendor Selection 24.2.1 Overview of the Vendor Selection Process 24.2.2 Sales Strategy and Relationships 24.2.3 Request for Information (RFI) 24.2.4 Request for Proposal (RFP) 24.2.5 Onsite Product Demonstrations 24.2.6 Site Visits 24.2.7 Vendors and Site Visits 24.2.8 Why Host Site Visits? 24.2.9 Visiting and Evaluating Show Sites 24.3 Organization and Technology Evaluation 24.3.1 Product Development Self-Assessment Questions Team Building and Project Management 25.1 Introduction 25.2 Members of the Project Team - Team Building 25.2.1 PACS Operations Workgroup 25.3 Identify Goal, Scope, and Risks 25.3.1 PACS Project Goals 25.3.2 PACS Project Scope 25.3.3 Common Risks for PACS Projects 25.3.4 Risk Mitigation Strategies 25.4 Evaluate the Feasibility of a Project 25.4.1 Local Environment Assessment 25.4.2 Financial Feasibility 25.5 Common Project Management Tools 25.5.1 Project Development Stages 25.5.2 Project Management Forms and Tools 25.5.3 PACS Administrator as Project Manager Suggested Reading Self-Assessment Questions Long-Range Planning 26.1 Introduction 26.2 Before the First Meeting 26.2.1 Strategy vs. Tactics 26.2.2 Define Goals Before the First Meeting 26.2.3 Picking the Team 26.3 The Actual Planning 26.3.1 Architecture 26.3.2 Identify Relevant Standards 26.3.3 Plan to Share 26.3.4 Scope 26.3.5 Buy-In 26.4 Executing the Plan 26.4.1 The Plan Must Have Measurable Milestones 26.4.2 Contingencies 26.4.3 Communications 26.4.4 End Points Suggested Reading Self-Assessment Questions back-matter Answer Key Chapter 1: Medical Imaging Modalities and Digital Images Chapter 2: Computers and Networking Chapter 3: Introduction to PACS Chapter 4: Modalities and Data Acquisition Chapter 5: Workflow Steps in Radiology Chapter 6: Standards and Interoperability Chapter 7: Viewing Images Chapter 8: Image Postprocessing and Volume Rendering Chapter 9: Image Distribution Chapter 10: Reporting and Dictation Chapter 11: Customer Relations Chapter 12: User Training Chapter 13: Quality Assurance for Medical Imaging Chapter 14: Data Storage and Disaster Recovery Chapter 15: Downtime Procedures and Departmental Policies Chapter 16: Reading Room Design Chapter 17: Workflow Testing and Workflow Engineering Chapter 18: Policy Management and Regulatory Compliance Chapter 19: Billing and Coding Chapter 20: Economics of PACS and Related Systems Chapter 21: PACS Readiness Chapter 22: Choosing a Vendor Chapter 23: Acceptance Testing Chapter 24: Working with Vendors Chapter 25: Team Building and Project Management Chapter 26: Long-Range Planning Glossary Index