1
VA IHE Success Story – DICOM Image Acquisition in and beyond Radiology
• Peter Kuzmak, VistA Imaging Project DICOM Team Leader
• Dr. Ruth Dayhoff, National Director, VistA Imaging Project
2
VA Healthcare Enterprise
• 158 Medical Centers & 850+ Outpatient Clinics
• Serves an active patient population of 5 million veterans
• All sites acquire DICOM images
• 500 million DICOM images online
• DICOM now used for Clinical Specialties besides Radiology
3
VistA & Computerized Patient Record System
4
Multimedia Patient RecordCombines Computerized Patient Record and VistA Imaging
• Chart Data– Textual chart data
– Computable data
– Handwritten and non-electronic chart data
• Multimedia Data– Images, graphics,
waveforms, audio, etc.
5
Wide Variety of Images Integrated with the Online Patient Record
• Cardiology• Bronchoscopy• Gastrointestinal
Endoscopy• Hematology• Pathology• Surgery• Nuclear Medicine• Dental• Radiology• Dermatology• Ophthalmology• Podiatry• Vascular• Urology• Nursing• Electrocardiography• Scanned Documents
7
VA IHE Success Story
• All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS: – #5 - Modality Worklist Provided - download patient and study
– #8 - Modality Images Stored - send images to the PACS.
• 200 different models of radiology instruments interfaced• Exactly the same IHE DICOM interface to Consults for
ophthalmology, dentistry, endoscopy, pathology, cardiology.• The VA will not purchase a new modality unless it supports
both of these capabilities.
8
VA’s Role in Advancement of DICOM in Radiology
• 1997 - required modality worklist + accession number
• 1999 – IHE initiative• 2004 - 200 million radiology
images acquired have been acquired from 200 different models of instruments
9
Using DICOM to Acquire Images in the Clinical Specialties
• Dentistry
• Ophthalmology
• Endoscopy
• Cardiology
• Pathology
10
Goal of Project
Interface the VistA HIS Consult package to new DICOM-based image acquisition devices used in the clinical specialties
Panoramic Image3064x1536 16-bits
11
Using Consults for Clinical Specialties (Simplified Workflow)
1. Consult Ordered
2. Schedule Appointment
3. Patient Arrives
4. Images Acquired
5. Patient Leaves
6. Diagnostic Reporting
7. Follow up Visits
369x359 24-bit
12
Workflow Messages
CPRS Order Entry VistA Appointment Management
Order entered for a Consult or Procedure or Clinical Procedure
13
Workflow Messages
CPRS Order Entry VistA Appointment Management
DICOM Gateway
Order signed
14
Workflow Messages
CPRS Order Entry VistA Appointment Management
DICOM Gateway
15
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Patient scheduled for appointment
16
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Patient arrives at image acquisition modality
Imaging Modality
17
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Modality obtains patient demographics and study information
Imaging Modality
18
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Images acquired and sent to VistA
Imaging Modality
19
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Images acquired and sent to VistA
Imaging Modality
20
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Images verified on VistA
Imaging Modality
21
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Patient leaves image acquisition modality
Imaging Modality
22
Workflow Messages
CPRS Consult Request Tracking VistA Appointment Management
DICOM Gateway
Patient checked out
Imaging Modality
23
Workflow Messages
CPRS Consult Request Tracking
DICOM Gateway
Patient checked out
Imaging Modality
24
Workflow Messages
CPRS Consult Request Tracking
Images diagnosed on VistA
Imaging Modality
DICOM Gateway
25
Workflow Messages
CPRS Consult Request Tracking
Images diagnosed on VistA
Imaging Modality
DICOM Gateway
26
Workflow Messages
CPRS Consult Request Tracking
Images diagnosed on VistA
Imaging Modality
DICOM Gateway
27
Workflow Messages
CPRS Consult Request Tracking
Report is entered
Imaging Modality
DICOM Gateway
28
Workflow Messages
CPRS Consult Request Tracking
Image icon appears on CPRS note
Imaging Modality
DICOM Gateway
Image icon on CPRS note
29
Workflow Messages
CPRS Consult Request Tracking
Image icon appears on CPRS note, and message sent to gateway
Imaging Modality
DICOM Gateway
Image icon on CPRS note
30
Workflow Messages
CPRS Consult Request Tracking
DICOM Gateway
Request Complete
Imaging Modality
31
Workflow Messages
CPRS Consult Request Tracking
DICOM Gateway
Request Complete
32
Workflow Messages
CPRS Consult Request Tracking
Request Complete
33
VA’s Role in Advancement of DICOM in Dentistry
• Prior to 2001, dental IODs & CDs existed, but no networking
• VA wanted dental IODs with MWL & Storage networking
• March, 2001 – VA Moratorium• August, 2001 – 1st demonstration
of MWL & Storage for Dentistry• ADA is now picking up this effort
1024x1536 8-bits
34
Results - Dentistry
• 2 kinds of sensors– CCD (DX)– Phosphorescent Plate
• 3 kinds of radiographs– Intraoral (18-20
image/study)– Panoramic– Cephalometric
• Color (VL)Various sized CCD sensors
35
Results - Dentistry
• 2 kinds of sensors– CCD (DX)– Phosphorescent Plate
• 3 kinds of radiographs– Intraoral (18-20
image/study)– Panoramic– Cephalometric
• Color (VL)
36
VA’s Role in Advancement of DICOM in Ophthalmology
• Initially no Ophthalmology specification in DICOM
• Could not even tell left from right
• 2002 - VA encouraged AAO develop new specification
• 2004 - Ophthalmic Photography Image DICOM Supplement 91
• 2005 - VA Diabetic Retinopathy Screening program Fundus Image
3072 x 2048 24-bit
37
Results - Ophthalmology
• External color photographs• Retinal (fundus)
– Color photographs– Stereoscopic photographs– R/G/B filtered photographs– Fluorescein angiography
(up to 30 images/eye)– Near infrared fluorescein
angiography
• Ultrasound• Visual Fields (not DICOM)• Diagrams (not DICOM)
38
Results - Ophthalmology
• External color photographs• Retinal (fundus)
– Color photographs– Stereoscopic photographs– R/G/B filtered photographs– Fluorescein angiography
(up to 30 images/eye)– Near infrared fluorescein
angiography
• Ultrasound• Visual Fields (not DICOM)• Diagrams (not DICOM)
Magnified Fundus Image
39
Results - Ophthalmology
• External color photographs• Retinal (fundus)
– Color photographs– Stereoscopic photographs– R/G/B filtered photographs– Fluorescein angiography
(up to 30 images/eye)– Near infrared fluorescein
angiography
• Ultrasound• Visual Fields (not DICOM)• Diagrams (not DICOM)
Fluorescein angiography1108x1016 8-bit
40
Diabetic Retinopathy Screening
• Diabetes mellitus causes degeneration of retina
• Leading cause of blindness in U. S.
• Treatable if detected in early stage
• Diagnosis can be made from digital retinal images
• VA has 763,000 patients with diabetes mellitus
• Goal: have all diabetic patient screened annually so that effective treatment can be scheduled
41
VA’s Teleophthalmology Diabetic Retinopathy Screening Program
• Uses CPRS & DICOM for Clinical Specialties
• Retinal cameras in OPC’s
• Images acquired remotely and sent to reading sites
• Orders & results directly entered into VistA CPRS Proliferative Diabetic Retinopathy
42
VA’s Teleophthalmology Diabetic Retinopathy Screening Program
• Uses CPRS & DICOM for Clinical Specialties
• Retinal cameras in OPC’s
• Images acquired remotely and sent to reading sites
• Orders & results directly entered into VistA CPRS Successful Treatment with Laser
43
VA’s Role in Advancement of DICOM in Endoscopy
1024x768 24-bit
• Acquisition Context (2005)
44
VA’s Role in Advancement of DICOM in Pathology
Microscopic Slide 1520 x 1144 24-bit
• 2004 – first vendor interfaced
45
Validated DICOM Clinical Specialty Imaging Systems
Specialty Manufacturers
Dental Gendex, Dexis, GE Dental, Planmeca, Schick, Sirona, Kodak, Medicor
Ophthalmology Canon, Carl Zeiss, Kowa, Medivision OIS, Nidek, Topcon
Endoscopy Olympus, Stryker Endoscopy, Utech Products
Pathology Apollo Telemedicine
Cardiology Heart Lab, ScImage (DICOM imaging only)
46
Thank You!