WORKFLOW-IN-RADIOLOGY.pdf

WORKFLOW IN RADIOLOGY is the automation of a business process, in whole or part, during which documents, information or work items are passed from one participant to another for action, according to a set of procedural rules. is a term that can be used in any industr...

WORKFLOW IN RADIOLOGY is the automation of a business process, in whole or part, during which documents, information or work items are passed from one participant to another for action, according to a set of procedural rules. is a term that can be used in any industry or in any organization. It simply means how a process is done, step by step. In radiology, the term workflow has always been used to describe how an examination is completed, from order entry to transcribed report. FILM BASED WORKFLOW Most departments were designed years ago for film and chemical processing. Pass boxes were built into walls that fed into darkrooms and into large open reading rooms that had gigantic multiviewer lightboxes lining the walls Eventually chemical-processing time decreased from a few minutes to less than 60 seconds in some cases. As film and processing technology advanced, workflow became more efficient, despite the fact that technologists still have to hand-deliver film to radiologists and make the occasional copy for a referring physician. The following list outlines a typical workflow in a radiology department, from entering the order to transcribing the report: The first step in any radiology department workflow is the entry of the order. The order may be a paper prescription from the ordering doctor, or the order may have been placed in the computer system by any hospital staff member.  Either way, an order is placed in the radiology information system (RIS), and a requisition is generated. A requisition generally contains the following information: 1. Patient’s name 2. Patient’s hospital identification (ID) number 3. Date of birth 4. Ordering physician’s name 5. Examination ordered 6. Reason for examination 7. Chief complaint The paper requisition is then passed on to the technologist who will be performing the examination. The technologist prepares the room for the patient and brings the patient back to the room. The technologist verifies all of the patient’s information and completes a patient history. The technologist also inquires whether the patient needs a complete set of copies to take to the next doctor’s appointment. The technologist performs the examination and processes all of the film after the complete examination is done. The technologist critiques each film and repeats exposures as necessary. The radiologist reads the films and dictates a report into the dictation system. The multiviewer lightbox is cleared of read films by the file room clerk, and the films are placed back into the film jacket. The film jacket is filed in the file room. A transcriptionist retrieves the recorded dictation and transcribes a report into the RIS. This may occur later that same day or the next day. The radiologist reviews the report, makes corrections, and signs the report as final. The final report is printed and placed in the patient’s film jacket along with any previous reports. A final report is also sent to the ordering physician for review. This final report may come several days after the examination was completed. PACS (PICTURE ARCHIVING AND COMMUNICATION SYSTEM) PACS (picture archiving and communication system) is a medical imaging technology used primarily in healthcare organizations to securely store and digitally transmit electronic images and clinically-relevant reports. The use of PACS eliminates the need to manually file and store, retrieve and send sensitive information, films and reports. Instead, medical documentation and images can be securely housed in off-site servers and safely accessed essentially from anywhere in the world using PACS software, workstations and mobile devices. Medical imaging storage technologies such as PACS are increasingly important as the volume of digital medical images grows throughout the healthcare industry and data analytics of those images becomes more prevalent. Who uses PACS While radiologists have predominately used PACS -- radiology traditionally being the most prolific producer of X-ray images -- PACS technologies have been incorporated into other departments, such as nuclear medicine imaging, cardiology, pathology, oncology and dermatology. Medical images are taken and reviewed for clinical analysis, diagnosis and treatment as part of a patient's care plan. The information collected can be used to identify any anatomical and physiological abnormalities, chart the progress of treatment and provide clinicians with a database of normal patient scans for later reference. Having digital access to the most updated version of a patient's medical images, clinical reports and history can expedite and improve care, lessening the likelihood of treatment and prescription errors and preventing redundant testing. Digital access can also improve patient safety and save both the healthcare facility and the patient time and money. Development This system is used to store, retrieve, present and share images produced by various medical hardware modalities, such as from an X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasound machines. The modern use of PACS can be attributed to DICOM (Digital Imaging and Communications in Medicine), which is a standard protocol for the management and transmission of medical images and related data. DICOM was originally developed by the National Electrical Manufacturers Association (NEMA) and the American College of Radiology (ACR). In 1983, ACR and NEMA formed a joint committee in hopes of developing medical imaging technology standards and to facilitate the development and expansion of PACS. PACS ARCHITECTURE PACS has four major components: -hardware imaging machines -a secure network for the distribution and exchange of patient images -a workstation or mobile device for viewing, processing and interpreting images -electronic archives for storing and retrieving images and related documentation and reports In turn, PACS has four main uses. The technology: -replaces the need for hard-copy films and management of physical archives. - allows for remote access, enabling clinicians in different physical locations to review the same data simultaneously. - offers an electronic platform for images interfacing with other medical automation systems such as a hospital information system (HIS), electronic health record (EHR), and radiology information system (RIS). - allows radiologists and other radiology and medical personnel to manage the workflow of patient exams What is medical imaging informatics? Because of increasing availability of medical images in digital form, medical digital images have become a core data type that must be considered in many biomedical informatics applications. It is a subfield of biomedical informatics that has arisen in recognition of the common issues that pertain to all image modalities and applications once the images are converted to digital form. Medical imaging informatics embraces the following areas: -Image Generation :The process of generating the images and converting them to digital form if they are not intrinsically digital. -Image Manipulation: Uses pre-processing and post-processing methods to enhance, visualize, or analyze the images -Image Management :Includes methods for storing, transmitting, displaying, retrieving, and organizing images. -Image Integration : The combination of images with other information needed for  interpretation, management, and other tasks (e.g. Patient record). Why medical imaging is important? Diagnosis (Detection) Treatment planning Image-guided treatment, e.g. Image-guided surgery produced minimally invasive surgery Assessment of response to treatment Estimation of prognosis Medical communication Education Research Medical imaging progress over time 1980s: Medical imaging technology development Computed radiograph(CR), MRI, CT, Ultrasonography(US), Digital Radiography(DR), WS, storage, networking Late 1980s: Imaging systems integration PACS, the American College of Radiology and the National Electrical Manufacturers Association (ACR/NEMA),DICOM, high-speed networks. Early 1990s: Integration of HIS/RIS/PACS DICOM, HL7, Intranet and Internet Late 1990s-present: Workflow and application servers Integrating the Healthcare Enterprise (IHE), ePR, enterprise PACS, Web-based PACS 2000s-present: Imaging informatics Computer-aided diagnosis (CAD), image contents indexing, Knowledge base, decision support, Image-assisted diagnosis and treatment. Energy sources to create images Light X-rays: fluoroscopy, CT scan Ultrasound: Ultrasonography Nuclear Magnetic Resonance: MRI, positron-emission tomography (PET) - nuclear-medicine imaging e.g. radioactive isotope