1. What to see at the
RSNA annual meeting?
RADIOLOGY IT 2011
David S. Mendelson, M.D.
Professor of Radiology
Chief of Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE International Board

2. Major Radiology IT Themes-
Meaningful Use for the Radiologist
 Radiation Exposure
 Aggregating and monitoring patient and population exposure
 Image Sharing
 Quality
 Diminished inappropriate utilization
 IHE XDS; Personal Health Records as a vehicle
 Reporting
 Decision Support
 Teaching and Research
 MIRC
 CTP
 IHE- TCE
 Radlex as a fundamental tool
 Playbook
 Meaningful Use – ONC/CMS

3. RSNA Informatics
 Radiology Informatics
Committee (RIC)
 RSNA Annual
Meeting
 IHE Showcase
(Technical Exhibit
floor)
 Scientific Sessions
 Scientific Posters /
Education Center
 Vendors

4. IHE Connectathon 2011

5. Radiation Exposure
 Evaluating legacy dose information
 OCR solutions
 Evaluating dose today
 Within the institution
 Comparing multiple instruments
 Patient
 Site comparison
 IHE-REM profile
 ACR registry
 Site to Site comparison as well as within an
enterprise
 Radlex terms

6. REM Actors and Transactions to move dose
information stored as DICOM SR

7. REM

8. MIRC - Teaching Files
Medical Imaging Resource Center
 Ease of installation
 Brand new user interface - more
intuitive, easier to operate
 TCE compatible - of course!!
 Improved conferencing capabilities
 Automatic conversion utility to bulk import
entire static image collections into the
system with a few clicks

10. CTP- Clinical Trials Processor
 Again, ease of installation and configuration
 Best anonymizer in the business!
 Audit trail repository - 21CFR11 compliance
for FDA- work in progress
 Plug-in architecture, customizable pipelines
 Extremely efficient - will easily process
millions of images
 De-facto image management tool for NCI
and other large trials

11. TCE- Teaching File and
Clinical Trial Export
 IHE profile
 How to get images directly out of
PACS as a part of your normal
workflow

12. TCE
 Image Selector
 Image Exporter
 Receiver

13. TCE

14. TCE – Actors and
Transactions

15. Reporting
 Structured reporting
 Standardization of content
 Quality
 Data mining
 Decision support
 Trigger events
 RSNA Templates
 Incorporation of RADLEX

16. RADLEX
 The Radlex playbook for CT orderables
will be released by the annual show
 The ACR Dose Registry is employing the
Radlex ontology for its exam dictionary
 ideally a site would use this exam
dictionary
 the ACR has a tool to map other exam
dictionaries to the RADLEX playbook

17. IMAGE SHARING
• Version 1.1 is in production
• Review and Update 2011

18. IHE-XDS (Cross-Enterprise
Document Sharing)
 XDS.a
 XDS- I.a
 XDS.b
 ?? XDS-I.b
 a vs. b
 Related to web standards
and transactions

19. XDS-I

20. NIBIB/RSNA Image Sharing
Project
A Standards Based Solution

22. Goals of Contract
 NIBIB contract
 Bootstrap an IHE based network
 Primary emphasis is Consumer Control
through PHRs
 Can be extended to other forms of sharing
 HIE
 Security and Confidentiality are drivers
 Replacement / Alternative to CD

24. NIBIB contract summary
 Consumer Control  5 Academic Institutions
 Mayo Clinic
 Employ IHE solutions  Mount Sinai Medical
whenever possible Center
 IHE generally has not  University of California
focused on San Francisco
consumer- driven  University of Chicago
solutions, but rather
on institutional and  University of Maryland
enterprise workflow
 Establish a
clearinghouse
 Engage PHRs
 300,000 patients over 2
years

25. Image Sharing/Elements of
Solution
 Edge Server
 Register a patient
 Listens to a Radiology Information System (RIS) - looking for a
complete exam
 Retrieves Image set from PACS and Report from RIS
 Send both to clearinghouse
 PHI hidden; an RSNA ID and 2nd factor security token are used to
identify the patient
 Clearinghouse (XDS-I) – functions as a secure router
 Transiently hold encrypted patient data
 PHR
 Consumer controls upload and future access
 Must have RSNA ID available and know answer to 2nd factor question
 Develop web based viewers
 Download full DICOM data set
 Misc Consumers

27. Project design assumptions
 Security is paramount
 Restrictive policy
 PHI is never unsecured
 Consumer controls the flow of
information by placing it in the PHR
 Diminishes the need for BAAs between
enterprises
 Imaging Site to Clearinghouse
 Clearinghouse to PHR

31. Image Enabled PHR

35. Report

36. Future Directions
 Refine Workflow
 Initial workflow is to replace a CD
 Exam updates
 Download DICOM data and archive in a local
PACS
 Edge server as a platform
 Radiation Monitoring
 Peer Review
 Quality Metrics

38. Live Q&A Session To Submit a
Question:
• Type your
question in the
David Mendelson white “Q and A”
box.
Professor of Radiology & Chief of Clinical Informatics • Hit “SUBMIT” to
The Mount Sinai Medical Center; Co-chair IHE deliver your
question to the
International Board speaker.
david.mendelson@mountsinai.org
Mary Tierney
VP, Chief Content Officer, Health Imaging
mtierney@healthimaging.com
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