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Integrating the Healthcare Enterprise
Echocardiography Profile
Cameron Brackett, Cerner
Echo Profile co-editor,
IHE Cardiology Technical & Planning Committee
Sept 13-15, 2004 1 IHE Interoperability Workshop
Introduction
Echo Profile
TTE, TEE, Stress Echo
Cath Profile
Intravascular ultrasound (IVUS) and intracardiac
echocardiography (ICE) are used in cardiac
catheterization procedures, and are supported as
modalities in the Cath Workflow, and not in the
Echo Workflow.
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 2
Goal for Year 1
High ROI—value added problem solutions
Standards in place (DICOM & HL-7)
No ―political‖ challenges – just technical
Restricted scope for a ―quick win‖
Reuse successful Radiology profiles to
meet similar needs
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 3
Year 1 Scope: Imaging Workflow
Reuse of similar IHE-Radiology Profiles
Scheduled Workflow (IHE-R SWF)
Patient Information Reconciliation (IHE-R PIR)
Intermittently Connected Modality
Workflow
Acquisition Modality storage
Stress Echo
Workflow
Staged Protocol
• Acquisition Modality (optional)
• Image Display (required)
Digital vs. Videotape
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 4
Echo – Out of scope year 1
Documentation/Reporting
Nursing (e.g. TEE)
Sonographer (e.g. measurements via DICOM SR)
Cardiologist (final report)
Medication administration
Counter-indication/clinical decision support
Fetal and pediatric echo
Combined echo/ECG stress acquisition workflow
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 5
Echo Actors & Transactions
ADT
Pt. Registration [Rad-1]
Patient Update [Rad-12] Pt. Registration [Rad-1]
Patient Update [Rad-12]
Placer Order Management [Rad-2]
Filler Order Management [Rad-3]
DSS/ Order Filler Order Placer
Modality PS in Progress [Card-1] Procedure Scheduled [Rad-4]
Modality PS Completed [Rad-7] Patient Update [Rad-12]
Procedure Updated [Rad-13]
Image Display
Performed Query Images [Rad-14]
Procedure Retrieve Images [Card-4]
Step Manager
Image Image
Manager Archive
Modality PS in Progress [Card-1]
Modality PS Completed [Rad-7]
Storage Modality Image/Evidence
Commitment Stored [Card-2]
[Card-3]
Modality PS in Progress [Card-1]
Modality PS Completed [Rad-7]
Acquisition
Modality
Query Modality Worklist [Rad-5]
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 6
Actors
No new Actors
Actors Using Cardiology Specific Transactions
Department System Scheduler/Order Filler (DSS/OF)
Performed Procedure Step Manager
Image Archive
Image Manager
Acquisition Modality
Image Display
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 7
Transactions
Modality Procedure Step In Progress An
Acquisition Modality notifies the Performed
Procedure Step Manager of the start of a new
Procedure Step and the PPS Manager informs
the Department System Scheduler/Order Filler
and Image Manager. [CARD-1, derived from
RAD-6]
Intermittently connected workflows may send the MPPS
“In Progress” immediately preceding the MPPS
“Complete”
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 8
Transactions
Modality Images/Evidence Stored – An Acquisition Modality
sends acquired or generated images, waveforms, or other
evidence documents to the Image Archive. [CARD-2,
derived from RAD-8 and RAD-43]
Echocardiography Option
• Image Archives must support:
– JPEG Baseline (Process 1): Default Transfer Syntax for Lossy JPEG 8 Bit
Image Compression for Ultrasound Multi-frame images
– YBR_FULL_422
– The follow SOP classes:
SOP Class UID SOP Class Name
1.2.840.10008.5.1.4.1.1.7 Secondary Capture Image Storage
1.2.840.10008.5.1.4.1.1.6.1 Ultrasound Image Storage
1.2.840.10008.5.1.4.1.1.3.1 Ultrasound Multi-frame Image Storage
1.2.840.10008.5.1.4.1.1.88.59 Key Object Selection
1.2.840.10008.5.1.4.1.1.88.11 Basic Text SR
1.2.840.10008.5.1.4.1.1.88.22 Enhanced SR
1.2.840.10008.5.1.4.1.1.88.33 Comprehensive SR
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 9
Transactions
Modality Images/Evidence Stored – cont’d
Stress Echo Option
• Acquisition Modality actors supporting the STRESS ECHO option
are required to support a number of attributes in Multi-frame
Ultrasound Images created for a stress echo procedure
Attribute Name Tag Requirement
Performed Procedure Step Description (0040,0254) R+
Protocol Name (0018,1030) R+
Performed Protocol Code Sequence (0040,0260) R+
Number of Stages (0008,2124) R+
Number of Views in Stage (0008,212A) R+
Stage Code Sequence (0040,000A) R+ (note 2)
Stage Number (0008,2122) R+
View Number (0008,2128) R+ (note 1)
View Code Sequence (0054,0220) R+ (note 2)
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 10
Transactions
Modality Images/Evidence Stored – cont’d
Stress Echo Option
• Numbers: Stage Number & View Number
• Code Sequences: Stage Code Sequence & View Code
Sequence
Stage
Coding Scheme Code Value Code Meaning (0008,0104)
Designator (0008,0100)
(0008,0102)
SRT P5-01201 Image acquisition at baseline
SRT P5-01202 Pre-stress image acquisition
SRT P5-01203 Mid-stress image acquisition
SRT P5-01204 Peak-stress image acquisition
SRT P5-01205 Image acquisition during recovery
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 11
Transactions
Modality Images/Evidence Stored – cont’d
View
Coding Scheme Code Value Code Meaning
Designator
SRT G-A19B Apical two chamber
SRT G-A19C Apical four chamber
SRT G-0395 Apical long axis
SRT G-0396 Parasternal long axis
SRT G-0397 Parasternal short axis
SRT G-0398 Parasternal short axis at the aortic valve level
SRT G-0399 Parasternal short axis at the level of the mitral chords
SRT G-039A Parasternal short axis at the Mitral Valve level
SRT G-039B Parasternal short axis at the Papillary Muscle level
SRT G-039C Right Ventricular Inflow Tract View
SRT G-039D Right Ventricular Outflow Tract View
SRT G-039E Subcostal long axis
SRT G-039F Subcostal short axis
SRT G-03A0 Suprasternal long axis
SRT G-03A1 Suprasternal short axis
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 12
Transactions
Storage Commitment – A requestor (Acquisition
Modality) requests that the Image Manager
confirm ownership for the specified DICOM
objects (images, waveforms, evidence
documents, or any combination thereof) that the
requestor stored in the Image Archive, thus
allowing the sender to delete those objects now
owned by the Image Manager. [CARD-3, derived
from RAD-10]
This option requires the Image Manager to send the N-Event
Report message to the mobile modality at the time that
reconnects to the Image Manager.
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 13
Transactions
Retrieve Images – An Image Display
requests and retrieves a particular image
or set of images from the Image Archive.
[CARD-4, derived from RAD-16]
Image Display
JPEG Baseline (Process 1): Default Transfer
Syntax for Lossy JPEG 8 Bit Image Compression
for Ultrasound Multi-frame images
YBR_FULL_422
May organize and present multiple images for
stress echo
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 14
Use Cases
Case E1: Patient Registered at ADT and Procedure Ordered
Case E2: Intermittently Connected Modality
Case E3: Intermittently Connected Modality with Ad Hoc
Procedure, Patient Registered, Scheduled Procedure
Case E4: Intermittently Connected Modality with Ad Hoc
Procedure, Patient Registered, Unscheduled Procedure
Case E5: Intermittently Connected Modality with Ad Hoc
Procedure, Patient Unregistered, Unscheduled Procedure
Case E6: Stress Echo Staged Protocol
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 15
Use Case E2: Intermittently
Connected Modality
Clinical Context
Echo system has gone mobile to perform procedures
TTE, TEE
IHE Context
MPPS in Progress
Storage Commitment
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 16
Use Case E2: Intermittently
Connected Modality
Order Department System Image
ADT Acquisition
Placer Scheduler/ Manager/
Order Filler Modality
PPS Manager
Register J.Doe
Patient
Registration [RAD-1]
Placer Order
Management–
One or the New [RAD-2]
other methods
of creating an
order is used Filler Order
Management - Schedule
New [RAD-3] Procedure
Procedure
Scheduled [RAD-4]
Query Modality Worklist [RAD -5]
Modality Procedure Modality Procedure
Filler Order Step In Progress Step In Progress Perform
Mgmt - Status [CARD-1]- [CARD-1]- Acquisition
Update [RAD-3]
Modality Procedure Modality Procedure
Patient Reconciliation Filler Order Step Completed Step Completed
J.Doe -> Mgmt - Status [RAD-7] [RAD-7]
J.Smith Update [RAD-3]
Storage Commitment
Patient Update/ -
[CARD-3]
Merge [RAD-12] Patient Update/
Merge [RAD-12]
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 17
More information….
IHE Web sites:
http://www.himss.org/IHE
http://www.rsna.org/IHE
http://www.acc.org/quality/ihe.htm.
Technical Frameworks:
• ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
• May 2004: Radiology
• August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles: Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements
Sept 13-15, 2004 IHE Educational Workshop 2004 Cameron – p. 18
