Practical guide: Medical Imaging Concepts PowerPoint Presentation, PPT - DocSlides

pamella-moone | 2017-07-11 | General

Steven Horii, MD, FACR, FSIIM. Professor of Radiology, . Clinical Director , Medical . Informatics Group. Modality Chief, Ultrasound. Hospital . of the . University . of . Pennsylvania. Attending Radiologist, Children’s Hospital of Philadelphia. ID: 568918

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Steven Horii, MD, FACR, FSIIM

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Slide1

Practical guide: Medical Imaging Concepts

Steven Horii, MD, FACR, FSIIM

Professor of Radiology,

Clinical Director , Medical Informatics Group Modality Chief, Ultrasound Hospital of the University of Pennsylvania Attending Radiologist, Children’s Hospital of Philadelphia

Clinical and workflow

Slide2

Disclosures

My wife is a full-time employee of

Cerner Corporation

Site PI, Phase III clinical trial, ultrasound contrast for liver masses,

Bracco

Pharmaceuticals, Inc.

Expert witness, Blakely

Sokoloff

Taylor &

Zafman

, LLP (Patent litigation)

Slide3

Introduction

A tiny bit

about clinical stuff

The unavoidability of workflow

The complexity of workflow and multiplication of that through interacting

(or colliding) workflows

The changing healthcare model

What that means for you

Slide4

Clinical

What we do

What do you mean “we”,

kemosabe

OK, then – what do physicians in general do; with some radiology particulars

Slide5

Workflow

How

we do it

In twenty minutes?

OK, then –

Why workflow

can

seem

simple

Why it generally is not

Why is workflow important?

Slide6

Clinical: An overview

Physicians:

Given a story or complaint by a patient,

Try to figure out what, if anything, is wrong

Figure out a treatment plan

Treat the patient

If the patient is not improving, return to bullet item 2

yeah, get paid

Slide7

Clinical: An overview

Slide8

Notice anything?

From a description of what we do, a flow diagram (of sorts) comes out

It is difficult to separate what we do from how we do it

Slide9

What do radiologists do?

Image humans (and animals) to:

Diagnose diseases or anomalies

Guide and perform

procedures

Help develop treatment plans

Evaluate progression or regression of

disease (response

treatment)

Assist in forensic investigations

Slide10

Imaging

Mechanical

energy (ultrasound)

Electromagnetic energy

RF (MR imaging)

Infrared (thermal)

Visible light (endoscopy, ophthalmology, dermatology)

Ultraviolet (fluorescence microscopy)

Gamma (radiographic imaging)

Protons (radiation therapy)

Slide11

Adult liver

A 50 year old man with cirrhosis and worsening LFTs

Slide12

Adult liver: good news for this patient

This is color flow and power Doppler: it shows that the blood

vessels in the liver are not distorted by any “mass”.

Slide13

Obstetrical ultrasound

Slide14

How we do it: Workflow

I recommend review of the IHE Profiles

for radiology if you are not already familiar with them

The profiles were developed largely through detailed examination of radiology workflow

Slide15

Scheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

Folder

Image Manager

& Archive

Film

Lightbox

report

Report

Repository

Diagnostic

Workstation

Modality

acquisition

in-progress

acquisition

completed

acquisition

completed

images

printed

Acquisition

Modality

Slide16

Why are healthcare workflows so complex?

Legacy procedures

and systems

We are idiosyncratic (Paul Chang)

Interactions between departments

Many personnel, each with particular tasks to perform and information needed

Slide17

Complex workflow: intraoperative ultrasound

We provide ultrasound

in the operating room to assist the surgeons in locating structures and planning surgical approaches

About 20% of the time, the ultrasound changes the surgical plan

Slide18

Display during intraoperative scanning

With permisson: Susan Rowling, MD, Frank Spitz, MD

Slide19

Display: the radiologist’s view

Slide20

Intraoperative ultrasound example

A 41 year-old woman with colon carcinoma for resection ofa solitary liver mass

Slide21

The mass looks more like normal liver after compression

This is NOT another metastasis – it is an

hemangioma

;

a benign liver lesion.

Slide22

Intraoperative ultrasound

Often resulted in delays for both surgery and radiology

Surgeons

had to wait for 20 minutes or more for us to arrive with our equipment

For radiology, it added to patient waiting time (took a radiologist and sonographer out of the Department)

Slide23

Basic workflow: Intraoperative liver

Slide24

Delays

We noted that some intraoperative

ultrasound studies were subject to much greater delays than others

We thought that one difference was whether or not the study was scheduled in advance

We looked at the difference in workflow

Slide25

The non-scheduled workflow addition

Slide26

The non-scheduled workflow addition

Included more steps

Each step involved

time

Once we showed how many more steps were involved, we discussed this with the surgeons and explained that scheduling ahead of time would result in shorter delays

They now routinely schedule their studies

Slide27

Intraoperative ultrasound

Illustrates that an already complex workflow

in radiology,

Is made more complex when it involves interaction with another department’s workflow

Note that this does not even include the workflow steps done by surgery

Slide28

Intraoperative ultrasound

Also

shows the need for standardization in the OR (hence the DICOM in Surgery WG)

There are vendor-based standards, but they are usually proprietary

There are standards (HDMI for video) that permit display on different devices, but not integration/interoperation

Slide29

Why is this stuff important for you?

Much of radiology workflow grew out of the film, paper, and pencil age

This includes not only processes, but organization

Radiology had been largely radiology-centric

This in a time when “patient centered” has become a goal

Slide30

Opportunities

Our workflow tends to be supported by thick

client, customized software

It is neither agile nor adaptable

The rapid changes in healthcare have meant much more difficult transitions for our legacy information systems

Slide31

Big changes are coming

Remember the bit about “getting paid”?

Much

of our (meaning healthcare in general) workflow is based on a fee for service model

The service-oriented specialties (radiology and pathology in particular) are effectively piece workers

Slide32

The approach to reducing healthcare costs

The US Government has, in

response to escalating healthcare costs, attempted to fix this by reducing payments to hospitals and physicians

What is the logical response to reduced reimbursement per procedure?

Why, perform more procedures, of course!

Slide33

The newer model for reimbursement

Accountable care

Reimbursement

is based on outcomes, cost reductions, and appropriateness rather than just what was done

How can radiology prepare for this?

It is why you are (or should be) hearing about quality measures, appropriateness criteria, and meaningful use

Slide34

Examples

CPOE – show that use improves

appropriate requesting of imaging studies

ACR Imaging 3.0

The Leapfrog Group

founded by large purchasers of healthcare services, mostly large

corporations

Slide35

Importance for you (us)

We need to be agile and adaptable enough to provide

the informatics and information technology resources to support changes in the way healthcare is practiced and reimbursed

Slide36

The emphasis

The emphasis will be (and is) on:

Rapid data mining

Increased patient involvement

Improved

communication between healthcare providers

Demonstrating improvements in outcome

Proving increased efficiency

Slide37

Think about how these things can be accomplished

you want to continue to write monolithic thick client applications with numerous customizations?

And then have to debug, support, and update them?

This meeting gives me hope that there is a better way and you folks are practicing it

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