Information Technology in Radiology

Introduction
Radiology
Information Technology
Application of Information Technology to Radiology
Conclusion
Information Technology in Radiology
Dr. Adegbenga Ismail
Rays & Waves Radiology Clinic
October 30, 2014
Dr. Adegbenga Ismail Information Technology in Radiology

Introduction
Radiology
Conclusion
Table of Contents
1 Introduction
2 Radiology
3 Information Technology
4 Application of Information Technology to Radiology
5 Conclusion

Introduction
Radiology
Conclusion
Radiology
Deﬁnition Medical specialty that uses imaging to diagnose
diseases [Wikipedia]
Fundamental Concerns Just two things:
1 Image acquisition
2 Interpretation of Images viz-a-viz Disease states

Introduction
Radiology
Conclusion
Deﬁnition Application of Computers and Telecommunications
equipment to store, retrieve, transmit and manipulate
data, often in the context of a business or other
enterprise [Wikipedia]
Fundamental Concern Automation

Introduction
Radiology
Conclusion
Modalities
Sound Ultrasound
X-rays Radiography, Fluoroscopy and Computed
Tomography

Introduction
Radiology
Conclusion
Modalities
Sound Ultrasound
Tomography
Magnets Magnetic Resonance Imaging

Introduction
Radiology
Conclusion
Modalities
Sound Ultrasound
Tomography
Magnets Magnetic Resonance Imaging
Sub-atomic particles Nuclear Medicine, and Positron Emission
Tomography

Introduction
Radiology
Conclusion
Modalities
Hardware Typical Conﬁguration: Client – Server Architecture:
Server + Dedicated Multi-modality viewing
Work-station
Server + General-purpose PC
Networks 1GB or faster ethernet hardware. Fast routers.
Implementations:
Local Area Network
Wide Area Network
Virtual Private Network

Introduction
Radiology
Conclusion
Modalities
Software Stored Instructions and procedures. DICOM is the
underlying protocol
Server + Fat client Server and Dedicated Client:
ConQuest DICOM-server +
k-PACS image-viewer
Osirix Server + Osirix
Image-viewer
Server + Thin client Server and Web browser
Clear Canvas Image Server +
Web-browser
Orthanc Server + Web-browser

Introduction
Radiology
Conclusion
Radiology already involves an intense use of Science,
Technology and Information. Can Computers,
Tele-communication and Information systems still add value?

Introduction
Radiology
Conclusion
Applications
Computed Radiography Computerized Radiography
Picture Archiving and Communication System (PACS) Provides
economical storage of, and convenient access to,
images from multiple modalities.

Introduction
Radiology
Conclusion
Applications
Computed Radiography Computerized Radiography
Picture Archiving and Communication System (PACS) Provides
economical storage of, and convenient access to,
images from multiple modalities.
Radiology Information System (RIS) Computerized database used
to store, manipulate and distribute patient
radiological data and imagery.

Introduction
Radiology
Conclusion
Applications
Teleradiology Transmission of radiological images from one
location to another for the purpose of sharing studies
with other radiologists and physicians.
Voice Recognition System Translation of spoken words into text

Introduction
Radiology
Conclusion
Applications
Computer-aided Diagnosis Pattern-recognition softwares highlight
suspicious areas on images, and draws the attention
of the radiologist to suspicious areas

Introduction
Radiology
Conclusion
Applications
Computer-aided Diagnosis Pattern-recognition softwares highlight
suspicious areas on images, and draws the attention
of the radiologist to suspicious areas
Decision Support Systems Particularly useful in assisting decision
for appropriate Imaging and follow-up Imaging

Introduction
Radiology
Conclusion
Computed Radiography
Combines four steps involved in radiographic film development
into just one step:
Developer A base (alkali) and metal solution used in
reducing ionized silver bromide crystals on
radiographic films to black metallic silver crystals
Stopper A glacial acetic acid solution used to neutralize
any excessive development of the film
Fixer Solution used to preserve radiographic image
over time
Rinsing and Drying Dry off water to allow film to be reported
Using a laser scanner to directly acquire images from a
photostimulable phospor imaging plate

Introduction
Radiology
Conclusion
Picture Archiving and Communication System
Uses the DICOM standard to acquire images and data from
diﬀerent HL7-compliant radiological imaging modalities
Stores images on RAIDs. RAID 5 in particular

Introduction
Radiology
Conclusion
Makes images available to reporting radiologists and clinicians
over high-speed broadband networks

Introduction
Radiology
Conclusion
Same image is simultaneously available over a LAN, a WAN
or the internet for reporting and clinical decision making

Introduction
Radiology
Conclusion
Long term storage is ensured by periodic oﬀ-site back-ups

Introduction
Radiology
Conclusion
Long term storage is ensured by periodic oﬀ-site back-ups
Provides fast image retrieval and redundant image availability

Introduction
Radiology
Conclusion
Radiologic Information System
Specialized instance of a Health Information System
addressing the peculiar needs of a radiology department
One-time input of patient data such as: name, age, gender,
registration number etc

Introduction
Radiology
Conclusion
Patient data can also be acquired from a hospital-wide HIS

Introduction
Radiology
Conclusion
Can Communicate via a Dicom Modality Work-list with
imaging equipments [Grainger & Allison, 2008]

Introduction
Radiology
Conclusion
Same patient data can be linked with multiple images from
diﬀerent imaging modalities

Introduction
Radiology
Conclusion
Same patient data can be linked with multiple images from
diﬀerent imaging modalities
Reduces clerical errors by eliminating multiple entry of same
patient information in diﬀerent imaging equipment

Introduction
Radiology
Conclusion
Teleradiology
Images transmitted over broadband networks to oﬀ-site
reporting radiologist
Enables oﬀ-site reporting of radiological images

Introduction
Radiology
Conclusion
Teleradiology
Enables virtual Multi-disciplinary Team Meetings

Introduction
Radiology
Conclusion
Teleradiology
Enables virtual Multi-disciplinary Team Meetings
Emerging area of Tele-education

Introduction
Radiology
Conclusion
Voice Recognition System
Seeks to automate stenography
Typical Reporting Work-ﬂow:
Radiologist’s Dictation ⇒ Secretary ⇒ Typed Report

Introduction
Radiology
Conclusion
Automated Reporting Work-ﬂow:
Radiologist’s Dictation ⇒ Voice Recognition Software ⇒
Computerized Report [Grainger & Allison, 2008]

Introduction
Radiology
Conclusion
Faster

Introduction
Radiology
Conclusion
Faster
Report is instantly veriﬁed and signed by radiologist author

Introduction
Radiology
Conclusion
Faster
Report is instantly veriﬁed and signed by radiologist author
Interfaces with the RIS and PACS

Introduction
Radiology
Conclusion
Computer-aided Diagnosis (CADx)
Uses pattern recognition to identify disease patterns in images
Machine learning technology is utilized to optimize algorithm

Introduction
Radiology
Conclusion
Images compared with anatomic databank of normal and
abnormal images

Introduction
Radiology
Conclusion
abnormal images
Uses Artiﬁcial Neural Network and Bayesian statistics in
analyzing images for probability of disease
[Stivaros et al, 2010]

Introduction
Radiology
Conclusion
abnormal images
Technology also used in Computer-aided Simple Triage
(CAST)

Introduction
Radiology
Conclusion
abnormal images
Technology also used in Computer-aided Simple Triage
(CAST)
Supplements and assists, not replace, human evaluation

Introduction
Radiology
Conclusion
Figure: Typical Neural Network

Introduction
Radiology
Conclusion
Figure: Simple Bayesian Network

Introduction
Radiology
Conclusion
Figure: Complex Bayesian Network for Mammography

Introduction
Radiology
Conclusion
Decision Support Systems
Uses bayesian statistics to make a weighted combination of:
Evidence in peer-reviewed publications
Information from Domain Experts
National Specialty Guidelines
Patient Information in the HIS
To Make Appropriate Imaging Requests

Introduction
Radiology
Conclusion
Figure: Typical Decision Support System

Introduction
Radiology
Conclusion
Aimed at Automating the work of a Radiology Beneﬁt
Manager
Assists clinicians in making appropriate Evidence-based Image
ordering

Introduction
Radiology
Conclusion
Manager
ordering
Increasingly being used by radiologists in making informed
imaging recommendations

Introduction
Radiology
Conclusion
Manager
ordering
Increasingly being used by radiologists in making informed
imaging recommendations
More objective and transparent replacement of the job of a
Radiology Beneﬁt Manager [ACR-RBMA, 2011]

Introduction
Radiology
Conclusion
To What End?
Machinery . . . will facilitate and abridge labour [Smith, 1776]

Introduction
Radiology
Conclusion
To What End?
Increased Eﬃciency and Productivity
Increased Revenue

Introduction
Radiology
Conclusion
Increased Productivity
What difference does automation make in productivity?
What is the difference in productivity between a manual
worker and an automated worker?
A mathematical metaphor:
Lazy Manual worker: ⇒ 0.2365 = 0
Efficient Manual worker: ⇒ 0.99365 = 0.026
Automated Worker: ⇒ 1.01365 = 37.78

Introduction
Radiology
Conclusion
Increased Revenue
Directly from the Increased Productivity
From accreted Value.
Data Client Database
Data Image Repositories

Introduction
Radiology
Conclusion
References
Wikipedia
http://en.wikipedia.org/wiki/Radiology
Wikipedia
http://en.wikipedia.org/wiki/Information technology
Stivaros SM, Gledson A, Nenadic G, Zeng XJ, Keane J, Jackson A.
Decision support systems for clinical radiological practice – towards the
next generation.
Br J Radiol. 2010 Nov;83(995):904-14. doi: 10.1259/bjr/33620087.
Review.
PMID:20965900 [PubMed - indexed for MEDLINE]
Adam Smith (1776)
An Inquiry into the Nature and Causes of the Wealth of Nations
http://www2.hn.psu.edu/faculty/jmanis/adam-smith/wealth-nations.pdf
12(3), 45 – 678.

Introduction
Radiology
Conclusion
References
ACR-RBMA Best Practices Guidelines on Radiology Beneﬁts Management
Programs (2011)
http://www.rbma.org/uploadedFiles/RBMA Web site/Advocacy/Advocacy Payer
RBMA%20Best%20Practices%20for%20Radiology%20Beneﬁts%20Management
%20Programs.pdf
Grainger & Allison’s Diagnostic Radiology (5th
edition).
Section 1, Chapter 1
Churchill Livingstone, Elsevier

Introduction
Radiology
Conclusion
Thank You For Listening

Introduction
Radiology
Conclusion
Questions

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