Keywords:  Image Management, patient list, thumbnails, worklist, key image, import, export
Image Management

Image and Information Management:  These features deal not with the images themselves, but rather anything needed to retrieve the correct image(s) and corresponding information.

Patient List:  This list is used to select the appropriate images or related clinical information.  Sorting by different columns in the patient list ("all STAT cases," based on exam time, by first, last name, by modalities, etc.) should be possible.  The capability of selecting specific columns to view or hide should also be an option.  It would also be desirable to specify logic for the patient search criteria in the column heading, such as, for example, "all female, CT patients, ending with Smith, done on September 4, 2003."

ThumbnailsAn additional common feature which is almost a requirement, is displaying a mini thumbnail image for each image series so that the physician immediately knows which one to retrieve.  Drag/drop these thumbnails to display window optimizes the selection process.

Worklist:  In addition to showing a complete list of all current exams, it should be possible to select a "worklist" for a specific radiologist, for a radiologist group, clinical specialty ("neuro," "ortho," etc.) body part ("chest," extremity"), modality (CT, MRI, Nuclear Medicine, Ultrasound) and other configurable criteria.  US HIPAA regulations require worklists to match the role of the user.

Display of Relevant Clinical Information:  The most important relevant clinical information are diagnostic reports concerning previous studies.  These should be easily available and integrated without having to change context or go to another software application.

Import/Export:  Importing images should be transparent, especially when done from the local archive.  One challenge is how to import images into the system that are available on electronic media, such as on a CD, which is rather common for cardiology exams.  Also, there could be a link with another institution which is sending images for a second opinion or to be used as a reference.  There should be an easy manner to import these images and alert the PACS image manager so they can be retrieved together with other images for this patient.  Exporting can be as simple as a "SEND: command on the workstation, for example, to another clinic, institution, or doctor's home.  Exporting images can also be done by storing images on a removable media such as CD.  Most images are retrieved and stored in a DICOM format.  When storing on exchange media, it is very common to add a simple DICOM viewer on the media so that a physician does not need to have one available.  For patients, images are often stored on media in a standard format such as JPEG.  Some images actually arrive at the workstation in JPEG or TIFF, o other semi-standard formats, especially from "visible Light" modalities such as ophthalmology, endoscopy or extra-oral dental images.

Key Images:  For studies containing a large number of images, such as those from a multi-slice CT or MRI (which could have hundreds of slices)  it is critical to flag clinically-significant images, a.k.a. "key images."  The purpose of flagging could be to identify them for other physicians, such as surgeons or referring physicians, so that they can easily access only these few selected images instead of having to browse the complete study.  Flagging can be done in different manners.  A vendor could update the image header with a private indicator, the information can be kept "out of band," such as in he database, or preferably the information can be kept as a special DICOM object allowing the reference to the image as being stored with additional text.  In IHE, the generation of DICOM key images is defined as part of the Key Image Notes integration profile.

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