Alain Gauvin MSc, Presenter: Shareholder, Connectimage Medical Inc

Suzanne Laframboise RT, Abstract Co-Author: Nothing to Disclose

Greg Ruthman BSC, Abstract Co-Author: Consultant, McKesson Corporation

Ingestion by a local PACS of foreign images is a challenge when importing studies. This work is based on the implantation of a XDS-I.b proxy to allow a PACS to receive pre-fetch priors from other hospitals in a same XDS affinity domain. The coercion of DICOM tags of foreign studies in the context of their ingestion by the PACS needed to be carefully defined. Given that the model was to be used for 6 different PACS technologies, a single automatic ingestion methodology was devised to satisfy all PACS requirements.

The implementation of the XDS-I.b proxy took place in a center producing about 250 000 studies/year. The XDS registry used in the affinity domain initially allowed the proxy to access studies from 3 different sites. The proxy was able to determine the required pre-fetch set from the HL7 activity of the RIS. Given the modality type and body part of the upcoming study, the required priors were determined by the proxy from a set of pre-defined rules, pulled from their locations, and sent to PACS after the coercion of multiple DICOM tags. The list of coerced tags includes MRN, accession number, institution name, study description and the alphanumerical code of the study. The coercion of the 2 last values of that list was more complex, and was accomplished using logic based on the modality, anatomical code, and keyword detection in the study description of the ingested study. These combined criteria allowed to achieve a granular normalized exam table, comprising more than 170 codes. A simulation tool was set up to allow refining the choice of keyword rules. The normalized codes were configured in the ingesting PACS alongside with the local procedure codes.

The initial daily rate of study intake was on average between 7 and 8, which was expected given that the content of only 3 sites were initially looked up in the XDS registry. That figure was expected to rise to 18 within the following few weeks, and further again over the course of a few months. 

The implementation of XDS-I in an affinity domain supporting various PACS technologies for the purpose of automatic pre-fetching of prior exams requires careful management of issues related to foreign study ingestion.

It is possible to use the XDS-I.b IHE profile to enhance medical imaging interpretation by increasing the number of priors accessed during reading, as long foreign studies are properly coerced.

Gauvin, A, Laframboise, S, Ruthman, G, Strategies for Foreign Study Ingestion by a PACS Interfaced to a XDS Affinity Domain.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13015760.html