Picture Archiving Communication Research Articles

Patient Identity Management Maturity Model (PIM3) for Imaging Information Technology Systems.

In Consolidated Enterprises, there are often more than one set of patient identities or some amount of historic records, such as imaging exams that are still identified by more than one patient identity (also known as a Patient Identifier or Medical Record Number) per person. Information technology systems often need some capability to cross-reference records for the same patient so that the records are linked to the one, correct person. If not, it may create a risk for the patient. Historically, each independent facility or organization managed its own patient identity information, including the unique identifier/Medical Record Number. This can result in a fractured view of a patient's records. To present a longitudinal, unified-view record of a patient, it is necessary to have functions to manage these multiple domains. Without this capability, multiple patient identity domains result in a broken imaging record for the patient and often prevents the discovery of, access to, and comparison of a patient's imaging exams. Even worse, without a method to manage patient identity across records where more than one patient identity domain is involved, the records for two different people can be linked to one patient, resulting in a potentially serious risk for harm. This paper proposes a maturity model to assess and categorize the capabilities of different imaging information technology systems, such as Picture Archiving Communication and Archiving System, Vendor Neutral Archive, and other image management and viewing applications.

An innovative strategy for standardized, structured, and interoperable results in ophthalmic examinations

BackgroundAlthough ophthalmic devices have made remarkable progress and are widely used, most lack standardization of both image review and results reporting systems, making interoperability unachievable. We developed and validated new software for extracting, transforming, and storing information from report images produced by ophthalmic examination devices to generate standardized, structured, and interoperable information to assist ophthalmologists in eye clinics.ResultsWe selected report images derived from optical coherence tomography (OCT). The new software consists of three parts: (1) The Area Explorer, which determines whether the designated area in the configuration file contains numeric values or tomographic images; (2) The Value Reader, which converts images to text according to ophthalmic measurements; and (3) The Finding Classifier, which classifies pathologic findings from tomographic images included in the report. After assessment of Value Reader accuracy by human experts, all report images were converted and stored in a database. We applied the Value Reader, which achieved 99.67% accuracy, to a total of 433,175 OCT report images acquired in a single tertiary hospital from 07/04/2006 to 08/31/2019. The Finding Classifier provided pathologic findings (e.g., macular edema and subretinal fluid) and disease activity. Patient longitudinal data could be easily reviewed to document changes in measurements over time. The final results were loaded into a common data model (CDM), and the cropped tomographic images were loaded into the Picture Archive Communication System.ConclusionsThe newly developed software extracts valuable information from OCT images and may be extended to other types of report image files produced by medical devices. Furthermore, powerful databases such as the CDM may be implemented or augmented by adding the information captured through our program.

Value of revised Geneva criteria and d-dimer levels in reducing overuse of pulmonary CT angiography in the diagnosis of pulmonary thromboembolism

Aim: To investigate the applicability of modified Geneva score which is used to evaluate the clinical probability, with the d-dimer results, to reduce the overuse of pulmonary CT angiography, on patients with suspicion of pulmonary thromboembolism. Material and Methods: A total of 400 patients who had performed pulmonary CT angiography, with the suspicion of pulmonary thromboembolism, in the emergency department, were included in this retrospective study. The clinic and demographic datas of the patients were classified according to the modified Geneva score, and d-dimer values were recorded. Presence of pulmonary thromboembolism was investigated on the pulmonary CT angiography images accessed from Picture Archiving Communication Systems.Results: In a 33 (%8.25) of 400 patients, thromboembolism was detected in the pulmonary CT angiography. 20% (n=1), 8.8% (n=25), and 6.4% (n=7) of the patients, have been diagnosed pulmonary thromboembolism by CT, with the high, intermediate, and low clinical probability, respectively. One hundred ninety-seven (49.25%) out of 400 patients had d-dimer results. One (2.9%) out of 34 patients with a negative d-dimer value had thromboembolism in CT. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as 78.8%, 28.1%, 9%, 93.6% of the modified Geneva score, and as 94.7%, 18.5%, 11%, and 97.1% of the d-dimer, respectively.Conclusion: In the diagnosis of pulmonary thromboembolism, modified Geneva score, and d-dimer test have high negative predictive values. Other clinic diagnoses can be considered primarily, in patients have low modified Geneva scores with negative d-dimer results. This may contribute to the reduction of the overuse of pulmonary CT angiography.

Utility of the Three-Point Index in the determination of reduction loss during the conservative treatment of pediatric forearm mid-third fractures.

Forearm fractures constitute approximately 40% of all pediatric fractures. Generally, in conservative treatment,a plaster cast is applied with the elbow in 90° flexion. Success of the treatment depends on theprevention of the reduction in the correct position and suitable duration of the plaster cast. Failure, or the risk of angulation within the cast, is associated with movement within the cast. The aim of this study was to evaluate the applicability of the Cast Index (CI) and Three-Point Index (TPI) measurements, which indicate the loss of reduction, in pediatric mid-third forearm fractures. The hypothesis of the study was that as edema decreases and deformity of the plaster cast occurs after fracture reduction, TPI and CI should be examined during follow-up, as they indicate shifting due to movement within the plaster cast. This retrospective study included a total of 48 patients, who were treated with closed reduction and long-arm plaster cast for a mid-third forearm diaphyseal fracture at our Emergency Polyclinic between March and September 2014. The mean age of the patients was 8.15±3.19 years (range, 5-14 years). Patients were excluded from the study if they had isolated radial or ulnar fracture, open fractures, concomitant fracture or systemic disease (bone metabolism disease, etc), and <10° fracture angulation in the ulna and radius on the initial radiograph and if they did not followup. TPI and CI values were calculated on anterioposterior (AP) and lateral radiographs in the Picture Archiving Communication Systems. In the AP plane, compared with TPI values after reduction, statistically significant increases were observed in TPI values 10 days after reduction (p<0.01). However, no significant difference was observed between those with and without reduction loss in TPI values in the AP plane (p>0.05). Although there was a statistically significant increase in TPI values 15 daysafter reduction compared with the values immediately after reduction, a significant difference between those with and without reduction loss was observed only on lateral TPI. In cases of pediatric forearm diaphyseal fracture, ulnar TPI examined in the lateral plane can be used in monitoring the fracture in a plaster cast applied after the reduction.

Mobile Health Is Worth It! Economic Benefit and Impact on Health of a Population-Based Mobile Screening Program in New Mexico

HABITS for Life was a 3-year initiative to broadly deliver a statewide biometric and retinal screening program via a mobile unit throughout New Mexico at no charge to participants. The program goal-to identify health risk and improve population health status-was tested over a 3-year period. Value to participants and impact to the healthcare system were measured to quantify impact and value of investing in prevention at the community level. We used the Mobile Health Map Return-on-Investment Calculator, a mobile screening unit, biometric screening, retinography, and community coordination. Our systems included satellite, DSL, and 3G connectivity, a Tanita® (Arlington Heights, IL) automated body mass index-measuring scale, the Cholestec® (Alere™, Waltham, MA) system for biomarkers and glycosylated hemoglobin, a Canon (Melville, NY) CR-1 Mark II camera, and the Picture Archiving Communication System. In this report for the fiscal year 2011 time frame, 6,426 individuals received biometric screening, and 5,219 received retinal screening. A 15:1 return on investment was calculated; this excluded retinal screening for the under-65 year olds, estimated at $10 million in quality-adjusted life years saved. Statistically significant improvement in health status evidenced by sequential screening included a decrease in total cholesterol level (p=0.002) (n=308) and an increase in high-density lipoprotein level after the first and second screening (p=0.02 and p=0.01, respectively), but a decrease in mean random glucose level was not statistically significant (p=0.62). Retinal results indicate 28.4% (n=1,482) with a positive/abnormal finding, of which 1.79% (n=93) required immediate referral for sight-threatening retinopathy and 27% (n=1,389) required follow-up of from 3 months to 1 year. Screening programs are cost-effective and provide value in preventive health efforts. Broad use of screening programs should be considered in healthcare redesign efforts. Community-based screening is an effective strategy to identify health risk, improve access, provide motivation to change health habits, and improve physical status while returning significant value.