RADIOLOGY

WORKFLOW
WORKFLOW
the sequence of industrial, administrative, or
other processes through which a piece of work
passes from initiation to completion.

It simply means how a process is done, step by

step

It describes how we complete an examination

from order entry to transcribed report.

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 Key steps in
Radiology Workflow
One of the essential points of
understanding the HL7 and
DICOM
1 aspects of digital image workflow
is
the concept of event triggers.
- Event Triggers are events that may produce a
cascade of other workflow events, some of
which are auto- mated, and some of which
rely on manual input.
HL7
▸ Health Level 7 International Standard
▸ is a set of standards, formats and
definitions for exchanging and developing
electronic health records

DICOM
▸ Digital Imaging and Communications in
Medicine
▸ is the international standard for medical
images and related information. It defines
the formats for medical images that can be
exchanged with the data and quality 4
Generic Radiology
Workflow
FILM-BASED WORKFLOW
▹ The radiology department were
designed
years ago for film and chemical
processing.
▹ Passbox were built into walls that fed
into
darkrooms and the examination rooms.

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Generic Radiology
Workflow
1. Order/Requisition
▹ Patient’s name
▹ Patient’s hospital identification (ID)
number
▹ Date of birth
▹ Ordering physician’s name
▹ Examination ordered
▹ Reason for examination
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Generic Radiology
Workflow
2.The paper requisition is then
passed on to the technologist who
will be performing the examination.
3.The technologist prepares the room for the
patient
and brings the patient back to the room
4. The technologistverifies all of the
patient’s
information and completes a patient history. 7
Generic Radiology
Workflow
5.The technologist performs the examination and
processes all of the film after the complete
examination is done.
6. The technologist critiques each film and repeats
exposures as necessary.
7. The technologist makes copies if necessary and
releases the patient with the films.

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Generic Radiology
Workflow
8.The technologist goes to the file room to find the
film jacket with all of the patient’s historic images, if
applicable.
9.The film jacket arrives a couple of hours or even
days later, and the current films are hung on a
multiviewer negatoscope to be read by a
radiologist.
10.The radiologist reads the films and dictates a
report into the dictation system. 9
Generic Radiology
Workflow
11.The multiviewer negatoscope is cleared of read films
by the file room clerk, and the films are placed back into
the film jacket.
12.A transcriptionist retrieves the recorded dictation and
transcribes a report into the RIS.
13.The radiologist reviews the report, makes corrections,
and signs the report as final.

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PACS Workflow
1. Order Entry
2. The order is input into the RIS, and the RIS sends a
message to the PACS to find all historic images and put
them on the short- term archive.
3. The technologist prepares the room, retrieves the
patient, and performs the patient history.
4. The technologist performs the examination, and depending
on the type of image acquisition device, the images are
processed and repeated as necessary and sent to the
appropriate PACS device.

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PACS Workflow
5. The requisition is either taken to
the radiologist, or the
radiologist may pull the images from an electronic worklist.
6.The radiologist dictates a report and has it transcribed, or
voice
recognition software may be used.

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 Login to PACS Set work list Launch case
filters/choose cases

Radiologis
t Dictate report
Review and interpret
images
Collect clinical
data/prior exams

Workflow
Steps Personally convey
urgent or unexpected
findings
Review and sign
report (maybe
performed
individually or as a
batch)
Protocol and check
ongoing cases

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 Determine next
Determine
patient/claim Retrieve patient
protocol

Technologist
patient in RIS

Workflow Post-process to
create additional
Check images
for quality
Obtain images

Steps
images

Complete study
Send images to
in RIS
PACS

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 Order study

Referring Provide clinical

Clinician
information for
radiologist

Workflow Patient will

proceed to the

Steps
Radiology
Department

Review radiologist
report

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Other Personnel
with Critical
Workflow
▸ Transcriptionist
▸ Nurses
▸ PACS Support Personnel
▸ File-room Clerk
▸ Transportation
Personnel

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Integrating the Healthcare
Enterprise (IHE)
▸ This is an initiative by healthcare professionals and industry
to improve the way computer systems in healthcare share
information.

▸ IHE worked to bridge both blatant and subtle gaps between

the
two standards in radiology.

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IHE Workflow Model

▸ This is an initiative by healthcare professionals and industry

to improve the way computer systems in healthcare share
information.

▸ IHE worked to bridge both blatant and subtle gaps between

the
two standards in radiology.

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IHE Workflow Model
PROCEDU
ORDE RE STE REPOR
R P T
1 3 5

2 4

REQUESTE WORKLI
D ST
PROCEDU
RE 21
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Key Benefits of
IHE
▸ Seamless exchange of data within hospitals & across the
healthcare community
▸ Easier access to patient data and pertinent clinical
information
▸ Well-defined implementation framework based on
established IT standards
▸ Manageable systems integration
▸ Cost-effective integrated solutions

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Goals of
Workflow
Analysis
▸ Go improve and enhance the workflows for efficiency,
reliability, fault tolerance, and transparency to the clinical
users.
▸ A further goal for digital imaging workflow design is to
facilitate interoperability. This is key deliverable of the IHE
initiative.

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