Материал: part17

code="110153"

codeSystemName="DCM" displayName="Source Role ID"/>

</ActiveParticipant>

<AuditSourceIdentification

AuditEnterpriseSiteID="Hospital"

AuditSourceID="ReadingRoom"> <AuditSourceTypeCode code="1"/>

</AuditSourceIdentification>

<ParticipantObjectIdentification

ParticipantObjectID="1.2.840.10008.2.3.4.5.6.7.78.8"

ParticipantObjectTypeCode="2"

ParticipantObjectTypeCodeRole="3"

ParticipantObjectDataLifeCycle="1">

<ParticipantObjectIDTypeCode

code="110180"

codeSystemName="DCM" displayName="Study Instance UID"/>

<ParticipantObjectDescription>

<MPPS UID="1.2.840.10008.1.2.3.4.5"/> <Accession Number="12341234" />

<SOPClass UID="1.2.840.10008.5.1.4.1.1.2" NumberOfInstances="1500"/> <SOPClass UID="1.2.840.10008.5.1.4.1.1.11.1" NumberOfInstances="3"/>

</ParticipantObjectDescription>

</ParticipantObjectIdentification>

<ParticipantObjectIdentification

ParticipantObjectID="ptid12345"

ParticipantObjectTypeCode="1"

ParticipantObjectTypeCodeRole="1"> <ParticipantObjectIDTypeCode code="2"/> <ParticipantObjectName>John Doe</ParticipantObjectName>

</ParticipantObjectIdentification>

</AuditMessage>

The message describes a study transfer initiated at the request of Dr. Smith on the system at the IP address 192.168.1.2 to a system​ at IP address 192.168.1.5. The study contains 1500 CT SOP Instances and 3 GSPS SOP Instances. The audit report came from the​ audit source "ReadingRoom".​

WW.2 Workflow Example​

The following is an example of audit trail message use in a hypothetical workflow. It is not intended to be all-inclusive, nor does it​ cover all possible scenarios for audit trail message use. There are many alternatives that can be utilized by the system designer, or​ that could be configured by the local site security administrator to fit security policies.​

As this example scenario begins, an imaging workstation boots up. During its start up process, a DICOM-enabled viewing application​ is launched by the start up sequence. This triggers an Application Activity message with the Event Type Code of (110120, DCM,​ "Application Start").​

After start up, a curious, but unauthorized visitor attempts to utilize the reviewing application. Since the reviewing application cannot​ verify the identity of this visitor, the attempt fails, and the reviewing application generates a User Authentication message, recording​ the fact that this visitor attempted to enter the application, but failed.​

Later,anauthorizeduseraccessesthereviewingapplication.Uponsuccessfullyidentifyingtheuser,thereviewingapplicationgenerates​ a User Authentication message indicating a successful login to the application.​

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The user, in order to locate the data of a particular examination, issues a query, which the reviewing application directs to a DICOM​ archive. The details of this query are recorded by the archive application in a Query message.​

The reviewing application, in delivering the results of the query to the user, displays certain patient related information. The reviewing​ application records this fact by sending a Patient Record message that is defined by some other standard. Audit logs will contain​ messages specified by a variety of different standards. The MSG-ID field is used to aid the recognition of the defining standard or​ proprietary source documentation for a particular message.​

From the query results, the user selects a set of images to review. The reviewing application requests the images from the archive,​ and records this fact in a Begin Transferring Instances message.​

The archive application locates the images, sends them back to the reviewing application, and records this fact in an Instances​ Transferred message.​

The reviewing application displays the images to the user, recording this fact via an Instances Accessed message.​

Duringthereviewingprocess,theuselooksupdetailsoftheprocedurefromthehospitalinformationsystem.Thereviewingapplication​ performs this lookup using HL7 messaging, and records this fact in a Procedure Record message.​

The user decides that a follow-up examination is needed, and generates a new order via HL7 messaging to the hospital information​ system. The reviewing application records this in an Order Record message.​

The user decides that a second opinion is desirable, and selects certain images to send to a colleague in an e-mail message. The​ reviewing application records the fact that it packaged and sent images via e-mail in an Export message.​

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XX Use Cases for Application Hosting​

XX.1 Agent-Specific Post Processing​

Many metabolic/contrast agents require more than just simple imaging to provide data for decision making. Rather than just detecting​ the presence or absence of the metabolic/contrast agents, calculations based on relative uptake rates, or decay rates, comparisons​ with previous or neighboring data, fusion of data from multiple sources or time points, etc. may be necessary to properly evaluate​ imagedatawiththesemetabolic/contrastagents.Oftenthenatureofthisprocessingiscloselyrelatedtothetypeofagent,theanatomy,​ and the disease process being targeted. The processing may be so specific that the general-purpose image processing features​ found on medical imaging workstations are inadequate to properly perform the procedure. The effective use of a particular agent for​ a particular procedure may depend on having properly tuned, targeted post-processing. Both the algorithms used, as well as the​ workflow in performing the analysis, may be customized for performing procedures with a particular agent.​

The stakeholders interested in developing such agentand exam-specific post-processing applications may have a vested interest​ in insuring that such post-processing applications can run on a wide variety of systems. The standard post-processing software API​ outlined in PS3.19 could simplify the distribution of such agent-specific analysis applications. Rather than creating multiple versions​ of the same application, each version targeted to a particular medical imaging vendor's system, the application developer need only​ create a single version of the application, which would run on any system that implemented the standard API.​

Differencesinphysicalcharacteristics,acquisitiontechniqueandequipment,anduserpreferenceaffectimagequalityandprocessing​ requirements. By allowing the sharing of applications based on device-independent (or conversely, device-specific) procedures, the​ Hosted Application technology will reduce these differences to a minimum.​

XX.2 Support For Multi-site Collaborative Research​

A common API for Application Hosting facilitates multi-site research.​

Site-specific problems: The development of molecular imaging applications can be accelerated with multiple site cooperation in the​ validationofnewalgorithmsandsoftware.However,therun-timeenvironmentandtoolsavailableatonesitetypicallyarenotmatched​ identicallyatothersites,hamperingthesharingofapplicationsbetweensites.Usingthesametoolsallowsthemtoshareapplications.​ One cannot simply take an application written at one of these sites, and make it run on the other site without major software work in-​ volvingtheinstallationandconfigurationofmultipletoolpackages.Evenafterinstallingtheneededtoolsandlibraries,softwaredeveloped​ at one site may be trying to access facilities that are unavailable at the other site, for example, facilities to store, access, and organize​ the image data. Often the data formats applications from one site are expecting are incompatible with the data formats available at​ other sites. Having a standard API could help minimize these data incompatibilities.​

Gapbetweenresearchandclinicalenvironments:Theinitialversionsofagent-specificapplicationsaretypicallycreatedinaresearch​ environment, and are not easily accessible in the clinical environment. The early experimental work generally is done by exporting​ the image data out of the clinical environment to research workstations, and then importing the results back into the clinical system​ once the analysis is done. While exporting and importing the images may be sufficient for the early research work, clinical acceptance​ of an application can be significant enhanced if that application could run in the same clinical environment where the images are​ collected, in order to better fit into the clinical workflow.​

Theproblemofmismatchedruntimeenvironmentsbecomesevenmoreacutewhenattemptingtorunthetypicalresearchapplication​ on a production clinical workstation. Due to a variety of legal and commercial concerns, vendors of the systems utilized in the clinical​ environment generally do not support running unknown software, nor do most commercial vendors have the time or resources to​ assist the hundreds of researchers who may wish to port a particular application to that vendor's system. Even if researchers manage​ to load an experimental program onto a clinical system, the experimental program rarely has direct access to the data stored on that​ clinical system, nor can it directly store results back into the system's clinical database. Without a single standard interface, users​ have to resort to the cumbersome and time-consuming export and input routines to be able to run research programs on clinical data.​ ItisexpectedthattheconstrainedenvironmentthatastandardAPIprovideswouldbesimplertovalidate,particularlyifitisuniversally​ deployed by multiple vendors, and could lessen the burden on any individual system vendor.​

XX.3 Screening Applications​

ComputerAidedDiagnosisandDecisionMaking(CAD)isbecomingmoreprevalentinradiologydepartments.Manyclassesofexams​ now routinely go through a computer screening process prior to reading. One potential barrier to more widespread use of CAD​ screening is that the various vendors of CAD applications typically only allow their applications to run on servers or workstations​

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provided by those companies. A clinical site that wishes to utilize, for example, mammo CAD from one vendor and lung CAD from​ another often is forced to acquire two different servers or workstations from the two different vendors.​

The Hosted Application concept described in PS3.19 could be used to facilitate the running of multiple CAD applications from multiple​ vendors on the same computer system.​

XX.4 Modality-Specific Post Processing​

Asmedicalimagingtechnologyprogresses,newmodalitiesareaddedtotheStandard.Forexample,vesselwalldetectioninintravas-​ cular ultrasound is often easier if the images are left in radial form. Unfortunately, most DICOM workstations would not know how to​ deal with images in such a strange format even though the workstation might recognize that it is an image.​

One possible solution is for a workstation to seek out an appropriate Hosted Application for handling Modalities or SOP classes that​ itdoesnotrecognize.Thiswouldallowforautomatichandlingofallimagetypesbyagenericimagingplatform.Similarly,SOPClasses,​ even private SOP Classes, could be created that depend on particular Hosted Applications to prepare data for display.​

XX.5 Measurement/Evidence Document Creation​

Another natural use for such a standardized API is the creation of exam-specific analysis and measurement programs for the creation​ of Evidence Documents (Structured Reports). The standardized API would allow the same analysis program to run on a variety of​ host systems, reducing the amount of development needed to support multiple platforms.​

XX.6 CAD Rendering​

Often the regulatory approval for CAD systems includes the method by which the CAD marks are presented to the user. Providers​ of CAD systems have used dedicated workstations for such display in the past in order to insure that the CAD marks are presented​ asintended.IftherewereasuitablestandardizedAPIforlaunchinghostedapplications,aHostedApplicationcouldhandlethedisplay​ of CAD results on any workstation that supports that standardized API.​

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