The following relates generally to the radiology arts, radiology reading arts, medical picture archiving and communications system (PACS) arts, radiology workstation arts, radiology workstation user interfacing arts, and related arts.
Radiologists are highly specialized medical professionals, and as such are expected to maintain a high throughput. In a typical work environment, the radiologist is seated at a PACS workstation running radiology workstation software such as the Philips iSite PACS workstation system (available from Koninklijke Philips N.V., Eindhoven, the Netherlands). A queue is maintained listing the radiology reading tasks to be performed by the radiologist (or team of radiologists) for that work shift. The radiologist selects a next task to perform from the queue, reads the images, and dictates a report of findings (i.e., the radiology report), which is sent to the patient's physician and also stored on the PACS.
Each radiology reading task typically has a compensation value designated by Relative Value Units (RVUs). For example, in some institutions, a CT reading is assigned 4 RVU points, an MRI reading is assigned 8 RVU points, and computed radiography (i.e., an x-ray) reading is assigned 1 RVU point. Other imaging modalities, such as positron emission tomography (PET) images or a single photon emission computed tomography (SPECT) images, can have their own RVU values. The radiologist is expected to perform readings with a certain number of total RVU points per shift. In some medical institutions, RVU points are assigned based on a corresponding medical procedure code, as these codes are used for billing. Two common medical procedure coding systems are Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes. In the case of medical imaging procedures, the procedure codes are delineated by imaging modality, anatomical region, and perhaps other features such as clinical task. Radiologists typically read between 3200 to over 6000 ‘RVU points’ per year, calling for a high level of efficiency.
The queue of radiology examination reading tasks is conventionally ordered by time of entry into the queue. The radiologist either works through the work list in order (“first in, first out”), which may not be the best order, or cherry-picks the next task which takes extra time as the radiologist must skim through the list and make the next selection based on the limited information available for each reading task in the work list.
In accordance with one illustrative example, a device operating in conjunction with a Picture Archiving and Communication System (PACS) stores a plurality of radiological images, which includes at least two different image modalities. The device includes a radiology workstation with at least one display device. An electronic processor is programmed to: organize a queue of radiology examination reading tasks in accord with information about the radiology examination reading tasks other than or in addition to their order in the queue to generate an ordered work list of the radiology examination reading tasks; display the ordered work list on the at least one display device of the radiology workstation; and retrieve from the PACS one or more radiology images of a radiology examination reading task of the ordered work list and display the retrieved radiology images on the at least one display device of the radiology workstation.
In accordance with another illustrative example, a device operating in conjunction with a Picture Archiving and Communication System (PACS) includes a radiology workstation with at least one display device and at least one user input device. An electronic processor is programmed to: retrieve a queue of radiology examination reading tasks in which the reading tasks are ordered by time of entry into the queue; organize the queue of radiology examination reading tasks in accord with reading task features including or derived from at least one of imaging modality, imaged anatomy, radiology examination type, and examination subject to generate an ordered work list of the radiology examination reading tasks; display the ordered work list on the at least one display device of the radiology workstation; receive a selection of a radiology examination reading task from the ordered work list via the at least one user input device of the radiology workstation; and retrieve from the PACS one or more radiology images of the selected radiology examination reading task and display the retrieved radiology images on the at least one display device of the radiology workstation.
One advantage resides in providing a radiology workstation with a more efficient user interface.
Another advantage resides in providing a radiology workstation providing for more efficient allocation of radiology examination reading tasks to one or more radiologists.
Further advantages of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description. It will be appreciated that a given embodiment may provide none, one, two, or more of these advantages.
The invention may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the invention.
Radiology examination reading tasks are queued for reading, usually in the order of arrival. Some radiology departments employ a “first in, first out” workflow, in which radiology reading tasks are performed in the order they arrive (that is, in the order of the queue). However, this approach can overstress a radiologist if, for example, the radiologist is forced to perform several complex and mentally taxing readings in a row due to their arrival order in the queue. To reduce the stress level, many radiology departments permit the radiologist to choose the next reading task to perform from the queue of radiology examination reading tasks. This allows the radiologist to interleave difficult and easier reading tasks in order to reduce stress, or otherwise organize the reading tasks to the radiologist's preferences. Reduced radiologist stress is expected to lead to more accurate readings, and ultimately to higher efficiency.
However, the selection of reading tasks takes valuable time, and furthermore the quasi-random sequencing (i.e. by order of arrival) of reading tasks in the queue may make it difficult for the radiologist to identify the “best” next reading task to perform. For example, the radiologist may wish to perform several reading tasks of the same anatomy in a row, but may find it difficult to locate all such reading tasks by visually scanning the queue. Likewise, if the queue includes two or more radiology examination reading tasks for the same radiology examination subject (e.g. a CT and MRI of the same patient) it might be advantageous to perform these together, so as to leverage information from the different examinations but it may be difficult for the radiologist to identify this set of reading tasks for the same patient.
Embodiments disclosed herein organize the queue into a work list having a principled ordering of reading tasks. The organizing is in accord with information about the radiology examination reading tasks other than or in addition to their order in the queue. For example, the organization may utilize reading task features including or derived from at least one of: imaging modality; imaged anatomy; radiology examination type; and examination subject.
In one approach, a work schedule is defined which delineates scheduled time blocks of a work shift (or work day) allocated to designated reading types. Thus, for example, the first half-hour may be assigned to computed radiography (CR) or direct radiography (DR) readings which are relatively easy and serve as a “warm-up” period, followed by a scheduled time block dedicated to more complex readings (e.g. MR or CT), and so forth. Within each scheduled time block, the ordering of the reading tasks assigned to that block may be by time of entry into the queue, or may be ordered on some other basis. The number of reading tasks that fit into one scheduled time block is estimated based on estimated reading times for the tasks. Since all tasks of the work list usually must be completed over the course of the work shift or work day, one or more time blocks are allocated to general or mixed use. With the scheduled time blocks defined (optionally in manual fashion by the radiologist similar to an electronic calendar scheduling), the system classifies tasks by reading type and allocates tasks into time blocks accordingly. In a variant of this approach, data mining is performed on the past work history of a radiologist to identify the time blocks.
In another approach, a set of rules is applied to order reading tasks of the work list. Two illustrative rules are as follows: Rule 1: group reading tasks for a single patient (more generally, radiology examination subject) together; and Rule 2: group similar reading tasks together. The rationale for Rule 1 is that it facilitates the radiologist developing a holistic understanding of the patient's overall condition and immediate past images, saving time. The rationale for Rule 2 is that efficiency is improved by limiting abrupt context switches between successive reading tasks. For Rule 2, automated task type classification is again applied.
These approaches may be variously combined in some embodiments. For example, scheduled time blocks may be assigned to different examination types and, within each time block tasks may be automatically grouped by patient and/or examination similarity. In the case of a patient with multiple reading tasks of very different types, these may be grouped in a general or mixed use time block.
As used herein, a “patient” refers to a radiology examination subject (or “examination subject” for brevity). The term “patient” as used herein broadly encompasses hospital in-patients, hospital out-patients, emergency room patients, independent imaging center clients, persons who visit a medical office of any kind and are directed to a radiology facility for a radiology examination, or so forth.
The term “Picture Archiving and Communication System” or “PACS” as used herein broadly encompasses any electronic database that stores radiology images acquired during radiology examinations and provides retrieval access for the stored radiology images. The PACS is distinct from general-purpose medical databases such as the Electronic Medical Record (EMR) or Electronic Health Record (EHR), although some integration of the PACS with a general-purpose medical database is contemplated. For example, the patient record in the EMR or EHR may include hyperlinks to radiology examinations stored in the PACS, and/or the PACS record for a patient may include a hyperlink to the patient's record in the EMR or EHR. In typical embodiments, the PACS stores radiology images in accordance with the Digital Imaging and Communications in Medicine (DICOM) file format definition promulgated by the National Electrical Manufacturers Association (NEMA), or in a variant of the standard DICOM definition.
Information, including current examination information can be stored for a current radiology examination, such as the reason for examination, the imaging modality of the examination, and/or the number of RVU points for the examination. The reason for examination is typically indicated by the ordering physician, and is commonly (though not necessarily) stored as an International Classification of Diseases (ICD-9) code which is a standard classification system used by medical institutions, medical insurance companies, and the like. The imaging modality may be obtained from the examination metadata or from metadata of individual images. For example, the standard DICOM header includes a field for specifying the image modality. The RVU points are generally a function of imaging modality and possibly ICD-9 code, and hence can be calculated. Other metadata of the current radiology examination and/or the DICOM headers of the images may also be used in organizing tasks of the radiology examination, such as the examination date, the number of images in the examination, image size/resolution, or so forth.
Some basic patient demographic information is also stored in the PACS. This is the demographic information for the examination subject of the selected radiology examination reading task. Such data generally include at least sex and date of birth, and may also include data such as ethnicity.
With reference to
Each radiology workstation 14 includes an electronic processor, for example embodied as a computer 16. Each radiology workstation 14 further includes at least one display device, e.g. an illustrative display device 20 of the computer 16 and an additional display device 22. This display device(s) 20 or 22 may include a browser. Providing the radiology workstation 14 with two (or more) display devices 20, 22 can be advantageous as it allows one display device to be used to display textual content or other auxiliary information while the other display device is used as a dedicated radiology image viewer; however a radiology workstation with only a single display device is also contemplated. At least one display device of the radiology workstation should be a high-resolution display capable of displaying radiology images with sufficiently high resolution to enable the radiologist to accurately read the radiology image. Each radiology workstation 14 further includes at least one user input device, such as: an illustrative computer keyboard 24; a mouse, touchpad 26, or other pointing device; a touch-sensitive display (e.g., one or both display devices 20, 22 may be a touch-screen display); a dictation microphone 28, or so forth. Optionally, the radiology workstation 14 is further capable of measuring a reading time defined between selection of a radiology examination reading task and completing receipt of the entry of the radiology report for that task with a timer (not shown) implemented by the computer 16, e.g. using the internal (i.e. system) clock of the computer.
With continuing reference to
The queue 32 is displayed as the ordered work list 34 on a display device of the radiology workstation. In illustrative
A radiologist can select the ordering of the tasks of the ordered work list 34 based on one or more rules 30. (Alternatively, these rules may be hard-coded and not selectable by the radiologist). With continuing reference to
With particular reference to
The queue 32 is then organized into the ordered work list 34 by assigning reading tasks to time blocks 52 of the reading schedule 50 based on the reading tasks having a time block-defining feature (e.g. the examination type 54 in illustrative
With continuing reference to
The radiologist viewing the displayed ordered work list 34 chooses a reading task from the work list 34 within the appropriate time block of the reading schedule 50, e.g. using at least one user input device 24, 26, 28. Upon selection, the radiology workstation 14 retrieves one or more radiology images of the selected radiology examination reading task from the PACS 10 and displays the retrieved radiology images, e.g. on the display device 20. This display may incorporate usual image display or rendering techniques such as zoom, pan, resizing, displaying selected images side-by-side or in another arrangement, allowing the radiologist to use on-screen cursors to perform spatial and/or intensity measurements, or so forth. It will be appreciated that only one image, or a subset of a set of images, or all images, may be displayed at any given time during the reading process. For example, the radiologist may choose to work through a set of image slices one-by-one so that only a single image slice is displayed at any given time. Optionally, the radiologist may bring up and display images from other radiology examinations, e.g. to compare a current tumor image with one acquired in an earlier radiology examination to observe growth or shrinkage of the tumor. During the reading, the radiology workstation 14 receives, via the at least one user input device, entry of a radiology report for the selected radiology examination reading task. In a common approach, the dictation microphone 28 is used to receive entry of an orally dictated radiology report; however, it is additionally or alternatively contemplated to employ another user input device, such as using the keyboard 24 to type in the radiology report or to edit the initially orally dictated report. When the radiologist is satisfied with the entered radiology report for the selected radiology examination reading task, the radiologist performs suitable operations to save the report in the PACS 10, send the report to the patient's physician, or otherwise store and/or disseminate the report. For example, the radiology workstation 14 may display a “file report” button or the like which can be selected by the radiologist using a pointer or the like to execute the filing of the report. The work list 34 (and the underlying queue 32) is updated by removing the completed radiology examination reading task from the queue 32 and work list 34, and the updated work list 34 is displayed on the radiology workstation 14. Unless up to a break, the radiologist will then move on to select a next radiology examination reading task to perform as just described.
Because the work list 34 is organized according to the reading schedule 50, the topmost reading task on the work list 34 is generally expected to be an appropriate choice for selection as the next reading task. In some cases, the radiologist may select some other reading task other than the topmost reading task, but typically it will still be a task within the current time block of the reading schedule 50. In a variant embodiment, the radiologist may be required to select the topmost reading task of the work list 34, or may be required to select a reading task assigned to the current time block of the reading schedule 50. In the case of the latter, one way to enforce this requirement is to display only those reading tasks assigned to the current time block in the displayed (portion of) the work list. However, it is understood that ‘STAT exams’, ultra-high priority determining life and death, may break into any schedule created. Once the STAT exam is read, the prior schedule can resume.
In some embodiments, the reading schedule 50 is not employed, and instead the electronic processor 36 organizes the queue 32 of radiology examination reading tasks in accord with rules 30 to generate the ordered work list 34. In such embodiments, there are no defined time blocks.
With reference now to
As another example,
In the embodiments just described with reference to
Time can be saved by reducing context-switching (mental change) of: the patient; the modality and body part; modality or body part. In the case of the example of
With reference to
With reference to
With returning reference to
With reference to
With reference to
Naturally, time-of-day hot zones can be made more specific by considering day-of-week. This is especially true when the week-long intensity may cause the radiologist to begin to tire slightly by the end of week.
It will be appreciated that the illustrative computational components may be embodied as a non-transitory storage medium storing instructions executable by an electronic processor (e.g. the workstation computer 16, or the PACS server 12) to perform the disclosed computations. The non-transitory storage medium may, for example, comprise a hard disk drive, RAID, or other magnetic storage medium; a solid state drive, flash drive, electronically erasable read-only memory (EEROM) or other electronic memory; an optical disk or other optical storage; various combinations thereof; or so forth.
The invention has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be constructed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.
Filing Document | Filing Date | Country | Kind |
---|---|---|---|
PCT/IB2016/054661 | 8/3/2016 | WO | 00 |
Number | Date | Country | |
---|---|---|---|
62208857 | Aug 2015 | US |