IHE's Procedure Scheduled/Update question - DICOM

This is a discussion on IHE's Procedure Scheduled/Update question - DICOM ; Hello all, I am working on the communication part between RIS and PACS and run into some issues while evaluating some extraordinary scenarios with study status update. Here is the scenario I would like ask about : 1. There is ...

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Thread: IHE's Procedure Scheduled/Update question

  1. IHE's Procedure Scheduled/Update question

    Hello all,

    I am working on the communication part between RIS and PACS and run
    into some issues while evaluating some extraordinary scenarios with
    study status update. Here is the scenario I would like ask about:
    1. There is an order with a particular study placed in the RIS system
    2. Procedure Scheduled sent from RIS to PACS
    3. The used at a modality selects the study and performs it (MPPS and
    Images accounted for this study)
    4. It has been realized that the worng study has been selected at a
    Modality. Someone re-attaches the Images to the correct study/patient

    Now, is it possible to revert the status of the study that has been
    selected in error so it is performed for the second time (this time
    selected for the correct patient)? Or it would be expected that the new
    order is placed instead?

    Thank you for your input.

    Pawel


  2. Re: IHE's Procedure Scheduled/Update question

    Pawel

    In your scenario there are a lot of steps which occur between step 3
    and 4 that you've left unstated and/or unacknowledged

    In the IHE radiology technical framework, there is some recognition of
    the situtation you describe. Vol 2, 4.7.4.1 Procedure Step
    Completed/Discontinued, one of the codes in table 4.7-1 Procedure
    Discontinued Reason is DCM 110541 "Incorrect worklist entry selected".

    There is discussion in the following sections about the handling of the
    discontinued PPS, essentially stating that it "shall be stricken from
    the record and shall be presumed to have occured" (to paraphrase jargon
    in television courtroom scenes after an objection). Look immediately
    following the table as well as in section 4.7.4.1.3.1 PPS Exception
    Management Option.

    Most of the guidance is on cleaning up artifacts from having selected
    and performed the wrong entry - clearing the PPS from the record and
    making sure the images are not included in any query results

    There is one sentence which states "When received by the DSS/Order
    Filler and Image Manager/Archive, the Reason Code may indicate the
    neccessity for modification or canceling an order"

    The fact of the matter is the relationship between the completion of a
    PPS and a change in state which results in an SPS being removed from
    the result set of MWL query has never been unambiguously specified in
    the IHE framework. It is generally agreed that an SPS should disappear
    from the MWL but the specific trigger for this to happen in the normal
    case is not an agreed upon part of the framework. The best you get is
    in section 4.6.4.1.3 which states the "DSS/OF RM and IM/IA receive
    information from the PPSM and link it with the SPS".

    In your scenario, it appears you're implying a couple things outside
    the scenarios envisioned by the IHE. First, it sounds as if you're
    indicating the discovery that the wrong SPS was selected from the
    worklist after the PPS complete message, images, and storage commit
    messages were transmitted from the modality to the systems. Second,
    you're asking whether, having fixed the images with the correct patient
    and procedure information, whether you can return the MWL requested
    procedure/SPS to a state ready to accept selection and PPS performance
    which the correct patient.

    The first inquiry (and maybe you didn't really ask this question), the
    scenario you've described is outside the scope the IHE exception
    processing. They've only allowed messaging to correct errors if it is
    discovered before the completion of the MPPS step. There is no way to
    "undo" an already completed MPPS once you've completed it. Anything you
    do is therefore going to be a manual equivalent to what the IHE profile
    specifies you should do if the error was discovered prior to the MPPS
    complete message (this is all the magic between your step 3 and step
    4).

    In regards to your 2nd inquiry, you weren't under any restrictions to
    on the state of the MWL entry to begin with. You can keep or reset the
    state of a procedure within your system to remain or re-appear on the
    MWL without any constraints imposed by the IHE. However, the language
    in section 4.7.4.1.3.1 regarding modification or cancelation of the
    order gives you wide lattitude to make corrections needed to put the
    MWL back into good order needed for continued clinical operations


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