Ancillary Software Flashcards
What is the “build vs buy” question?
when an imaging practice
has to decide whether the software solution they need exists and can be purchased or will have to be developed in-house
What are some examples of common purchased software in a radiology practice?
PACS, RIS, and EMR
What are some advantages of home-built solutions?
Customization
Greater knowledge of necessary data streams and interfaces
Better integration to the clinical workflow
easier navigation of any governance approvals or security clearances
What is an advantage of commercial solutions?
Service contracts that provide application maintenance and updates
CTRM system
Critical test results management system
What can a CTRM system be used for?
It can connect to
the various software applications
that the radiologist uses (PACS/
RIS, EMR, report generation system, paging system)
as well as alerting the referring physician/APP
In what form does the CTRM alert the ordering provider?
It can take on many forms including phone calls, electronic pages, or text messages
How does the CTRM system encourage closed-loop communication?
The system will continue trying to reach the ordering provider until they acknowledge receipt of the message
If they do not answer the message after a predetermined number of attempts, the system will launch an escalation protocol
What happens when the CTRM launches an escalation protocol?
It will attempt to reach another designated individual
What happens if no one answers the CTRM system’s alert?
Radiology will become notified and attempt a phone call or in-person message delivery
What is the purpose of a recommendation-tracking system?
Ideally, the system would identify each finding of
interest, the recommended follow-up, and the timing, and notify the ordering physician/APP in a closed-loop fashion
What have many radiology practices implemented as a hybrid solution for identification of noncritical actionable findings/
Structured Reporting
REM
Radiation Exposure Monitoring
What do REM tools do?
REM tools enable a radiology practice to monitor radiation dose indices for different modalities
What are two way dose indices can be generated and stored?
- A legacy dose sheer
- a DICOM Radiation Dose Structured Report object
DICOM RDSR
DICOM Radiation Dose Structured Report
What is a Legacy Dose Sheet?
typically a DICOM Secondary Capture object, with the numeric data burned into the pixels of the image
Who should be included on the multidisciplinary review committee for a radiation exposure monitoring program and why?
radiologists, physicists, and technologists
To periodically review reports from the REM tool and identify areas for improvement
What person represents the REM software and where should they be sending dose information to?
- Dose information reporter
- Dose Index Registry
DRLs
Dose Reference Levels
What can DRLs do?
They can help imaging facilities
determine if the radiation exposure from a particular imaging examination or procedure is unusually high
What would constitute as an unusually high dose?
At the 75th percentile
PAMA
The Protecting Access to Medicare Act
CDSM
Clinical Decision Support Mechanism
What did PAMA require?
That ordering providers use a qualified clinical decision support mechanism (CDSM) when ordering certain types of advanced imaging
examinations
How are radiologists reimbursed for CMS patients?
CMS will only reimburse radiologists for the interpretation of
advanced imaging that is ordered using a qualified CDSM
What is a numeric appropriateness score?
A scored formulated by the CDSM (ranging from 0 for least appropriate to 9 for most appropriate)
based on the ordered exam and the indication chosen from a picklist of options
Why are numeric appropriateness scores important?
They can be used to better understand physician/APP ordering patterns and
the number and nature of outliers among physicians/APPs ordering
advanced imaging
What factors affect the adoption of CDSMs?
- Seamless integration into the EMR and clinical workfow
- Suffcient education of end-user physicians/APPs
- Customization of the CDSM to the clinical context
- Level of experience of the CDS vendor
What does a radiologist decision support system do?
Provides guidance around
the interpretation process
(help radiologists craft more consistent and
evidence-based follow-up recommendations, provide differential diagnoses
based on findings identified on the images, or standardize the language used to
report particular findings)
CAR/DS
computer-assisted reporting
and decision support
What does a CAR/DS do for radiologists?
It can be used to encode follow-up guidelines in a radiologist’s report generation system, to make clinical guidelines accessible at the point of care
What is an example of how CAR/DS can be used by a radiologist?
It can prompt the radiologist for specific
data elements (e.g., the size of a pulmonary nodule; whether the nodule is solid,
subsolid, or ground glass; and whether or not the patient has a smoking history)
It additionally can compute the appropriate time interval for follow-up chest CT and appropriate language generation
What are some examples of ACR Assist modules that have been developed using the CAR/DS framework?
BI-RADS for breast
imaging
LI-RADS for liver mass reporting on MRI
Lung-RADS for CT
lung cancer screening
What can Bayesian networks be used for?
They can be used to
implement point-of-care decision support for radiologists who have
identified the characteristics of an imaging abnormality but are unsure what it represents
What do many PACS vendors include in their system to aid in education through real-studies?
integrated teaching file modules
What is the main purpose of discrepancy tracking systems?
to give feedback to residents and allow them to review additions to
their reports
as well as identify major and minor discrepancies between the preliminary and final reports
Which of these costs of home-built software applications is often overlooked
during the build-versus-buy decision-making process?
A. Up-front fnancial expenditure
B. Maintenance and support cost
C. Hardware infrastructure
D. User training
B
Which of the following features of a recommendation-tracking system is
important for decreasing the likelihood of an adverse patient outcome?
A. Asynchronous messaging
B. Message logging
C. Text paging
D. Closed-loop communication
D
What is the most salient difference between a critical imaging test result and a
noncritical actionable fnding?
A. Timeline during which patient harm may occur
B. Size of the detected abnormality
C. Modality on which the finding was identified
D. Location where the patient was imaged
A
Which actor in the IHE REM profle transaction diagram would be expected to
collect dose indices from exams sent to PACS?
A. Acquisition modality
B. Image archive
C. Dose information consumer
D. Dose register
C
What output does a CDS system generate in response to the selection of an
imaging exam and associated indication for the study?
A. Pre-authorization
B. Appropriateness score
C. Peer-to-peer authorization
D. Explanation of benefits
B
What is the major advantage of using radiologist decision support to generate
follow-up recommendations?
A. Standardization of recommendation language across a practice
B. Increased revenue from follow-up imaging
C. Increased need for structured reporting templates
D. Decreased cost to the department or practice
A
Which of the following is a potential pitfall of teaching fle systems that ingest
DICOM image objects?
A. Limited data storage due to larger fle sizes
B. Compromise of PHI still in the DICOM header
C. Slower loading times for individual teaching cases
D. Less likelihood of backward compatibility
B
Which of the following systems is least likely to need connections to PACS?
A. Teaching fle
B. Radiation exposure monitoring
C. Discrepancy tracking
D. Clinical decision support
C
Which of the following systems requires the least integration with the PACS,
RIS, or EMR?
A. Critical test results management
B. Radiologist decision support
C. Recommendation tracking
D. Incident reporting
D
Which important feature do web conferencing applications generally lack?
A. Interactivity via chat or question/answer box
B. Simultaneous audio and video sharing
C. Multi-monitor display to replicate PACS viewer functionality
D. Collaboration features, e.g., sharing mouse control
