Guidelines for Handling Media Containing Patient Information
© 2006-2011 OFFIS e. V.
Guidelines for Handling Media Containing Patient Information
Correct handling of patient CDs is an important premise for a smooth and reliable exchange of image data between medical institutions. However, problems with patient CDs are not only caused by faulty CDs alone, but also by incorrect handling at the recipient's side, e. g. by importing images into a local archive without reconciliation of critical data such as the Patient ID. Therefore, guidelines for the correct handling of patient CDs have been developed in the context of the Media Exchange Certification Project. These guidelines are summarized on this page. The full text document of the guidelines can be found here.
A summary can be found in the following text.
Not every PC is well suited for displaying radiological images. It is suggested to follow the recommendations in the German X-ray Regulation Quality Assurance Rule ("Qualitätssicherungsrichtlinie zur Röntgenverordnung"), where section 8 defines requirements for display systems used for the diagnostic reporting or general display of medical images for all anatomic regions of the body. In addition, it should be verified that at least 256 shades of gray can be displayed. This is the case if the graphics adapter addresses 24 bits or 32 bits per pixel, but not if only 16 bits per pixel (often referred to as "high color" or "medium color quality") are available. Brightness and contrast settings of the monitor should be adjusted carefully and the place of the monitor and the room lighting should be chosen such that the reflection from ambient light on the monitor is minimized. Main memory and computing power of the computer used should be sufficiently large.
The system should be protected against malicious software as good as possible; in particular, a virus scanner and a firewall should be installed and activated. Furthermore, any autostart functionality of the operating system that automatically executes specific programs from CD media should be disabled. In order to visualize all possible CD content, a DICOM viewing application, an Internet browser and a PDF viewer should be installed on the computer. Finally, all software components, especially the operating system and the virus scanner, should be updated on a frequent basis. Users are advised to log-in to the operating system with a standard user account (without administrator privileges).
1st Szenario: Basic Visualization
In many cases, it is sufficient for a recipient of a patient CD to visualize its content on the screen without the need for a permanent import of data into an electronic patient record or a PACS.
The most important data on a radiological patient CD are the images in DICOM format, which are mandatory as required by the DRG specification. These images can either be visualized using a locally installed DICOM viewer or the DICOM viewer optionally provided on the CD. In case the CD contains Web Content in addition to the DICOM data, this can be displayed by opening the file "INDEX.HTM" found in the root directory of the CD.
In addition to DICOM and Web Content, other data (e. g. diagnostic reports, discharge summaries or a short manual for the DICOM viewer on CD) may be present on a CD. Such documents should be located in a separate directory on the CD. Since these documents do not necessarily have a "DICOM counterpart" on the CD, it is important not to miss them. PDF documents can be displayed using a previously installed PDF viewer and may be printed if necessary.
2nd Szenario: PACS Import
If the recipient of a patient CD uses a DICOM image archive (PACS) as well as dedicated diagnostic workstations for visualizing the DICOM objects stored in the archive, he/she may want to import the DICOM contents from the CD into the existing archive in order to visualize the data at the diagnostic workstation (e. g. to compare current and previous study). For such an import of DICOM data into the PACS further preparations are necessary to make sure that the images are not assigned to the wrong patient or the wrong order in the archive.
Besides the pure radiological image data, DICOM objects contain additional information about the patient, the equipment used, the corresponding order, and about the study and series the image belongs to. The most important identifiers in this context are the Patient ID, which is a unique identifier for the patient within a medical institution, and the Accession Number, which is used to relate the images to an order in the radiology information system (RIS). Both identifiers must be reconciliated when importing from an external source (like a CD from another institution) in order to guarantee the correct assignment of images to a specific patient in the PACS and to the corresponding order in the RIS. Furthermore, there are some additional data elements in the header of a DICOM image that should be reconciliated during import, including name and birth date of the patient. In any case, the importing system has to offer the ability for the user to adapt key identifiers before actually storing the DICOM data in the local archive.
When performing a manual import of DICOM objects, the user manually enters values for Patient ID and Accession Number. The Patient ID must be looked up in the RIS or in the hospital information system (HIS); if necessary, the patient must be first newly admitted to the HIS. The Accession Number can be left empty, alternatively a new order "Import of Patient CD" can be created at the RIS to let the RIS create a new Accession Number. Both, Patient ID and Accession Number, must be entered manually during CD import. If the CD contains data for more than one patient, these steps must be repeated for each patient.
Import Using a Worklist
More comfortable, complete and reliable is the import using the DICOM worklist capabilities of the RIS, if supported by the import system. In this case, a new order for the patient is placed in the RIS and made available via DICOM worklist. The import system queries the worklist – similar to an imaging modality – and uses the data in the worklist to reconciliate all necessary information in the DICOM objects being imported from CD. The worklist provides information about the Patient ID, the Accession Number and all further data required for reconciliation. Thus the rest of the import procedure can be performed automatically and the risk of incorrect data entry can be reduced significantly.
The Guidelines for Handling Media Containing Patient Information should serve as best-practice instructions for recipients of patient CDs wanting to visualize or import the CD content. Especially for PACS Import, a reliable and consistent import into the local archive should be guaranteed by providing detailed information about the data fields to be reconciliated.
Last page update: 2013-06-10