U.S. patent application number 14/599090 was filed with the patent office on 2015-08-13 for methods and systems for analyzing, prioritizing, visualizing, and reporting medical images.
The applicant listed for this patent is Radlogics, Inc., TEL HASHOMER MEDICAL RESEARCH AND INFRASTRUCTURE AND SERVICES LTD.. Invention is credited to Moshe Becker, Hayit Greenspan, Eliahu Konen, Arnaldo Mayer.
Application Number | 20150227695 14/599090 |
Document ID | / |
Family ID | 44320180 |
Filed Date | 2015-08-13 |
United States Patent
Application |
20150227695 |
Kind Code |
A1 |
Becker; Moshe ; et
al. |
August 13, 2015 |
METHODS AND SYSTEMS FOR ANALYZING, PRIORITIZING, VISUALIZING, AND
REPORTING MEDICAL IMAGES
Abstract
Methods and systems for retrieving and processing medical
diagnostic images are provided, comprising using picture analysis
prioritization visualization and reporting system ("PAPVR system")
to determine whether each of one or more images from an image
database or imaging device is of medical interest to a reviewing
physician, determine whether one or more of the images is
representative of the images, and provide the one or more images to
a display and analysis system for review by a reviewing physician.
The PAPVR system can provide the one or more images with a Key
Image that is representative of the images. In addition, the PAPVR
system can detect whether a patient suffers from a particular
ailment, and provide a reviewing physician quantitative information
that is relevant to the patient's condition.
Inventors: |
Becker; Moshe; (Los Gatos,
CA) ; Greenspan; Hayit; (Los Gatos, CA) ;
Konen; Eliahu; (Tel-Aviv, IL) ; Mayer; Arnaldo;
(Herzeliya, IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Radlogics, Inc.
TEL HASHOMER MEDICAL RESEARCH AND INFRASTRUCTURE AND SERVICES
LTD. |
Los Gatos
RAMAT-GAN |
CA |
US
IL |
|
|
Family ID: |
44320180 |
Appl. No.: |
14/599090 |
Filed: |
January 16, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13575841 |
Oct 22, 2012 |
8953858 |
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PCT/US11/23059 |
Jan 28, 2011 |
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14599090 |
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61299309 |
Jan 28, 2010 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G06K 2009/4666 20130101;
G06T 7/0012 20130101; G16H 15/00 20180101; G06K 9/6201 20130101;
G16H 10/60 20180101; G06F 16/51 20190101; G16H 30/20 20180101; G06K
9/46 20130101 |
International
Class: |
G06F 19/00 20060101
G06F019/00; G06F 17/30 20060101 G06F017/30; G06K 9/62 20060101
G06K009/62; G06T 7/00 20060101 G06T007/00; G06K 9/46 20060101
G06K009/46 |
Claims
1-20. (canceled)
21. A computer-implemented method for providing medical diagnostic
images, comprising: retrieving a set of images from an image
database or an imaging device, wherein the set of images includes
images from a patient; determining whether each of the images of
the patient is of medical interest to a reviewing physician based
on quantitative measurements of one or more physiological features
and a determination as to whether each of the quantitative
measurements deviates from a threshold value; determining whether
one or more of the images is a representative image of the set of
images of the patient, which representative image is determined to
capture a medical condition of the patient among other images of
the set of images; and providing the images to a display and
analysis system for review by the reviewing physician, wherein the
images are provided with the representative image.
22. The computer-implemented method of claim 21, wherein the
quantitative measurements include cross sectional areas of the one
or more physiological features.
23. The computer-implemented method of claim 21, wherein the
quantitative measurements include volumes of the one or more
physiological features.
24. The computer-implemented method of claim 21, wherein the set of
medical images includes at least one two-dimensional medical
image.
25. The computer-implemented method of claim 21, wherein the set of
medical images includes at least one three-dimensional medical
image.
26. A computer-implemented method for providing medical diagnostic
images, comprising: retrieving a set of images from an image
database or an imaging device, wherein the set of images comprises
images from a present session and images from at least one previous
session on the same patient; determining whether each of the images
of the patient is of medical interest to a reviewing physician by
(i) comparing one or more measurements of one or more physiological
features identified in each of the images from the present session
with one or more physiological features identified in each of the
images from the at least one previous session on the same patient,
and (ii) determining changes in the one or more physiological
features present in each of the images between the present session
and the at least one previous session; determining a localization
region in a representative image obtained from the set of images,
wherein the localization region is associated with an identified
abnormality upon determining changes in the one or more
physiological features present in each of the images; and providing
at least a subset of the set of images to a display and analysis
system for review by the reviewing physician, wherein the at least
the subset of the set of images is provided with the representative
image having the localization region identified for the reviewing
physician.
27. The computer-implemented method of claim 26, wherein the set of
medical images includes at least one two-dimensional medical
image.
28. The computer-implemented method of claim 26, wherein the set of
medical images includes at least one three-dimensional medical
image.
29. The computer-implemented method of claim 26, wherein comparing
the one or more measurements of the one or more physiological
features identified in each of the images from the present session
with one or more physiological features identified in each of the
images from the at least one previous session comprises identifying
changes in one or more quantitative measurements of the one or more
physiological features.
30. The computer-implemented method of claim 29, wherein the one or
more quantitative measurements include cross sectional areas of the
one or more physiological features.
31. The computer-implemented method of claim 29, wherein the one or
more quantitative measurements include volumes of the one or more
physiological features.
Description
CROSS-REFERENCE
[0001] This application claims the benefit of U.S. Provisional
Patent Application Ser. No. 61/299,309, filed on Jan. 28, 2010,
which is entirely incorporated herein by reference.
FIELD OF THE INVENTION
[0002] This application generally relates to medical imaging; more
particularly, this invention relates to systems and methods for
analyzing, prioritizing, visualizing and reporting medical
images.
BACKGROUND OF THE INVENTION
[0003] Medical imaging systems, such as computerized tomography
("CT") scanners and magnetic resonance imaging ("MRI") scanners,
allow a physician to examine a patient's internal organs and areas
of the patient's body that require a thorough examination for
medical treatment. In use, a visualizing scanner outputs
two-dimensional ("2D") and three-dimensional ("3D") medical images
that can include a sequence of computerized cross-sectional images
of a certain body organ, which is then interpreted by reviewing
physician, such as a specialized radiologist.
[0004] Commonly, a patient is referred for a visual scan by a
general practitioner or an expert (or specialized) practitioner. A
series of 2D and sometimes 3D medical images (or scans) are
subsequently obtained. The scan is then forwarded to a reviewing
physician (such as a radiologist) who is responsible for the
analysis and diagnosis of the scan. Radiologists are typically
trained to analyze medical images from various parts of a patient's
body, such as medical images of the brain, abdomen, spine, chest,
pelvis and joints. After a radiologist (or other reviewing
physician) analyzes the medical images, he or she prepares a
document ("Radiology Report") that includes radiological findings,
and sometimes key images from the scan that best show the findings.
The radiology report is then sent back to the referring
practitioner.
[0005] In most hospitals and radiology centers, the scan is
transferred to a picture archiving communication system ("PACS")
before being accessed by the radiologists. A PACS is a computer
system that acquires, transmits, stores, retrieves, and displays
digital images and related patient information from a variety of
imaging sources and communicates the information over a network.
Many hospitals are also equipped with a radiology information
system ("RIS")--used by radiology departments to perform patient
tracking and scheduling, result reporting and image tracking.
Medical images are typically stored in an independent format, such
as a Digital Imaging and Communications in Medicine ("DICOM")
format. Electronic images and reports are transmitted digitally via
PACS, which eliminates the need to manually file, retrieve or
transport film jackets. A PACS typically includes four components:
the imaging modalities, such as computer axial tomography ("CAT")
or CT, MRI, position emission tomography ("PET"), or PET/CT; a
secured network for the transmission of patient information;
workstations for interpreting and reviewing images; and long and
short term archives for the storage and retrieval of images and
reports.
[0006] There are image retrieval and processing systems and methods
available in the art. For example, U.S. patent application Ser. No.
12/178,560 to Yu ("Yu"), entitled "SYSTEMS FOR GENERATING RADIOLOGY
REPORTS," which is entirely incorporated herein by reference,
teaches a method for generating a patient report, comprising
presenting an operator with an on screen menu of standardized types
of reports and having the operator select a standardized type of
report from the on screen menu of standardized types of reports. Yu
further teaches presenting the operator with an on screen organ
list corresponding to the selected standardized type of report; for
each organ, presenting the operator with a menu of standard medical
descriptions corresponding to the organ; and having the operator
determine a medical description corresponding to each organ. Yu
teaches outputting a patient report describing the medical
description of each organ.
[0007] As another example, U.S. patent application Ser. No.
11/805,532 to Nekrich ("Nekrich"), entitled "RADIOLOGY CASE
DISTRIBUTION AND SORTING SYSTEMS AND METHODS," which is entirely
incorporated herein by reference, teaches a system and method for
processing an image, including a means for receiving image
information, a means for queuing the image information, and a means
for receiving profile information for a plurality of image
analysts. The system of Nekrich can further include a means for
selecting an image analyst from the plurality of image analysts by
comparing the image information from the profile information.
[0008] As another example, U.S. patent application Ser. No.
12/224,652 to Bar-Aviv et al. ("Bar-Aviv"), entitled "SYSTEM AND
METHOD OF AUTOMATIC PRIORITIZATION AND ANALYSIS OF MEDICAL IMAGES,"
which is entirely incorporated herein by reference, teaches a
system for analyzing a source medical image of a body organ. The
system of Bar-Aviv comprises an input unit for obtaining the source
medical image having three dimensions or more, a feature extraction
unit that is designed for obtaining a number of features of the
body organ from the source medical image, and a classification unit
that is designed for estimating a priority level according to the
features.
[0009] While current medical image retrieval and processing systems
have provided physicians tremendous capabilities in storing and
retrieving medical images, there are limitations associated with
these systems. For instance, for a typical scan, a hospital may
obtain hundreds of images, and a reviewing physician might not have
time to review each of the images to determine whether a patient
has a particular type of medical condition. In cases in which a
hospital scans several patients in a relatively short period of
time, the hospital might not have the resources to timely review
each patient's medical images to determine whether a physician
should review the image further, and whether the patient has a
particular type of medical condition. In addition, modern medical
imaging systems can operate much more quickly than older systems,
which has led to a decrease in the time it takes to generate a
scan. While a shorter scan time could be beneficial for providing
rapid patient care, it has resulted in the generation of a
significant amount of data that must be compiled, analyzed and
presented to a reviewing physician. Further, modern medical imaging
systems can operate at higher resolutions, resulting in increased
number of higher resolution two-dimensional images and/or
three-dimensional images (or scans thereof). As the time to
generate scans decreases and the number of scans (and images
obtained) per patient increases, hospitals without sufficient
resources might not be able to review each image and provide
patients with medical care in an accurate and efficient manner.
Further, while some hospitals might have medical imaging,
processing and retrieval systems for handling scans, current
systems are not capable of accurately and efficiently prioritizing
scans. In addition, current systems do not provide scan reviewing
and patient treating physicians with the capability to acquire
accurate patient-specific diagnostic information from each of the
images or scans.
[0010] Accordingly, there is a need in the art for improved
imaging, analysis, prioritization and reporting systems. In
particular, there is a need in the art for methods and systems for
accurately and efficiently analyzing and prioritizing medical
images, such as images acquired from CT scans and MRIs, to provide
better patient risk management.
SUMMARY OF THE INVENTION
[0011] In an aspect of the invention, computer-implemented methods
for providing medical diagnostic images and enhanced report
capabilities are provided.
[0012] In one embodiment, a computer-implemented method for
providing medical diagnostic images comprises using a computer
system to retrieve one or more images from an image database or an
imaging device (e.g., imaging modality), the one or more images
defining a set of images; using the computer system to determine
whether each of the images is of medical interest to a reviewing
physician; using the computer system to determine whether one or
more of the images is representative of the set of images; and
providing the one or more images to a display and analysis system
for review by a reviewing physician, wherein the one or more images
are provided with an image that is representative of the set of
images.
[0013] In another embodiment, a computer-implemented method for
providing enhanced report capabilities for medical diagnostic
images comprises retrieving one or more images from an image
database or an imaging device, the one or more images defining a
set of images; determining whether each of the images is of medical
interest to a reviewing physician; determining whether one or more
of the images is representative of the set of images; providing the
one or more images to a display and analysis system for review by a
reviewing physician; and providing one or more text blocks
associated with items determined to be of medical interest, the one
or more text blocks for being mixed, matched and edited by a
reviewing physician to create a report.
[0014] In another aspect of the invention, a system for visualizing
and reporting patient-specific medical information comprises an
imaging modality for retrieving medical diagnostic images from a
patient; a reviewing system for displaying medical images to a
reviewing physician; a prioritization visualization and reporting
system in communication with the imaging modality and the reviewing
system, wherein the prioritization visualization and reporting
system is for retrieving one or more images from the imaging
modality, the one or more images defining a set of images,
determining whether each of the images is of medical interest to a
reviewing physician, determining whether one or more of the images
is representative of the set of images and providing the one or
more images to the reviewing system, wherein the one or more images
are provided with an image that is representative of the set of
images.
INCORPORATION BY REFERENCE
[0015] All publications, patents, and patent applications mentioned
in this specification are herein incorporated by reference to the
same extent as if each individual publication, patent, or patent
application was specifically and individually indicated to be
incorporated by reference.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] The novel features of the invention are set forth with
particularity in the appended claims. A better understanding of the
features and advantages of the invention will be obtained by
reference to the following detailed description that sets forth
illustrative embodiments, in which the principles of the invention
are utilized, and the accompanying drawings of which:
[0017] FIG. 1 shows a medical imaging workflow with a timeline, in
accordance with an exemplary embodiment of the current art;
[0018] FIG. 2 shows an examination workflow, in accordance with an
embodiment of the invention;
[0019] FIG. 3 shows a picture analysis prioritization visualization
and reporting ("PAPVR") system as part of a workflow system, in
accordance with an embodiment of the invention;
[0020] FIG. 4 shows a CT scan of a patient's pleural cavity, in
accordance with an embodiment of the invention;
[0021] FIG. 5 shows steps taken in flagging an image as a
representative image, in accordance with an embodiment of the
invention;
[0022] FIG. 6 shows a series of steps for prioritizing medical
images, in accordance with an embodiment of the invention;
[0023] FIG. 7 is a screenshot of a patient case queue and the
indication of priority of each case in the queue, in accordance
with an embodiment of the invention;
[0024] FIG. 8 is a screenshot of an interactive window, in
accordance with an embodiment of the invention;
[0025] FIG. 9 is an exemplary overview of a computer system as may
be used in any of the various locations throughout the system and
method disclosed herein;
[0026] FIG. 10 is an exemplary overview of a network-based system,
in accordance with an embodiment of the invention; and
[0027] FIG. 11 is an exemplary revised timeline for the medical
imaging workflow shown in FIG. 1, in accordance with an embodiment
of the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0028] While various embodiments of the invention have been shown
and described herein, it will be obvious to those skilled in the
art that such embodiments are provided by way of example only.
Numerous variations, changes, and substitutions will now occur to
those skilled in the art without departing from the invention. It
should be understood that various alternatives to the embodiments
of the invention described herein may be employed in practicing the
invention.
[0029] The invention provides methods and systems for analyzing and
prioritizing medical images, and for reporting medical findings.
For example, an analysis of medical images according to some
aspects of the system and methods disclosed herein may be used to
identify critical medical conditions, and, based on this analysis,
said system and method may further be used to organize a work list
for a reviewing physician based on the severity of the medical
findings and to then create a text document that lists the medical
findings in the analyzed medical images. For example, a database
may be created, showing a "normalized" version of each possible
aspect of a region. Accordingly, deviations above a certain
threshold may be used to flag a certain image. Furthermore, in some
areas, just the appearance of an unexpected presence (for example,
a liquid in the pleural space) maybe used to flag an image or a
series of images. It is clear that many variations can be done
without changing the spirit of the invention. Various aspects of
the invention described herein may be applied to any of the
particular applications set forth below or for any other types of
displays, or radiological data management applications. The
invention may be applied as a standalone system or method, or as
part of an integrated software package, such as a medical and/or
laboratory data management package or application, or as part of an
integrated picture archiving communication systems ("PACS")
solution. It shall be understood that different aspects of the
invention can be appreciated individually, collectively, or in
combination with each other.
[0030] Current medical imaging, processing and retrieval systems
are incapable of providing sufficient patient risk management. This
is due at least in part to the lack of case prioritization. In
addition, hospitals may not have the resources to review and
analyze each medical image in a set of medical images in a timely
manner, and current PACS do not provide physicians the resources to
efficiently and accurately analyze, prioritize, and report findings
in medical images.
[0031] In embodiments of the invention, methods and systems are
provided for efficiently and accurately interpreting medical
images, acquiring quantitative measurements for each of the medical
images, and providing the reviewing physicians the capability to
generate medical reports. Methods and systems of embodiments of the
invention can provide hospitals with the capability to streamline
their medical image processing, which advantageously reduces the
time and resources necessary to review each scan (e.g., CT/CAT,
MRI, PET/CT) associated with a subject (e.g., patient), and provide
physicians accurate data necessary to provide adequate medical
care.
[0032] In embodiments of the invention, methods and systems are
provided for analyzing medical images (e.g., CT scans of the chest,
abdomen, and head). Methods and systems of embodiments of the
invention improve the quality of patient care by automatically
prioritizing cases prior to review by a reviewing physician or
specialist (e.g., radiologist) based on pathological findings. In
various embodiments, methods and systems for analyzing and
prioritizing medical images generate preliminary reports, which are
available to reviewing physicians as they open cases for review.
This advantageously reduces the time it takes a radiologist to
prepare a final report. The report can include additional
information, such as quantified measurements (e.g., cross-sectional
areas, volumes) automatically extracted, generated, or calculated
from the data. Methods and systems of embodiments of the invention
can seamlessly integrate into an existing radiological
workflow.
[0033] Reference will now be made to the figures. It will be
appreciated that the figures are not necessarily drawn to
scale.
[0034] With reference to FIG. 1, a typical medical imaging workflow
as currently used is shown. Approximate lengths of time associated
with each step in the workflow are also indicated in the figure.
Such times are provided by way of example only. It will be
appreciated that other times are possible.
[0035] Initially, in step 101, a patient is admitted to a hospital
or other healthcare provider for treatment or a routine checkup.
For example, the patient may be admitted through the emergency room
("ER"), the in-patient unit, or the out-patient unit of a
healthcare provider. An admitting physician or nurse conducts a
preliminary examination of the patient to determine whether the
patient's condition warrants immediate medical attention (i.e.,
"Stat "or "No-Stat"). For instance, the admitting physician can
determine whether the patient's condition is of high or low
priority. The admitting physician or nurse may indicate the
patient's status (e.g., high priority, low priority) in a patient
tracking system, such as the patient tracking feature of a
radiology information system ("RIS"). The admitting physician or
nurse can also indicate "Stat" or "Non-Stat" (or "No-Stat"). Cases
indicated as "Stat" may be placed in a high priority queue while
cases indicated as "No-Stat" can be placed in a low priority
queue.
[0036] With continued reference to FIG. 1, in a patient examination
step 102, medical images (e.g., CAT/CT scan, MRI, PET/CT scan) are
obtained from a patient. Medical images may be obtained using a
variety of methods. For example, a three-dimensional image (with
2-D cross-sections) of a particular region of a patient's body may
be obtained using a CT scanner. As another example, a
three-dimensional image may be obtained using an MRI. Such
three-dimensional image may have two-dimensional cross-sectional
images. Alternatively, multiple images may be provided, whether
they originate from a three-dimensional image or not. Medical
images (or scans) thus obtained are stored in a PACS. The PACS
makes these images available for review by a reviewing physician or
specialist (e.g., radiologist).
[0037] Next, in step 103, a radiologist retrieves and interprets
the images obtained during the patient examination step. The
radiologist reviews all of the images in a case in step 104.
[0038] In the next step 105, the radiologist prepares a report
having the radiologist's analysis of the patient's medical images.
The radiologist might dictate (or type) a report comprising the
radiologist's diagnosis of the patient's condition. The radiologist
may add to the report images taken from the case that show visual
representation of the diagnosis ("Key Images"). The radiologist can
then make the report available for review by a referring
physician.
Picture Analysis Prioritization Visualization and Reporting
System
[0039] In an aspect of the invention, a computer system is provided
for improving the efficiency and accuracy of a workflow process. In
embodiments of the invention, the computer system, which, for
example, could be a standard personal computer with a standard CPU,
memory and storage, is an enhanced picture archiving communication
system, or an add-on subsystem to an existing PACS and/or RIS. In
embodiments of the invention, the computer system can be configured
to analyze and prioritize images and patient cases. The computer
system can be referred to as a picture analysis prioritization
visualization and reporting system (also "PAPVR system" herein).
The computer system can automatically retrieve medical images from
an imaging modality (e.g., CAT/CT scanner, MRI, PET/CT scanner) or
a database in which medical images are stored, or a PACS,
automatically analyze the medical images, and provide the medical
images and the results of the analysis for review by a reviewing or
referring physician, or a specialist, such as a radiologist.
[0040] With reference to FIG. 2, an examination workflow is
illustrated, in accordance with an embodiment of the invention. In
a first step 210, a patient is admitted for treatment or a routine
checkup. An admitting physician or nurse can determine whether the
patient's condition is of high priority or low priority. Next, in
step 215 a predetermined region of the patient's body is scanned.
In an embodiment, a predetermined region of the patient's body is
imaged using CT (or CAT) scan. In another embodiment, a
predetermined region of the patient's body can be imaged using MRI,
PET scan, or PET/CT scan. Scanning the patient can provide one or
more images (e.g., 2-D or 3-D images) of a predetermined region of
the patient's body. Next, in step 220 the one or more images (or
set of images) are stored in an image database. In an embodiment,
the image database can be a subsystem of a PACS. In another
embodiment, the image database can be a standalone computer system.
In such a case, the standalone computer system can be in
communication with a PACS.
[0041] With continued reference to FIG. 2, in step 225, the one or
more images are analyzed by a PAPVR system (or enhanced PACS), in
accordance with an embodiment of the invention. In an embodiment, a
subset of the one or more images is analyzed and interpreted by the
PAPVR system. Next, in step 230, the PAPVR system reviews the one
or more images to determine whether the one or more images would be
of interest (e.g., Key Images) to a reviewing or referring
physician. This can entail determining whether the one or more
images show any abnormalities with respect to the patient's
condition, for example, free pleural air (pneumothorax) or fluid,
aortic dissection, intracranial hemorrhage, liver metastases etc.
These various conditions, for example, can be determined using
comparable images, as well as comparing them to normalized images
as described throughout herein. In an embodiment, the PAPVR system
can determine whether each or a subset of the one or more images is
important for further review by a reviewing or referring physician.
In some cases, further the system may perform additional analysis,
including but not limited to providing quantitative measurements,
as well as, in some cases, the indication of the localization (for
example with an added color overlay that can be turned off for
better viewing, or other suitable methods) where the measurement
has been performed. This localization is more specific than a
keyframe as it may be a small region inside a key frame. For
example, When we detect blood in the pleural effusion (hemothorax),
we can highlight the areas where blood was detected into the
pleural effusion. This can save time in some cases since if blood
is detected correctly somewhere in the pleural effusion and the
radiologist is brought automatically to that place for
verification, the radiologist can diagnose the hemothorax without
further measuring liquid intensity in other slices.
[0042] Next, in step 235, the PAPVR system can perform quantitative
measurements and calculations (e.g., distances, cross-sectional
areas, volumes), that is relevant to the patient's condition, for
example, measuring the volume of air in a pneumothorax by doing
image analysis as described herein. Next, in step 240, the PAPVR
system can create a draft report that includes the findings,
calculations and Key Images. Next, in step 245, the PAPVR system
can designate case priority. Next, in step 250, the PAPVR system
can provide the one or more images and the draft report for review
and preparation of the final report by a reviewing or referring
physician. In an embodiment, the one or more images can be provided
with the PAPVR system's interpretation of the one or more images.
The steps 225, 230, 235, 240 and 245 can be collectively referred
to as step 255.
[0043] Further, in some cases, the system could be automatically
comparing the present study with a previous similar study obtained
on the same patient in the past; in these cases the invention can
compare findings and quantify changes such as increased pleural
fluid or increased dilatation of an aortic aneurysm which has
significant clinical implications.
[0044] In an aspect of the invention, methods for retrieving and
processing medical diagnostic images are provided. The methods
comprise using a computer system, such as an enhanced picture
archiving communication system (also "picture archiving
communication and analysis system" herein), to retrieve one or more
images (e.g., two-dimensional images from a three-dimensional scan)
from an image database or directly from an imaging device (e.g.,
imaging modality). In an embodiment, the one or more images define
a set of images. Next, the computer system determines whether each
of the images is of medical interest to a reviewing physician, for
example, by identifying the image that shows the point in which the
aorta is seen at its widest diameter, or, for example, by analyzing
that specific aspect in a series of volumetric images and
calculating the value, and then flagging the one with the largest
numeric value, either by dimension, area or any other suitable
measure. In an embodiment, this can include the computer system
comparing each of the images to images from patients with known
medical conditions. Next, the computer system determines whether
one or more of the images is representative of the set of images
and designates them as Key Images. The computer system then
provides the one or more images to a display and analysis system
for review by a reviewing physician. In addition, using the above
image comparisons, the computer system can detect whether a patient
suffers from a particular ailment, and provide a reviewing
physician quantitative information (e.g., distances,
cross-sectional areas, volumes), that is relevant to the patient's
condition.
[0045] In an aspect of the invention, a PAPVR system is provided
for automatically retrieving, reviewing and analyzing one or more
medical images acquired from an imaging modality. In embodiments,
the PAPVR system can analyze and interpret each or a subset of one
or more images acquired by an examination system, such as an
imaging modality (e.g., CAT/CT scan, NMI, PET/CT scan). In some
case, the PAPVR system can be referred to as an enhanced or
improved PACS. The PAPVR system of preferable embodiments can
automatically perform step 255 of FIG. 2.
[0046] In preferable embodiments of the invention, the PAPVR system
is configured to automatically detect and quantify various
physiological features or abnormalities, for example, by using
image processing algorithms that identify the pneumothorax
condition, and other image processing algorithms that can segment
the area of the pneumothorax and calculate its volume, as discussed
exemplarily throughout this document,. By automatically detecting
various physiological features or abnormalities, the PAPVR system
of embodiments of the invention can advantageously reduce the time
and resources required to review images provided from an imaging
modality (e.g., CT scan, MRI, PET/CT). This increases the accuracy
of detection and quantification, and provides for improved patient
care and more efficient workflow. PAPVR systems of embodiments of
the invention advantageously enable healthcare providers to provide
patients with accurate and rapid patient care.
[0047] With reference to FIG. 3, in an embodiment of the invention,
a PAPVR system 310 configured to retrieve, analyze and interpret
one or more images provided by an examination system is
illustrated, in accordance with an embodiment of the invention. The
PAPVR system 310 can include tangible, non-transitory computer
readable media. The PAPVR system 310 can be part of a healthcare
provider's workflow. In an embodiment, the PAPVR system can
automatically perform step 255 of FIG. 2. The PAPVR system 310 can
retrieve images from a storage unit that can be part of the PAPVR
system 310, or from a separate PACS system 325, and prepare the
images for review. The PAPVR system 310 can be in communication
with other components or computer systems (also "systems" herein)
of a healthcare provider. In an embodiment, the PAPVR system 310
can be physically situated at the location of a healthcare provider
(i.e., the PAPVR system can be on-site). In such a case, the PAPVR
system can communicate with other components or systems of the
healthcare provider via the healthcare provider's network, such as
an intranet. In another embodiment, the PAPVR system 310 can be an
off-site system that communicates with other components of a
healthcare provider via the Internet or World Wide Web.
[0048] With continued reference to FIG. 3, the PAPVR system 310 is
configured to retrieve one or more images from an examination
system 315 or a PACS 325; analyze and interpret (also referred to
as "process" herein) some or all of the one or more images; and
provide the one or more images for review by a referring or
treating physician. In an embodiment, following processing, the
PAPVR system 310 can provide the images to a reviewing system 320
configured to display the images to a physician. In an embodiment,
the PAPVR system 310 can analyze and interprets each cross-section
of a three-dimensional scan of a particular region of a patient's
body. The PAPVR system may contain, receive, or utilize computer
readable media, which may contain instructions, logic, data, or
code that may be stored in persistent or temporary memory of a
computer, or may somehow affect or initiate action by the PAPVR
systems, or any computers or servers contained therein. Any steps
or analysis described herein may be performed by utilizing such
computer readable media.
[0049] In embodiments, the PAPVR system 310 can automatically
detect various physiological features, again, for example, by using
image processing algorithms that identify the pneumothorax
condition, and another image processing algorithm that can segment
the area of the pneumothorax and calculate its volume. For example,
the PAPVR system can automatically detect air and/or liquid pockets
and quantify (or calculate) the volume of the air and/or liquid
pockets. The PAPVR system can also quantify cross-sectional areas
and distances. In some embodiments, the PAPVR system can detect
bones and organs, and quantify the cross-sectional areas and/or
volumes of the bones and organs.
[0050] In embodiments, the PAPVR system 310 can provide additional
data with each of the one or more images. The PAPVR system 310 can
provide the additional data for review by a reviewing or referring
physician (using the reviewing system 320, for example). The
additional data can include distances (e.g., distances between
features) cross-sectional areas, gas (e.g., air) volumes, liquid
(e.g., blood) volumes, blood vessel cross-sectional measurements,
location and number of bone fractures, and shift in the position of
body organs such as the mediastinum in tension pneumothorax. In an
embodiment, when a physician accesses each of the one or more
images, the additional data is made accessible to the physician. In
an embodiment, when the physician views a two-dimensional
cross-sectional image of a three-dimensional image, the additional
data is provided with each two-dimensional cross-sectional image.
In some embodiments, additional data may be provided with each
image by way of metadata associated with each image.
[0051] With continued reference to FIG. 3, the PAPVR system 310 can
be in communication with other systems or components associated
with the healthcare provider's workflow system. In embodiments, the
PAPVR system 310 can be in communication with one or more of an
imaging modality (e.g., CAT/CT scan, MRI, PET/CT scan) remote
backup system, a DICOM storage and PACS server 325, a PACStoGO
system, a CD/DVD publishing system and a film digitizer. The PAPVR
system 310 can be in communication with other workflow systems
and/or components via an intranet, the Internet (e.g., wired or
wireless web), or other mode of communication, such as Bluetooth.
In certain embodiments, the PAPVR system can be configured to
interact manually or automatically with one or more systems or
components associated with a workflow system.
[0052] FIG. 4 shows one image of a CT scan 400 processed by a PAPVR
system of embodiments of the invention. The image 400 is a
two-dimensional cross-sectional image of a patient's pleural
cavity. The image 400 is one example of an image among many images
that can be provided from a CT scan. The CT scan shows free pleural
effusion, free pleural air and mediastinal shift (=tension
hydropneumothorax) 405 and the patient's rib cage 410. In
embodiments, the PAPVR system is configured to automatically detect
a pleural effusion and quantify the volume of free liquid and free
air in the patient's pleural cavity and identify the mediastinal
shift which suggest a medical emergency. In an embodiment, the
PAPVR system can also automatically detect the presence of an air
volume or space (e.g., pneumo-thorax) and quantify the volume. In
some embodiments, the PAPVR system can automatically detect and
quantify various physiological features or abnormalities, such as,
e.g., pneumothorax, tension pneumothorax, pleural effusion,
ascending and descending aortic caliber and aortic dissections.
Key Image
[0053] In an aspect of the invention, a PAPVR system can be
configured to provide a radiologist or other reviewing physician
with one or more images, Key Images that are representative of a
set of images and/or representative of the patient's condition.
[0054] With reference to FIG. 5, in an embodiment, a PAPVR system
can automatically identify one or more images as Key Images, based
on, for example, the image that shows the aorta at its widest. In
an embodiment, a Key Image is an image that is representative of a
set of images. In another embodiment, a Key Image is representative
of the patient's condition. In such a case, the Key Image can best
capture the patient's condition. In some cases, the Key Image can
accurately define a set of images. For instance, if a patient's CT
scan shows a pleural effusion, the Key Image can be the image
(e.g., two-dimensional cross-sectional image) determined by the
PAPVR system to clearly and accurately show the pleural effusion.
In some embodiments, when the PAPVR system provides one or more
images and data for review by a reviewing (such as a radiologist)
or referring physician, the Key Image can be the first image the
reviewing physician observes. In other embodiments, the Key Images
provided by the PAPVR system can be the images used by the
reviewing physician in the final report prepared for the referring
physician. For example, a Key Image can be found by comparing
tissue density of certain sections with average examples (i.e.,
liquids have a different density than "normal tissue") or
structural abnormalities, such as "speckles" of another density,
which could indicate for example tumors, or fracture lines in a
bone, etc.
[0055] With continued reference to FIG. 5, in a first step 505, the
PAPVR system retrieves an image (e.g., two-dimensional
cross-section of a three-dimensional image or scan) for processing.
Next, in step 510, the PAPVR system determines whether a reviewing
physician would consider the image representative of the set of
images. If the image is determined to be representative of the set
of images, in step 515 the image is flagged as a "Key Image." If
the image is determined to not be representative of the set of
images, in step 520 the image is not flagged as a "Key Image."
Next, in step 525, the set of images or a subset of the set of
images is provided to a reviewing (or treating) physician for
review. In an alternative embodiment, if an image is not found to
be representative, the PAPVR system can skip step 515 and proceed
directly to step 525.
Image Prioritization
[0056] In an aspect of the invention, a PAPVR system can
automatically prioritize an image. Image prioritization can
advantageously reduce time and resources required by a reviewing or
treating physician to make an accurate diagnosis. In some
embodiments, the PAPVR system can flag some images as having a
higher priority relative to other images, and a physician or
radiologist can review only those images, thus saving considerable
time in analyzing images associated with a particular scan.
[0057] A PAPVR system of embodiments of the invention can
automatically prioritize an image. In an embodiment, the PAPVR
system can be configured to flag an image as having a "high
priority" or a "low priority." In other embodiments, the PAPVR
system can flag an image as having high, medium or low priority. In
an embodiment, the PAPVR system can categorize an image among a
predetermined number of categories. For example, one, two, three,
four, five, six, seven, eight, or more categories may be utilized.
In still other embodiments, the PAPVR system can assign a numerical
value (e.g., 1-10, 1-100, 1-1000, 1-10,000) to an image that is
indicative of the priority of the image. For example, a high
priority image can be assigned a numerical value of 1, while a low
priority image can be assigned a numerical value of 100. In some
embodiments, the user can specify how an image is to be
prioritized. For example, the user can specify that images are to
be prioritized as high, medium, or low priority.
[0058] In some embodiments, a user (e.g., a reviewing/referring
physician, radiologist) can request that the PAPVR system only
provide images having a priority that is above a minimum (or
cut-off) priority. For example, the user can request that the
system provide only high priority images for review. As another
example, the user can request that the PAPVR system provide images
having a priority numerical value above a certain value or within a
certain range. In some embodiments, the user can specify the
minimum (cut-off) priority.
[0059] With reference to FIG. 6, in an embodiment of the invention,
a method for prioritizing an image from an imaging modality is
provided. In a first step 605, the PAPVR system retrieves images
for review. Next, in step 610, the PAPVR system determines whether
a reviewing or treating physician, such as a radiologist, would
consider each image important. In an embodiment, step 610 can
entail comparing each image to images from patients with known
conditions to determine whether there is a match. In an embodiment,
the PAPVR system can access an image database for image comparison.
If the image under review is found by the PAPVR system to be
important, in step 615 that image can be flagged as a "high
priority" image. If the image is not found to be important (or if
it is found to be unimportant), in step 620 that image can be
flagged as "low priority." Next, in step 625, the PAPVR system
prepares the images for review by a reviewing or treating
physician.
[0060] In an embodiment, the PAPVR system can assign a priority
value to an image based on the degree that the image matches one or
more images from one or more patients with a known condition. Such
matching can be accomplished by comparing the image under review by
the PAPVR system to images from an image database. A higher
priority value can be assigned to images that match known
conditions (or physiological abnormalities) while a low priority
can be assigned to images that do not match any known condition.
For example, if an image under review matches an image from a
patient with tension pneumo-thorax, that image can be assigned a
high priority value. In some cases, a reverse priority value can be
assigned, in which case a priority value is assigned based on the
degree to which a given image matches one or more images from
patients with no known conditions.
Case Prioritization
[0061] In another aspect of the invention, the PAPVR system can
automatically prioritize patient cases. In various embodiments, the
PAPVR system can automatically identify various medical conditions
and assign that case a certain priority. The priorities assigned to
the cases can be relative priorities (i.e., the PAPVR system
determines that one case is of higher priority relative to another
case in the queue of cases for a reviewing physician).
Alternatively, the PAPVR system can prioritize cases based on
absolute priority, which can entail prioritizing cases with
patients having life-threatening conditions as high priority cases
and patients without life-threatening conditions as low priority
cases. The rules used by the PAPVR system to determine case
priorities are configurable by the reviewing physician and the
medical institution.
[0062] In an embodiment, the PAPVR system can automatically review
a patient's images to determine whether the patient requires
immediate medical care. If the PAPVR system determines that the
patient requires immediate medical care, the PAPVR system can flag
the patient's case as high priority. Otherwise, the PAPVR system
can flag the patient's case as a lower priority (e.g., medium
priority, low priority) case.
[0063] With reference to FIG. 7, a screenshot of a patient case
queue for a reviewing physician 700 is shown. The case queue
includes a column 705 having a date and time stamp for each case, a
column 710 with the modality (e.g., CAT/CT scan, MRI, PET/CT scan)
used to acquire images, a column 715 showing the body part
associated with each case, and a column 720 showing the priority
associated with each case. The priority for each case can be
indicated by a colored circle, with the color red indicating high
priority, the color orange indicating medium priority, and the
color green indicating low priority. Alternatively, the priority
for each case can be indicated by a numerical value (e.g., 1-10,
1-100, 1-1000).
[0064] In an embodiment of the invention, the PAPVR system can
automatically update case priorities. This can advantageously
enable a reviewing physician, such as a radiologist, to be aware of
the highest priority cases, such that these cases are reviewed
first by the reviewing physician, and thus enable the referring or
treating physician to get the reviewing physician's report sooner
than if all cases were assigned the same priority. This capability
of the PAPVR system can significantly shorten the time interval
between when a patient is tested (e.g., with a CAT/CT scan, MRI,
PET/CT scan) and when a patient is treated by the referring or
treating physician after receiving the report from the reviewing
physician. For example, if a case queue (such as queue 700 of FIG.
7) includes 10 cases with 1 case having high priority, 5 cases
having medium priority and 4 cases having low priority, after the
high priority case has been reviewed, the PAPVR system can
reclassify the 9 remaining cases. This might entail reprioritizing
the cases. In such fashion, the priorities assigned to the cases
might be relative priorities (i.e., one case is of higher priority
relative to another case). Alternatively, the PAPVR system can
prioritize cases based on absolute priority, which might entail
prioritizing cases with patients having life-threatening conditions
as high priority cases.
[0065] In embodiments, the PAPVR can optionally sort cases by
priority. In an embodiment, the PAPVR system can sort cases in
descending order based on priority. For example, the PAPVR system
can display high-priority cases at the top of the queue and low
priority cases at the bottom of the queue.
Case Review and Reporting
[0066] In an aspect of the invention, the PAPVR system can provide
one or more images associated with a particular patient, in
addition to data associated with each image, to a radiologist (or
other reviewing physician) for review. In a preferable embodiment,
the PAPVR system provides a radiologist an assessment of each
image. In an embodiment, the PAPVR system can determine whether a
particular ailment or abnormality is present in an image, and
provide its assessment (e.g., "A pleural effusion has been
detected") to a reviewing physician. The PAPVR system of preferable
embodiments of the invention can enable improved patient outcomes
and increased productivity.
[0067] FIG. 8 an interactive window 800 that enables a radiologist
to review images associated with each case, in addition to data
provided by the PAPVR system. The interactive window 800 can also
permit a radiologist to provide notes, including her/his assessment
of the patient's condition. With continued reference to FIG. 8, the
interactive window 800 includes a case or scan selection panel (or
list) 805, a window 810 for displaying an image selected from the
panel 805, an interactive report window 815 with information
relevant to each image in the image window 810, a findings
navigator window 820 that indicates the ailments or conditions
(e.g., right pleural effusion) identified by the PAPVR system for
the reviewed scan, and menu features 825 to permit a radiologist
(or other reviewing physician) to generate a report and change the
image visualization parameters (e.g., contrast or brightness),
resize and center the window 810. The interactive report window 815
can include the patient's identification ("ID") number, the
modality (CAT/CT scan, MRI, PET/CT scan) used to acquire the
images, and the PAPVR system's assessment of the patient's
condition. The interactive report window 815 can include other
information, such as whether the priority associated with the
patient's case, whether the image displayed in the window 810 is a
Key Image, and whether the image displayed in the window 810 is a
high priority image. The interactive report window 815 also permits
a radiologist to provide additional information, such as additional
findings with respect to the image shown in the window 810, and to
edit the information provided by the PAPVR system.
[0068] In various embodiments, the findings navigator window 820
can be used by the reviewing physician to quickly navigate to and
visualize in the image display window 810 Key Images the PAPVR
system automatically associated with each of the findings that are
listed in the findings navigator window 820. The PAPVR system can
automatically adjust the visualization parameters of the image
(e.g., contrast, brightness), or part of the image (e.g.,
highlighting the body organ in which an ailment was detected by the
PAPVR system) displayed in the image display window 810 to help the
reviewing physician better see or visualize the particular finding
or findings.
[0069] In an embodiment, a PAPVR system prioritizes cases and
provides the cases for review by a reviewing physician, such as a
radiologist. The radiologist can use a computer terminal in
communication with the PAPVR system to select the case of highest
priority from the case queue (such as case queue 700 of FIG. 7). In
an embodiment, the radiologist can use a reviewing system, such as
the reviewing system 320 of FIG. 3, to retrieve a case. Next, the
PAPVR system provides the radiologist an interactive window (such
as interactive window 800 of FIG. 8) with images (e.g.,
two-dimensional cross-sections) from a particular region of a
patient's body. In the interactive window the PAPVR system can
provide its assessment of the patient's condition. The PAPVR system
can permit the radiologist to provide additional information to the
patient's case. The PAPVR system can also provide a radiologist
additional information relevant to a particular image, such as
distances, cross-sectional areas, and volumes.
[0070] With reference to FIG. 9, a computer system 900 is exemplary
of any computer that may execute code to process data. Various
modifications and changes may be made to computer system 900
without departing from the broader spirit and scope of the system
and method disclosed herein. CPU 901 is connected to bus 902, to
which bus is also connected to memory 903, nonvolatile memory 904,
display 907, I/O unit 908, and network interface card (MC) 913. I/O
unit 908 may, typically, be connected to keyboard 909, pointing
device 910, hard disk (or in some cases other suitable storage,
including, but not limited to solid state disk, RAID, network
attached storage, storage area network, etc. 912, and real-time
clock 911. MC 913 connects to network 914, which may be the
Internet or a local network, which local network may or may not
have connections to the Internet. Also shown as part of system 900
is power supply unit 905 connected, in this example, to ac supply
906. Not shown are batteries that could be present, and many other
devices, including but not limited to special enhanced pointing or
navigational devices, such as mice, jog wheels, etc, microphone(s)
and speaker(s) and/or headset(s) for recording and or playing back
audio, and other modifications that are well known but are not
applicable to the specific novel functions of the current system
and method disclosed herein.
[0071] FIG. 10 shows a simplified overview of an exemplary PAPVR
system 1000 in an Internet- or other network-based implementation,
according to one aspect of the system and method disclosed herein.
In an embodiment of the invention, the PAPVR system can be seen as
a software 1005x running on server 1004 connected to a network 1002
(the Internet or a private network, or combination), having a local
repository 1006, as well as additional software instances 1005a-n
including such as operating system, networking software, image
processing software and any other suitable or needed software. The
system presents all images acquired from an imaging modality (e.g.,
CAT/CT scan 1021a, MRI 1021b, PET/CT scan 1021c, etc.) in one
exemplary location in a hospital 1020 to a reviewing physician at a
terminal or computing device 1021r in said hospital. In this
example, the PAPVR is off site, and the physician views images in
the hospital, but processing may happen off site. Additionally,
patient data may be encrypted, so patient confidentiality is
protected, etc. In an embodiment, the PAPVR system can first
present the reviewing physician with the one or more Key Images
(and data associated with the one or more representative images)
and provide the reviewing physician the option to review the other
(i.e., non-representative) images. In an embodiment, the
non-representative images (and data associated with the
non-representative images) can be viewed after the reviewing
physician has viewed the one or more Key Images. By prioritizing
transmission of key images, valuable minutes in an emergency room
can be saved, for example. Also shown is a local storage 1021d.
[0072] Exemplary hospital 1001 may be in a remote location and use
wireless communication to provide the same services to its
physicians and patients, etc., having the same or similar equipment
1001a-n, analogous to 1021a-n.
[0073] FIG. 11 shows an enhanced work flow with work times amended
from those in FIG. 1, showing the time savings for steps for
enhanced steps 1102, 1103, 1104 and 1105, which are analogous to,
but improved as described herein, steps 102, 103, 104 and 105 of
FIG. 1, with respectively revised times 1112, 1113, 114, and 1115.
The PAPVR system 1120 generates items 1121a-n for the physician and
other medical personnel.
[0074] In some other embodiments, the PAPVR system may present the
reviewing physician the images in order of priority. In some
embodiments, only the higher priority images may be displayed to
the reviewing physician. Alternatively, all of the images, starting
with the higher priority images may be displayed to the
physician.
[0075] In some embodiments, the system may use a Key Image, or a
high priority image to assist a physician with generating a report.
In some embodiments, the default images for a report may be Key
Images. A physician may be presented with the option of changing
the image for the report. Alternatively, the physician may make an
initial selection of the image(s) to be included within the report.
This may help streamline the medical review process, and the report
generation process.
[0076] While various embodiments of the invention have made
reference to a "scan" or "scans," it will be appreciated that any
use or reference to a "scan" or "scans" can refer to any type of
image. As an example, a "scan" can refer to a medical image or a
diagnostic image. As another example, "scans" can refer to multiple
medical images.
[0077] It will be appreciated that PAPVR systems and methods of
various embodiments of the invention can be integrated in (or used
with) other systems and/or methods, such as, for example, medical
or diagnostic systems and/or methods, both in part or in whole.
[0078] It should be understood from the foregoing that, while
particular implementations have been illustrated and described,
various modifications can be made thereto and are contemplated
herein. It is also not intended that the invention be limited by
the specific examples provided within the specification. While the
invention has been described with reference to the aforementioned
specification, the descriptions and illustrations of embodiments of
the invention herein are not meant to be construed in a limiting
sense. Furthermore, it shall be understood that all aspects of the
invention are not limited to the specific depictions,
configurations or relative proportions set forth herein which
depend upon a variety of conditions and variables. Various
modifications in form and detail of the embodiments of the
invention will be apparent to a person skilled in the art. It is
therefore contemplated that the invention shall also cover any such
modifications, variations and equivalents.
* * * * *