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ReportAssistant: a highly useable structured reporting system for PET-CT studies June 3, 2010

Here is the first poster I am involved with:

ReportAssistant: a highly useable structured reporting system
for PET-CT studies

Zoltán Barta, Zoltán Tóth, András Székely, Nikoletta Pócsi, Nikol
Fedinecz, Bernadett Szűcs, Ildikó Garai

OBJECTIVES
Structured reporting (SR) solutions may have many practical benefits compared to conventional reporting. While SR systems are widely used in various diagnostic settings (in gastroenterology, cardiology and obstetrics), their use in general radiology and nuclear medicine is very limited due to the complexity of the domains and the lack of useable software products. The main objective of our project was to develop a practical SR system for whole-body oncological PET-CT studies, which can be easily adapted to general nuclear medicine and diagnostic CT imaging studies later on.

METHODS

Requirements

We defined the following main requirements:

* easy creation of multimedia reports

* context-sensitive and quick access to relevant decision
support materials

* user-friendly support of academic – research and education – activities

* flexible and simple integration with custom DICOM image
processing softwares

Concepts and prototyping

We used the concept of tagging as the basis of the design for our
softwares. We hypothetised that tagging – as used by many contemporary popular web services – can be the unifying component in interlinking lesion data, patient history, relevant scientific publications, etc. Our initial studies proved that
using composite tags of “location + lesion type + disease”
(the classic gamut formula), we can eliminate the deep hierarchical
navigational lists found in several commercial radiology point-n-click SR softwares. After experimenting with various decision support models, we concluded that a simple and cost-effective solution would be to use tagged, high quality, and freely accessible review and CME articles as decision support resources. (This work is presented in an accompanying poster). During the whole project we considered software usability as the most important problem to be solved. Therefore many throw-away prototypes were built and tested in order to find simple and effective UIs to streamline the workflow. We invested significant effort in reducing the time required to perform key repetitive tasks to the minimum. It is
obvious that even a two-second reduction in the completion time of a moderately frequent task can save many hours or days per person at a year scale.

Final design & architecture

The ReportAssistant platform consists of three independent, but
interconnected programs: an “editor” responsible for the creation of structured reports, a “viewer” application for archiving, teaching
file viewing and querying of the report database, and a custom
“papermanager” program, for collecting, full text indexing and tagging of scientific papers.

Software development

All software development was done by using the X4Tk toolkit. X4Tk is an open source (LGPL), object-oriented MVC-framework for easy desktop application development and more, including support for standard enterprise messaging protocols, TCP/IP based server-client development and various interprocess communication solutions. X4Tk is written in Perl by one of the authors (Z Barta), with the first release in 2005, it is actively maintained and field-tested.

RESULTS
RA Editor

RA Editor is the key application of the ReportAssistant platform: it
provides all the functionalities needed to create structured reports.
Other important features are:

* report template editing

* flexible, adaptable text macro subsystem

* study metadata and patient data viewing/importing/editing

* connection to our legacy RIS database

* communication with Mediso InterviewFusion image processing
software, through standard TCP/IP connection, by using a simple
XML-based declarative mini-language.

RA Viewer

RA Viewer is responsible for the viewing and searching of structured reports created with RA Editor. RA Viewer features include:

* search based on “free” and Dx tags, patient and study metadata

* export of ROI/VOI data combined with patient and study data
(MS Excel format)

* display of key images, report text, report summaries for quick reviewing

* annotation of images and export to PDF and MS PowerPoint formats

* digital signing and email distribution of the electronic
reports (in PDF format)

RA PaperManager

The main features of RA PaperManager are:

* extensive support for collecting scientific papers ranging
from dragging-and-dropping of files to direct web browser integration through bookmarklets, respectively import of list of URLs pointing to full text PDFs and scanning & monitoring of hard drive directories.

* “free” and gamut-list based tagging of papers

* indexing for full text search

* easy linking & interprocess communication with other
applications (STOMP, Windows MMF, HTTP)

CONCLUSION

We have designed, implemented and tested a highly useable, general purpose, point-n-click SR software. Our solution provides decision support directly integrated in the workflow. We believe (suggest) that access to “solved” cases and relevant evidence-based papers (reviews, CME articles from top journals) increases confidence in decision making, facilitates learning, deepens experience, which indirectly can lead to a better and more effective/reliable medical practice and is specially useful for resident students. Academic research and education activities are also supported by the software in the form of easy search & export of lesion data to spreadsheets, calculation of likelihood ratios, respectively a searchable structured report database of studies. Undergoing work will integrate speech-to-text solutions and will provide support for the conversion of the reports to DICOM SR (Suppl 23) standard format.

Look for Zoltán Barta and Zoltán Tóth on site for more details!

– András