Integration of CBIR in radiological routine in accordance with IHE

Increasing use of digital imaging processing leads to an enormous amount of imaging data. The access to picture archiving and communication systems (PACS), however, is solely textually, leading to sparse retrieval results because of ambiguous or missing image descriptions. Content-based image retrieval (CBIR) systems can improve the clinical diagnostic outcome significantly. However, current CBIR systems are not able to integrate their results with clinical workflow and PACS. Existing communication standards like DICOM and HL7 leave many options for implementation and do not ensure full interoperability. We present a concept of the standardized integration of a CBIR system for the radiology workflow in accordance with the Integrating the Healthcare Enterprise (IHE) framework. This is based on the IHE integration profile 'Post-Processing Workflow' (PPW) defining responsibilities as well as standardized communication and utilizing the DICOM Structured Report (DICOM SR). Because nowadays most of PACS and RIS systems are not yet fully IHE compliant to PPW, we also suggest an intermediate approach with the concepts of the CAD-PACS Toolkit. The integration is independent of the particular PACS and RIS system. Therefore, it supports the widespread application of CBIR in radiological routine. As a result, the approach is exemplarily applied to the Image Retrieval in Medical Applications (IRMA) framework.