Radiology & Diagnostic Imaging (PACS)

The Radiology & Diagnostic Imaging module in MOANA integrates modality worklists, DICOM picture archiving and communication systems (PACS), interactive image viewing, structured radiological report authoring, and urgent critical finding notifications into a seamless clinical workflow.

Radiology Command Dashboard showing active modality queues, unread studies, and urgent STAT requests.🔍 Click to enlarge

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1. System Architecture & Two-Step Verification Model

The Radiology subsystem connects three tightly integrated components:

graph LR
    A[Doctor: CPOE Imaging Order] --> B[Modality Worklist: X-Ray, CT, MRI, US]
    B --> C[Scanner: DICOM C-STORE to PACS]
    C --> D[Radiologist: OHIF Viewer Review]
    D --> E[Radiologist: 3-Part Structured Report]
    E -->|Release Report| F[Electronic Dispatch to EHR]
    F -->|Independent Step| G[Doctor: Critical Acknowledgment]

1. MOANA EHR Core: Manages electronic order entry, patient demographics, clinical indications, and final report delivery.
2. Orthanc PACS Server: High-performance medical archive storing raw DICOM image series transmitted via DICOM C-STORE from scanners.
3. OHIF Diagnostic Viewer: Zero-footprint, web-based DICOM viewer embedded directly within MOANA for high-resolution image manipulation and measurement.

:::important The Two-Step Verification Model The Radiologist's report release and the Attending Doctor's acknowledgment are two separate, independently timestamped legal actions. This dual-timestamped audit trail represents the highest standard of patient safety and medico-legal compliance. :::

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2. Radiologist & Radiographer Workflow — Step by Step

Step 1: Modality Worklist & Patient Preparation

1. Open Radiology → Imaging Requests & Worklist.
2. Filter by modality (X-Ray, CT, Ultrasound, MRI, Mammography, Fluoroscopy) and urgency (STAT, Urgent, Routine).
3. Pre-Procedure Safety Screening:
   • IV Contrast Studies: For contrast-enhanced CT/MRI, verify recent serum creatinine and estimated GFR (eGFR > 30 mL/min/1.73 m²).
   • Pregnancy & Radiation Safety: Confirm pregnancy screening for female patients of childbearing age undergoing ionizing radiation.
   • MRI Safety Checklist: Screen for ferromagnetic implants, cardiac pacemakers, or metallic foreign bodies.

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Step 2: Image Acquisition & Automatic PACS Synchronization

1. The radiographer acquires images on the imaging modality.
2. The scanner pushes the DICOM series directly to the Orthanc PACS server via DICOM C-STORE.
3. Automated Study Linkage: MOANA matches incoming studies with the original electronic order using the unique Accession Number.
4. If an unlabelled or emergency trauma study arrives without an order, the radiographer uses the Reconcile Orphan Study tool to bind the images to the patient's MOANA Health ID.

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Step 3: Diagnostic Image Review in the OHIF Viewer

Click "Launch Viewer" on the worklist to open the full-featured diagnostic viewer:

OHIF Integrated Diagnostic DICOM PACS Viewer showing multi-planar reconstructions and toolbars.🔍 Click to enlarge

Advanced Viewer Capabilities:

• Window Width & Level (W/L) Presets: Instant switching between Bone, Soft Tissue, Lung, Brain, Liver, or custom manual contrast leveling.
• Multi-Planar Reconstruction (MPR): Real-time orthogonal reformatting into Axial, Coronal, and Sagittal planes for 3D volumetric CT/MRI acquisitions.
• Clinical Measurement Toolset: Calibrated length (mm), Cobb angles, region-of-interest (ROI) mean density (Hounsfield Units - HU), and ellipse area tools.
• Prior Study Comparison: Side-by-side comparative viewing of historical imaging to track tumor regression, fracture healing, or pneumonia resolution.

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Step 4: Structured 3-Part Report Authoring

MOANA enforces a structured 3-part reporting standard to eliminate ambiguity in radiological findings:

Structured Radiology Report Editor with Findings, Impression, and Recommendations.🔍 Click to enlarge

1. FINDINGS (Section 1):
   • Systematic, objective description of all anatomical structures within the field of view.
2. IMPRESSION (Section 2):
   • Concise clinical interpretation summarizing the primary diagnostic conclusion.
   • Standardized RADS classifications where applicable (e.g., BI-RADS for Breast, Lung-RADS for Thoracic CT, TI-RADS for Thyroid, PI-RADS for Prostate).
3. RECOMMENDATIONS (Section 3):
   • Actionable clinical advice regarding follow-up imaging intervals, complementary modalities, or urgent specialty consultations.

:::tip Mandatory Report Completeness To ensure clinical clarity, MOANA requires non-empty text in all three sections (Findings, Impression, and Recommendations) before the report can be officially released. :::

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Step 5: Critical & Urgent Finding Notification Protocol

graph TD
    A[Radiologist Detects Critical Finding] --> B[Flag Report as CRITICAL URGENT]
    B --> C[Direct Telephone Call to Ordering Doctor]
    C --> D[Log Doctor Name, Time & Verbal Read-Back]
    D --> E[Release Report to EHR]
    E --> F[High-Priority Banner Alerts Doctor Dashboard]
    F --> G[Doctor Formally Acknowledges in Chart]

1. If an acute life-threatening emergency is detected (e.g., Intracranial Hemorrhage, Tension Pneumothorax, Acute Aortic Dissection, Bowel Perforation with Free Air):
2. Flag the study as 🔴 Critical Urgent.
3. Direct Clinician Contact: Call the ordering doctor or attending emergency physician directly.
4. Document Verbal Read-Back: In the report header, record:
   • Name and designation of the clinician spoken to.
   • Exact time of verbal communication.
   • Confirmation of verbal read-back.
5. Click "Release Report".

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Step 6: Dispatch & Attending Clinician Acknowledgment

1. Releasing the report immediately publishes the verified findings to the patient's continuous longitudinal EHR dossier.
2. The ordering doctor receives an alert on their Doctor Command Dashboard.
3. The doctor opens the report, reviews the impression, and clicks "Acknowledge Report", completing the closed-loop safety verification.

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3. Radiology Role-Based Access Control (RBAC)

Operational Capability	Radiographer / Tech	Consultant Radiologist	Clinical Doctor	Radiology Administrator
View Modality Worklist	✅	✅	✅	✅
Mark Study as Performed	✅	✅	❌	✅
Launch OHIF DICOM Viewer	✅	✅	✅	✅
Author & Sign Radiology Reports	❌	✅	❌	❌
Flag & Release Critical Reports	❌	✅	❌	❌
Acknowledge Reports in EHR	❌	❌	✅	❌
Configure PACS Storage & Modality AET	❌	❌	❌	✅