WO2024115156A1 - Systems and methods for adaptive image acquisition - Google Patents

Abstract

A non-transitory computer readable medium (26s) stores instructions executable by at least one electronic processor (14s) to perform a method (100) of constructing an imaging protocol for a medical imaging examination of a patient. The method includes receiving information related to the medical imaging examination of the patient; applying a protocol customization algorithm (140) to automatically modify a standard imaging protocol (120) based on the information related to the medical imaging examination of the patient to generate a customized imaging protocol (142); and performing (144) at least a portion of the medical imaging examination of the patient using the customized imaging protocol.

Description

SYSTEMS AND METHODS FOR ADAPTIVE IMAGE ACQUISITION

[0001] The following relates generally to the imaging arts, remote imaging assistance arts, remote imaging examination monitoring arts, and related arts.

BACKGROUND

[0002] Medical imaging, such as computed tomography (CT) imaging, magnetic resonance imaging (MRI), positron emission tomography (PET) imaging, fluoroscopy imaging, and so forth, is a valuable component of providing medical care, and is used in a wide range of medical fields, such as cardiology, oncology, neurology, orthopedics, to name a few. The operator of the medical imaging device used to acquire the medical images is typically a trained technologist, while interpretation of the medical images is often handled by a medical specialist such as a radiologist.

[0003] Currently, diagnostic imaging is in high demand. As the world population ages, the demand for quick, safe, high quality imaging can be expected to continue to grow, putting further pressure on imaging centers and their staff. One approach for imaging centers to boost efficiency and grow operations without concomitant extra labor costs is through a radiology operations command center (ROCC) system. Radiology operations command centers enable remote experts to remotely provide assistance to imaging technicians at numerous imaging sites, providing their expertise as needed and remotely assisting less experienced technologists in carrying out high quality scans. Remote technologists or experts can monitor the local operators of scanning procedures through cameras installed in the scanning areas (or from other sources, such as sensors (including radar sensors), console video feeds, microphones connected to Internet of Things (loT) devices, and so forth. In addition, these sources can be supplemented by other data sources like Health-Level 7 (HL7), Digital Imaging and Communications in Medicine (DICOM), Electronic Health Record (EHR) databases, and so forth.

[0004] The remote expert is often a senior imaging technologist (i.e., “super-tech”) who, within the ROCC setup, is often concurrently assigned to assist a number of different imaging bays at different sites that may be spread out across different cities or different states. In practice, however, the super-tech can only be paying attention to a single imaging bay at any given time. The super-tech will typically be assisting local technologists who actively call for super-tech support. [0005] ROCC systems are a promising way for large imaging centers or IDNs (integrated delivery networks) with diverse pools of senior technologist talent to remotely share their advice and expertise across the entire imaging network to imaging technicians who are actually performing imaging examinations. By providing means of communication and remote console sharing, ROCC aims to empower the most experienced technologists to provide guidance and oversight for junior techs when performing difficult scans or facing challenges during exam acquisition.

[0006] Some of the challenges faced by local technologists stem from certain patient characteristics (claustrophobic, pediatric, obese, etc.) or significant time pressures. Patient anxiety may result in excessive patient coaching or premature exam termination. Obese patients may require longer scans with greater field of view and larger slabs, potentially exceeding allotted time slot. Additionally, in cases of incidental findings or significant patient motion, repeat or additional sequences are required, potentially adding time to the exam.

[0007] Apart from patient-specific difficulties, imaging technologists may face significant time pressures to finish exams quickly to keep the patient flow moving. Regardless of the nature of the challenge, in an ROCC setting, an expert user may be expected to assist a local tech in tailoring the acquisition to meet the demands associated with patient condition or fit the acquisition within the given time constraints.

[0008] The following discloses certain improvements to overcome these problems and others.

SUMMARY

[0009] In one aspect, a non-transitory computer readable medium stores instructions executable by at least one electronic processor to perform a method of constructing an imaging protocol for a medical imaging examination of a patient. The method includes receiving information related to the medical imaging examination of the patient; applying a protocol customization algorithm to automatically modify a standard imaging protocol based on the information related to the medical imaging examination of the patient to generate a customized imaging protocol; and performing at least a portion of the medical imaging examination of the patient using the customized imaging protocol.

[0010] In another aspect, a non-transitory computer readable medium stores instructions executable by at least one electronic processor to perform a method of constructing an imaging protocol for a medical imaging examination of a patient. The method includes receiving information related to the medical imaging examination of the patient; applying a protocol customization algorithm to automatically modify a standard imaging protocol based on the information related to the medical imaging examination of the patient to generate a customized imaging protocol; performing at least a portion of the medical imaging examination of the patient using the customized imaging protocol; during the performing, receiving and/or detecting updated information relating to the medical imaging examination of the patient; applying the protocol customization algorithm to automatically modify the customized imaging protocol based on the updated information related to the medical imaging examination of the patient to generate an updated customized imaging protocol; and continuing the performing of the medical imaging examination of the patient using the updated customized imaging protocol.

[0011] In another aspect, a method of constructing an imaging protocol for a medical imaging examination of a patient includes receiving information related to the medical imaging examination of the patient; applying a protocol customization algorithm to automatically modify a standard imaging protocol based on the information related to the medical imaging examination of the patient to generate a customized imaging protocol; performing at least a portion of the medical imaging examination of the patient using the customized imaging protocol; and establishing a natural communication pathway between a local operator and a remote expert based on the customized imaging protocol.

[0012] One advantage resides in ensuring an imaging exam is completed within a scheduled time period.

[0013] Another advantage resides in automated or semiautomated adjusting a workflow of an imaging exam to ensure the imaging exam is completed within a scheduled time period and/or meets other patient-specific or examination-specific constraints.

[0014] Another advantage resides in providing automated or semiautomated adjustment of an imaging examination based in part on information obtained from a radiology operations command center (ROCC) system for establishing a communication pathway between an expert technician and a technician performing an imaging exam so that the expert technician can assist the technician performing the imaging exam. [0015] Another advantage resides in using an artificial intelligence (Al) component to adjust steps in a workflow to ensure the imaging exam is completed within a scheduled time period.

[0016] A given embodiment may provide none, one, two, more, or all of the foregoing advantages, and/or may provide other advantages as will become apparent to one of ordinary skill in the art upon reading and understanding the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] The disclosure may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the disclosure.

[0018] FIGURE 1 diagrammatically shows an illustrative apparatus for providing remote assistance in accordance with the present disclosure.

[0019] FIGURE 2 shows an example flow chart of operations suitably performed by the apparatus of FIGURE 1.

DETAILED DESCRIPTION

[0020] The following discloses approaches for automated optimizing of an imaging scan for specific patient situations, while still ensuring the imaging examination meets clinical and regulatory (e.g., insurance eligibility) requirements. For example, if the patient is claustrophobic, then the optimization can adjust parameters to keep the scan within a timeframe the claustrophobic patient can tolerate while still ensuring collection of all requisite imaging data with acceptable (even if nonoptimal) image quality. As another example, if there is a last-minute change to a less- capable imaging device then the optimization can adjust the scan to accommodate the lesser capabilities of the imaging device that will actually be used.

[0021] The process starts by collecting information about the upcoming scan. This can include automated data gathering and specific user inputs provided by the radiologist and/or imaging technologist. In some embodiments, the data gathering leverages data gathering components of a radiology operations command center (ROCC) system primarily designed to enable a remote expert to assist a local imaging technologist in performing an imaging examination. By way of the automated examination adjustment, the workload on the remote experts of the ROCC can be reduced, so that the remote expert can concentrate attention on other assistive aspects. Disclosed herein, in some illustrative embodiments, is an optimization sequence. In some cases, this “optimization” may include selecting a preexisting protocol that satisfies the constraints, but if no suitable preexisting protocol is available (or if the preexisting scan does not meet one or more constraints of the upcoming imaging examination) then scan parameters can be optimized by iterative optimization of a cost function, using simulation-based optimization, or using a trained artificial neural network (ANN) or other deep learning module.

[0022] The imaging examination adjustment process continues through the examination. The system can leverage data collected by automated image analysis modules (e.g., motion detection image analyzers) or feedback from the ROCC to detect issues that arise during the imaging examination, such as patient motion, an abort due to patient anxiety in the case of claustrophobia, or so forth. Based on this additional information the system can provide recommendations as to whether additional scans are still needed, and (if so) can also tailor those scans (e.g., if the patient experienced a claustrophobic episode after 5 minutes in the scanner, then it can use the previous optimization to optimize the scan for 5 minutes while still satisfying clinical and other requirements).

[0023] With reference to FIGURE 1 , an apparatus 1 for providing assistance from a remote medical imaging expert RE (or supertech) to a local technologist operator LO is shown. As shown in FIGURE 1, the local operator LO, who operates a medical imaging device (also referred to as an image acquisition device, imaging device, and so forth) 2, is located in a medical imaging device bay 3, and the remote expert RE is disposed in a remote service location or center 4. It should be noted that the “remote expert” RE may not necessarily directly operate the medical imaging device 2, but rather provides assistance to the local operator LO in the form of advice, guidance, instructions, or the like. The remote location 4 can be a remote service center, a radiologist’s office, a radiology department, and so forth. The remote location 4 may be in the same building as the medical imaging device bay 3 (this may, for example, in the case of a “remote operator or expert” RE who is a radiologist tasked with peri-examination image review), but more typically the remote service center 4 and the medical imaging device bay 3 are in different buildings, and indeed may be located in different cities, different countries, and/or different continents. In general, the remote location 4 is remote from the imaging device bay 3 in the sense that the remote expert RE cannot directly visually observe the imaging device 2 in the imaging device bay 3 (hence optionally providing a video feed as described further herein). [0024] The image acquisition device 2 can be a Magnetic Resonance (MR) image acquisition device, a Computed Tomography (CT) image acquisition device; a positron emission tomography (PET) image acquisition device; a single photon emission computed tomography (SPECT) image acquisition device; an X-ray image acquisition device; an ultrasound (US) image acquisition device; or a medical imaging device of another modality. The imaging device 2 may also be a hybrid imaging device such as a PET/CT or SPECT/CT imaging system. While a single image acquisition device 2 is shown by way of illustration in FIGURE 1, more typically a medical imaging laboratory will have multiple image acquisition devices, which may be of the same and/or different imaging modalities. For example, if a hospital performs many CT imaging examinations and relatively fewer MRI examinations and still fewer PET examinations, then the hospital’s imaging laboratory (sometimes called the “radiology lab” or some other similar nomenclature) may have three CT scanners, two MRI scanners, and only a single PET scanner. This is merely an example. Moreover, the remote service center 4 may provide service to multiple hospitals. The local operator controls the medical imaging device 2 via an imaging device controller 10. The remote operator is stationed at a remote electronic processing device 12 (or, more generally, an electronic controller 12).

[0025] Some types of imaging modalities and some types of imaging examinations may employ a contrast agent. For example, some types of MRI angiography imaging examinations employ a gadolinium-based magnetic contrast agent to observe blood flow into and out of an anatomical organ or region. To provide for such contrast-enhanced imaging, a programmable contrast injector 11 with a display 13 is configured to inject the patient with a contrast agent. In such an embodiment, the injector display 13 may be monitored by a further ROCC sensor such as a camera viewing the injector display 13.

[0026] As used herein, the term “medical imaging device bay” (and variants thereof) refer to a room containing the medical imaging device 2 and also any adjacent control room containing the medical imaging device controller 10 for controlling the medical imaging device. For example, in reference to an MRI device, the medical imaging device bay 3 can include the radiofrequency (RF) shielded room containing the MRI device 2, as well as an adjacent control room housing the medical imaging device controller 10, as understood in the art of MRI devices and procedures. On the other hand, for other imaging modalities such as CT, the imaging device controller 10 may be located in the same room as the imaging device 2, so that there is no adjacent control room and the medical bay 3 is only the room containing the medical imaging device 2. In addition, while FIGURE 1 shows a single medical imaging device bay 3, it will be appreciated that the remote service center 4 (and more particularly the remote electronic processing device 12) is in communication with multiple medical bays via a communication link 14, which typically comprises the Internet augmented by local area networks at the remote expert RE and local operator LO ends for electronic data communications. In addition, while FIGURE 1 shows a single remote service center 4, it will be appreciated that the medical imaging device bays 3 is in communication with multiple medical bays via the communication link 14.

[0027] As diagrammatically shown in FIGURE 1, in some embodiments, a camera 16 (e.g., a video camera) is arranged to acquire a video stream or feed 17 of a portion of a workspace of the medical imaging device bay 3 that includes at least the area of the imaging device 2 where the local operator LO interacts with the patient, and optionally may further include the imaging device controller 10. In other embodiments, a microphone 15 is arranged to acquire an audio stream or feed 18 of the workspace that includes audio noises occurring within the medical imaging device bay 3 (e.g., verbal instructions by the local operator LO, questions from the patient, and so forth). The video stream 17 and/or the audio stream 18 is sent to the remote electronic processing device 12 via the communication link 14, e.g., as a streaming video feed received via a secure Internet link.

[0028] The communication link 14 also provides a natural language communication pathway 19 for verbal and/or textual communication between the local operator and the remote operator. For example, the natural language communication link 19 may be a Voice-Over- Internet-Protocol (VOIP) telephonic connection, an online video chat link, a computerized instant messaging service, or so forth. Alternatively, the natural language communication pathway 19 may be provided by a dedicated communication link that is separate from the communication link 14 providing the data communications 17, 18, e.g., the natural language communication pathway 19 may be provided via a landline telephone. In some embodiments, the natural language communication link 19 allows a local operator LO to call a selected remote expert RE. The call, as used herein, can refer to an audio call (e.g., a telephone call), a video call (e.g., a Skype or Facetime or other screen-sharing program), or an audio-video call. In another example, the natural language communication pathway 19 may be provided via an ROCC device 8 with a display device 36. For example, an “app” can run on the ROCC device 8 (operable by the local operator LO) and the remote electronic processing device 12 (operable by the remote expert RE) to allow communication (e.g., audio chats, video chats, and so forth) between the local operator and the remote expert.

[0029] FIGURE 1 also shows, in the remote service center 4 including the remote electronic processing device 12, such as a workstation, a workstation computer, or more generally a computer, which is operatively connected to receive and present the video feed 17 of the medical imaging device bay 3 from the camera 16 and/or to the audio feed 18. Additionally or alternatively, the remote workstation 12 can be embodied as a server computer or a plurality of server computers, e.g., interconnected to form a server cluster, cloud computing resource, or so forth. The workstation 12 includes typical components, such as an electronic processor 20 (e.g., a microprocessor), at least one user input device (e.g., a mouse, a keyboard, a trackball, and/or the like) 22, and at least one display device 24 (e.g., an LCD display, plasma display, cathode ray tube display, and/or so forth). In some embodiments, the display device 24 can be a separate component from the remote electronic processing device 12. The display device 24 may also comprise two or more display devices. The electronic processor 20 is operatively connected with a one or more non-transitory storage media 26. The non-transitory storage media 26 may, by way of non-limiting illustrative example, include one or more of a magnetic disk, RAID, or other magnetic storage medium; a solid state drive, flash drive, electronically erasable read-only memory (EEROM) or other electronic memory; an optical disk or other optical storage; various combinations thereof; or so forth; and may be for example a network storage, an internal hard drive of the workstation 12, various combinations thereof, or so forth. It is to be understood that any reference to a non-transitory medium or media 26 herein is to be broadly construed as encompassing a single medium or multiple media of the same or different types. Likewise, the electronic processor 20 may be embodied as a single electronic processor or as two or more electronic processors. The non-transitory storage media 26 stores instructions executable by the at least one electronic processor 20. The instructions include instructions to generate a graphical user interface (GUI) 28 for display on the remote operator display device 24. The video feed 17 from the camera 16 can also be displayed on the display device 24, and the audio feed 18 can be output on the remote electronic processing device 12 via a loudspeaker 29. In some examples, the audio feed 18 can be an audio component of an audio/video feed (such as, for example, recording as a video cassette recorder (VCR) device would operate). [0030] FIGURE 1 shows an illustrative local operator LO, and an illustrative remote expert RE (e.g., supertech). However, in a Radiology Operations Command Center (ROCC) as contemplated herein, the ROCC provides a staff of supertechs who are available to assist local operators LO at different hospitals, radiology labs, or the like. Each remote expert RE can operate a corresponding remote electronic processing device 12. The ROCC may be housed in a single physical location or may be geographically distributed. For example, in one contemplated implementation, the remote expert RE are recruited from across the United States and/or internationally in order to provide a staff of supertechs with a wide range of expertise in various imaging modalities and in various imaging procedures targeting various imaged anatomies. A server computer 14s can be in communication with the medical imaging bay 3 and the remote service center 4 with one or more non-transitory storage media 26s. The non-transitory storage media 26s may, by way of non-limiting illustrative example, include one or more of a magnetic disk, RAID, or other magnetic storage medium; a solid state drive, flash drive, electronically erasable read-only memory (EEROM) or other electronic memory; an optical disk or other optical storage; various combinations thereof; or so forth; and may be for example a network storage, an internal hard drive of the server computer 14s, various combinations thereof, or so forth. It is to be understood that any reference to a non-transitory medium or media 26s herein is to be broadly construed as encompassing a single medium or multiple media of the same or different types. Likewise, the server computer 14s may be embodied as a single electronic processor or as two or more electronic processors. The non-transitory storage media 26s stores instructions executable by the server computer 14s.

[0031] The medical imaging device controller 10 in the medical imaging device bay 3 also includes similar components as the remote electronic processing device 12 disposed in the remote service center 4. Except as otherwise indicated herein, features of the medical imaging device controller 10, which includes a local workstation 12', disposed in the medical imaging device bay 3 similar to those of the remote workstation 12 disposed in the remote service center 4 have a common reference number followed by a “prime” symbol, and the description of the components of the medical imaging device controller 10 will not be repeated. In particular, the medical imaging device controller 10 is configured to display a GUI 28' on a display device or controller display 24' that presents information pertaining to the control of the medical imaging device 2, such as configuration displays for adjusting configuration settings an alert 30 perceptible at the remote location when the status information on the medical imaging examination satisfies an alert criterion of the imaging device 2, imaging acquisition monitoring information, presentation of acquired medical images, and so forth. A screen mirroring data stream 27 carries the content presented on the display device 24’ of the medical imaging device controller 10. The screen mirroring data stream 27 can be acquired in various ways. In one approach, the screen mirroring data stream 27 can be acquired by screen mirroring software running on the imaging device controller 10. In another approach, screen scraping hardware interposed between the display device 24' of the imaging device controller 10 and the at least one electronic processor 20' (e.g., video card or the like) that outputs the video signal. In this later approach, the screen scraping hardware may, by way of nonlimiting illustrative example, include a video splitter that splits the video signal, with one video signal being sent to the display device 24' and the other being sent to the remote electronic processing device 12 as the screen mirroring data stream 27. The communication link 14 allows for screen sharing between the display device 24 in the remote service center 4 and the display device 24' in the medical imaging device bay 3. The GUI 28' includes one or more dialog screens, including, for example, an examination/scan selection dialog screen, a scan settings dialog screen, an acquisition monitoring dialog screen, among others. The GUI 28' can be included in the video feed 17 and displayed on the remote workstation display 24 at the remote location 4.

[0032] Furthermore, as disclosed herein, the server 14s performs a method or process 100 for constructing or adjusting an imaging protocol for a medical imaging examination of a patient performed using a medical imaging device 2 (i.e., by assisting a local operator LO of the medical imaging device 2 during medical imaging examinations by a remote expert RE). The method or process 100 is further operative to provide assistance between local operators LO, as disclosed herein. By providing automated adjustment of the imaging protocol, the method or process 100 may advantageously reduce a workload on the remote expert RE.

[0033] With reference to FIGURE 2, and with continuing reference to FIGURE 1, an illustrative embodiment of the method 100 is diagrammatically shown as a flowchart.

[0034] To begin the method 100, information related to the medical imaging examination of the patient is received at the server computer 14s. The received information can include a variety of different types of information. For example, the received information can include inputs 110 related to the medical imaging examination that are received from the remote monitoring by the ROCC and/or input by the local operator LO (i.e., the local imaging technologist LO) via the ROCC device 8; information from prior studies or medical imaging examinations 112, reimbursement guidelines 114 for medical imaging examinations; inputs 116 related to the medical imaging examination that are input by a radiologist (for example, as annotations to the examination order made by the radiologist) and/or the remote expert RE via the remote electronic processing device 12; and/or so forth. The information 110 from the ROCC and/or local operator LO can include, for example: information obtained by analyzing the video stream 17, audio stream 18, and/or the screen sharing video stream 27 providing a copy of the content displayed on the display device 24' of the imaging device controller 10. For example, the information 110 extracted from the screen sharing video stream 27 may include pilot or preview images acquired during a setup phase of the imaging protocol 120, i.e. prior to commencement of acquisition of the clinical images, and/or the subsequently acquired clinical images (or lower resolution renderings thereof presented on the display device 24’ for review by the local operator LO). The information 110 extracted from the screen sharing video stream 27 may additionally or alternatively include information derived by automated analysis of such images, such as an indication of an incorrect field of view (FOV) detected by an automated FOV analysis algorithm that detects the presence or lack thereof of an image features that is expected to be in the FOV (e.g., if the imaging protocol 120 is a cardiac imaging protocol but the scout image does not include the heart this could be automatically detected by pattern matching applied to a scout image), or detection of patient motion manifested in the images as image blurring, and/or so forth. As another example, the information 110 could include detection of a patient of large girth by analysis of the video stream 17, or detection of patient anxiety by voice analysis of the audio stream 18 possibly indicative of a claustrophobic patient, and/or so forth. The information from prior studies 112 may, for example, identify which imaging sequences or series are most used or contributed to diagnosis. The reimbursement rule or guideline information 114 may, for example, comprise an identification of the medical insurance company and/or policy covering the patient, a current procedural terminology (CPT) code or other billing code assigned to the imaging examination, or so forth. From the collected information 110, 112, 114, 116, information 118 relating to the medical examination of the patient is extracted, such as: a standard imaging protocol 120 for the medical imaging examination; information related to time constraints 122 for the medical imaging examination (e.g., information imposing a time limit on the medical imaging examination, information imposing a time limit on how long the patient can remain still during the medical imaging examination, and so forth); capabilities 124 of the medical imaging device 2, a status 126 of the medical imaging device 2 (i.e., “are the coils connected); information on one or more requirements imposed by insurance reimbursement criteria 130 and/or clinical image criteria 132 (e.g., content to support a clinical diagnosis, information on a medical implant of the patient, and so forth); and so forth. The insurance reimbursement criteria 130 may, for example, be determined from the CPT code if certain required imaging scans are specified under that CPT code, or from the insurance policy if that policy specifies certain imaging tasks are or are not covered by the policy. The information 124, 126, 130 may for example be obtained from a database storing the information indexed by imaging device (for the scanner capabilities 124 and status 126) or by CPT code and/or insurance company/policy (for the insurance reimbursement criteria 126). The content for diagnosis 132 may be derived from information specified by the radiologist in the examination order, for example. These are merely illustrative examples and should not be construed as limiting. [0035] Next, a protocol customization algorithm 140 is applied to the received information to automatically modify the standard imaging protocol 120 to generate a customized imaging protocol 142 for the medical imaging examination. In some examples, the protocol customization algorithm 140 includes the Al component 42. The protocol customization algorithm 140 can be applied in a variety of manners based on what type of information is received at the receiving operation. In one example, the applying of the protocol customization algorithm 140 to automatically modify the standard imaging protocol 120 includes modifying the standard imaging protocol 120 to generate the customized imaging protocol 142 conforming with the time limit 122 (e.g., the time limit 122 for the medical imaging examination, a customization of the imaging sequence that conforms with the time limit 122 on how long the patient can remain still, and so forth). In another example, the applying of the protocol customization algorithm 140 to automatically modify the standard imaging protocol 120 includes modifying the standard imaging protocol 120 to generate the customized imaging protocol 142 conforming with the one or more requirements imposed by the insurance reimbursement criteria 130 and/or clinical image criteria 132. In another example, the applying of the protocol customization algorithm 140 to automatically modify the standard imaging protocol 120 includes modifying the standard imaging protocol 142 by removing one or more imaging scans of the standard imaging protocol 120 that are not compatible with the medical implant of the patient. These are merely illustrative examples and should not be construed as limiting.

[0036] The protocol optimization 140 is an automated process that produces the customized imaging protocol 142, which for example can beneficially reduce the workload of the remote expert RE who is thereby not called to assist in customizing the imaging examination protocol. However, the overall process may optionally be semi-automated insofar as the customized imaging protocol output by the automated adjustment process may thereafter be further adjusted by the local operator LO and/or the remote expert RE. For example, the protocol customization 140 may be presented to the local operator LO for review and approval. If the local operator LO is inexperienced in this type of examination protocol, he or she may call the remote expert RE to review the automatically generated customized imaging protocol 142. This can still reduce the workload of the remote expert RE since he or she merely needs to review the customized settings or the like of the automatically generated customized imaging protocol 142, and in some embodiments the displayed customized imaging protocol 142 may be displayed with the customization changes highlighted for ease of review. By contrast, without the automated protocol customization 140, the remote expert RE would instead need to go through the entire standard examination protocol 120 in detail to identify any appropriate customizations with no automated guidance.

[0037] Then, at least a portion of the medical imaging examination of the patient is performed 144 using the customized imaging protocol 142.

[0038] In some embodiments, the method 100 constitutes a continuous feedback loop. For example, during the performing 144 of the medical imaging examination, updated information 146 relating to the medical imaging examination can be received or detected. The protocol customization algorithm 140 is applied to automatically modify the customized imaging protocol 142 based on the updated information related to the medical imaging examination to generate an updated customized imaging protocol 142. The medical imaging examination is then performed 144 using the updated customized imaging protocol 142. In a particular example, the updated information 146 can include updated information relating to the medical imaging examination of the patient includes detecting motion blurring in an image acquired by an imaging sequence during the performing of the medical imaging examination of the patient. The protocol customization algorithm 140 is applied to automatically modify the customized imaging protocol 142 based on the updated information 146 to generate an updated customized imaging protocol 142 including adding a repetition of the imaging sequence.

[0039] In another example, the updated information 146 can include a detected time length of the performing of a portion of the medical imaging examination of the patient is longer than an expected time length expected for performing that portion of the medical imaging examination of the patient. For example, the examination monitoring information 17, 18, 27 can be analyzed to determine a time limit 122 on how long the patient can remain still. This can be done, for example, by analyzing the video feed 17 after a command for the patient to remain still (which command may be detected in the audio feed 18, for example) to detect how long the patient is able to comply. As another example, if a sequence of images of the patient are acquired after such as command to remain still then the sequence of images can be extracted from the screen sharing video stream 27 and analyzed to detect how long the patient was able to comply. This imposes a time constraint 122 on a time length of a remainder of the medical imaging examination of the patient based on the detected time length and the expected time length is then determined. The protocol customization algorithm 146 is then applied to the determined time constraint to modify the portion of the standard imaging protocol corresponding to the remainder of the medical imaging examination to generate the customized imaging protocol 142.

[0040] In the following, some further nonlimiting illustrative examples are provided of operation of the automated examination protocol adjustment method 100.

[0041] In one example, the patient has claustrophobia and may only stay in the scanner for a few minutes. The claustrophobia could be identified in various ways, such as by an annotation thereof in the patient medical or health record, or detection of vocal anxiety in the audio stream 18 obtained as part of the ROCC during loading into the imaging bore (as concurrently detected by the video stream 17 also obtained as part of the ROCC). Without the method 100, the remote expert RE would need to decide what scans can be cut, or otherwise how can the protocol be shortened. With the method 100, an Al algorithm can automatically adapt the acquisition protocol based on the identified claustrophobia, with a radiologist or the remote expert RE only providing the set the number of minutes he or she thinks a patient may tolerate inside the bore (part of the radiologist input 116) and then reviewing the customized imaging protocol 142 created by the model. An expert user may thus provide time constraints and allow Al algorithm to come back with a shortened protocol, suggestions to speed up acquisition, etc. [0042] In another example, the patient has a medical implant. The implant could be indicated in the patient medical or health record or could be detected by automated analysis of a scout image extracted from the screen mirroring data stream 27 obtained as part of the ROCC. In this case, the quality of imaging can be subpar due to magnetic susceptibility artifacts. Based on entered location and type of implant, the protocol customization 140 may suggest which sequences can be skipped due to poor quality and/or suggest alternative sequences (designed to reduce artifacts). The resulting customized imaging protocol 142 may include short surveys to assess quality prior to acquisition of longer scans.

[0043] In another example, MR and CT scans require for patients to stay still for the duration of the acquisition. However, some patients cannot comply, which results in motion artifacts and subpar imaging studies. Breath holds and other gating techniques are often used to collect consistent images. However, some patients cannot hold their breath sufficiently, or for a sufficiently long time, to enable acquisition of images that are free from motion blurring. This may be noted by the local operator LO and entered as part of the input 110 or may be detected by automated analysis of one or more scout images extracted from the screen mirroring data stream 27 obtained as part of the ROCC during the setup phase of the imaging protocol. For patients unable to hold their breath, the protocol customization 140 can substitute alternative sequences with shorter (or no) breath holds. Based on the input from the radiologist or remote expert RE regarding patient’s ability to stay still or hold his breath, the protocol customization 140 can provide alternative sequences, customizing acquisition protocols to accommodate the patient.

[0044] In another example, updated information 142 received during the performing of the imaging examination relates to patient motion during the examination. This can be detected, for example, by automated analysis of the clinical images (or lower resolution review renderings thereof) extracted from the screen mirroring data stream 27 obtained as part of the ROCC to detect motion-blurred image content. If significant motion is detected, then the protocol optimization 140 may be automatically invoked to suggest aborting the sequence and restarting in case of significant patient motion. This can involve tracking the scan and determining how much of the prior sequence is salvageable and if a repeat sequence is required and what it should entail. Some sequences have a good deal of redundancy and might be salvageable through post-processing - that is an evaluation the protocol optimization 140 can make. [0045] In another example, large patients tend to require larger coverage, which translates into longer scans, potentially resulting in too high of specific absorption rate (SAR), thus presenting both a timing and a safety issue. A large patient can be noted by data entered by the local operator LO as part of the inputs 110 or can be detected by automated analysis of the video stream 17 obtained as part of the ROCC. In such a case, the protocol optimization 140 may modify the imaging protocol by specifying different MR coils or a different scanner if required to speed up the exam and meet optimization constraints. More generally, the detection via the video stream 17 could be of a patient size (such as weight, height, girth, or so forth), and the scan is then adjusted accordingly (e.g., as another example reducing X-ray intensity during a scan of a thin patient since a lower X-ray intensity may be sufficient for the imaging).

[0046] In yet another example, some clinical indications for imaging do not require a full-fledged standard protocol, with abbreviated protocols containing fewer sequences being deemed sufficient. For example, in the case of liver metastases, the reduction in sequences is achieved by running specific set of sequences sensitive to liver metastases. This results in reduction of both acquisition time and cost while meeting the clinical needs of the exam. The protocol optimization 140 could factor in such sequence reduction based on the previously followed practices at the imaging center. Patient conditions that may dictate a reduction in sequences can be obtained from the patient medical or health record, entered by the LO as part of the inputs 110, or can be identified in scout images or clinical images extracted from the screen mirroring data stream 27 obtained as part of the ROCC.

[0047] In still yet another example, if the patient’s insurance policy or the CPT code requires a certain scan be performed in order for the imaging examination to be reimbursable, but the standard imaging protocol 120 does not include that scan required for reimbursement, then the protocol optimization 140 can add the scan required for reimbursement into the imaging protocol. Conversely, if the standard imaging protocol 120 calls for an imaging scan that is not reimbursable under the patient’s insurance policy or under the CPT code assigned to the examination, then the protocol optimization 140 can substitute a clinically equivalent reimbursable scan. If no clinically equivalent reimbursable scan is available, then the protocol optimization 140 can assess whether the imaging scan that is not reimbursable is part of the content 132 required to support the clinical diagnosis - if it is not, then the imaging scan that is not reimbursable can be omitted. If none of these resolutions is feasible, then the protocol optimization 140 can report the issue during the customized imaging protocol review, e.g., by noting that the scan will not be reimbursable. This can then facilitate the local operator LO contacting the on-call radiologist or remote expert RE to discuss how to handle the situation.

[0048] The foregoing are merely nonlimiting illustrative examples.

[0049] In some embodiments, the method 100 can further include establishing the natural communication pathway 19 between the local operator LO and the remote expert RE based on the customized imaging protocol 142. This may occur in response to the local operator LO making a request for remote expert assistance via the ROCC device 8, and the communication pathway may, by way of nonlimiting illustrative example, comprise a telephonic or videoconference link established between the local operator LO and the assisting remote expert RE, along with sharing of the controller display and imaging bay sensor data with the remote expert RE. Advantageously, however, such involvement of the remote expert RE can be reduced or (in some cases) eliminated entirely by way of automated analysis of the remote monitoring 17, 18, 27 of the medical imaging examination acquired by the ROCC, thus enabling the ROCC to provide such assistance in an automated fashion without involvement of the remote expert RE thereby freeing the remote expert RE to handle more complex assistive tasks that cannot be performed in such automated fashion.

[0050] As disclosed herein, however, the ROCC framework is also used in the method 100 to provide assistive communication between two (or more) local operators. Since there may be dozens, hundreds, or more local operators performing imaging examinations under ROCC monitoring at any given time, the method 100 promotes targeted local operator-local operator assistance by identifying local operators that are likely to be in a position to assist one another.

[0051] The disclosure has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the exemplary embodiment be construed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

Claims

CLAIMS:

1. A non-transitory computer readable medium (26s) storing instructions executable by at least one electronic processor (14s) to perform a method (100) for assisting a medical imaging examination of a patient, the method comprising: receiving examination monitoring information (17, 18, 27) related to the medical imaging examination of the patient and transmitting the examination monitoring information (17, 18, 27) to a remote expert (RE), the examination monitoring information including at least a screen mirroring data stream (27) of a controller (10) of a medical imaging device (2) used to perform the medical imaging examination of the patient; providing a natural communication pathway (19) between a local operator (LO) performing the imaging examination and the remote expert (RE); applying a protocol customization algorithm (140) to automatically modify a standard imaging protocol (120) based at least on the examination monitoring information to generate a customized imaging protocol (142); and performing (144) at least a portion of the medical imaging examination of the patient using the customized imaging protocol.

2. The non-transitory computer readable medium (26s) of claim 1, wherein: the examination monitoring information includes information imposing a time limit (122) on the medical imaging examination of the patient; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol to generate the customized imaging protocol (142) conforming with the time limit.

3. The non-transitory computer readable medium (26s) of either one of claims 1 and 2, further comprising: analyzing the examination monitoring information to determine a time limit (122) on how long the patient can remain still; and wherein the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying an imaging sequence of the standard imaging protocol to generate the customized imaging protocol (142) with a customization of the imaging sequence that conforms with the time limit on how long the patient can remain still.

4. The non-transitory computer readable medium (26s) of any one of claims 1-3, wherein: the information related to the medical imaging examination of the patient includes information on one or more requirements imposed by insurance reimbursement criteria (130) and/or clinical image criteria; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol to generate the customized imaging protocol (142) conforming with the one or more requirements imposed by the insurance reimbursement criteria and/or clinical image criteria.

5. The non-transitory computer readable medium (26s) of any one of claims 1-4, wherein: the information related to the medical imaging examination of the patient includes information (132) on a medical implant of the patient identified by automated analysis of an image of the patient acquired as part of the medical imaging examination and extracted from the screen mirroring data stream (27); and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) to generate the customized imaging protocol includes modifying the standard imaging protocol (142) by removing one or more imaging scans of the standard imaging protocol that are not compatible with the medical implant of the patient.

6. The non-transitory computer readable medium (26s) of any one of claims 1-5, wherein the method further comprises: during the performing of the medical imaging examination of the patient, continuing to receive the examination monitoring information (17, 18, 27); applying the protocol customization algorithm (140) to automatically modify the customized imaging protocol (142) during the performing of the medical imaging examination of the patient based on continued receipt of the examination monitoring information to generate an updated customized imaging protocol; and continuing the performing (144) of the medical imaging examination of the patient using the updated customized imaging protocol.

7. The non-transitory computer readable medium (26s) of any one of claims 1-6, wherein the received and transmitted examination monitoring information (17, 18, 27) related to the medical imaging examination of the patient further includes a video stream (17) of the medical imaging examination, and the method further comprises: detecting a patient size based on analysis of the video stream (17); wherein the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol (120) based on the detected patient size to generate the customized imaging protocol (142).

8. The non-transitory computer readable medium (26s) of any one of claims 1-7, wherein the received and transmitted examination monitoring information (17, 18, 27) related to the medical imaging examination of the patient further includes a video stream (17) of the medical imaging examination and an audio stream (18) of the medical imaging examination, and the method further comprises: detecting claustrophobia of the patient based on the audio stream and/or the video stream; wherein the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol (120) based on the detected claustrophobia to generate the customized imaging protocol (142).

9. The non-transitory computer readable medium (26s) of any one of claims 1-8, the method further comprising: receiving local operator-provided information related to the medical imaging examination of the patient via inputs input by a local operator (LO) to an electronic processing device (8) operable by the local operator; wherein the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) is further based on the local operator- provided information.

10. The non-transitory computer readable medium (26s) of any one of claims 1-9, the method further comprising: receiving remote expert-provided information related to the medical imaging examination of the patient via inputs input by the remote expert (RE) to a remote electronic processing device (12) operable by the remote expert; and wherein the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) is further based on the local remote expert-provided information.

11. The non-transitory computer readable medium (26s) of any one of claims 1-10, wherein the method further includes: conducting a call between the local operator (LO) and the remote expert (RE) using the natural communication pathway (19) provided between a local operator (LO) performing the imaging examination and the remote expert (RE).

12. The non-transitory computer readable medium (26s) of any one of claims 1-11, wherein the protocol customization algorithm (140) comprises an artificial intelligence (Al) component (42).

13. A non-transitory computer readable medium (26s) storing instructions executable by at least one electronic processor (14s) to perform a method (100) of constructing an imaging protocol for a medical imaging examination of a patient, the method comprising: receiving information related to the medical imaging examination of the patient; applying a protocol customization algorithm (140) to automatically modify a standard imaging protocol (120) based on the information related to the medical imaging examination of the patient to generate a customized imaging protocol (142); performing (144) at least a portion of the medical imaging examination of the patient using the customized imaging protocol; during the performing, receiving and/or detecting updated (146) information relating to the medical imaging examination of the patient; applying the protocol customization algorithm (140) to automatically modify the customized imaging protocol (142) based on the updated information related to the medical imaging examination of the patient to generate an updated customized imaging protocol; and continuing the performing (144) of the medical imaging examination of the patient using the updated customized imaging protocol.

14. The non-transitory computer readable medium (26s) of claim 13, wherein: the information related to the medical imaging examination of the patient includes information imposing a time limit (122) on the medical imaging examination of the patient; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol to generate the customized imaging protocol (142) conforming with the time limit.

15. The non-transitory computer readable medium (26s) of either one of claims 13 and 14, wherein:

The information related to the medical imaging examination of the patient includes information imposing a time limit (122) on how long the patient can remain still; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying an imaging sequence of the standard imaging protocol to generate the customized imaging protocol (142) with a customization of the imaging sequence that conforms with the time limit on how long the patient can remain still.

16. The non-transitory computer readable medium (26s) of any one of claims 13-15, wherein: the information related to the medical imaging examination of the patient includes information on one or more requirements imposed by insurance reimbursement criteria (130) and/or clinical image criteria; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) includes modifying the standard imaging protocol to generate the customized imaging protocol (142) conforming with the one or more requirements imposed by the insurance reimbursement criteria and/or clinical image criteria.

17. The non-transitory computer readable medium (26s) of any one of claims 13-16, wherein: the information related to the medical imaging examination of the patient includes information (132) on a medical implant of the patient; and the applying of the protocol customization algorithm (140) to automatically modify the standard imaging protocol (120) to generate the customized imaging protocol includes modifying the standard imaging protocol (142) by removing one or more imaging scans of the standard imaging protocol that are not compatible with the medical implant of the patient.

18. The non-transitory computer-readable medium (26s) of any one of claims 13-17 wherein the method further comprises: receiving examination monitoring information (17, 18, 27) related to the medical imaging examination of the patient and transmitting the examination monitoring information (17, 18, 27) to a remote expert (RE), the examination monitoring information including at least a screen mirroring data stream (27) of a controller (10) of a medical imaging device (2) used to perform the medical imaging examination of the patient; and providing a natural communication pathway (19) between a local operator (LO) performing the imaging examination and the remote expert (RE); wherein the received information related to the medical imaging examination of the patient includes the examination monitoring information.

19. The non-transitory computer readable medium (26s) of claim 18, wherein the method (100) further includes: conducting a call between the local operator (LO) and the remote expert (RE) using the natural communication pathway (19) provided between a local operator (LO) performing the imaging examination and the remote expert (RE).

20. A method (100) for assisting a medical imaging examination of a patient, the method comprising: receiving examination monitoring information (17, 18, 27) related to the medical imaging examination of the patient and transmitting the examination monitoring information (17, 18, 27) to a remote expert (RE); providing a natural communication pathway (19) between a local operator (LO) performing the imaging examination and the remote expert (RE); applying a protocol customization algorithm (140) to automatically modify a standard imaging protocol (120) based at least on the examination monitoring information to generate a customized imaging protocol (142); and performing (144) at least a portion of the medical imaging examination of the patient using the customized imaging protocol.