A.A.T. Bui et al Poor reporting. The last potential point of failure concerns reporting of study results, which is a key concern in the coordination of care as related to the diagno- sis and intervention for a given case. This lack of coordination is due to: 1)poor documentation of study results; and 2)difficulties communicating the results of tests to referring healthcare providers. These inefficiencies can lead to problems such as initiating treatment before a definitive diagnosis is established, and From this perspective, medical imaging informatics aims to improve the use of imaging throughout the process of care. For example, what is the best imaging method to assess an individual's given condition? Are there image processing methods that can be employed to improve images post-acquisition (e.g, histogram correction, denoising, etc)? These and other questions motivate medical imaging informatics research Indeed, imaging plays a significant role in the evaluation of patients with complex diseases. As these patients also account for the majority of expenses related to health care, by improving the utility of imaging, cost savings can potentially be realized Choosing a Protocol: The Role of Medical Imaging Informatics To further highlight the role of medical imaging informatics, we consider the task of choosing an imaging protocol when a patient first presents in a doctor's office, ad dressing issues related to sub-optimal study design. When a primary care physician (PCP) decides to obtain an imaging study to diagnosis or otherwise assess a problem, the question arises as to which imaging modality and type of study should be ordered. Furthermore, the ability to make the best decisions regarding a patient is variable across individual physicians and over time. Individual physician biases often creep into decision making tasks and can impact the quality and consistency of healthcare provided [1, 6 To ground this discussion, we use an example of a 51 year-old female patient who visits her PCP complaining of knee pain. The selection of an appropriate imaging protocol to diagnosis the underlying problem can be thought of in three steps: 1)standard- izing the patient,s chief complaint, providing a structured and codified format to understand the individual's symptoms: 2) integrating the patient,'s symptoms with past evidence(e.g, past imaging, medical history, etc. )to assess and to formulate a differ ential diagnosis; and 3) selecting and tailoring the imaging study to confirm (or deny) the differential diagnosis, taking into account local capabilities to perform and evaluate an imaging study(there is no point in ordering a given exam if the scanner is unavailable or unable to perform certain sequences). We elaborate on each of the steps below, illustrating current informatics research and its application Capturing the chief complaint. As mentioned earlier, a patient's description of his or her symptoms is very subjective; for physicians-and computers more so-translating their complaints into a"normalized" response(such as from a controlled vocabulary) is tricky. For instance, with our example patient, when asked her reason for seeing her doctor, she may respond, "My knee hurts a lot, frequently in the morning. "Consider the following two related problems: 1)mapping a patient-described symptom or condition to specific medical terminology/disease (e.g, knee hurts= knee pain>ICD-9 719.46 Pain in joint involving lower leg); and 2)standardizing descriptive terms(adjec tives, adverbs) to the some scale(e.., Does"a lot"mean a mild discomfort or a cr pling pain? Does"frequently"mean every day or just a once a week6 A.A.T. Bui et al. ƒ Poor reporting. The last potential point of failure concerns reporting of study results, which is a key concern in the coordination of care as related to the diagno￾sis and intervention for a given case. This lack of coordination is due to: 1) poor documentation of study results; and 2) difficulties communicating the results of tests to referring healthcare providers. These inefficiencies can lead to problems such as initiating treatment before a definitive diagnosis is established, and duplicating diagnostic studies. From this perspective, medical imaging informatics aims to improve the use of imaging throughout the process of care. For example, what is the best imaging method to assess an individual’s given condition? Are there image processing methods that can be employed to improve images post-acquisition (e.g., histogram correction, denoising, etc.)? These and other questions motivate medical imaging informatics research. Indeed, imaging plays a significant role in the evaluation of patients with complex diseases. As these patients also account for the majority of expenses related to health￾care, by improving the utility of imaging, cost savings can potentially be realized. Choosing a Protocol: The Role of Medical Imaging Informatics To further highlight the role of medical imaging informatics, we consider the task of choosing an imaging protocol when a patient first presents in a doctor’s office, ad￾dressing issues related to sub-optimal study design. When a primary care physician (PCP) decides to obtain an imaging study to diagnosis or otherwise assess a problem, the question arises as to which imaging modality and type of study should be ordered. Furthermore, the ability to make the best decisions regarding a patient is variable across individual physicians and over time. Individual physician biases often creep into decision making tasks and can impact the quality and consistency of healthcare provided [1, 6]. To ground this discussion, we use an example of a 51 year-old female patient who visits her PCP complaining of knee pain. The selection of an appropriate imaging protocol to diagnosis the underlying problem can be thought of in three steps: 1) standard￾izing the patient’s chief complaint, providing a structured and codified format to understand the individual’s symptoms; 2) integrating the patient’s symptoms with past evidence (e.g., past imaging, medical history, etc.) to assess and to formulate a differ￾ential diagnosis; and 3) selecting and tailoring the imaging study to confirm (or deny) the differential diagnosis, taking into account local capabilities to perform and evaluate an imaging study (there is no point in ordering a given exam if the scanner is unavailable or unable to perform certain sequences). We elaborate on each of the steps below, illustrating current informatics research and its application. Capturing the chief complaint. As mentioned earlier, a patient’s description of his or her symptoms is very subjective; for physicians – and computers more so – translating their complaints into a “normalized” response (such as from a controlled vocabulary) is tricky. For instance, with our example patient, when asked her reason for seeing her doctor, she may respond, “My knee hurts a lot, frequently in the morning.” Consider the following two related problems: 1) mapping a patient-described symptom or condition to specific medical terminology/disease (e.g., knee hurts = knee pain → ICD-9 719.46, Pain in joint involving lower leg); and 2) standardizing descriptive terms (adjec￾tives, adverbs) to the some scale (e.g., Does “a lot” mean a mild discomfort or a crip￾pling pain? Does “frequently” mean every day or just a once a week?)