1 Introduction Medical Imaging Informatics: From Theory to Application There are two arms to medical imaging informatics: the development of core informatics theories and techniques that advance the field of informatics itself; and the translation of these techniques into an application that improves health. To demonstrate, we first consider the reasons for the improper use of imaging today, and then how imaging informatics can impact these issues Improving the Use of Imaging The process of providing an accurate, expedient medical diagnosis via imaging can fail for several reasons(Fig. 1. 2): Sub-optimal study selection. The first potential point of failure arises when an imaging study is requested. Given the fairly rapid changes across all elements of imaging technology, it is unrealistic to believe that a physician can always make up-to-date if not optimal decisions about an imaging exam [9]. Thus, the wrong study may be requested for a given patient. To reduce this problem, practice guidelines have been introduced, but are often generic and do not take into account the specific condition of the patient. Poor acquisition. The next potential point of failure occurs during study acquisi tion. Problems arise due to poor instrumentation (e.g, sensitivity), equipment calibration, poor data acquisition methods, or poor technique. For example, due to the very technical nature of imaging procedures, the average clinician is unable to determine the most specific diagnostic protocol; this process is often left to a technologist or radiologist, who without fully knowing the context of the patient, may not use ideal acquisition parameters Poor interpretation. Study interpretation presents an additional point for potential failure. Poor study interpretation can be due to inadequate historical medical information, poor information filtering/presentation, or poor/mismatched skills by the study reader. Studies have shown that historical clinical information can improve the perception of certain radiographic findings [3]. Poor information presentation often leads to important data being buried within the medical record. nally, study reading itself can be improved by providing users with the facility to retrieve relevant data from online medical literature, or by choosing the best matched readers (i.e, generalist vS. specialist) for a particular exam. However, currently available search techniques do not support specific and directed retrievals nd no electronic framework exists for efficiently matching a given exam with the most appropriate reader for that exam. insufficient poor reading background wrong study poor study poor study acquIsition documentation/ reque interpretation communication alibration Figure 1.2: Identification of potential problems in the diagnostic process. In emergency cases, the process may also fail due to excessively long times to completion1 Introduction 5 Medical Imaging Informatics: From Theory to Application There are two arms to medical imaging informatics: the development of core informatics theories and techniques that advance the field of informatics itself; and the translation of these techniques into an application that improves health. To demonstrate, we first consider the reasons for the improper use of imaging today, and then how imaging informatics can impact these issues. Improving the Use of Imaging The process of providing an accurate, expedient medical diagnosis via imaging can fail for several reasons (Fig. 1.2): ƒ Sub-optimal study selection. The first potential point of failure arises when an imaging study is requested. Given the fairly rapid changes across all elements of imaging technology, it is unrealistic to believe that a physician can always make up-to-date if not optimal decisions about an imaging exam [9]. Thus, the wrong study may be requested for a given patient. To reduce this problem, practice guidelines have been introduced, but are often generic and do not take into account the specific condition of the patient. ƒ Poor acquisition. The next potential point of failure occurs during study acquisi￾tion. Problems arise due to poor instrumentation (e.g., sensitivity), equipment calibration, poor data acquisition methods, or poor technique. For example, due to the very technical nature of imaging procedures, the average clinician is unable to determine the most specific diagnostic protocol; this process is often left to a technologist or radiologist, who without fully knowing the context of the patient, may not use ideal acquisition parameters. ƒ Poor interpretation. Study interpretation presents an additional point for potential failure. Poor study interpretation can be due to inadequate historical medical information, poor information filtering/presentation, or poor/mismatched skills by the study reader. Studies have shown that historical clinical information can improve the perception of certain radiographic findings [3]. Poor information presentation often leads to important data being buried within the medical record. Finally, study reading itself can be improved by providing users with the facility to retrieve relevant data from online medical literature, or by choosing the best￾matched readers (i.e., generalist vs. specialist) for a particular exam. However, currently available search techniques do not support specific and directed retrievals and no electronic framework exists for efficiently matching a given exam with the most appropriate reader for that exam. Figure 1.2: Identification of potential problems in the diagnostic process. In emergency cases, the process may also fail due to excessively long times to completion