A.A.T. Bui et al The Process of Care and the role of Imaging From a high-level perspective, the healthcare process can be seen in of thr clinical questions(Fig. 1. 1), each related to aspects of the scientific od For a given patient, a physician has to: 1 )ascertain what is wrong with the t (identify the problem, develop a hypothesis); 2 )determine the seriousness of a patient,'s condi tion by performing diagnostic procedures(experiment); and 3)after obtaining all needed information, interpret the results from tests to reach a final diagnosis and initiate therapy (analyze and conclude). At each point, medical imaging takes on a critical role What is wrong? Patient presentation, for the most part, is relatively subjective For example, the significance of a headache is usually not clear from a patient,'s description (e.g, my head throbs). Imaging plays a major role in objectifying clinical presentations (e.., is the headache secondary to a brain tumor, intra cranial aneurysm, or sinusitis? and is an optimal diagnostic test in many cases to relate symptoms to etiology. In addition, when appropriately recorded, imaging serves as the basis for shared communication between healthcare providers detailing evidence of current and past medical findings 2. How serious is it? For many conditions, the physical extent of disease is visually apparent through imaging, allowing us to determine how far spread a problem has become(e.g, is it confined to a local environment or is it systemic? ) Moreover, imaging is progressively moving from qualitative to quantitative assessment. Already, we use imaging to document physical state and the severity of disease tumor size in cancer patients; dual energy x-ray absorptiometry(DXA) scores in osteoporosis; cardiothoracic ratios; arterial blood flow assessment based on Doppler ultrasound; and coronary artery calcification scoring are all rudimentary quantitative imaging techniques that further characterize biophysical phenomena. 3. What to do? Treatment is contingent on an individuals response: if a given drug or intervention fails to have the desired effect, a new approach must be taken to resolve the problem. For many diseases, response assessment is done through imaging: baseline, past, and present studies are compared to deduce overall behavior. By way of illustration, many of today's surgical procedures are assessed on a follow-up imaging study, and the effects of chemotherapy are tracked over time(eg, is the tumor getting smaller?). Additionally, contemporary image-guided interventional techniques are opening new avenues of treatment. As the ubiquity and sophistication of imaging grows, methods are needed to fully real- ize its potential in daily practice and in the full milieu of patient care and medical research. The study of medical imaging informatics serves this function. analyze results how serious is it Figure 1. 1: The process of care can be roughly summarized in three stages: 1) what is wrong, which entails identifying the problem and establishing a differential diagnosis 2) how serious is it, which involves testing the differential diagnosis and determining the extent of the problem; and 3) what to do, which based on analysis of test results concludes with a treatment decision4 A.A.T. Bui et al. The Process of Care and the Role of Imaging 1. What is wrong? Patient presentation, for the most part, is relatively subjective. For example, the significance of a headache is usually not clear from a patient’s description (e.g., my head throbs). Imaging plays a major role in objectifying clinical presentations (e.g., is the headache secondary to a brain tumor, intra￾cranial aneurysm, or sinusitis?) and is an optimal diagnostic test in many cases to relate symptoms to etiology. In addition, when appropriately recorded, imaging serves as the basis for shared communication between healthcare providers, detailing evidence of current and past medical findings. 2. How serious is it? For many conditions, the physical extent of disease is visually apparent through imaging, allowing us to determine how far spread a problem has become (e.g., is it confined to a local environment or is it systemic?). Moreover, imaging is progressively moving from qualitative to quantitative assessment. Already, we use imaging to document physical state and the severity of disease: tumor size in cancer patients; dual energy x-ray absorptiometry (DXA) scores in osteoporosis; cardiothoracic ratios; arterial blood flow assessment based on Doppler ultrasound; and coronary artery calcification scoring are all rudimentary metrics that quantify disease burden. On the horizon are more sophisticated quantitative imaging techniques that further characterize biophysical phenomena. 3. What to do? Treatment is contingent on an individual’s response: if a given drug or intervention fails to have the desired effect, a new approach must be taken to resolve the problem. For many diseases, response assessment is done through imaging: baseline, past, and present studies are compared to deduce overall behavior. By way of illustration, many of today’s surgical procedures are assessed on a follow-up imaging study; and the effects of chemotherapy are tracked over time (e.g., is the tumor getting smaller?). Additionally, contemporary image-guided interventional techniques are opening new avenues of treatment. As the ubiquity and sophistication of imaging grows, methods are needed to fully real￾ize its potential in daily practice and in the full milieu of patient care and medical research. The study of medical imaging informatics serves this function. Figure 1.1: The process of care can be roughly summarized in three stages: 1) what is wrong, which entails identifying the problem and establishing a differential diagnosis; 2) how serious is it, which involves testing the differential diagnosis and determining the extent of the problem; and 3) what to do, which based on analysis of test results, concludes with a treatment decision. From a high-level perspective, the healthcare process can be seen in terms of three clinical questions (Fig. 1.1), each related to aspects of the scientific method. For a given patient, a physician has to: 1) ascertain what is wrong with the patient (identify the problem, develop a hypothesis); 2) determine the seriousness of a patient’s condi￾tion by performing diagnostic procedures (experiment); and 3) after obtaining all needed information, interpret the results from tests to reach a final diagnosis and initiate therapy (analyze and conclude). At each point, medical imaging takes on a critical role: