Patent Publication Number: US-2022238213-A1

Title: System and method for workflow management and image review

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority benefit from U.S. Provisional Application No. 63/199,850, filed on Jan. 28, 2021. The patent application identified above is incorporated here by reference in its entirety to provide continuity of disclosure. 
    
    
     FIELD OF THE INVENTION 
     The technical field of the invention relates to an automated workflow management system which dynamically optimizes radiological image review. 
     BACKGROUND OF THE INVENTION 
     Radiology and the interpretation of radiographs are important tools for the diagnosis and treatment of injury and disease in modern medicine. 
     The typical radiology process begins with a physician determination that a radiology scan is required. The physician creates a radiology order for a radiology scan. The radiology order is then sent to the radiology technician who performs the radiology scan which produces a set of radiology images. The technician assembles a radiology study, which includes the set of radiology images and the radiology order. The study is then sent to a radiologist for review. The radiologist reads and interprets the images and generates a radiology report. The radiology report is attached to the study and returned to the ordering physician. 
     In the past, radiology systems were based on radiographic images, or radiographs, were recorded on specialized radiographic film. After exposure, developed film is physically cataloged, stored, and secured. The radiographs require physical organization and tracking. Additionally, the radiographs require physical transportation to and from technicians and radiologists, for reading and interpretation. Physically cataloging, storing and securing radiographs are cumbersome problems that create gross inefficiencies in the radiology process  which often interfere with patient care. 
     Modern radiology systems create and store images as electronic data files, in a database, along with metadata that identifies the type of image and capture date, among other things. Modern radiology systems also allow electronic images to be efficiently stored and transmitted over the internet to different locations. Modern systems often incorporate a Radiology Information System (RIS). A RIS is a computer-based application that typically processes administrative and medical data, such as patient files, scheduling, report management and billing. 
     Most modern RIS applications often operate in tandem with picture archiving and communication systems (PACS). A PACS typically stores images and related metadata and can electronically transmit them for use with compatible systems. 
     Typical RIS and PACS systems process data using the Health Level Seven (HL7) and Digital Imaging and Communications in Medicine (DICOM) protocols. These protocols provide international standards for management and communication of medical images and data that ensures certain common formats are used to store, transmit, and display radiographic images across various different vendor platforms. 
     Storage of modern medical imaging files is typically accomplished through a PACS Archive or a vendor neural architecture (VNA). These archiving systems provide a standard format for long term archiving of digital images and studies and enable consolidation of images from different RIS and PACS systems into a single repository. 
     Even considering the advances in modern radiology systems, the task of routing radiology studies to radiologists for review remains a challenging task. Radiologists typically specialize in one or more different disciplines, such as neuroradiology, nuclear  radiology, pediatric radiology and cardiovascular radiology. Radiologists also typically specialize in various different techniques or “modalities” such as X-ray imaging, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. Each of the modalities requires different qualifications and credentialling. Differing specialties and qualifications among radiologists limit the types of radiographs they may efficiently review and requires that the studies be sorted before distribution. 
     Another challenge which remains in modern radiology systems is efficient distribution of electronic images to radiologists in different physical locations with differing schedules. Radiologists are often resident at a single hospital or clinic, even though they review and analyze radiology images from other sources. Similarly, radiologists typically work in different shifts and are “on call” at different times. 
     Another challenge facing modern systems is timely review of priority orders. Various physical disorders or injuries may require expedited radiological review. Other disorders may require less rapid radiology attention. Routing of radiology studies based on urgency complicates radiology review because expedited cases often replace less urgent cases in queue, delaying the radiology review and forcing reallocation of radiology resources. Likewise, each medical facility generally recommends time limits on the review of images by the radiologist in order to promote efficiency. Differing time limits for image review between facilities often interferes with prioritization of studies by artificially elevating studies for less severe cases over studies for more severe cases. 
     Similarly, communication between the patient, the physician, the radiologist and the technician presents an ongoing challenge for modern radiology systems. Scheduling of radiological scans requires close coordination between the patient, the physician and the  technician. Likewise, replacing incorrect radiographs, emergency communication of radiology orders reports and studies, questions and reprioritization of studies all require rapid and efficient communication of messages to facilitate the radiology process and proper timely treatment. 
     The prior art has attempted to address these challenges, but has fallen short. 
     For example, U.S. Publication No. 2013/0018674 to Bedi, et al. discloses a method for managing radiology orders which provides for assigning a radiologist for the study based on scheduling rules and control parameters. A “quality index” is provided which grades each radiologist for an assignment of the study. 
     Another example, U.S. Pat. No. 9,727,935 to Esposito, discloses a method of obtaining data describing medical image studies from a medical data server, and assigning each for examination based on preferences and the complexity of the medical images. 
     Yet another example, U.S. Pat. No. 9,558,323 to Jester, et al. discloses a system to manage radiologist workflow, including an interface to distribute medical exams to a work queue. 
     As another example, U.S. Publication No. 2013/0132104 to Wood-Saloman, et al. discloses a method of assigning image studies to a work list using a set of parameters. The parameters include radiologist specialty and location of the patient. 
     As another example, U.S. Pat. No. 8,924,233 to Backhaus, et al. discloses a method of forecasting radiologist assignments based on sets of parameters. Parameters for a radiologist are matched to parameters for a medical facility. A schedule is implemented based on a volume of medical requests and resource availability. 
     Hence, there is a continuing need for a radiology system and method that organizes and optimizes the distribution and review of radiographs and which accommodates  resolution of issues with communication, scheduling, report generation, case urgency, and case pendency.  
     SUMMARY OF THE INVENTION 
     Disclosed is a system and method for optimizing radiological workflow management and medical image review. A preferred embodiment provides a system interoperable with various RIS and PACS systems and that provides efficient access to information by a dynamic prioritized worklist that constantly changes to optimize distribution of studies for timely review. The novel system facilitates automated assignment, communication between physicians, technicians and radiologists regarding orders, radiographs, reports and studies. The system automatically analyzes exam data, urgency and pendency times, among other things, to determine an overall priority for a constantly evolving set of radiology orders. Cases are assigned for review in the most efficient time, resulting in optimal turnaround time and improved patient care. 
     The system disclosed provides a significant advantage over the prior art because it enables more efficient review of radiographic images and report generation. The system provides a database workflow management system which strategically assigns radiological studies for efficient review of images and provides a dynamic prioritized workflow. The system comprises a workflow management application which integrates third party software and hardware to allow for voice recorded notes and the review of different types of radiological images such as X-rays, CT, MRI, PET, ultrasound and others. Furthermore, the system automatically integrates data from multiple enterprises and medical imaging providers into a single, consolidated, and universal database. The system assigns studies based on analysis of different data and features of a study to determine urgency, priority, radiologist availability, radiologist credentialing, radiologist sub specialization and then assigns studies to maximize work efficiency and minimize review time. In the preferred embodiment, a list of cases is created based on matching the radiologist, shift responsibility, patient details, and case  requirements. The list is constantly updated to elevate urgent studies and aged studies in priority for any given radiologist. 
     The preferred system also provides an integrated communication system which allows instant contact between physicians, technicians and radiologists and which stores and associates all such communications with the proper radiology study for later review.  
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the detailed description of the preferred embodiments presented below, reference is made to the accompanying drawings. 
         FIG. 1A  is architecture diagram of a preferred radiological workflow management system. 
         FIG. 1B  is a flowchart of a preferred method of workflow management. 
         FIGS. 2A, 2B, 2C, 2D, and 2E  are a network communication diagram of a preferred embodiment. 
         FIGS. 2F and 2G  are a flowchart for a preferred method of study prioritization. 
         FIG. 2H  is a flowchart for a preferred method of study assignment. 
         FIGS. 2I and 2J  is a flowchart for a preferred method of querying a database for available radiologists. 
         FIG. 3A  is a screenshot of a graphic user interface for a home screen of a preferred embodiment. 
         FIG. 3B  is a screenshot of a graphic user interface for a groups tab selection of a preferred embodiment. 
         FIG. 3C  is a screenshot of a graphic user interface for a credentialling the selection of a preferred embodiment. 
         FIG. 4A  is a screenshot of a graphic user interface for a worklist summary tab selection of a preferred embodiment. 
         FIG. 4B  is a screenshot of a graphic user interface for a worklist summary tab selection of a preferred embodiment. 
         FIG. 5A  is a screenshot of a graphic user interface for dictation application  of a preferred embodiment. 
         FIG. 5B  is a screenshot of a PACS application of a preferred embodiment. 
         FIG. 6A  is a screenshot of a graphic user interface of a patient profile of a preferred embodiment. 
         FIGS. 6B and 6C  are screenshots of a graphic user interface of a study summary side panel of a preferred embodiment. 
         FIG. 7  is a screenshot of a graphic user interface of shift selection tab of a preferred embodiment. 
         FIGS. 8  is a screenshot of a graphic user interface for a search function tab of a preferred embodiment. 
         FIG. 9A  is a screenshot of a graphic user interface for a study overview tab of a preferred embodiment. 
         FIG. 9B  is a screenshot of a graphic user interface for a demographics tab of a preferred embodiment. 
         FIG. 9C  is a screenshot of a graphic user interface for an assignment tab of a preferred embodiment. 
         FIG. 9D  is a screenshot of a graphic user interface for the audit tab of a preferred embodiment.  
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     In the description that follows, like parts are marked throughout the specification and figures with the same numerals. The figures are not necessarily drawn to scale and may be shown in exaggerated or generalized form in the interest of clarity and conciseness. 
     Referring then to  FIG. 1A , a preferred architecture for system  100  will be described. 
     System  100  is comprised of multiple servers with supportive software and services which form the workflow management system. Each of the servers is preferably a standalone server and with appropriate processors and memory capable of high-speed communication of large files and radiographic images. In other embodiments, the servers may be implemented as virtual machines resident in the cloud with access provided to users as software as a service. 
     Administrative server  108  includes assignment service application  110  and management application  112 . Assignment service application  110  coordinates location and availability of radiologists with incoming radiology orders, among other things, as will be further described. Management application  112  coordinates communication with various RIS and PACS systems, receipt and processing of image data requests and reports, database queries and worklist generation and updating, as will be further described. Administrative server  108  is operatively connected to database  106  and wide area network  138 . Administrative server  108  communicates with database  106  preferably through the DICOM protocol. 
     Database  106  is preferably a Microsoft SQL server based database system capable of carrying out complex queries and association of images, metadata and associated files required by the study, such as oral dictation files, transcriptions, and associated email storage. A radiologist list and study list are resident on database  106 .  
     The radiologist list is comprised of all radiologist user records. The records include the location, specialty, certifications, work shift, current workload, and current efficiency of each radiologist. The workload and efficiency are automatically updated by the system. The efficiency is calculated as the rate of reviews conducted per hour. The system utilizes advanced SQL queries and code-based algorithms to extract sub lists of radiologists records with specific characteristics to assign studies for review, as will be further described. 
     The study list is comprised of all the study records. The study records include all information related to the study, such as order number, urgency, patient name, age, injury physiology, location, image type, notes, dictations, preferred radiologist, assigned radiologist, start time, end time, assigned study priority number, any communications between users, and lock out indications, as will be further described. When study images are uploaded into the database they are associated with the appropriate study profile in the database. 
     In a preferred embodiment, database  106  is further in operative communication with image integration server  102  and order integration server  118 . 
     Image integration server  102  further comprises application  104 . Application  104  comprises a VNA system capable of communication with and storage of images from PACS system  114 . Preferably PACS system  114  and image integration server  102  communicate through the DICOM protocol. 
     PACS system  114  is operatively connected to imaging device  116 . In a preferred embodiment, imaging device  116  is a third-party radiology imaging device, CT imaging device, X-ray device, or other device capable of recording and transmitting radiographs. In another embodiment, imaging device  116  is a translation device capable of reading and encoding physical radiographs into an electronic format, such as the DICOM format.  
     Imaging device  116  is operatively connected to technician device  115 . Technician device  115  is further operatively connected to network  138 . Technician device  115  is responsible for controlling the intake of radiology images from imaging device  116  and communication of those images to PACS system  114  and image integration server  102 . Technician device  115  is also responsible for intake and display of data related to the study such as order changes and communications from other services related to the study and the images. 
     Image integration server  102  is operatively connected with database  106 . Preferably, image integration server  102  is capable of retrieving and storing images according to an appropriate database protocol for patient files, according to unique patient IDs and radiology order numbers. Order integration server  118  further comprises application  120 . Application  120  is preferably capable of receipt and transmission of radiology orders organized according to a patient ID and a radiology order number. 
     Order integration server  118  is operatively connected to RIS  148 . RIS  148  is responsible for the receipt of radiology orders, storage, organization and communication of those orders to order integration server  118 . Order integration server  118  is operatively connected with database  106  and is capable of storing radiology orders in an appropriate format for communication into and from the database. 
     The system further comprises a plurality of client devices  126 ,  140 ,  154 ,  150 ,  134  and  122 , each connected to administrative server  108  through network  138 . Each of the client devices is a smart device, such as a computer, tablet, or cell phone, with applications  128 ,  142 ,  156 ,  152 ,  136 , and  124 , respectively, installed. Each of the client devices incorporates appropriate user interfaces, displays, processors and memories sufficient to enable connection with the network and various third party software and hardware to allow creation, viewing and  manipulation of radiographic images. 
     Client devices  126 ,  140  and  154  are also operatively connected to third-party imaging viewer applications  130 ,  144 ,  158  and dictation software  132 ,  146 ,  160 , respectively. The imaging viewer applications are typically applications associated with specific PACS system  114 , and are responsible for reading electronic files and displaying radiographic images. 
     Referring then to  FIGS. 1A and 1B , preferred method of radiology workflow management  162  will be further described. 
     At step  164 , a patient file is created in RIS system  148 . The patient file includes patient demographics, physical exam notes, symptoms, medical history and most importantly, the radiology order. 
     At step  166 , the patient file and the radiology order are sent to order integration server  118 . At step  167 , the patient file and the radiology order are sent to the database. 
     At step  168 , the patient file and the radiology order are retrieved by the administrative server and sent to the technician device through the network. At step  170 , radiographic scans of the patient are taken by imaging device  116 . 
     At step  172 , the imaging device then uploads the scans into PACS system  114 . 
     At step  174 , a radiology study is then created in RIS  148  and transmitted to the administrative server through the order integration server. The radiology study includes the patient file and the scans. 
     At step  176 , administrative server  108  retrieves the study. 
     At step  182 , the study status is set by administrative server  108  to “review requested”.  
     At step  184 , the assignment service is initialized by the “review requested” status. The assignment service analyzes the details of the study such as patient symptoms, type of image review requested and urgency. Details extrapolated from the study are used to determine prioritize study and the assigned radiologist, as will be further described. Different factors that determine which radiologist is assigned to a study may include the radiologists&#39; shifts, current worklist, locations, sub-specialties and credentialling. In a preferred embodiment, studies may be reassigned either manually or automatically if certain events occur, such as a radiologist shift change or a time out condition. 
     At step  185 , once a study is assigned, it is transmitted to a radiologist. The radiologist may select a study to review. At step  186 , when the study is selected, an imaging viewer, such as imaging viewer applications  130 ,  144  and  158 , opens. 
     At step  188 , a report is added to the study by the radiologist with an analysis of the scans. The analysis may be manually entered into the system, or a third-party voice recognition software, such as dictation software  132 ,  146  and  160 , may be used. 
     At step  190 , the report is appended to the study. At step  192 , the study status is then changed to “review complete.” At step  193 , the study is returned to the administrative server. In a preferred embodiment, when a study has been reviewed, the system updates RIS  148  and a notification is sent to the original office where the order was created to notify the physician. 
     Referring then to  FIGS. 2A, 2B, 2C, 2D, and 2E  method  200  for a preferred embodiment of workflow management will be further described. 
     Referring then to  FIG. 2A , at step  2002 , order integration server  118  receives patient data, such as demographics, medical history, injury notes, and physiology of interest and a radiology order. At step  2004 , the order integration server receives an image  capture request including the number and position of images requested and modality. 
     At step  2006 , the order integration server receives a priority indication, such as “stat”, “urgent”, or “routine”. At step  2008 , the order integration server generates a radiology order under a unique radiology order number, including the radiology order, the patient data, image capture request, and priority. 
     At step  2010 , the order is transmitted to administrative server  108  and recorded in database  106 . At step  2012 , the administrative server generates a study file, containing the order and stores the study in the database, associated with the radiology order number. 
     At step  2013 , the study is transmitted to technician device  115 . At step  2014 , the technician device unpacks the image capture request. At step  2016 , technician device  115  receives the requested images. At step  2018 , the images are then transmitted to image integration server  102 . 
     At step  2020 , the image integration server associates the images with the order according to the appropriate radiology order number. At step  2022 , the images are transmitted to administrative server  108 . At step  2024 , the images are appended to the study and stored in the database. 
     At step  2026 , the administrative server continuously queries the database for new images which have been marked “study requested”. In a preferred embodiment, a query is submitted approximately every 10 seconds, so as to not over-tax the network. At step  2028  when a study request marking is detected, the administrative server retrieves the study containing the new images. 
     At step  2029 , an elapsed time clock is started and associated with the study.  The time clock runs until the study is completed, and an elapsed time field is associated with the study in the database. At step  2030 , the priority of the study is determined, as will be further described. The priority of each study is then associated with the appropriate study based on the unique radiology order number. 
     At step  2031 , optionally, the study is assigned to a radiologist based on various factors, such as location, study priority, radiologist specialty, radiologist credentialling, radiologist shift, and radiologist workload, as will be further described. 
     At step  2032 , administrative server  108  updates the list of studies stored in the database with the radiologist assigned. 
     At step  2033 , the administrative server queries the study list for “time violations.” In a preferred embodiment, a time violation occurs when a study&#39;s elapsed time clock reaches a predetermined value without being completed. Predetermined values are set depending on the urgency of the study. In a preferred embodiment, “stat” priority is 1 hour, “urgent” priority is 6 hours, and “routine” priority is 24 hours. 
     At step  2034 , if a time violation occurs, then the study priority is incrementally raised. In one embodiment, if a time violation occurs on a study with a stat priority, then an alert is generated and sent to the assigned radiologist and ordering physician. In another embodiment, if a time violation occurs on a study with a stat priority, then the study is reassigned to another available radiologist. 
     At step  2035 , client device  126 , usually associated with a radiologist, receives a request for an updated study list. In a preferred embodiment, the study list is a flat file identifying studies by the unique radiology order number. At step  2036 , the request is transmitted to administrative server  108 . At step  2037 , the updated study list is retrieved from  the database. At step  2038 , the updated study list is returned to the client device. At step  2039 , the updated study list is displayed on client device  126 . 
     At step  2040 , the study list is filtered at client device  126  to produce a study selection. In a preferred embodiment, the study list may be filtered by categories of priority, time in queue, patient name, location, patient medical record number (MRN) or study, status, patient age, or modality. Categories not elected are not displayed in the study list. 
     At step  2041 , the client device receives a study selection. At step  2042 , client device  126  periodically queries the administrative server to refresh the filtered study list. In a preferred embodiment, refresh queries are generated about every 10 minutes, but the refresh query rate may, of course, vary. At step  2043 , the study selection is transmitted to administrative server  108 . At step  2044 , the selected study and associated images are retrieved from the database. Studies and images that have been “locked”, as will be further described, are not retrieved from the database. Limiting retrieval to unlocked studies and images prevents duplication of effort and conflicting radiology reports and increases system efficiency by preventing generation of reports for studies that are currently under review. Limiting retrieval to unlocked studies also increases computational efficiency by eliminating transmission of unused data through the network. At step  2045 , the study and images that are not locked are returned to the client device. At step  2046 , the selected study details are displayed at the client device. 
     At step  2047 , the client device sends an API call to the PACS software to display an image associated with a selected study. In another preferred embodiment, the client device issues an API call to a third-party image viewer, resident on the client device. At step  2048 , the image is displayed on the client device. At step  2049 , the client device retrieves the radiology number from the study. At step  2050 , the study number associated with the image  being viewed is transmitted to the administrative server. At step  2051 , the administrative server marks each of the studies identified as “locked”. Simultaneously, the administrative server starts a pendency clock on each locked file. At step  2052 , a “locked” acknowledgement is transmitted to the client device. At step  2053 , if the pendency clock on any locked file reaches a predetermined “timeout” limit, the file lock is removed, and the study is released for viewing by others. At step  2054 , a timeout message is sent to the client device. At step  2055 , the client device automatically closes the study. 
     At step  2056 , the client device receives a dictation selection. At step  2057 , an API call for dictation software  132  is transmitted to activate dictation device  133 . At step  2058 , dictation device  133  receives the dictation and creates a dictation file using the dictation software. 
     At step  2059 , the dictation file is transmitted to client device  126 . At step  2060 , the dictation file is logged. At step  2061 , the client device receives notes. In a preferred embodiment, the notes are stored in an ASCII text file. At step  2062 , the client device receives a study “complete” selection, indicating that the report is completed. 
     At step  2063 , the client device receives a selection to update, or save, the dictation and notes added to the study. In one embodiment, a selection of “complete” automatically saves the dictation file and notes. In another embodiment, the dictation is transcribed and the transcription is automatically saved upon completion. 
     At step  2064 , the status, dictation, and notes are transmitted to administrative server  108 . At step  2065 , the elapsed time clock on the study is stopped when the status is changed to “complete”. Likewise, the pendency clock is stopped. The values of the elapsed time clock and the pendency clock are both stored in the database associated with the study. At step  2066 , the study is unlocked. At step  2067 , the elapsed time between when the study was  ordered and when the study was completed is calculated. At step  2068 , the database is updated with the status, dictation, notes and elapsed time. 
     At step  2069 , client device  126  generates a communication, such as a test request for reimaging or to add additional background on the results of a study. At step  2070 , the communication is transmitted to administrative server  108 . At step  2071 , the communication is stored in the database, appended to the appropriate study. 
     At step  2072 , the communication is transmitted to order integration server  118 , and, if applicable, to technician device  115 . At step  2073 , the order integration server logs the communication. At step  2074 , the technician device logs and displays the communication. At step  2075 , the communication is displayed. In one preferred embodiment, the communication is sent from the order integration server to a physician device (not shown). At step  2076 , order integration server  118  receives a response to the communication. At step  2077 , the response is transmitted to administrative server  108 . At step  2078 , the response received is stored in the database, and associated with the appropriate study. At step  2079 , the response is transmitted to client device  126 . At step  2080 , the response is displayed at client device  126 . 
     At step  2082 , communication is received at order integration server  118 . At step  2084 , the communication is transmitted to administrative server  108 . At step  2086 , the communication is stored in the database. At step  2088 , the communication is transmitted to client device  126 , and, if applicable, to technician device  115 . At step  2090 , the communication is displayed at client device. At step  2092 , the technician device logs and displays the communication. 
     At step  2094 , a response communication is received at client device  126 . Optionally, a response communication may be received at the technician device. At step  2096 ,  the response communication is transmitted to administrative server  108 . At step  2098 , the response communication is stored in the database, as previously described. At step  2100 , the response is transmitted to order integration server  118 . At step  2102 , the response communication is displayed. 
     At step  2104 , communication is received at technician device  115 . At step  2106 , the communication is transmitted to administrative server  108 . At step  2108 , the communication is stored in the database. At step  2110 , the communication is transmitted to order integration server  118 , and, if applicable, to client device  126 . At step  2112 , the communication is displayed. At step  2114 , the client device displays the communication. 
     At step  2116 , a response communication is received at order integration server  118 . Optionally, a response communication may be received at the client device. At step  2118 , the response communication is transmitted to administrative server  108 . At step  2120 , the response communication is stored in the database, as previously described. At step  2122 , the response is transmitted to technician device  115 . At step  2124 , the response communication is displayed. 
     Referring then to  FIGS. 2F and 2G , step  2030  for determining study priority in a preferred embodiment will be further described. 
     At step  2131 , the system retrieves the urgency status of the current study, such as, “stat”, “urgent”, or “routine”. At step  2132 , the system determines the urgency priority value (UPV) of the study. In a preferred embodiment, the urgency value of a study is determined according to Table 1 below. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 1 
               
               
                   
                   
               
               
                   
                 Urgency Status 
                 Urgency Priority Value 
               
               
                   
                   
               
             
            
               
                   
                 Stat 
                 3 
               
               
                   
                 Urgent 
                 2 
               
               
                   
                 Routine 
                 1 
               
               
                   
                   
               
            
           
         
       
     
      At step  2133 , the elapsed time, t, is retrieved. At step  2134 , the elapsed time priority value, ETPV, is determined according to the following formula: 
     
       
         
           
             ETPV 
             = 
             
               
                 t 
                 - 
                 
                   ( 
                   
                     t 
                     ⁢ 
                        
                     mod 
                     ⁢ 
                        
                     5 
                   
                   ) 
                 
               
               5 
             
           
         
       
     
     Where: 
     t=is the elapsed time. 
     In a preferred embodiment, the modulus is 5. However, other modulus numbers may be used. 
     At step  2135 , the system retrieves the study physiology designation. At step  2136 , the physiology priority value (PPV) is determined. In a preferred embodiment, PPV may be determined according to Table 2 below. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 2 
               
               
                   
                   
               
               
                   
                 Physiology Designation 
                 Physiology Priority Value 
               
               
                   
                   
               
             
            
               
                   
               
            
           
           
               
               
               
            
               
                   
                 Head 
                 10 
               
               
                   
                 Chest 
                 9 
               
               
                   
                 Neck 
                 8 
               
               
                   
                 Spine 
                 7 
               
               
                   
                 Abdomen 
                 6 
               
               
                   
                 Pelvis 
                 5 
               
               
                   
                 Humerus/Femur 
                 4 
               
               
                   
                 Tibia/Fibula/Ulna/Radius 
                 3 
               
               
                   
                 Joints 
                 2 
               
               
                   
                 Phalanges 
                 1 
               
               
                   
                   
               
            
           
         
       
     
      At step  2137 , the study priority number, SPN is calculated according to the following equation: 
       SPN=UPV+ETPV+PPV 
     Where: 
     SPN is the study priority number of the current study; 
     UPV is the urgency priority value of the current study; 
     ETPV is the elapsed time priority value of the current study; and, 
     PPV is the physiology priority value of the current study. 
     At step  2138 , the current study is inserted into the study list. At step  2139 , the study list is arranged in descending order, based on the SPN of each of the studies. At step  2140 , the system queries whether or not one or more studies have the same SPN. If not, the method proceeds to step  2147  and returns. If so, then the method proceeds to step  2141 . 
     At step  2141 , all studies containing the same SPN are designated “tied studies” and removed from the study list. At step  2142 , the tied studies are reordered by the UPV and reinserted into the study list. At step  2143 , the system again queries whether or not a tie still exists. If no tied studies exist, then the method proceeds to step  2147 . If so, then the method proceeds to step  2144 . 
     At step  2144 , the tied studies are designated and removed from the study list. At step  2145 , the tied studies are reordered in descending order by the elapsed time value and reinserted in the study list. At step  2147 , the studies are returned in their new order to the study list.  
     Referring then to  FIG. 2H , step  2031  for optionally assigning a study to a radiologist in a preferred embodiment will be further described. In a preferred embodiment, the option to invoke step  2031  is made by the administrative server at system startup. 
     At step  2150 , the system queries for a sub list of available radiologists. In a preferred embodiment, the system queries radiologist records for those that specifically align with the unassigned study details and a sub list is created, as will be further described. 
     At step  2152 , the system determines whether or not the sub list of available radiologists contains more than one (1) record. If not, the method proceeds to step  2154 . If so, the method proceeds to step  2160 . 
     At step  2154 , the system determines whether or not the sub list of available radiologists contains more than zero (0) records. If so, then the method proceeds to step  2162 . If not, the method proceeds to step  2158 . At step  2158 , a null set occurs because no available radiologists can be assigned and the method proceeds to step  2164  and returns. 
     At step  2160 , the system determines the available radiologist with the highest efficiency rating. At step  2162 , a radiologist is assigned to the study. At step  2164 , the updated study record is returned. 
     Referring then to  FIGS. 2I and 2J , step  2150  for querying the database for available radiologists will be further described. 
     At step  2170 , study details are extracted, from the database record such as the location, image type, injury physiology, urgency, preferred radiologist, and elapsed time. 
     At step  2172 , the system determines whether or not the study record has a preferred radiologist selection. If so, the method proceeds to step  2198  and the preferred radiologist record is returned. If not, the method proceeds to step  2174 .  
     At step  2174 , a radiologist record is retrieved from the database. 
     At step  2184 , the system queries if the location in the radiologist record matches the study location. In a preferred embodiment, the location for consideration for automatic assignment may optionally be expanded to include multiple locations in a hospital network. If so, then the method proceeds to step  2186 . If not, then the method proceeds to step  2196 . 
     At step  2186 , the system queries if the radiologist record lists the required certifications to review the type of image associated with the study record. If not, then the method proceeds to step  2196 . If so, then the method proceeds to step  2188 . 
     At step  2188 , the system queries if the radiologist record lists the specialty associated with the study physiology, such as pediatric or neurological. If not, the method proceeds to step  2196 . If so, then the method proceeds to step  2190 . 
     At step  2190 , the system queries if the radiologist shift aligns with the study urgency and elapsed time. An alignment occurs when the radiologist is on duty with enough shift time to review the study without causing a time violation. If not, the method proceeds to step  2196 . If so, the method proceeds to step  2192 . 
     At step  2192 , the system queries if the radiologist workload is open. In a preferred embodiment, a radiologist workload is restricted to a predetermined number, such as two (2), assigned studies per hour, or a total of ten (10) assigned studies per shift. Once the predetermined number of assigned studies is reached, the radiologist workload is considered closed. Different numbers of assigned studies and additional restrictions may be utilized, such as the number of “stat” or “urgent” studies assigned. If not, the method proceeds to step  2196 . If so, then the method proceeds to step  2194  and adds the radiologist record to a sub list of  available radiologists. 
     At step  2196 , the system determines whether or not all records have been reviewed. If not, the method returns to step  2174  and retrieves the next record. If so, then the sub list of all available radiologists is returned at step  2198 . 
     Referring then to  FIG. 3A , home screen  300  will be described. 
     Home screen  300  includes menu column  302 . Menu column  302  includes home button  306  and home tab  304 . When home button  306  is selected the system returns to home screen  300 . Menu column  302  also includes worklist button  308 . When worklist button  308  is selected, the system displays the user&#39;s worklist, which will be further described. Analytics button  310  is also located in menu column  302 . When analytics button  310  is selected, the system displays to the user&#39;s progress and productivity metrics, which includes, but is not limited to, the number of exams reviewed by shift for the time and date selected, as will be further described. Menu column  302  also includes calendar button  312 , resources button  314 , notes button  316  and credential button  318 . When calendar button  312  is selected, the system displays to the user&#39;s calendar. When resources button  314  is selected the system displays a list of medical facilities that includes the website link for each facility. When notes button  316  is selected, the system displays the user&#39;s saved notes. When credential button  318  is selected, the system displays the user&#39;s credentials. 
     Menu column  302  also includes folders button  320 . When folders button  320  is selected, the system displays a list of saved folders. History button  322  is also found under menu column  302 . When history button  322  is selected, the system displays a list of studies that have been read for a particular time period selected. Menu column  302  further includes settings button  324 . When settings button  324  is selected, the system displays settings dialog box where  the user can modify personal settings, such as shift and open orders on dictation, profile settings, site credentials settings, and VPN credentials settings. 
     Home screen  300  lists current shift  326  and performance data  338  for a specified time period. Home screen  300  includes time period drop down menu  328  that allows the user to select different time periods, such as 7 days and 30 days. When time period drop down menu  328  is selected, the metrics on home screen  300  are refreshed to show updated information for the selected period of time. Estimated RVU  330  is a measure of productivity and is shown for the time period and shift selected and updates when time period drop down menu  328  is updated to a new time period. Studies reviewed  332  shows the number of studies the user has reviewed for the time period and shift selected. Studies reviewed  332  also updates when time period drop down menu  328  is updated. The studies the user reviews for a specified time period are shown in pie chart  334 . Pie chart  334  details the studies reviewed by modality. Bar graph  336  displays RVU  330  and studies reviewed  332  by days in the radiologist shift identified in current shift  326 . 
     Referring then to  FIG. 3B , home button  306  includes groups tab  339 . When groups tab  339  is selected, my groups list  342  and all groups list  344  are shown under groups column  340 . My groups list  342  are all the groups of which the user is a member. All groups list  344  is a list of all currently available groups. The user can select a group from all groups list  344  to see all current members of the selected group. 
     Referring then to  FIG. 3C , home button  306  includes credentialing tab  346 . When credentialing tab  346  is selected, my credentials list  350  and credentials by site list  352  are shown under my credentials column  348 . My credentials list  350  lists all the credentials for the user. Credentials by site list  352  is a list of all credentials by site and the user can select a  particular site to see how other users are credentialed. 
     Referring then to  FIGS. 4A and 4B , a preferred embodiment of a graphic user interface worklist summary  400  will be further described. 
     Worklist summary  400  includes a list of outstanding review requests assigned to the user. The worklist includes menu column  302  and worklist button  308 . When worklist button  308  is selected, the system displays worklist summary  400 . Worklist summary  400  includes worklist column  402 . Worklist column  402  displays “My Cases”  428  and “Case Cloud”  430 . My Cases  428  includes studies assigned to the user through automatic assignment or self-assignment. Case Cloud  430  includes all studies that are currently unreviewed but are available for review by the user based on the users profile and credentials. 
     Worklist summary  400  also includes work button  404 , browse button  406 , search button  408 , folders button  410 , history button  412 , and helpdesk button  414 . When work button  404  is selected, the system displays My Cases  428  and Case Cloud  430 . Work button  404  shows the number of studies that are in stat, urgent, and routine status. 
     When browse button  406  is selected, the system displays the users currently assigned studies. The users actively saved worklists, favorites, and groups are displayed under browse button  406 . The saved worklists, favorites, and group lists may be organized based on discipline, clinics, hospitals, or work groups. The groups may be viewed together or individually. 
     When search button  408  is selected, the system displays a screen that includes a quick search option and an advanced search option. 
     When folders button  410  is selected, the system displays the folders screen which allows creation and manipulation of patient file folders. 
     When history button  412  is selected, the system displays a screen showing all  studies read by a radiologist for a time period selected. 
     When helpdesk button  414  is selected, the system displays a screen that allows the user to seek technical assistance with the workflow management system. 
     Worklist summary  400  further includes “play” button  416 . When play button  416  is selected, the system opens dictation software for dictating a study. The user can select multiple studies. The studies selected will be executed in the order of selection so the studies can be reviewed and dictated. If a patient has more than one study available for review, a dialog box will appear asking the user to review the studies for that patient. The user can choose “Que Next”, “Continue”, or “Cancel”. If the user chooses “Que Next”, the additional unreviewed study will be added to the studies list in the dictation software system. If the user chooses “Ignore”, the additional unreviewed study will not be added to the list of selected unreviewed cases. 
     Worklist summary  400  also includes skip button  418 , clear selection button  420 , auto next slider  422 , hide reserved slider  424 , and hide dictating slider  426 . When skip button  418  is selected, a user can skip a study and move to the next study in the queue. A skipped study is removed from the worklist. When clear selection button  420  is selected, the studies previously selected will be deselected and the work queue cleared of any active filters. When auto next slider  422  is selected, a user can select play button  416  and studies will be reviewed and dictated from the top-down. When the user is finished reviewing and dictating the first study in the list, the second study will be automatically queued for review and dictation. When the second study is completed, the third study will be queued, and so on, until all studies are reviewed or until the user decides to exit the queue. When hide reserved slider  424  is selected, all studies that are assigned to a different user or assigned to a group of which a  radiologist is not a member, will be hidden from view on the worklist. When hide dictating slider  426  is selected, all studies currently in active dictation status will be hidden from view. Hide dictating slider  426  allows the user to filter the worklist of studies that are currently being reviewed which saves time and prevents unnecessary scrolling of the worklist by a user to find cases that are currently unreviewed. 
     Manage worklists button  403  and shift selection button  405  are located in worklist column  402  on worklist summary  400 . Shift selection button  405  allows a user access to a shift selection box, as will be further described. Manage worklists button  403  allows a user to access the worklist manager dialog box. The worklist manager dialog box allows a radiologist to search by site to create certain lists, such as main worklist, group 1, group 2, or favorites. A site is added to one of these lists by highlighting the site and selecting the add button. A site can also be removed from one these lists by highlighting the site and selecting the remove button. If a site is added under favorite, that site is permanently stored as a favorite site. If a site is added under main worklist, that site is only saved for the session for which the radiologist is logged in currently. 
     Referring to  FIG. 4B , a detailed view of My Cases  428  will be further described. My Cases  428  includes dictate button  432 , view button  434 , and study selection button  436 . When dictate button  432  is selected, third party dictation software is automatically launched so the user can generate a report for the selected study, as will be further described. When view button  434  is selected, any images attached to the patient&#39;s file will open in a separate window, as will be further described. In a preferred embodiment, study selection button  436  allows the user to select multiple studies to open and review. An additional option to open the dictation software and the image viewer is to right click on the patient&#39;s name and a dialog  box will appear with the options to dictate exam and view images. This dialog box also includes “Add to Queue”, which allows the user to add the study to the list of studies for dictation, “Skip/Un-skip Exam”, and “View Exam Manager”. Skip/Un-skip Exam allows the user to skip or un-skip a previously skipped study for review. If a study is skipped, it is removed from the user&#39;s worklist. View Exam Manager allows the user to easily access any notes attached to the patient file and any prior studies for the patient. 
     Worklist summary  400  includes study summaries header list  480 . Study summaries header list  480  includes columns of priority, time, assignment, patient&#39;s name, ordering physician&#39;s name, exam, reason, site, location, ready date and time, medical records number, status, date of birth, and image modality. My Cases  428  includes priority and time column  438 . Priority and time column  438  further includes status icon  440  and time elapsed icon  442 . Status icon  440  provides the current priority status of each study, which can be “stat”, “urgent”, or “routine”. In one preferred embodiment, status icon  440  is one color when studies are classified as stat, another color when studies are classified as urgent, and a different color when studies are classified as routine. Any number of color combinations may be used to differentiate the study priorities. Alternatively, a master study priority number for each study, calculated by the administrative server is displayed in the icon. Elapsed time icon  442  indicates the amount of time elapsed since a study has been available for review. In one preferred embodiment, elapsed time icon  442  will show in one color if 50% of service level agreement time has elapsed and, in another color, if 75% of service level agreement time has elapsed. In one preferred embodiment, when time elapsed icon  442  for each cases reaches the 50% threshold these studies will automatically be escalated in the worklist queue. 
     Worklist summary  400  also includes assigned and indicators column  444 .  Assigned and indicators column  444  further includes assign icon  446 , review icon  448 , study notes icon  450 , telerad assistance icon  452 , and call request icon  454 . Assign icon  446  indicates the user that is assigned to review the study. If the study is assigned to the user, then assign icon  446  is highlighted one color and lists the users name. If the study is assigned to one of the user&#39;s groups, then assign icon  446  is highlighted in a different color and lists the group&#39;s name. If the study is not assigned, then assign icon  446  shows “Assign” highlighted in another color and gives the user or other individual the opportunity to assign the study to himself or to another for review. To assign a study to a user, the user can select assign icon  446  which is highlighted in a different color, or the user can select and choose “Assign to Me” from the dialog box. If a study is currently being dictated, then assign icon  446  is highlighted in yet a different color and other icons are inactive, but if a study is simply assigned to a different user and not being dictated, then assign icon  446  is inactive and all other icons are active. Assign icon  446  is highlighted in a different color when the user is actively dictating a study. In a preferred embodiment, any number of different color combinations may be used. 
     Review icon  448  indicates whether a study is ready for review. If a study is ready for review, then review icon  448  is highlighted one color, if a study is not ready for review, it is highlighted in a different color. Hovering over review icon  448 , provides a list that includes the current status, the number of images, the number of documents, and if there is an existing report. Study notes icon  450  is highlighted one color if there are any notes in the patient file for that study, if not, study notes icon  450  is highlighted a different color. Hovering over this icon shows the number of notes in the patient file for that study. Telerad assistance icon  452 , if activated, will be highlighted, and indicates whether communication with the referring physician, nurse, or technician has been requested by the user. Call request icon  454  will be highlighted if a  user needs to return a request for a phone call from a physician, nurse, or technician. In a preferred embodiment, any number of different highlight color combinations may be used. 
     Worklist summary  400  also includes name and ordering column  456  and exam and reason column  462 . Name and ordering column  456  includes the patient&#39;s name and ordering physician information. Exam and reason column  462  includes the type of exam the patient received, such as CT, MRI, or X-ray, and the medical reason for the exam, or the patient condition, the urgency rating and optionally the study priority number. 
     Refresh button  458  and worklist study numbers  460 A,  460 B and  460 C are included in worklist summary  400 . Refresh button  458  refreshes a user&#39;s worklist when selected. Worklist study number  460 A represents the number of cases in a worklist that are “stat”. Worklist study number  460 B represents the number of cases in a worklist that are “urgent”. Worklist study number  460 C represents the number of cases in a worklist that are “routine”. 
     Worklist summary  400  further includes search text box  464 , site and location column  466 , and ready date and ready time column  468 . Search text box  464  allows a user to search and filter the worklist, including but not limited to, by patient name, site name, assigned radiologist, and current status. When a user searches by stat status, for example, the user&#39;s worklist will refresh and will list all cases that are currently classified as stat. All other studies that are not classified as stat will not be listed in the worklist. Site and location column  466  lists the information for the facility that performed the patient&#39;s exam. Ready date and ready time column  468  list the date and time a particular study became available for review. 
     Worklist summary  400  provides modality filters  470 A,  470 B,  470 C,  470 D,  470 E,  470 F and  470 G. The modality filters organize worklist by modality. Modality filter  470 A filters by CT studies. Modality filter  470 B filters by MRI studies. Modality filter  470 C filters  by ultrasound studies. Modality filter  470 D filters by X-ray studies. Modality filter  470 E filters by nuclear medicine studies. Modality filter  470 F filters by X-ray angiography studies. Modality filter  470 G filters by mammogram studies. When one or more of the modality filters are selected, they are highlighted one color, and the selected studies will be listed in the worklist. When any of the modality filters are not selected, they are highlighted in another color and will not be listed in the worklist. 
     Worklist summary  400  also includes medical record number and accession column  472 , status and images column  474 , age and date of birth column  476 , and modality and tags column  478 . Medical record and accession column  472  are unique to each patient and each exam facility to uniquely identify each patient. Status and images column  474  indicates whether a study is ready for review and how many images are included in the study for review. Modality and tags column  478  indicates they type of exam received, such as CT or MRI, and the general area of the patient&#39;s body that was examined, such as neuro. 
     Referring then to  FIG. 5A , dictation software  500  will be further described. 
     Dictation software  500  includes GUI screen  504  and includes a patient&#39;s exam and allows a user to perform multiple actions and functions related to the exam report through the use of different icons and buttons, such as editing the text after dictation and includes reporting space  502 , GUI screen  504 , and signature block  506 . In a preferred embodiment, the dictation software is PowerScribe  360 , available from Nuance Communications of London, England. Dictation software  500  automatically launches when the user selects dictate button  432 . Reporting space  502  is the space to dictate the study report that will be attached to the patient&#39;s file for physician review once the report is complete. Dictation software  500  also allows the user to make text notes that are attached to the patient&#39;s study. Signature block  506  allows a user to  manually enter a signature for a completed report. 
     Referring then to  FIG. 5B , imaging software system  508  will be further described. 
     Imaging software system  508  includes GUI  512 . GUI  512  includes images display  510 , and imaging icons  514 . Imaging software system  508  provides the images of the patient to be reviewed and is launched when a user selects view button  434 . GUI  512  provides imaging icons  514  to manipulate and adjust the view of the images. In a preferred embodiment, the imaging software is Synapse® PACS, available from Fujifilm Holdings America Corporation, located in Valhalla, N.Y. 
     Referring then to  FIG. 6A, 6B, and 6C  patient jacket  600  will be further described. 
     Patient jacket  600  includes patient name  602 , exam received  604 , and exam option buttons  606  for the selected patient. Patient jacket  600  is opened when a user selects assign icon  446  or right clicks the patient information and selects the view patient jacket option from the dialog box. Exam received  604  is the particular exam the patient received. 
     Exam option buttons  606  includes dictate button  650 , view button  652 , queue next button  654 , and close button  656 . When dictate button  650  is selected, the associated dictation software system will automatically launch so the user can dictate a report. When view button  652  is selected, the associated imaging software system will launch, and the radiologist will be able to review exam images. Queue next button  654  opens the current study and the patient jacket will automatically skip to the next study. The study that was skipped will be removed from the user&#39;s worklist. If a user selects close button  656 , then the patient jacket is closed, and all changes are saved. 
     Patient jacket  600  also includes demographics section  608 , assignment section  610 , assistance section  616 , exam quality section  624 , request call back section  630 , and notes section  636 . Demographics section  608  displays patient information, such as gender, birthdate, ordering physician information, such physician name and order date, site where the exam was performed, exam modality, and how many images are attached, and the reason for the exam. Assignment section  610  includes individual drop down menu  612  and group drop down menu  614  to choose an individual or a group to assign the study. Assignment section  610  also allows a user to assign, unassign or reassign a study to a user. To unassign a study, then an individual or group name is chosen from individual drop down menu  612  or group drop down menu  614  and unassign button  609  is selected. If a study is to be reassigned, then a new individual or group will be chosen from individual drop down menu  612  or group drop down menu  614  and save assignment button  611  will be selected. Once save assignment button  611  is selected and a study is assigned to a particular user, that study will appear on their worklist for review. 
     Assistance section  616  provides a user with the option to submit a request for assistance. Assistance section  616  includes urgency drop down menu  618 , quick note drop down menu  620 , and note text box  622 . Urgency drop down menu  618  provides three options, namely, “high”, “medium”, and “low”, but other options may be provided. In one embodiment, priority is assigned to the studies classified as having the highest urgency priority number if there are not other studies with the same urgency number. In another embodiment, the priority of the studies is assigned by elapsed time on the system. Quick note drop down menu  620  allows a user to choose from a predetermined list of messages. Note text box  622  allows a user to enter a text message from the keyboard. Once the assistance information is added to assistance section  616 , request assistance button  623  is selected. When button  623  is selected, a message is sent to the  referring physician, nurse, or technician. 
     Exam quality section  624  includes quick note drop down menu  626  and note text box  628 . Exam quality section  624  allows a user to provide feedback on the quality of the exam and images in the patient file. Quick note drop down menu  626  includes a predetermined set of text messages which can include positive and negative feedback. Note text box  628  allows the user to enter a message from the keyboard. Once the information is added to exam quality section  624 , save button  625  is selected and the information is saved to the patient file for that study. 
     Request call back section  630  includes urgency dop down menu  632  and contact drop down menu  634 . Urgency drop down menu  632  provides the user to select high, medium, or low priority. Contact drop down menu  634  provides the user to choose the contact person, such as physician, nurse, or technician. Once all necessary information is added to request call back  630 , save button  633  is selected and a “call back” message is sent to the chosen contact person. 
     Notes section  636  provides a text box for the user to enter text for the patient file. When no notes are attached to the patient file, there is a number zero next to the notes header. Once there is a note in the patient file, the number zero will change to a one and will continue to change as notes are subsequently added. Once a note is added in the text box, save button  637  is selected to save the note to the patient file. 
     Patient jacket  600  further includes review icon  638 , study notes icon  640 , telerad assistance icon  642 , and call request icon  644 . As previously discussed, review icon  638  indicates whether a study is ready for review. If a study is ready for review, then review icon  638  is highlighted one color, if not, it is highlighted a different color. Study notes icon  640  is  highlighted in one color if there are any notes in the patient file for that study, if not, study notes icon  640  is highlighted a different color. Telerad assistance icon  642 , if activated, is highlighted one color if the urgency is medium or routine, and highlighted a different color if the urgency is high, and indicates whether communication with the referring physician, nurse, or technologist has been requested by the user. Call request icon  644  will be highlighted if a radiologist needs to return a phone call request to a physician, nurse, or technician. 
     Prior studies section  658  lists summaries of a patient&#39;s prior studies. The summaries include study assignment, date and time  664 , image modality  666 , exam type  668 , location  670 , medical record number  672 , and study status  674 . Prior studies section  658  also includes link buttons  662  to view prior study files or images for comparison. The summaries may be filtered by modality buttons  660 . More than one modality button may be chosen and when chosen the prior study summaries for the chosen modalities will be listed. 
     Report summary section  676  displays exam type  678  and technique  680 , as well as study findings  682  and impression  684 . 
     Referring then to  FIG. 7 , shift selection box  700  will be further described. 
     Shift selection box  700  includes shift selection menu  702  and reading profile menu  704 . When shift selection button  405  is selected, shift selection box  700  opens. Shift selection menu  702  is a drop-down menu and lists all available shifts. The user can choose any available shift. Reading profile menu  704  is also a drop-down menu and lists all available reading profiles from which a user can choose. A reading profile is the particular healthcare system, such as a hospital or other healthcare provider, from which studies will be pulled for review. Once a shift and reading profile are selected and save button  710  is selected, the worklist is filtered and updated to reflect all available unreviewed studies for that shift and  reading profile. 
     Shift selection box  700  also includes shift details area  706  and shift responsibilities area  708 . Shift details area  706  includes the name of the shift, description, location of the shift, and the date and time of the shift. Shift responsibilities area  708  includes all responsibilities associated with that particular shift, such as reviewing exams for a hospital&#39;s neonatal ICU or pediatric radiology department. Get expanded shift list button  714  functions to display all shifts for which the user is qualified. If a user does not wish to update the shift selection or reading profile, then cancel button  712  may be selected. 
     Referring then to  FIG. 8 , a preferred graphic user interface of search screen  800  will be further described. 
     Quick search section  802  allows access to data based on a patient&#39;s name, medical record number, accession number, image modality, or exam date. Magnifying glass icon  806  presents a display of advanced search filters. Advanced search filters  804  allow access to data based on site, site group, activity state, date of birth, age, or user assigned. Once a user inputs the search information into quick search section  802  or advanced search filters  804 , the relevant studies will be listed in study search list section  808 . 
     Referring then to  FIGS. 9A, 9B, 9C and 9D , screenshots of a graphic user interface for detailed views of study  900  will be further described. Detailed views of study  900  is accessed from worklist summary  400 . 
     Overview tab  902  includes exam details section  904 , assignment section  906 , assistance section  908 , and communication section  910 . 
     Exam details section  904  includes information regarding the current exam, such as patient name  912 , location  914 , date of birth  916 , exam type  918 , reason for visit and  comments  920 , ordering physician  922 , exam notes  924 , order date information  926 , and status dropdown  928 . Status drop down  928  includes different indications for the study review process, such as review requested, pending, or complete. 
     Assignment section  906  includes details for individual  930  and group  932  assigned to the study, and details on priority  938  and call request  940 . Individual  930 , group  932 , priority  938 , and call request  940  may be modified using individual drop down  934 , group drop down  936 , priority drop down  942 , and call request drop down  944 . 
     Assistance section  908  allows the user to request assistance. The request must include urgency selection  946  and contact selection  948 . When a request is submitted for assistance, completed button  950  is highlighted. 
     Communication section  910  shows all notes and communication added to the study. Communication section  910  also includes note text box  952  to submit additional notes to the study. Once a note is typed into note text box  952 , submit button  954  is selected to add the note to the study. 
     Demographics tab  956  shows the demographics of the exam and the order request. Demographics column  958  for the exam includes details regarding exam location  955 , exam type  960 , reason and comments  962 , priority and exam information  964 , medical record numbers  966 , patient information  968 , and image type  970 . Order column  972  includes requesting physician&#39;s information  974 , performing location  976 , and order date  978 . 
     Assignment tab  980  includes assignment section  981 , assignment history section  982 , and communication history  984 . Communication history  984  shows all notes added to the study. Assignment section  981  allows for assignment to an individual or group. The study assignment may be modified and reassigned using individual drop down  986  and group drop  down  988 . Assignment history section  982  shows all reassignments for the study. Communication history  984  also includes text box  994  and submit button  996  to type and to submit additional notes to the study. 
     Audit tab  997  shows summary column  998  of all edits made to the study, such as notes, assignments, and assistance requests. This tab is used to provide a summary of the study for productivity audits. 
     Detailed views of a study  900  also includes DICOM send tab  999 . DICOM send tab  999  allows a user to easily transmit patient data and images to a non-ordering physician or medical facility, which ensures data and image continuity and integration when managing and communicating this information to the other physician or facility. 
     It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept. It is understood, therefore, that this disclosure is not limited to the particular embodiments herein, but it is intended to cover modifications within the spirit and scope of the present disclosure as defined by the appended claims.