11.3 Imaging Informatics: HIS, RIS, EMR, PACS & DICOM

ARRT Sonography Primary

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1 Introduction & Exam Overview

1.1 Current Exam Facts & Logistics 1.2 Scoring, Section Minimums & the August 2026 Cut-Score Change 1.3 Official Blueprint & Study Strategy

2 Patient Care: Ethics, Legal Practice & Communication

2.1 Ethical & Legal Aspects of Patient Care 2.2 Interpersonal Communication & Patient Education 2.3 Physical Assistance, Monitoring & Sonographer Ergonomics

3 Patient Care: Safety, Emergencies & Infection Control

3.1 Medical Emergencies & Critical Findings 3.2 Infection Control & Hazardous Materials 3.3 Ultrasound Safety & Interventional Procedure Care

4 Image Production: Transducers & the Ultrasound Beam

4.1 Piezoelectric Effect & Transducer Construction 4.2 Beam Configuration: Near Field, Far Field & Focus 4.3 Transducer Types, Selection, Care & Malfunctions

5 Image Production: Pulse Characteristics & Resolution

5.1 Pulse Characteristics: PRF, PRP, SPL & Duty Factor 5.2 Resolution: Axial, Lateral, Temporal, Elevational & Contrast 5.3 Frequency, Bandwidth, Q Factor, Power, Pressure, Intensity & Amplitude

6 Image Production: Imaging Modes & Doppler Principles

6.1 B-Mode & M-Mode Imaging 6.2 Spectral Doppler: Pulsed Wave vs Continuous Wave 6.3 Color Doppler & Power Doppler

7 Image Production: Optimization Controls

7.1 Power, Gain, TGC, Depth & Focal Zone 7.2 Frame Rate, Line Density, Dynamic Range, Harmonics & Compounding 7.3 Doppler Optimization Controls

8 Image Production: Sound–Tissue Interactions

8.1 Speed of Sound & the Range Equation 8.2 Acoustic Impedance, Reflection, Refraction & Scattering 8.3 Attenuation, Absorption & Intensity

9 Image Production: Signal Processing, Display & Bioeffects

9.1 Receiver, Signal Processing & Analog-Digital Conversion 9.2 Postprocessing, Magnification, Panoramic & 3D/4D Imaging 9.3 Bioeffects & Output Display Measures

10 Image Production: Image Evaluation & Artifacts

10.1 Criteria for Diagnostic Quality & Annotation 10.2 Grayscale Artifacts 10.3 Doppler Artifacts

11 Image Production: Real-Time Interpretation & Informatics

11.1 Real-Time Imaging, Echogenicity & Echotexture 11.2 Color & Spectral Analysis: Measurements and Waveforms 11.3 Imaging Informatics: HIS, RIS, EMR, PACS & DICOM

12 Procedures: Abdominal & Transplant Vasculature

12.1 Aorta, Its Branches & the IVC 12.2 Portal Venous System & Hepatic Vasculature 12.3 Liver & Renal Transplant Sonography

13 Procedures: Liver

13.1 Liver Anatomy, Variants & Examination Technique 13.2 Diffuse Liver Disease 13.3 Focal Liver Lesions

14 Procedures: Biliary System, Pancreas & Spleen

14.1 Gallbladder & Bile Ducts 14.2 Pancreas 14.3 Spleen

15 Procedures: Urinary Tract, GI Tract & Other Abdominal Structures

15.1 Kidneys & Ureters 15.2 Bladder & Prostate 15.3 GI Tract, Adrenals, Lymph Nodes, Hernias & Peritoneal Cavity

16 Procedures: First-Trimester Obstetrics

16.1 Early Gestation: Normal Development & Structures 16.2 First-Trimester Measurements, Dating & Maternal Anatomy 16.3 First-Trimester Abnormalities

17 Procedures: Second/Third-Trimester Biometry & Fetal Survey

17.1 Standard Biometry: BPD, HC, AC, FL & Growth Assessment 17.2 Fetal Anatomic Survey: Head, CNS, Face & Spine 17.3 Fetal Anatomic Survey: Heart, Chest, GI, GU, Skeleton & Fetal Position

18 Procedures: Chromosomal, Genetic & Structural Abnormalities

18.1 Chromosomal & Genetic Abnormalities 18.2 Major Structural Anomalies by System 18.3 Fetal Infection, Neoplasms & Hydrops

19 Procedures: Placenta, Amniotic Fluid, Cord & Cervix

19.1 Placenta: Normal, Previa, Abruption & Accreta 19.2 Amniotic Fluid Assessment & Growth Disorders 19.3 Umbilical Cord & Cervical Assessment

20 Procedures: Fetal Assessment, Doppler & Multiple Gestation

20.1 Biophysical Profile & Fetal Surveillance 20.2 Fetal & Uteroplacental Doppler 20.3 Multiple Gestations, Assisted Reproduction & Maternal Disease

21 Procedures: Gynecology — Uterus

21.1 Uterine Anatomy, Myometrium & Fibroids 21.2 Endometrium: Cyclic Changes, Hyperplasia & Cancer 21.3 Cervix & Congenital Uterine Anomalies

22 Procedures: Gynecology — Adnexa & Pelvis

22.1 Ovaries: Normal, Functional Cysts & Benign Masses 22.2 Ovarian Malignancy, Torsion & Fallopian Tubes 22.3 Cul-de-Sac, Vagina & Pelvic Floor

23 Procedures: Neck & Scrotum

23.1 Thyroid & Parathyroid 23.2 Salivary Glands & Neck Lymph Nodes 23.3 Scrotum & Testes

24 Procedures: Breast & Peripheral Vascular

24.1 Breast & Axilla 24.2 Venous Extremity Doppler 24.3 Carotid Doppler & Post-Catheterization Complications

25 Procedures: Pediatric, Interventional & Miscellaneous

25.1 Neonatal Head, Spine & Hip Sonography 25.2 Pediatric GI & Noncardiac Chest 25.3 Ultrasound-Guided Interventions, MSK & Superficial Masses

11.3 Imaging Informatics: HIS, RIS, EMR, PACS & DICOM

Key Takeaways Explain This Topic AI

The HIS manages hospital-wide functions (admission, demographics, billing, orders), the RIS manages imaging-department operations (scheduling, tracking, reporting), and the EMR/EHR holds the patient's longitudinal clinical record

PACS (Picture Archiving and Communication System) provides storage, retrieval, display, and distribution of imaging studies, replacing film-based archives

DICOM (Digital Imaging and Communications in Medicine) is the universal standard for both the image file format and the network communication between modalities, PACS, and workstations

The ultrasound system queries the DICOM modality worklist to pull scheduled patient demographics and order details from the RIS, eliminating manual data-entry errors

Teleradiology transmits DICOM studies to off-site readers or third-party coverage services, enabling subspecialty interpretation and after-hours coverage

Last updated: July 2026

Information Systems: HIS, RIS, and the Electronic Record

A hospital runs on several layered information systems, and exam questions expect you to assign each system its correct role.

System Full Name Primary Role

HIS Hospital Information System Enterprise-wide administration: admission/discharge/transfer, patient demographics, registration, billing, and order entry

RIS Radiology Information System Imaging-department operations: exam scheduling, patient tracking, workflow management, and radiology reporting/results distribution

EMR Electronic Medical Record The digital chart of a patient's care within one organization — history, notes, medications, results

EHR Electronic Health Record The broader, interoperable record designed to follow the patient across organizations and providers

The distinction that matters clinically is orders and results flow . A provider typically places an imaging order through computerized provider order entry into the HIS or EMR; the order populates the RIS, where the exam is scheduled and tracked; and when the study is finalized, the radiology report is sent back from the RIS into the EMR/EHR, where the ordering clinician reads it. The EMR versus EHR nuance is worth remembering: the EMR is the record within a single practice or hospital, while the EHR is conceived as shareable across health systems. Sonographers interact with these systems daily when verifying patient identity and orders, reviewing the clinical indication and prior reports before scanning, and entering technologist notes or worksheets that become part of the permanent record.

• Networking: PACS, DICOM, and Teleradiology
• PACS

A PACS (Picture Archiving and Communication System) is the networked system responsible for the storage, retrieval, display, and distribution of medical images. It replaced film libraries: instead of printing sheets of film, the ultrasound system transmits the study over the network to the PACS archive, from which radiologists, sonologists, and referring clinicians pull the images onto diagnostic or clinical workstations. Key functions include short- and long-term archive, query and retrieval of priors for comparison, and distribution of images alongside the final report.

DICOM

DICOM (Digital Imaging and Communications in Medicine) is the universal standard that makes all of this interoperable. It defines two things: (1) the file format for medical images, which embeds the image data together with a header of metadata — patient name and ID, accession number, study description, date, and technical parameters — and (2) the communication protocol by which modalities, workstations, and PACS exchange those objects over the network. Because every compliant device "speaks" DICOM, an ultrasound machine from one manufacturer can store to a PACS from another.

One DICOM service deserves special emphasis: the modality worklist (MWL) . Rather than typing patient demographics into the ultrasound system by hand, the sonographer queries the worklist and the scanner pulls the day's scheduled patients — names, medical record numbers, accession numbers, and ordered exam types — from the RIS. Technically the modality is the querying party (it issues a C-FIND request), not a passive recipient of a push. Selecting the patient from the worklist guarantees the images are labeled with identifiers that exactly match the RIS and the order, which prevents transcription errors and misfiled studies. Manually keyed demographics, by contrast, are a classic source of unmatchable or misassigned exams.

Teleradiology

Teleradiology is the transmission of DICOM studies to readers at a remote location for interpretation. Its two common forms tested on the exam: off-site reading , in which radiologists interpret from home or a remote reading room, and third-party coverage services (sometimes called nighthawk services), in which an external group provides preliminary interpretations during nights, weekends, or staffing gaps. Teleradiology also gives small or rural sites access to subspecialty expertise; secure transmission and proper licensure of the remote reader are required.

Workflow: From Order to Archived Report

A complete imaging encounter threads every system together:

• Order — the clinician enters the exam request (with indication) into the HIS/EMR
• Schedule — the order arrives in the RIS, which assigns an accession number and schedules the slot
• Worklist — the DICOM modality worklist delivers the scheduled patient to the ultrasound machine
• Acquire — the sonographer selects the patient from the worklist, scans, annotates, and ends the study
• Store — images transmit via DICOM to PACS; the study status updates in the RIS
• Interpret — the radiologist/sonologist reads from PACS and dictates the report into the RIS

Distribute — the signed report flows from the RIS back into the EMR/EHR for the ordering provider; images and report remain archived in PACS for future comparison

Data Integrity and Downtime Basics

Informatics questions also touch on keeping data safe and working when systems fail. Core principles:

Data integrity — images and reports must be accurate, complete, and matched to the correct patient; the worklist and standardized DICOM headers exist precisely to protect this. Verify at least two patient identifiers before scanning and confirm the images landed in PACS before the patient leaves.

Security and privacy — access is role-based and audited under HIPAA; only authorized users may view or modify records, and removable media containing images must be protected.

Downtime procedures — when the RIS/PACS or network is unavailable, departments switch to a documented downtime plan: paper requisitions and worksheets, manual patient identifiers written carefully, local storage of images on the modality, and — critically — reconciliation after systems recover, meaning the locally stored studies are sent to PACS and matched to the proper orders so nothing is lost or misfiled.

For the exam, map each acronym to its job, keep the workflow order straight, and remember that the modality worklist is the error-prevention bridge between the RIS and the scanner.