Deletions and corrections

When images have to be withdrawn after they were sent (poor quality, the wrong patient, the wrong worklist entry, or their retention ending), the PACS or modality sends a rejection note: a Key Object Selection document titled Rejected for Quality Reasons, Rejected for Patient Safety Reasons, Incorrect Modality Worklist Entry or Data Retention Policy Expired, listing the instances it withdraws. Corrected images, if any, follow as new instances. This is the IHE Imaging Object Change Management (IOCM) profile.

The router makes sure the note reaches every system that has the images, not only the destinations of the route it arrives on:

• It goes where the images went. The node asks the central history which destinations received the rejected instances, or are about to, from any node, and sends the note there as well as to its route’s destinations. A de-identified destination gets the note de-identified the same way, so it still names the images it got.
• Rejected images stop here. Rejected instances still waiting in any of the node’s queues are taken off them and recorded as discarded (“Rejected by a rejection note”), and those held for their study are dropped, so they are never sent after the note. Instances being sent at that very moment still go; the note follows them.
• Nothing goes halfway. If the central service cannot be reached to find out where the images went, the note is refused with a processing failure, and the sender sends it again later.
• The note is never held for its study, reconciled or treated as an AI result. Each one is written to the audit log (who sent it, why, how many instances, where it went).

Routes need a source that accepts the notes from the PACS or modalities that send them, like any other instance: a route that takes them to the destinations that should always have them.