1. DICOM SR: Evidence Documents Key Image Notes Simple Image and Numeric Reports Rita Noumeir, Ph.D. Professor, University of Quebec

2. Evidence Documents

3. Evidence Documents Value proposition Measurements and coded data –DICOM SR document Created by either Acquisition Modality or Evidence Creator Produced during acquisition or post- processing workflows Interpreted along with the images

4. Evidence Documents Workflow ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Evidence Document Stored Storage Commitment Query / Retrieve

5. Evidence Documents Examples Mammography CAD Chest CAD OB-Gyn Ultrasound Measurements Vascular Ultrasound Measurements Vascular Intervention Results Echocardiography Measurements

6. Key Image Notes

7. Key Image Notes Value proposition There is more to teamwork than images and reports With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between: –The Technologist and the Radiologist about specific examination events –The Radiologist and the Technologist about image quality issues –The Radiologist and other department clinicians (surgeon, orthopedist,..) –The Radiologist and collegues about selecting images for conferences –The Radiologist to the Referring Provider, …..etc. Query for the KIN using title codes

8. Key Image Notes Use cases “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me” –Thinking… “#$@%!%# You”, says “Sure”#$@%!%# You “Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those” Tech to radiologist: “The patient wouldn’t hold still”

9. for referring physician Here you can see the renal osteopathy. For teaching Fibroosteoclasia

10. Different notes on different images for referring physician Here you can see the renal rupture. Note1 for referring physician This is the hematoma. Note2 for refering physician Here you can see the renal rupture. Note1 for refering physician This is the hematoma. Note2

11. for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for referring physician Hematoma everywhere Note3 Same note on different images

12. Key Image Notes Titles & Codes Defined by DICOM. May be extended The note title defines the semantics of the reason of significance. Key Image Notes can be queried by code. The user comments are meant to be informal. Codes Of Interest Rejected for Quality Reasons For Referring Provider For Surgery For Teaching For Conference For Therapy For Patient For Peer Review For Research Quality Issue For Reporting

13. Simple Image & Numeric Report

14. Can you make a report like this: Institution Identification Patient Identification Study Identification Technique Identification Discussion The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal. Impression CT of the abdomen within normal limits Signature

15. Simple Image & Numeric Report Or like this: Discussion Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal. Impression Worsening L Paratracheal adenopathy. Signature

16. Simple Image & Numeric Report Value proposition Reports’ content is more than words… Based on DICOM SR Allows to include without transcription: –measurements –image links –structured content Integrated with the imaging workflow Friendly to XML implementations Easy to export with HL7

17. Simple Image & Numeric Report Pattern – Simple Image Report Minimal Structure : Coded Title and HeadingsMinimal Structure : Coded Title and Headings Full image links from specific sections of reportFull image links from specific sections of report Observation Context (who, what, when) may be section specificObservation Context (who, what, when) may be section specific

18. Simple Image & Numeric Report Pattern Simply adds Measurements to Simple Image Reports

19. Simple Image & Numeric Report an illustration

20. Evidence Documents Key Image Notes Simple Image & Numeric Report Interpretation ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Simple Image & Numeric Report Evidence Documents ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Key Image Notes