HIMSS/RSNAApril 2003 Workshop What is a DICOM Structured Report Object ? A “Persistent Document” which: Provides “semantic” documentation of diagnosis Provides context such as: scheduled procedure, observer, current and previous images Link text and codes with images, and measurements Coded entries using standardized or private lexicons Flexible enough to address: – Minimally structured radiology reports (IHE Simple Image and Numeric) – More advanced and specialized reports ( obgyn, mammography, etc.) – Beyond radiology imaging (cardiac cath logs, etc.) Facilitates computer outcomes analysis
HIMSS/RSNAApril 2003 Workshop Simple Image & Numeric Reports Based on DICOM SRBased on DICOM SR Allows to include without transcription: - measurements - image links - structured contentAllows to include without transcription: - measurements - image links - structured content Integrated with the imaging workflowIntegrated with the imaging workflow Friendly to XML implementationsFriendly to XML implementations Easy to export to the EPR (HL7)Easy to export to the EPR (HL7)
HIMSS/RSNAApril 2003 Workshop What Isn’t DICOM SR?... it isn’t a document presentation standard! MALIGNANCY Based on: MASS Size: 7mm Shape: irregular Margin: spiculated Associated with: CALCIFICATION Type: Heterogeneous Type: Branching Distribution: Grouped
HIMSS/RSNAApril 2003 Workshop Actors and Transactions Acq.Modality Report Creator Report Mgr Evidence Docs (DICOM SR) Measurements, Image Analysis, etc. ReportReposit. Formal Reports (DICOM SR) ReportReader External Report RepositoryAccess Enterprise Report Repository HL7 Text Reports Electronic Patient Record Imaging Department RIS/PACS Formal Reports (DICOM SR) Other Departments Repositories Workstations Evidence Creator ImageManager Images Workstations
HIMSS/RSNAApril 2003 Workshop SR Is Managed Like Any Other DICOM Object Patient Information Study Information Series Information Image Series Information SR Document Information Series Information Presentation State Series Information Other Composite IODs Patient ID Study Inst. UID Series Inst. UID SOP Inst. UID Images, SR Documents, Presentation States, Stored Print, etc. can exist in same Study
HIMSS/RSNAApril 2003 Workshop Report Creator Provides user interface to create new reports including setting status flags - “Completion Flag” and “Verification Flag” Configurable coded entries (Title, Headings, etc.) May reference images in report content Must support “Identical Documents Sequence” if necessary Creates Basic Text SR with TID 2000 object OR Creates Enhanced SR with TID 2000 object (when including measurements) Stores report in Report Manager using: – Basic Text SR Storage SOP class; OR – Enhanced SR Storage SOP class; OR both
HIMSS/RSNAApril 2003 Workshop Report Manager Receives reports from Report Creator Supports Basic Text SR with TID 2000 objects Supports Enhanced SR with TID 2000 objects (optional) May forward reports to Report Repository at any time Must allow users to set status flags - “Completion Flag” and “Verification Flag” Other modifications and report manipulation is possible – Amending reports – Merging reports – Additional content – etc. All changes require new SOP Instance UID Must send final (verified) reports to Report Repository
HIMSS/RSNAApril 2003 Workshop Report Repository Receives reports from Report Manager Supports Basic Text SR and Enhanced SR objects Responds to Query and Retrieve requests from Report Reader to sends reports to Report Reader
HIMSS/RSNAApril 2003 Workshop Report Reader Provides user interface to view reports Allows user to select report from either Report Repository or External Report Repository Access via DICOM Query/Retrieve mechanisms Supports Basic Text SR objects Supports Enhanced SR objects (optional) Must show any object references May retrieve and display image objects if grouped with Image Display Must support SCU query keys in following table - allows user to filter for particular reports
HIMSS/RSNAApril 2003 Workshop External Report Repository Access Allows radiology to access reports generated outside radiology, for example Laboratory Converts external report to DICOM SR objects Supports Basic Text SR objects Supports Enhanced SR objects (optional) Assumes consistent Patient ID with radiology May create Study, Series, and Instance UIDs and must conform to DICOM UID rules Must provide consistent UIDs - if same report is queried and retrieved several times, then the same UIDs shall be used Must support same Instance level query keys as Report Repository but reduced set of keys for Patient, Study, and Series levels
HIMSS/RSNAApril 2003 Workshop Enterprise Report Repository Receives final reports (verified/signed) from Report Manager. Actor may be implemented by a Clinical Patient Record, or any other systems. Report Manager converts/presents Simple Image and Numeric Reports (DICOM SR objects) as an HL7 ORU Message (OBX Segments). IHE does not define the mapping of the structured content of DICOM SR in non structured ASCII Text in OBX segments. This presentation is created by the Report Manager. Assumes consistent Patient ID/Order Numbers managed by the same ADT and Order Placer. In addition to ASCII Text, receives the « links » to native DICOM objects so that Enterprise Report Repository may retrive native images and structured report.
HIMSS/RSNAApril 2003 Workshop SR Document Tree Single Root Content Item Followed by nested Content Items Root Content Item Content Item
HIMSS/RSNAApril 2003 Workshop SINR with Basic SR 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
HIMSS/RSNAApril 2003 Workshop SINR with Advanced SR Simply adds Measurements to Simple Image Reports
HIMSS/RSNAApril 2003 Workshop Report Pattern - Observation Context Required only when the Observation Context is different from the default. Fully defined in TID 1001 and related Templates in Supplement 53. An Example : Who : ObserverWho : Observer What : Observed EvidenceWhat : Observed Evidence Subject : Patient/Fœtus/SpecimenSubject : Patient/Fœtus/Specimen
HIMSS/RSNAApril 2003 Workshop An Illustration Chest, PA & Lateral (GCS,T78) Chest, PA & Lateral (GCS,T78) Procedure PA and Lateral radiographs were ……. Conclusions Possible Mass (ICD,XXX) Findings The PA demonstrates... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Dr Andrew Smith ……. George Jones …...
Content Items and Relationship ‘Chest PA & LAT’ (GCS,T78) Document Title ‘Chest PA & LAT’ (GCS,T78) ‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Text ‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Contains ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Code ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Contains ‘Procedures’ (GCS,H12) Document Heading ‘Procedures’ (GCS,H12) ‘Conclusions’ (GCS,H56) Document Heading ‘Conclusions’ (GCS,H56) Document Heading ‘Findings’ (GCS,H34) ‘findings (GCS,H34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended.’ Text ‘findings (GCS,H34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended.’ Contains Inferred From Instance UID=220.127.116.11 Image Reference Instance UID=18.104.22.168 ‘Smith^Andrew^^Dr’ Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context ‘Jones^George’ Observation Subject ‘Jones^George’ Has Obs. Context
HIMSS/RSNAApril 2003 Workshop Document Title ‘Chest PA & LAT’ (GCS,T78)
HIMSS/RSNAApril 2003 Workshop Diagnostic Report Titles Defined by DICOM Part 16 May be extended
HIMSS/RSNAApril 2003 Workshop Diagnostic Report Headings Defined by DICOM Part 16 May be extended
HIMSS/RSNAApril 2003 Workshop Status and Verifying Attributes Completion Flag - PARTIAL or COMPLETE – how to set the flag is open to implementation Completion Flag Description - free form text Verification Flag - UNVERIFIED or VERIFIED Verifying Observer Sequence – identifies person(s) verifying the document and organization(s); required if flag = VERIFIED Prevailing final version = most recent Verification DateTime, VERIFIED, COMPLETE
HIMSS/RSNAApril 2003 Workshop SR IODs Basic Text SR IOD – Minimal usage of coded entries – Reference to SOP Instances restricted to leaves from text tree – No by-reference Content Items (i.e. by-value only) Enhanced SR IOD – superset of Basic Text but extended to include measurements, spatial and temporal regions of interest Comprehensive SR IOD – superset of Basic Text and Enhanced, references to leaves not restricted and includes by-reference Content Items
HIMSS/RSNAApril 2003 Workshop Simple Image and Numeric Report Report content is more than words….. With IHE, it is possible to add value to reporting with input from modalities and image processing applications (e.g. Measurements). This IHE Integration Profile is the cost effective solution for sharing reports and inclusion of image enabled reports into the Electronic Patient Record.
HIMSS/RSNAApril 2003 Workshop Questions? Documents Available On the Web at: www.rsna.org/IHEwww.rsna.org/IHE