1. June, 2006What IHE Delivers 1 Donald Van Syckle President, DVS Consulting, Inc. www.dvsconsult.com IHE Eye Care “Evidence Documents”

2. June, 2006 2 Evidence Documents An extension of the Eye Care SWF profile (i.e. actors must support SWF before supporting Eye Care ED) Measurements, observations and coded data created using DICOM objects Typically created by either an Acquisition Modality or Evidence Creator (i.e. eye care instruments, standalone workstations, EMRs, etc.)

3. June, 2006 3 Evidence Documents Produced during acquisition or post-processing workflows May be Interpreted along with images or stand alone Either DICOM Structured Reports (SR) or DICOM Encapsulated PDF

4. June, 2006 4 Eye Care Evidence Documents Examples Glaucoma progression analysis performed on visual field analyzers RNFL analysis performed on an OCT device Measurements on fundus images Measurements on anteriour chamber OCT images for phakis IOL implantation planning Corneal ablation planning based on corneal topography maps Others….

5. June, 2006 5 DICOM Structured Report (SR) The DICOM object used by IHE for reporting Reports that include actual measurement values, observations and/or coded data to describe eye care evidence Eye Care specific DICOM SRs being defined by WG9 – IHE will adopt upon completion  Keratometer, Autorefractor, Lensometer, biometry, visual fields Note: Fundus measurements may be possible using Simple Image and Numeric DICOM SR, but has yet to be reviewed by WG9

6. June, 2006 6 Eye Care Extension DICOM Encapsulated PDF Also includes measurement values, observations and/or coded data to describe eye care evidence However, DICOM Encapsulated PDF is a “display only” solution Is used when no specific DICOM SR solution is defined Note - since there are no current DICOM SRs defined for Eye Care, it is expected that only DICOM Encapsulated PDF will be used in the AAO showcase

7. June, 2006 7 Evidence Documents Query / Retrieve Storage Commitment Evidence Document Stored

8. June, 2006 8 Images Evidence Documents Professional Report ….. Findings: Image Refs.: Header : Report Type: …… Retinal..... ….. Eye Care Impressions : ……. …... Interpretation

9. June, 2006 9 Managed Like Images Evidence Documents can be transferred, stored, and query/retrieve just like images Exists in the same study as images Patient Information Study Information Series Information Image SR Evidence Document Series Information DICOM Encp. PDF Series Information Other Composite IODs Patient ID Study Inst. UID Series Inst. UID SOP Inst. UID

10. June, 2006 10 ED a Part of Performed Procedure Step` Image Patient Imaging Serv. Req. (Order) Requested Procedure Scheduled Procedure Step Study Mgt Performed Procedure Step Study Series ED Image A PPS is an “Atomic Imaging/Measurements Exam” A PPS Starts and Ends. It is never resumed ! A PPS Starts and Ends. It is never resumed ! A PPS produces one or more series of images/evidence documents A PPS produces one or more series of images/evidence documents Once a PPS is completed, images/evidence documents cannot be added to a series Once a PPS is completed, images/evidence documents cannot be added to a series Additional PPS can always be performed Additional PPS can always be performed A Study usually holds the work product for a Requested Procedure A Study usually holds the work product for a Requested Procedure A Study may be multi-modality (I.e. multiple instruments) A Study may be multi-modality (I.e. multiple instruments)

11. June, 2006 11 Workflow

12. June, 2006 12 Example – Acquisition Modality Images have been taken at an Acquisition Modality After image acquisition, the Acquisition Modality performs post processing such as:  a glaucoma progression analysis  RNFL analysis performed on an OCT device  Others….. Evidence Documents are created using DICOM SR or DICOM Encapsulated PDF Evidence Documents are:  stored in the same Study as the images (in a separate series)  tracked using DICOM MPPS  sent to the storage server  securely stored using Storage Commitment

13. June, 2006 13 Example – Workstation, EMR Unscheduled post-processing done after the acquisition, products support both the Image Display Actor and Evidence Creator Actor Use DICOM query/retrieve to acquire previous images and/or measurements then perform post-processing  measurements on fundus images  corneal ablation planning based on corneal topography maps  measurements on anterior chamber OCT images for phakic IOL implantation planning  Others… Evidence documents are:  either DICOM SR or DICOM Encapsulated PDF  stored in the same study as created by the Acquisition Modality  sent to the storage server  securely stored using Storage Commitment

14. June, 2006 14 IHE Generic Keys for Query Retrieve of: - Images - Evid. Doc. - SR R = Required and the SCU shall be able to display R+ = IHE Requirement on top of DICOM

15. June, 2006 15 Extension for PDF Query How to store, query, retrieve for Evidence Documents is defined by SWF DICOM SR queries for Evidence Documents have been defined by radiology Eye Care added the storage and query for DICOM Encapsulated PDF  Added a new display field for the Image Display actors from query, the PDF “Document Title”

16. June, 2006 16 More information…. IHE Web site: www.ihe.net www.ihe.net Technical Frameworks  ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version)  ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version)  ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology)  ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology)  ihe_CARD_tf_vol2_2.1_FT (Cardiology) Standards used by IHE Eye Care  DICOM Standard www.nema.medical.org www.nema.medical.org  HL7 Standard www.hl7.org www.hl7.org IHE Connectathon Oct. 2006 at RSNA HQ IHE Showcase at Nov. 2006 AAO Conference Vendor Products Integration Statements

17. June, 2006 17