1. DICOM INTERNATIONAL DICOM INTERNATIONAL CONFERENCE & SEMINAR April 8-10, 2008 Chengdu, China Applications of DICOM SR Andrei Leontiev Dynamic Imaging Solutions, GE Healthcare Add logo if desired

2. Structured Reporting DICOM Structured Reporting (SR) is an encoding for non-imaging content: –evidence information generated in a course of medical imaging acquisition, –diagnostic reports, –other types of documentation

3. DICOM SR Document Each SR object represents a document; the content of a document is a tree of Content Items connected via different types of relationships As other DICOM objects, SR Document is composite object fitting Patient- Study-Series hierarchical model

4. Content Items and Relationships The Content Item is a node of the SR Document Provides a name-value pair, i.e., a Concept Name, and a Concept Value. The Concept Name is a code identifying the concept the Content Item represents The Concept Value may be of different Value Type, including text, personal name, numeric, and coded concept values.

5. Data Types Content Items may represent: –Text (words, sentences or paragraphs) –NUMERIC (measurements) –Dates, times –Person Names –References to images and other objects –Spatial and time coordinates –Codes –Containers (groups of other items)

6. Coded Entries Coded values for Content Items provide for ability to use vocabularies to convey content Vocabularies used: –DICOM Content Mapping Resource –SNOMED –Subject-specific coded schemes

7. SR Tree

8. Chest X-Ray has concept modifier Views=PA and Lateral Recording Observer=Smith^John^^Dr^ Study Instance UID …=1.2.3.4.5.6.7.100 Patient-Data-Acquisition-Subject=Homer^Jane^^^ Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4.2) Baseline Image Conclusions conclusion=probable malignancy inferred from 1.4.2 inferred from 1.7.1 Specific Image Findings best illustration of findings(1.7.1). Slide by D. Clunie Sample Report

9. CODE SCOORD CODE “Chest X-Ray” “Recording Observer”=“Smith^John^^Dr^” “Study Instance UID...”=“1.2.3.4.5.6.7.100” Context “… Acquisition Subject”=“Homer^Jane^^^” “Finding”=“Mass” Contains “Baseline”= Contains “Conclusions” Contains “Specific Image Findings” Contains “Views”=“PA and Lateral” Modifier Context “diameter”=“1.3” “cm” Properties “margination”=“infiltrative” Properties “conclusion”=“probable malignancy” Contains “best illustration of findings”= Contains Sel d From Inf d From CONTAINER PNAME UIDREF PNAME CODE NUM IMAGE CODE 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.4.1 1.4.2 1.6.1 1.7.1 1.7.1.1 1.6.1.1 1.6.1.2 Slide by D. Clunie

10. Relationships Relationships between nodes convey meanings of: –Containment –Observation Context –Modification/clarification of the Concept Code –Derivation of content of one Item from other item(s)

11. Observation Context The content of an SR document exists in Observation Context –Initially provided by Patient/Study/Series/Instance level attributes –Inherited by all nodes in tree hierarchy –Can be overridden for each node

12. Templates To define appropriate structure for specialized applications, DICOM defines templates. Templates may be applied to: –Generic SOP Classes (Basic Text, Enhanced, Comprehensive) –Specialized SOP Classes (Mammo CAD, Chest CAD Templates may be extensible and non- extensible

13. CONTAINER Finding Heading CONTAINER Finding Heading Typical Top Level Template Structure CONTAINER Document Title CONTAINER Patient Characteristics … … Template specified title OB-GYN, Adult Echo, IVUS Ultrasound Vascular, Cath/Hemo … TID 1002 Observation Context CONTAINER Summary … Other Context e.g. procedure CONTAINER … … Summary Findings CONTAINER Findings Heading Findings … Slide by D. Sluis

14. Key Object Selection Documents Initiated by the desire to have simple Key Image Note Developed as generic “manifest” – collection of pointers to images (or even specific frames) Specifies intent of selection, simple textual note Non-extensible template

15. Key Image Notes One use of KOSD is to attach « electronic post-it™ » to images to communicate: –specific examination events –image quality issues –consultancy KOSD can be stored in the archive and later retrieved

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

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

18. Diagnostic Reports SR infrastructure supports creation and interchange diagnostic report documents: –Simple structure of section headings and paragraphs –More coded entries on different levels to support data mining and statistical analysis –Measurements, image references, etc.

19. Simple Dx 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

20. Added Measurements Adds Measurements to Simple Image Reports

21. ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Workflow of SR objects Interpretation ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Dx Report Evidence Documents Key Image Notes

22. Link into IT world DICOM SR structure can be transcoded into HL7 CDA XML-based document structure Allows for creation of DICOM SR documents with subsequent emnterprise distribution as CDA documents Both structures allow cross-referencing of documents (images, reports, etc.) in other encoding.