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Dr Christel DANIEL IHE Anatomic Pathology co-chair IHE Anatomic Pathology DICOM WG26 IHE Anatomic Pathology - San Diego 2011.

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Presentation on theme: "Dr Christel DANIEL IHE Anatomic Pathology co-chair IHE Anatomic Pathology DICOM WG26 IHE Anatomic Pathology - San Diego 2011."— Presentation transcript:

1 Dr Christel DANIEL IHE Anatomic Pathology co-chair IHE Anatomic Pathology DICOM WG26 IHE Anatomic Pathology - San Diego 2011

2 Agenda Results of recent IHE efforts PathLex Better use of DICOM in Anatomic Pathology workflow – DICOM Modality Work list IHE Anatomic Pathology - San Diego 2011

3 Overview Intra hospital integration profiles – Anatomic Pathology Workflow (APW) Ordering and performing anatomic pathology examinations Community – Anatomic Reporting for Public Health (ARPH) Sending anatomic pathology reports to public health organizations – Anatomic Pathology Structured Report (APSR) Sharing/exchanging structured anatomic pathology reports as CDA documents IHE Anatomic Pathology - San Diego 2011

4 Organization of Anatomic Pathology Technical Framework Revision 2.0 July 23, 2010 Draft for Trial Implementation 2010 & 2011 Supplements for Trial Implementation IHE Anatomic Pathology - San Diego 2011

5 Anatomic Pathology Workflow (APW) Establishes the integrity of basic pathology data acquired for examinations being ordered for an identified patient Defines the actors and transactions involved in – Ordering and reporting aspects of the workflow Order entry, report creation and transmission. – Imaging aspects of the workflow Image acquisition, storage and distribution among multiple systems. IHE Anatomic Pathology - San Diego 2011

6 Anatomic Pathology Workflow (APW) Order Placer Image Mgmt Acquisition Modality Order Mgmt Order Filler Care WardAnatomic Pathology Laboratory Hospital Image Archive/ Image Manager (PACS) Order result tracker Report Mgmt IHE Anatomic Pathology - San Diego 2011

7 APW actors & transactions IHE Anatomic Pathology - San Diego 2011

8 Standards used HL7 v2.5 – OML^O21/ORL^O22 (PAT-1, 2 &4) – ORU^R01 + report (PAT-3) DICOM – DICOM 2003 PS 3.4: Modality Worklist SOP Class (PAT-5 & 6) – DICOM 2007 PS 3.4: Storage Service Class – DICOM 2007 PS 3.4: Storage Commitment Push Model SOP Class – DICOM 2007 PS 3.4: Query/Retrieve Service Class – Supplement 122 : Specimen Identification Module and Revised Pathology SOP Classes – Supplement 145 : Whole Slide Image Information Object Definition (WSI IOD) IHE Anatomic Pathology - San Diego 2011

9 Test cases Different « subspecialties » – Surgical pathology (4 cases) – Biopsies (2 cases) – Cytopathology (2 cases) – Autopsy (1 case) – TMA (1 case) Complex relationships specimen/container – 1 specimen per container – Several specimen per container IHE Anatomic Pathology - San Diego 2011

10 Test cases Specimen model : Usual situation Specimen can be identified by containers ID Gross imaging Virtual slide IHE Anatomic Pathology - San Diego 2011

11 Test cases Unusual situation: Tissue Micro Array More than one derived specimen on slide coming from the different blocks coming from different parts and from different patients IHE Anatomic Pathology - San Diego 2011

12 Anatomic Pathology Reporting to Public Health (ARPH) Joint initiative : IHE AP, HL7 AP, NAACCR (North American Association of Central Cancer Registries), CDC (Centers for Disease Control). Defines the actors and transactions involved in anatomic pathology reporting to public health organizations. Global Perspective of Cancer Surveillance – International Association of Cancer Registries 241 Registries (Voting Member) from all 6 continents – North American Association of Central Cancer Registries All Canadian Provinces All US States All US Territories and Jurisdictions IHE Anatomic Pathology - San Diego 2011

13 Order Filler Care WardAnatomic Pathology Laboratory Report Sender Hospital Anatomic Pathology Reporting to Public Health (ARPH) Healthcare community Report Receiver Public Health Report Mgmt Report Sender Anatomic Pathology Laboratory Clinics

14 ARPH actors & transactions IHE Anatomic Pathology - San Diego 2011

15 Standards used HL7 v2.5 – ORU^R01 message (PAT-10) LOINC SNOMED CT NAACCR* – Standards for Cancer Registries Volume V: Pathology Laboratory Electronic Reporting v3.0 – Search Term List International Classification of Diseases, 10th rev (and 9th rev) *NAACCR - North American Association of Central Cancer Registries (www.naaccr.org) IHE Anatomic Pathology - San Diego 2011

16 Anatomic Pathology Structured Report (APSR) Joint IHE and HL7 anatomic pathology initiative Content integration profile standardizing Anatomic Pathology Structured Report (APSR) using HL7 CDA – APSR as CDA documents including Anatomic Pathology observations bound to images or regions of interest – Shared or exchanged within a community of care providers using existing integration profiles defined by IHE Information Technology Infrastructure Unique opportunity to share/exchange Anatomic Pathology Structured Reports that are semantically interoperable at an international level IHE Anatomic Pathology - San Diego 2011

17 Scope APSR for surgical pathology – 21 CDA templates Generic APSR template – All fields of anatomic pathology (inflammatory, vascular, traumatic, metabolic diseases as well as cancer) 20 organ-specific cancer APSR templates – Traditional anatomic pathology observation using light microscopy (including immunohistochemistry, FISH, etc) Further cycles – Forensic (autopsy, toxicology) – Special ancillary techniques (flow cytometry, cytogenetics, electronic microscopy) – Research (TMA, etc) IHE Anatomic Pathology - San Diego 2011

18 Background From clinical document models… Recent recommendations for required, preferred, and optional elements for any APR of surgical pathology, regardless of report types [Goldsmith 08] National initiatives – Anatomic Pathology SR (Netherlands, Germany, Australasia) – Cancer APSR US - CAP (College of American Pathologists) – 67 cancer checklists and protocols (October 2009) France - SFP (French society of pathology) – INCa (French National Cancer Institute) – Minimum data sets for cancer APSR in 20 locations (85% of new cancers in France) (required by accrediting bodies) Australasia – 6 templates for cancer APSR UK Royal college Goldsmith, J.D., et al., Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, (10): p

19 Background … to IT templates Non healthcare IT standard – CAP electronic Cancer Checklist Healthcare IT standard – CEN archetypes Australia – HL7 CDA Most reliable standard for clinical document templates Existing implementation guides for the APSR ? – Netherlands, Germany IHE Anatomic Pathology - San Diego 2011

20 Order Filler Care Ward Anatomic Pathology Laboratory Document Source Hospital Anatomic Pathology Structured Report (APSR) Healthcare community Document Repository Document sharing Anatomic Pathology Laboratory Clinics Document Source

21 APSR actors & transactions Content (Anatomic Pathology Structured Report) is created by a Content Creator consumed by a Content Consumer. Sharing or transmission of content from one actor to the other – XDS, XDM and XDR Integration Profiles, described in Volume 3 of the Anatomic Pathology Technical Framework. IHE Anatomic Pathology - San Diego 2011

22 CDA Document Content Module (n=21) Any APSR CDA document content module is composed of a header and a structured body. 2 types of CDA Document Content Modules Generic APSR ( ) 20 organ-specific cancer APSR IHE Anatomic Pathology - San Diego 2011

23 CDA Section Content Modules (n=6)

24 CDA Entry Content Module (n=5) e.g Diagnosis entry Diagnoses on all specimens that are delivered to the pathology reported separatly Additional pathologic finding(s), results of ancillary studi(es) & images In case of cancer, this section includes the cancer checklists

25 Anatomic Pathology Observation [0..*] (zero to many response) coded (code, coding system, version, display name) [0..*] (post coordinated expression) numeric (integer or real, unit) textual

26 The CDA Iceberg Pathologist/clinician sees Machine sees IHE Anatomic Pathology - San Diego 2011

27 The pathologist/clinician sees… IHE Anatomic Pathology - San Diego 2011

28 The pathologist/clinician sees… IHE Anatomic Pathology - San Diego 2011

29 The machine sees…...remainder of the header not shown... Relevant information provided by the ordering physician Tissue submitted: left breast biopsy and apical axillary tissue... Reason for anatomic pathology procedure Breast mass - left breast... IHE Anatomic Pathology - San Diego 2011

30 DICOM Modality Work list Better use of DICOM in Anatomic Pathology workflow IHE Anatomic Pathology - San Diego 2011

31 What is anatomic pathology? It is not radiology Order – => report Imaging procedure step is optional Specimen-driven – One study = one or more specimen (one or more patients) – Slides always available Order – => imaging procedure => report Patient driven – One study = one patient IHE Anatomic Pathology - San Diego 2011

32 Modality Work list: Requested procedure, accession number & Study Order & Requested procedure – The Order Filler translates the received Orders into Requested Procedure(s) identified by Order Filler Numbers and automatically assigns Study Accession Numbers Accession number Order Filler Number – The unique identifier assigned by the Pathology Information System of an Anatomic Pathology laboratory to an imaging Study. – As expressed in DICOM Supplement 122: The concept of accession in Anatomic Pathology has been determined to be sufficiently equivalent to an accession in Radiology so that the existing Accession Number at the Study level may be reused for the same purpose and with essentially the existing definition. – For Anatomic Pathology, like in Radiology, the Accession Number may correspond to the Order Filler Number, as specified in HL7 v2.x. IHE Anatomic Pathology - San Diego 2011

33 Modality Work list Procedure step & Series Procedure Step – A Procedure Step (Work Order Step) is an atomic operation belonging to Requested Procedure, to be performed on one specimen by a single type of device (e.g. immune-histo-chemistry automaton, staining automaton, image acquisition modality). Some Procedure Steps are dedicated to image acquisition Series – A subset of an imaging Study acquired from a single specimen by a single acquisition modality. – Whenever an image is acquired from a new specimen or involves a new acquisition modality a new Series is created. – A new series is also created when an image is acquired for an existing study after the original order has been fulfilled. IHE Anatomic Pathology - San Diego 2011

34 Modality Work list Requested procedures & procedure steps OR123: Lungectomy – DP07110: Lungectomy DP07110-A: Left upper lobe (gross image) – DP07110-A-1: Frozen section, mass DP07110-A-1-1: FS DP07110-A-1-2: H&E – DP07110-A-2: Entire mass DP07110-A-2-1: H&E (WSI) IHE Anatomic Pathology - San Diego 2011 Order Study Case OrderFiller ID Accession Number = One Requested procedure Study Case OrderFiller ID Accession Number = One Requested procedure Two procedure steps Series Two (imaging) procedure steps Series Two (imaging) procedure steps

35 Modality Work list Requested procedures & procedure steps Order : AP examination of Breast biopsy – Requested procedure : Imaging of AP examination of Breast biopsy (at the patient level) = ACCESSION NUMBER = OrderFiller ID (Imaging) procedure step: scanning Slide DP07110-A-5-1 (at the specimen/derived specimen level) Order : Mammography – Requested (imaging) procedure : mammography (at the patient level) = ACCESSION NUMBER = OrderFiller ID IHE Anatomic Pathology - San Diego 2011

36 Modality Work list – A mechanism defined to support the imaging workflow, by which the Patthology Information System provides the attributes of the imaging subject to modalities. – In anatomic pathology, the imaging subject is a specimen derived from the patient. – Query Modality Worklist: Based on a query entered at the Acquisition Modality, a modality worklist is generated listing all the items that satisfy the query. This list of Scheduled Procedure Steps with selected demographic information and information about specimen is returned to the Acquisition Modality. The Modality Worklist provides patient, order (study) and specimen identification and description to be included in the acquired images. The attributes of the Specimen Module have been defined in a Macro construct, and added to the Scheduled Procedure Step Module of Modality Worklist. IHE Anatomic Pathology - San Diego 2011

37 Modality Work list Requested procedures & procedure steps Order : AP examination of Breast biopsy – Requested procedure Procedure step: scanning Slide DP07110-A-5-1 Worklist (attributes of the imaging subject) – List of requested procedures (patient/study level) – List of procedure steps (specimen/series level) Order : Mammography – Requested (imaging) procedure : mammography Worklist (attributes of the imaging subjec ) – List of requested procedures (patient/study level) IHE Anatomic Pathology - San Diego 2011

38 Modality Work list Specimen description DICOM Supp 122 : Robust new Specimen Module at image level of hierarchy Specimen short/detailed textual description Including specimen ancestry description in case of derived specimen – In conformance with DICOM supp122, the short textual description of a specimen retrieved from the Order Filler is a concatenation of the short description of the specimen and all the short descriptions of the specimen ancestry – Example : Whole Slide Image of DP07110-A-5-1 DP07110-A: Left upper lobe – DP07110-A-5: Left upper lobe/Tumor DP07110-A-5-1:H&E DP07110-A-5-1: Left upper lobe/Tumor/H&E IHE Anatomic Pathology - San Diego 2011

39 More information Googlegroup : ihe-anatomic-pathology- Road map – logy logy IHE Anatomic Pathology - San Diego 2011


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