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Aspects of DICOM for Patient Safety

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Presentation on theme: "Aspects of DICOM for Patient Safety"— Presentation transcript:

1 Aspects of DICOM for Patient Safety
Helmut Koenig, Siemens Healthcare Harry Solomon, GE Healthcare Co-chairs, HL7/DICOM Imaging Integration WG

2 Topics Brief Intro to DICOM Radiation Dose Reporting
Substance Administration Adverse Event Reporting

3 Digital Imaging and Communications in Medicine (DICOM) is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department Published as NEMA PS3 and as ISO 12052

4 Relationships Memorandum of Understanding with HL7
Joint Working Group (Imaging Integration / WG-20) Type B Liaison with ISO TC215 Health Informatics DICOM is an ISO Standard “by reference” SDO Member of Integration the Healthcare Enterprise Liaison with International Health Terminology SDO SNOMED license as primary external vocabulary

5 Key features of DICOM Focus on practical needs of biomedical imaging
Object-oriented, persistent information objects Tagged data elements, binary encoding Client-server network services, service negotiation Image compression by encapsulation Conformance Statements

6 DICOM Network Services
Information object exchange Reliable object storage (commitment) Object repository (PACS) query / retrieve Modality worklist query Performed procedure step status notification Image print Others Network Services are denoted “Service-Object Pair (SOP) Classes”

7 The DICOM Change Process
Continuous process for evolution of the standard It’s just “DICOM”, not DICOM 3.0, 3.1, etc. Conformance is to SOP Classes, not to a ‘version’ of the Standard Change Proposals for minor corrections About 100 / year Supplements for major changes – new object types, services, compression schemes About 10 / year Require Work Item approved by DICOM Standards Committee Consolidated edition published ~ every 18 months Most recently, July 2011 Available free at DICOM web site

8 Radiation Dose Structured Report and Radiology Report Dose Summary

9 Dose SR Radiation Dose Structured Report is a SOP Class (unit of conformance) Standard templates TID Projection X-Ray (including Mammo) TID CT Typically produced for each Study or for each Performed Procedure Step Each exposure event has a unique ID Associated workflow profiled in IHE Radiation Exposure Management (REM) Profile

10 Templates Developed in conjunction with IEC and AAPM
~ 80 discrete data elements Aligned with NEMA XR-25 CT Dose Check Standard Check parameters and authorizations captured

11 Status Identified in ACR White Paper on Radiation Dose
On FDA “radar” – identified in Radiation Dose Reduction White Paper Commitments from NEMA members to implement Interoperability testing at IHE Connectathons

12 Dose Summary Standard sub-template for radiology reports
Specified as DICOM template Standard transcoding to CDA Conveys summary of radiation dose data Conforms to German, French, other national regulations on dose reporting, ACR best practice

13 Substance Administration (Imaging Contrast)

14 Substance Administration
Patient safety issue – “five rights” checking for imaging contrast agents Point of use verification for substances often “out of the loop” of hospital pharmacy systems Intended as DICOM interface to EHR / CDS functionality Typically via gateway Three DICOM SOP Classes

15 SOP Classes Query: Look up product characteristics
Given a barcode ID (from contrast agent bottle), get name, active ingredient, concentration, etc. Contrast attributes may be included in DICOM image metadata Query: Check for substance contra-indications Given agent, patient, route of administration; get approval or warnings based on label and on patient record Report contrast used to Medication Administration Record

16 Status Limited HL7 standards for these functions to which DICOM services may be mapped Currently each implementation needs custom development Possible standard query definition using pharmacy segments RAS^O17 for MAR submission Not included in any IHE Profiles No known product implementations

17 Adverse Event Reporting

18 Adverse Events No specific DICOM services related to adverse event reports Generally not considered within competency or scope of radiology technologists / exams Performed Procedure Step discontinuation codes Insufficient data to report nature of adverse event Optional

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