Simple Image and Numeric Reports Cor Loef Philips Medical Systems Co-Chair IHE Radiology Technical Committee

IHE Integration profiles Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Presentation of Grouped Procedures Post-Processing Workflow Reporting Workflow Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Access to Radiology Information Basic Security HIMSS/RSNA April 2003 Workshop

Overview Report Definition Reporting Transactions Reporting Actor Requirements Report Content Structure HIMSS/RSNA April 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/RSNA April 2003 Workshop

Simple Image & Numeric Reports Based on DICOM SR Allows to include without transcription: - measurements - image links - structured content Integrated with the imaging workflow Friendly to XML implementations Easy to export to the EPR (HL7) HIMSS/RSNA April 2003 Workshop

. . . it isn’t a document presentation standard! What Isn’t DICOM SR? MALIGNANCY Based on: MASS Size: 7mm Shape: irregular Margin: spiculated Associated with: CALCIFICATION Type: Heterogeneous Type: Branching Distribution: Grouped . . . it isn’t a document presentation standard! HIMSS/RSNA April 2003 Workshop

Actors and Transactions Imaging Department Measurements, Image Analysis, etc. Acq. Modality Electronic Patient Record Images Image Manager Enterprise Report Repository Evidence Docs (DICOM SR) Evidence Creator Report Creator HL7 Text Reports Workstations Report Mgr RIS/PACS Formal Reports (DICOM SR) Formal Reports (DICOM SR) Other Departments Repositories Report Reposit. External Report Repository Access Report Reader Workstations HIMSS/RSNA April 2003 Workshop

SR Is Managed Like Any Other DICOM Object Patient Information Patient ID Study Information Study Inst. UID Series Information Series Information Series Information Series Information Series Inst. UID Image Presentation State SR Document Information Other Composite IODs SOP Inst. UID Images, SR Documents, Presentation States, Stored Print, etc. can exist in same Study HIMSS/RSNA April 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/RSNA April 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/RSNA April 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/RSNA April 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/RSNA April 2003 Workshop

Report Query Keys HIMSS/RSNA April 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/RSNA April 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/RSNA April 2003 Workshop

SR Document Tree Single Root Content Item Followed by nested Content Items Root Content Item Content Item Content Item Content Item Content Item HIMSS/RSNA April 2003 Workshop

SINR with Basic SR Minimal Structure : Coded Title and Headings Full image links from specific sections of report Observation Context (who, what, when) may be section specific HIMSS/RSNA April 2003 Workshop

SINR with Advanced SR Simply adds Measurements to Simple Image Reports HIMSS/RSNA April 2003 Workshop

Report Pattern - Observation Context An Example : Who : Observer What : Observed Evidence Subject : Patient/Fœtus/Specimen Required only when the Observation Context is different from the default. Fully defined in TID 1001 and related Templates in Supplement 53. HIMSS/RSNA April 2003 Workshop

An Illustration Chest, PA & Lateral (GCS,T78) Dr Andrew Smith ……. George Jones …... Procedure PA and Lateral radiographs were ……. Findings The PA demonstrates ... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Conclusions Possible Mass (ICD,XXX) HIMSS/RSNA April 2003 Workshop

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS,T78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS,H12) Document Heading ‘Conclusions’ (GCS,H56) Document Heading ‘Findings’ (GCS,H34) Has Obs. Context Observation Subject ‘Jones^George’ Text ‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Contains 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 Image Reference Instance UID=3.56.18.9 Code ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Contains

Document Title ‘Chest PA & LAT’ (GCS,T78) HIMSS/RSNA April 2003 Workshop

Diagnostic Report Titles Defined by DICOM Part 16 May be extended HIMSS/RSNA April 2003 Workshop

Diagnostic Report Headings Defined by DICOM Part 16 May be extended HIMSS/RSNA April 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/RSNA April 2003 Workshop

SR IODs Basic Text SR IOD Enhanced SR IOD Comprehensive 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/RSNA April 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/RSNA April 2003 Workshop

Questions? www.rsna.org/IHE Documents Available On the Web at: HIMSS/RSNA April 2003 Workshop