DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis2 Overview Recent Template Supplements Interoperability Considerations Templates for Measurement Findings DCMR Developments

D Sluis3 WG15 WG12 WG1 Supplements Breast Report (79) Mammography CAD (50) Key Object (59) OB-GYN (26) Patient History (75) Chest CAD (65) QCA&QVA(76) Cath, Hemo, ECG (66) Echocardiography (72) IVUS (77) Vascular (71) MRA/CTA (XX) Fetal & Ped. (78) DCMR (53)

D Sluis4 Image Derived Findings Findings Analysis, CAD, Quantification, Observations Norms Report Images Recent Focus / Evidence Clinical History Sup 75

D Sluis5 Software Roles for Evidence & Findings Streamline differential diagnosis, trending Task-optimized presentation Indices and ratios Compare to norms Ease data navigation Outcomes Images Measurements, estimations

D Sluis6 SR Interoperability – Contrast to Image Image SOP’s Product, engineering realm IOD is one, or few discrete objects Behavior is simple – display Interoperability mostly depends on data conformance SR SOP’s User clinical realm Many discrete findings, many types Interoperability criteria depend on behavior Variety of product behavior Product X Product Domain Image User Domain Findings Product Z

D Sluis7 Interoperability: Comparable Findings Findings comparability is key goal –Unambiguous, well defined Coded Concepts Product X Product Y SR Product Z Compare Collate, Sort Match to norms agree?

D Sluis8 Comparable Concepts Phrase may evoke multiple concepts Comparability depends on concept oriented codes Umbilical vein (fetal) Umbilical vein (portal) (T-F1820, SRT, “umbilical vein”) (T-F8817, SNM3, “umbilical vein”)

D Sluis9 DCMR Role in Interoperability Clinical Concepts User Domain Product X Concepts Product Domain Product Z Concepts findings   images map to DCMR standard map Standards Domain SNOMED, LOINC NCDR, SCPECG …

D Sluis10 Measurement Finding Concepts Findings Property Diameter, area, volume, blood velocity, indices, ratios … Anatomy Finding site, Site Modifier, Laterality Physiological phase Cardiac - systole, diastole … Respiratory – exp., insp. … Procedural phase Induced stress state Intervention state Acquisition Image view Image mode Derivation Mean, max, min… Method/Technique

D Sluis11 Direct Concept Mapping Clinical Concepts DCMR LOINC Fetal femur length Direct pre-coordinated concept Template has marginal role

D Sluis12 DCMR Molecular Concepts Clinical Concepts LN SRT Left Peak Velocity Template binds concept atoms Based on model (implicit) Femoral Artery

D Sluis13 DCMR Choosing Concept Atoms Clinical Concepts Peak Velocity Issues Coupled concepts Degrees of specificity Solution options Many Templates Mapping Annex (72) Aortic Valve Diastolic Regurgitant

D Sluis14 Quick Review Value Type Concept Name = Value relationship Value Type Concept Name = Value Value Types CONTAINER, NUM, CODE, IMAGE … Concept Names and Values of type CODE are triplets Code Value Coding Scheme Designator Code Meaning (actually, just some text to evoke meaning to user) relationship Value Type Concept Name = Value

D Sluis15 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 …

D Sluis16 Document Headings CONTAINER Heading … Findings CONTAINER Document Title The heading may have semantics shared by children findings Specific: “Exercise Challenge” Generic: “Findings” “Laterality” = “Left” “Finding Site” = “Cerebral Vessels” CODE Concept Modifier has concept modifier contains

D Sluis17 Discrete Numeric Findings CONTAINER Group NUM Measurement Diameter, Area, Volume, Blood Velocity, Indices, Ratios, Time Interval … or pre-coordinated concept: BPD, FL … CODE Modifier Concept has concept modifier CODE Modifier Concept has concept modifier Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase … contains Distributed semantics

D Sluis18 Vascular Content Hierarchy CONTAINER Anatomy CONTAINER Findings CODE Laterality has concept modifier NUM Measurement CODE Topographical Modifier contains CONTAINER Vascular Report Document Title Section Heading Group Discrete Finding Minimum Concepts contains property

D Sluis19 Vascular Templates CONTAINER Findings CODE Laterality has concept modifier TID 5103 Content Item Value Set Right, Left, or Unilateral

D Sluis20 TID 5104 Vascular Templates CONTAINER Anatomy CONTAINER Findings CODE Laterality has concept modifier contains Content Item Value Set

D Sluis21 TID 5104 Vascular Templates CONTAINER Anatomy CONTAINER Findings CODE Laterality has concept modifier CODE Longitudinal Modifier has concept modifier contains Optional specificity Content Item Value Set

D Sluis22 TID 5104 Vascular Templates CONTAINER Anatomy CONTAINER Findings CODE Laterality has concept modifier CODE Branch Modifier has concept modifier contains Content Item Value Set

D Sluis23 Vascular Templates CONTAINER Anatomy CONTAINER Findings CODE Laterality has concept modifier NUM Measurement CODE Topographical Modifier contains TID 5104 Content Item Value Set

D Sluis24 Findings Origin and Context NUM Measurement SCOORD Inferred from IMAGE CODE Inferred from Equation or Table Inferred from has acquisition context Image Mode Image View CODE, TEXT Normality, Significance Normal Range, … has properties Coordinates Image NUM Inferred from Numeric dependency TID 300 Measurements

D Sluis25 Harmonization CONTAINER Findings CONTAINER Findings CODE Procedure Reported has concept modifier CODE Wall Segment CODE Finding Site contains CONTAINER Echo Report Myocardial Wall Left Ventriculography Wall Motion Analysis contains CONTAINER Hemo Report CODE Cardiac Wall Motion CODE Associated Morphology DCID 3704 Wall Morphology DCID 3703 Wall Motion has properties BCID 3717 Wall Segments Sup 66Sup 72 Content Item Value Set

D Sluis26 DCMR Usability Text format Needless translation step for development Hard to maintain! Quality impact DICOM Standard Application Developer Product SW

D Sluis27 DCMR in XML Referential integrity DCMR Interchange Standard (XML Schema) PDF Interactive Web Access Product configuration Web services DCMR Maintenance Environment DCMR (XML) Information model

D Sluis28 Future 3D coordinates 3D shapes HL7 V3 Harmonization