1. IHE Eye Care “Evidence Documents”
IHE Workshop Changing the Way Healthcare Connects
Donald Van Syckle DVS Consulting, Inc.
Jim Riggi, CTO Medflow, Inc.
Co-Chair IHE Eye Care Technical Committee

2. Evidence Documents
An extension of the Eye Care SWF profile (i.e. actors must support SWF before supporting Eye Care ED)
Measurements, observations and coded data created using DICOM objects
Typically created by either an Acquisition Modality or Evidence Creator (i.e. eye care instruments, standalone workstations, EMRs, etc.)
June, 2006

3. Evidence Documents
Produced during acquisition or post-processing workflows
May be Interpreted along with images or stand alone
Either DICOM Structured Reports (SR) or DICOM Encapsulated PDF
June, 2006

4. Eye Care Evidence Documents Examples
Glaucoma progression analysis performed on visual field analyzers
RNFL analysis performed on an OCT device
Measurements on fundus images
Measurements on anteriour chamber OCT images for phakis IOL implantation planning
Corneal ablation planning based on corneal topography maps
Others….
June, 2006

5. DICOM Structured Report (SR)
The DICOM object used by IHE for reporting
Reports that include actual measurement values, observations and/or coded data to describe eye care evidence
Eye Care specific DICOM SRs being defined by WG9 – IHE will adopt upon completion
Keratometer, Autorefractor, Lensometer, biometry, visual fields
Note: Fundus measurements may be possible using Simple Image and Numeric DICOM SR, but has yet to be reviewed by WG9
June, 2006

6. Eye Care Extension DICOM Encapsulated PDF
Also includes measurement values, observations and/or coded data to describe eye care evidence
However, DICOM Encapsulated PDF is a “display only” solution
Is used when no specific DICOM SR solution is defined
Note - since there are no current DICOM SRs defined for Eye Care, it is expected that only DICOM Encapsulated PDF will be used in the AAO showcase
June, 2006

7. Evidence Document Stored
Query / Retrieve
Storage Commitment
Evidence Document Stored
June, 2006

8. Evidence Documents Professional Report Images Interpretation Header:
…..
Findings:
Image Refs.:
Header:
Report Type: ……
Retinal..
...
Eye Care
Impressions:
……. …
Interpretation
Images
June, 2006

9. Managed Like Images
Evidence Documents can be transferred, stored, and query/retrieve just like images
Exists in the same study as images
Patient Information
Patient ID
Study Information
Study Inst. UID
Series Information
Series Information
Series Information
Series Information
Series Inst. UID
Image
DICOM Encp.
PDF
SR Evidence Document
Other Composite IODs
SOP Inst. UID
June, 2006

10. ED a Part of Performed Procedure Step`
Image
Patient
Imaging Serv. Req. (Order)
Requested Procedure
Scheduled Procedure Step
Study Mgt
Performed Procedure Step
Study
Series ED
A PPS is an “Atomic Imaging/Measurements Exam”
A PPS Starts and Ends. It is never resumed !
A PPS produces one or more series of images/evidence documents
Once a PPS is completed, images/evidence documents cannot be added to a series
Additional PPS can always be performed
A Study usually holds the work product for a Requested Procedure
A Study may be multi-modality (I.e. multiple instruments)
June, 2006

11. Workflow
June, 2006

12. Example – Acquisition Modality
Images have been taken at an Acquisition Modality
After image acquisition, the Acquisition Modality performs post processing such as:
a glaucoma progression analysis
RNFL analysis performed on an OCT device
Others…..
Evidence Documents are created using DICOM SR or DICOM Encapsulated PDF
Evidence Documents are:
stored in the same Study as the images (in a separate series)
tracked using DICOM MPPS
sent to the storage server
securely stored using Storage Commitment
June, 2006

13. Example – Workstation, EMR
Unscheduled post-processing done after the acquisition, products support both the Image Display Actor and Evidence Creator Actor
Use DICOM query/retrieve to acquire previous images and/or measurements then perform post-processing
measurements on fundus images
corneal ablation planning based on corneal topography maps
measurements on anterior chamber OCT images for phakic IOL implantation planning
Others…
Evidence documents are:
either DICOM SR or DICOM Encapsulated PDF
stored in the same study as created by the Acquisition Modality
sent to the storage server
securely stored using Storage Commitment
June, 2006

14. IHE Generic Keys for Query Retrieve of: - Images - Evid. Doc. - SR
R = Required and the SCU shall be able to display
R+ = IHE Requirement on top of DICOM
June, 2006

15. Extension for PDF Query
How to store, query, retrieve for Evidence Documents is defined by SWF
DICOM SR queries for Evidence Documents have been defined by radiology
Eye Care added the storage and query for DICOM Encapsulated PDF
Added a new display field for the Image Display actors from query, the PDF “Document Title”
June, 2006

16. More information…. IHE Web site: www.ihe.net Technical Frameworks
ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version)
ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version)
ihe_tf_rev6.0ft_vol1_ FINAL (Radiology)
ihe_tf_rev6.0ft_vol2_ FINAL (Radiology)
ihe_CARD_tf_vol2_2.1_FT (Cardiology)
Standards used by IHE Eye Care
DICOM Standard
HL7 Standard
IHE Connectathon Oct at RSNA HQ
IHE Showcase at Nov AAO Conference
Vendor Products Integration Statements
June, 2006

17. June, 2006