1. DICOM SR Requirements Applications Benefits
W. Dean Bidgood, Jr., M.D., M.S.
SR Data Solutions, Inc.
(919)

2. No report is unstructured.
But not all reports are effective …..
“A picture is worth a thousand words”
Knowledge is valuable
Don’t waste it.
It’s time for DICOM SR

3. With SR, Useful Structure is Available
User decides how much “structure” to use
and precisely controls (with templates) not only the type of content …
But also the degree of OPTIONALITY
And the MODE OF EXPRESSION
… where required

4. SR Distinctives DICOM base Simple entry point
Supports high-end applications
Practical approach to codes and terminology
Availability (trading partners)
The model is the message

5. Simple Entry Point Title and text Links to images
…. But also supports advanced applications

6. DICOM Environment Unique object identifiers Persistent objects
Workflow context
Binary data types
Print management
Consistent soft-copy display

7. SR Highlights Integrate fully into the DICOM environment
Achieved in DICOM SR
Support measurements by imaging devices
Achieved in DICOM SR
Enable collaborative reporting by any number of persons or devices
Achieved in DICOM SR

8. SR Highlights Enable links to key images of any case
Achieved in DICOM SR
Enable links to regions of interest within images and waveforms
Achieved in DICOM SR
Template-driven content and structure
Achieved in DICOM SR

9. SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS
Customization Permitted For
Presentation
User interface
Database implementation
SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS

10. Structured Documentation
Forty years of progress ….
… , Lindberg, Hall, Pendergrass, Barnett, Greenes, Wheeler, Simborg, Gitlin, Clayton, McDonald, Weed, Shortliffe, Hammond, Stead, Cote, Sowa, Bernauer, McCray, Johnson, Rector, Kuhn, Cimino, Huff, Campbell, Bell, Kahn, Poon, Friedman, …..
1960’s Lab, Radiology (1969), Early SQL …
1970’s Hopkins (76), ACR-NEMA, Early SNOMED
1980’s OBUS (82), SGML (86), HL7, UMLS, …
1990’s UltraSTAR, DICOM (93), WWW, CMT, DRML
NEMA SR Workshop: rollout of DICOM SR

11. SR Applications

12. Ultrasound Measurements
Immediate Need
Generate with image
LOINC codes
Spatial Coordinates

13. CAD Device Emerging application Generate from image BIRADS codes
Spatial coordinates

14. Device Output Predictable content and meaning
Measurements, codes, text
Coordinates
Inferences

15. Numeric Measurement Unambiguous description
LOINC code -- measurement name
SNOMED code -- units
Concept Name
( LOINC )
Units
( SNOMED )
Numeric Value
NUM Content Item

16. Inference Tree
Inferred From

17. Structured Reporting for the Cath Lab
HIS/CIS
Patient
Demographics XA
IVUS
Hemo
Monitoring
Images
Reports
Measurements
Audio
Waveforms
Procedure Log
Lab Reports
Hx/Px Information
Structured Reporting for the Cath Lab
Integrated
Structured
Report
Author: Thomas Kennedy

18. Content Integration
Author: Harry Solomon

19. Miscellaneous Documents
Intradepartmental messages
Teaching files
Quality control (e.g. densitometry, floods, ….)

20. Interpretation

21. Link Features to Description
New nodule
superimposed
with right
fourth rib
10% PTX
Cavitation
Free air

22. Who’s talking? Who said what Persons and/or devices OBSERVER CONTEXT
DIRECT or QUOTED
OBSERVER CONTEXT

23. How good is the evidence?
Source (Study Instance UID)
CURRENT or OTHER
Audit trail
PROCEDURE CONTEXT

24. What are they talking about?
Patient? Data? Procedure?
Mother? Twin A? Twin B?
Slide: block
, cut
, stain
, re-stain
OBSERVATION SUBJECT

25. What is being said? Document title Heading for type of content
Concept name (coded label)
OBSERVATION CATEGORY

26. Anywhere in the document
WE KNOW
Who’s talking
Source of evidence
Subject and scope talked about
Category of information
OBSERVATION CONTEXT

27. Accountability Referring physician and request
Status (COMPLETE, VERIFIED)
Verifying Observer, organization
Evidence checklist: CURRENT, OTHER
ADMINISTRATIVE CONTEXT

28. Delivery to Point of Care
DICOM SR Documents in database
DICOM to PACS workstations
Web to enterprise

29. Analysis Scientific research Education and training Clinical trials
Performance evaluation

30. Databaseable Reporting*
Chuck Thomas coined this term
Share knowledge
Enhance understanding in consultation
Increase effectiveness
Say it once!
Re-use clinical findings for training
Increase efficiency
Evaluate
Improve outcomes