1. Simple Image and Numeric Reports ベンダーワークショップ２００３資料２００３．９．１２ IHE-J 技術検討委員会 簡単な画像と数値を含むレポート 日立メディコ 井桁

2. September,12, 2003 Vendor Workshop JIRA/JAHIS2 Access to Radiology Information Easy access to pertinent images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements 画像および数値を 含むレポート Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders

3. September,12, 2003 Vendor Workshop JIRA/JAHIS3 Overview Report DefinitionReport Definition Reporting TransactionsReporting Transactions Reporting Actor RequirementsReporting Actor Requirements Report Content StructureReport Content Structure

4. September,12, 2003 Vendor Workshop JIRA/JAHIS4 What is a DICOM Structured Report Object ? A “Persistent Document” which: : A “Persistent Document” which: ずっと使える！ : Provides “semantic” documentation of diagnosisProvides “semantic” documentation of diagnosis Provides context such as : scheduled procedure, observer, current and previous imagesProvides context such as 意味のあるドキュメント！ : scheduled procedure, observer, current and previous images Link text and codes with images, and measurementsLink text and codes with images, and measurements Coded entries using standardized or private lexiconsCoded entries using standardized or private lexicons Flexible enough to address: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

5. September,12, 2003 Vendor Workshop JIRA/JAHIS5 Simple Image & Numeric Reports Based on DICOM SRBased on DICOM SR Allows to include without transcription: - measurements - image links - structured contentAllows to include without transcription: - measurements - image links - structured content Integrated with the imaging workflowIntegrated with the imaging workflow Friendly to XML implementationsFriendly to XML implementations Easy to export to the EPR (HL7)Easy to export to the EPR (HL7)

6. September,12, 2003 Vendor Workshop JIRA/JAHIS6 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!

7. September,12, 2003 Vendor Workshop JIRA/JAHIS7 IHE Simple Image & Numeric Report Acq.Modality Report Creator Report Mgr Evidence Docs (DICOM SR) Measurements, Image Analysis, etc. ReportReposit. Formal Reports (DICOM SR) ReportReader External Report RepositoryAccess Enterprise Report Repository HL7 Text Reports Electronic Patient Record Imaging Department RIS/PACS Formal Reports (DICOM SR) Other Departments Repositories Workstations Evidence Creator ImageManager Images Workstations

8. September,12, 2003 Vendor Workshop JIRA/JAHIS8 SINR Actors 画像検索 最初のレポート チェックされたレポート レポートと画像の検索 画像保管・管理 レポートチェック 診断のために提示された 画像と検査データ ネットワークアクセスのできる レポート保管 患者治療のための レポートと画像参照 Report Creator Report Manager Report Repository Report Reader レポート作成 レポート管理と保存 レポートを読む

9. September,12, 2003 Vendor Workshop JIRA/JAHIS9 ＲｅｐｏｒｔＣｒｅａｔｏｒ Ｒｅｐｏｒｔ Ｍａｎａｇｅｒ Ｒｅｐｏｒｔ Ｒｅｐｏｓｉｔｏｒｙ Ｒｅｐｏｒｔ Ｒｅａｄｅｒ Enterprise Report Repository External Report Repository Access ↓[24] Report Submission ↓[25] Report Issuing ↓[26] Query Report ↓[27] Retrieve Report ↓[28] Structured Report Export ↓[26] Query Report ↓[27] Retrieve Report Simple Image and Numeric Report Diagram 読影レポートのアクター分割 ｛レポート作成｝ ｛レポート管理｝ ｛レポート保存｝ ｛レポート閲覧｝ ｛電子カルテへ｝ > ｛レポート閲覧｝

10. September,12, 2003 Vendor Workshop JIRA/JAHIS10 SR Is Managed Like Any Other DICOM Object Patient Information Study Information Series Information Image Series Information SR Document Information Series Information Presentation State Series Information Other Composite IODs Patient ID Study Inst. UID Series Inst. UID SOP Inst. UID Images, SR Documents, Presentation States, Stored Print, etc. can exist in same Study

11. September,12, 2003 Vendor Workshop JIRA/JAHIS11 Report Creator Provides user interface to create new reports including setting status flags - “Completion Flag” and “Verification Flag” （完成、承認のフラグ）Provides user interface to create new reports including setting status flags - “Completion Flag” and “Verification Flag” （完成、承認のフラグ） Configurable coded entries (Title, Headings, etc.)Configurable coded entries (Title, Headings, etc.) May reference images in report contentMay reference images in report content Must support “Identical Documents Sequence” if necessaryMust support “Identical Documents Sequence” if necessary Creates Basic Text SR with TID 2000 object ORCreates Basic Text SR with TID 2000 object OR Creates Enhanced SR with TID 2000 object (when including measurements)Creates Enhanced SR with TID 2000 object (when including measurements) Stores report in Report Manager using:Stores report in Report Manager using: –Basic Text SR Storage SOP class; OR –Enhanced SR Storage SOP class; OR both

12. September,12, 2003 Vendor Workshop JIRA/JAHIS12 Report Manager Receives reports from Report CreatorReceives reports from Report Creator Supports Basic Text SR with TID 2000 objectsSupports Basic Text SR with TID 2000 objects Supports Enhanced SR with TID 2000 objects (optional)Supports Enhanced SR with TID 2000 objects (optional) May forward reports to Report Repository at any timeMay forward reports to Report Repository at any time Must allow users to set status flags - “Completion Flag” and “Verification Flag”Must allow users to set status flags - “Completion Flag” and “Verification Flag” Other modifications and report manipulation is possibleOther modifications and report manipulation is possible –Amending reports –Merging reports –Additional content 修正・マージ・追加が –etc. All changes require new SOP Instance UIDAll changes require new SOP Instance UID Must send final (verified) reports to Report RepositoryMust send final (verified) reports to Report Repository

13. September,12, 2003 Vendor Workshop JIRA/JAHIS13 Report Repository Receives reports from Report ManagerReceives reports from Report Manager Supports Basic Text SR and Enhanced SR objectsSupports Basic Text SR and Enhanced SR objects Responds to Query and Retrieve requests from Report Reader to sends reports to Report ReaderResponds to Query and Retrieve requests from Report Reader to sends reports to Report Reader

14. September,12, 2003 Vendor Workshop JIRA/JAHIS14 Report Reader Provides user interface to view reportsProvides user interface to view reports Allows user to select report from either Report Repository or External Report Repository Access via DICOM Query/Retrieve mechanismsAllows user to select report from either Report Repository or External Report Repository Access via DICOM Query/Retrieve mechanisms Must support SCU query keys in following table - allows user to filter for particular reportsMust support SCU query keys in following table - allows user to filter for particular reports Supports Basic Text SR objectsSupports Basic Text SR objects Supports Enhanced SR objects (optional)Supports Enhanced SR objects (optional) Must show any object referencesMust show any object references May retrieve and display image objects if grouped with Image DisplayMay retrieve and display image objects if grouped with Image Display

15. September,12, 2003 Vendor Workshop JIRA/JAHIS15 Report Query Keys

16. September,12, 2003 Vendor Workshop JIRA/JAHIS16 External Report Repository Access Allows radiology to access reports generated outside radiology, for example LaboratoryAllows radiology to access reports generated outside radiology, for example Laboratory Converts external report to DICOM SR objectsConverts external report to DICOM SR objects Supports Basic Text SR objectsSupports Basic Text SR objects Supports Enhanced SR objects (optional)Supports Enhanced SR objects (optional) Assumes consistent Patient ID with radiologyAssumes consistent Patient ID with radiology May create Study, Series, and Instance UIDs and must conform to DICOM UID rulesMay 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 usedMust 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 levelsMust support same Instance level query keys as Report Repository but reduced set of keys for Patient, Study, and Series levels

17. September,12, 2003 Vendor Workshop JIRA/JAHIS17 Enterprise Report Repository Receives final reports (verified/signed) from Report Manager.Receives final reports (verified/signed) from Report Manager. Actor may be implemented by a Clinical Patient Record, or any other systems.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).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.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.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.In addition to ASCII Text, receives the « links » to native DICOM objects so that Enterprise Report Repository may retrive native images and structured report.

18. September,12, 2003 Vendor Workshop JIRA/JAHIS18 SR Document Tree Single Root Content Item Followed by nested Content Items Root Content Item Content Item

19. September,12, 2003 Vendor Workshop JIRA/JAHIS19 SINR with Basic SR Minimal Structure : Coded Title and HeadingsMinimal Structure : Coded Title and Headings Full image links from specific sections of reportFull image links from specific sections of report Observation Context (who, what, when) may be section specificObservation Context (who, what, when) may be section specific

20. September,12, 2003 Vendor Workshop JIRA/JAHIS20 SINR with Advanced SR Simply adds Measurements to Simple Image Reports

21. September,12, 2003 Vendor Workshop JIRA/JAHIS21 Report Pattern - Observation Context Required only when the Observation Context is different from the default. Fully defined in TID 1001 and related Templates in Supplement 53. An Example : Who : ObserverWho : Observer What : Observed EvidenceWhat : Observed Evidence Subject : Patient/Fœtus/SpecimenSubject : Patient/Fœtus/Specimen

22. September,12, 2003 Vendor Workshop JIRA/JAHIS22 An Illustration Chest, PA & Lateral (GCS,T78) Chest, PA & Lateral (GCS,T78) Procedure PA and Lateral radiographs were ……. Conclusions Possible Mass (ICD,XXX) Findings The PA demonstrates... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Dr Andrew Smith ……. George Jones …...

23. Content Items and Relationship ‘Chest PA & LAT’ (GCS,T78) Document Title ‘Chest PA & LAT’ (GCS,T78) ‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Text ‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Contains ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Code ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Contains ‘Procedures’ (GCS,H12) Document Heading ‘Procedures’ (GCS,H12) ‘Conclusions’ (GCS,H56) Document Heading ‘Conclusions’ (GCS,H56) Document Heading ‘Findings’ (GCS,H34) ‘findings (GCS,H34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended.’ 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 Instance UID=3.56.18.9 Image Reference Instance UID=3.56.18.9 ‘Smith^Andrew^^Dr’ Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context ‘Jones^George’ Observation Subject ‘Jones^George’ Has Obs. Context

24. September,12, 2003 Vendor Workshop JIRA/JAHIS24 Document Title ‘Chest PA & LAT’ (GCS,T78)

25. September,12, 2003 Vendor Workshop JIRA/JAHIS25 Diagnostic Report Titles Defined by DICOM Part 16 May be extended

26. September,12, 2003 Vendor Workshop JIRA/JAHIS26 Diagnostic Report Headings Defined by DICOM Part 16 May be extended

27. September,12, 2003 Vendor Workshop JIRA/JAHIS27 Status and Verifying Attributes Completion Flag - PARTIAL or COMPLETECompletion Flag - PARTIAL or COMPLETE –how to set the flag is open to implementation Completion Flag Description - free form textCompletion Flag Description - free form text Verification Flag - UNVERIFIED or VERIFIEDVerification Flag - UNVERIFIED or VERIFIED Verifying Observer SequenceVerifying Observer Sequence –identifies person(s) verifying the document and organization(s); required if flag = VERIFIED Prevailing final version = most recent Verification DateTime, VERIFIED, COMPLETE

28. September,12, 2003 Vendor Workshop JIRA/JAHIS28 SR IODs Basic Text SR IODBasic Text 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 IODEnhanced SR IOD –superset of Basic Text but extended to include measurements, spatial and temporal regions of interest Comprehensive SR IODComprehensive SR IOD –superset of Basic Text and Enhanced, references to leaves not restricted and includes by-reference Content Items

29. September,12, 2003 Vendor Workshop JIRA/JAHIS29 Simple Image and Numeric Report Report content is more than words…..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).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.This IHE Integration Profile is the cost effective solution for sharing reports and inclusion of image enabled reports into the Electronic Patient Record.

30. September,12, 2003 Vendor Workshop JIRA/JAHIS30 SINR の利点 Reporting Actor を定義し、トランザクショ ンを明確化することで、必要な Actor をシステ ムに付加できる。Reporting Actor を定義し、トランザクショ ンを明確化することで、必要な Actor をシステ ムに付加できる。 ユーザは SINR をレポート間の交換ファイル として利用できる。施設間のレポートやり取 りが可能になる。 ユーザは SINR をレポート間の交換ファイル として利用できる。施設間のレポートやり取 りが可能になる。 SR は発展途上。より詳細なレポートへ発展 －ユーザにとって使いやすいレポートへ。SR は発展途上。より詳細なレポートへ発展 －ユーザにとって使いやすいレポートへ。

31. September,12, 2003 Vendor Workshop JIRA/JAHIS31

32. September,12, 2003 Vendor Workshop JIRA/JAHIS32 Questions? Documents Available On the Web at: www.rsna.org/IHE or www.himss.org IHE Technical Framework Ｖｅｒ．５．５ Vol. I p86 – p92 Vol. II p150-p176