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

2. 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

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

4. 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

5. 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

6. . . . 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Report Query Keys
HIMSS/RSNA
April 2003 Workshop

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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 CT recommended.
Conclusions
Possible Mass (ICD,XXX)
HIMSS/RSNA
April 2003 Workshop

21. 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=
Code ‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’
Contains

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

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

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

25. 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

26. 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

27. 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

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