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DICOM Structured Reporting Recent Standards Activity

DICOM Structured Reporting Recent Standards Activity. Doug Sluis SPIE, Feb 18, 2003. Overview. Recent Template Supplements Interoperability Considerations Templates for Measurement Findings DCMR Developments. Supplements. MRA/CTA (XX). Key Object (59). Vascular (71). WG12. OB-GYN (26).

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DICOM Structured Reporting Recent Standards Activity

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  1. DICOM Structured ReportingRecent Standards Activity Doug Sluis SPIE, Feb 18, 2003

  2. Overview • Recent Template Supplements • Interoperability Considerations • Templates for Measurement Findings • DCMR Developments

  3. Supplements MRA/CTA (XX) Key Object (59) Vascular (71) WG12 OB-GYN (26) Fetal & Ped. (78) Echocardiography (72) Cath, Hemo, ECG (66) QCA&QVA(76) IVUS (77) WG1 Chest CAD (65) Patient History (75) MammographyCAD (50) WG15 Breast Report (79) 2001 2002 2003 2004 DCMR (53)

  4. Norms ClinicalHistory Sup 75 Image Derived Findings Report / Evidence Findings Analysis, CAD,Quantification, Observations Recent Focus Images

  5. 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

  6. 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 Findings SR Interoperability – Contrast to Image UserDomain ProductDomain Product X Product Z Image

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

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

  9. map to map to ProductDomain Product Z Concepts Product X Concepts map to standard map map to StandardsDomain DCMR SNOMED, LOINC NCDR, SCPECG… DCMR Role in Interoperability Clinical Concepts UserDomain findings  images

  10. Measurement Finding Concepts AnatomyFinding site, Site Modifier,Laterality PropertyDiameter, area, volume,blood velocity, indices, ratios … Findings DerivationMean, max, min… Method/Technique Physiological phaseCardiac -systole, diastole … Respiratory – exp., insp. … AcquisitionImage viewImage mode Procedural phaseInduced stress state Interventionstate

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

  12. Molecular Concepts Clinical Concepts PeakVelocity Template binds concept atoms Based on model (implicit) Left SRT LN SRT Femoral Artery DCMR

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

  14. Quick Review Value Types CONTAINER, NUM, CODE, IMAGE … Value Type Concept Name = Value relationship relationship Value Type Concept Name = Value Value Type Concept Name = Value • 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)

  15. Typical Top Level Template Structure Template specified title OB-GYN, Adult Echo, IVUS Ultrasound Vascular, Cath/Hemo … CONTAINER Document Title … CONTAINER … CONTAINER Patient Characteristics CONTAINER Summary CONTAINER Findings Heading CONTAINER Finding Heading CONTAINER Finding Heading TID 1002ObservationContext … … … … SummaryFindings Findings Other Context e.g. procedure

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

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

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

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

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

  21. Vascular Templates has concept modifier Content Item Value Set CONTAINER Findings CODE Laterality TID 5104 contains has concept modifier CONTAINER Anatomy CODELongitudinal Modifier Optional specificity

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

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

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

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

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

  27. Future • 3D coordinates • 3D shapes • HL7 V3 Harmonization

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