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DICOM SR

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DICOM SR

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  1. DICOM SR • Requirements • Applications • Benefits W. Dean Bidgood, Jr., M.D., M.S. SR Data Solutions, Inc. www.srdata.com (919) 806-2220

  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. 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 • 2000 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. Inferred From Inferred From Inference Tree

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