DICOM SR• Requirements

• Applications

• BenefitsW. Dean Bidgood, Jr., M.D., M.S.

SR Data Solutions, Inc.

www.srdata.com

(919) 806-2220

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

With SR, Useful Structure is Available

• User decides how much “structure” to use

… where required

• But also the degree of OPTIONALITY

• And the MODE OF EXPRESSION

and precisely controls (with templates) not only the type of content …

SR Distinctives• DICOM base

• Availability (trading partners)

• The model is the message

• Simple entry point

• Practical approach to codes and terminology

• Supports high-end applications

Simple Entry Point

Title and text

Links to images

…. But also supports advanced applications

DICOM Environment

• Unique object identifiers

• Persistent objects

• Workflow context

• Binary data types

• Consistent soft-copy display

• Print management

SR Highlights

• Support measurements by imaging devices

Achieved in DICOM SR

• Integrate fully into the DICOM environment Achieved in DICOM SR

• Enable collaborative reporting by any number of persons or devices

Achieved in DICOM SR

SR Highlights

• Enable links to regions of interest within images and waveforms

Achieved in DICOM SR

• Enable links to key images of any case Achieved in DICOM SR

• Template-driven content and structure

Achieved in DICOM SR

Customization Permitted For

• User interface

• Presentation

• Database implementation

SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS

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

SR Applications

Ultrasound Measurements

Immediate Need

Generate with image

LOINC codes

Spatial Coordinates

CAD Device

Emerging application

Generate from image

BIRADS codes

Spatial coordinates

Device Output

• Predictable content and meaning

• Measurements, codes, text

• Coordinates

• Inferences

Numeric Measurement• Unambiguous description

• LOINC code -- measurement name

• SNOMED code -- units

Concept Name

( LOINC )

Numeric Value

Units

( SNOMED )

NUM Content Item

Inference TreeM am m og rap h y C A D F in d in g s

D etec ted F ea tu re D etec ted F ea tu re D etec ted F ea tu re

C om p os ite F ea tu reInferred FromInferred From

HIS/CIS

PatientDemographics

XA

IVUS

HemoMonitoring

• Images• Reports• Measurements

• Images• Reports• Audio• Measurements

• Waveforms• Reports• Measurements• Procedure Log

• Lab Reports• Hx/Px Information

Structured Reporting for the Cath Lab

Integrated Structured Report

Author: Thomas Kennedy

F i d u c i a l 1 a t ( p i x e l 1 7 2 , 2 0 1 )

F i d u c i a l 2 a t ( p i x e l 2 3 7 , 2 9 0 )

R - w a v e p e a k a t ( s a m p l e 7 7 2 )

F i g u r e 1 - B a s i c A n n o t a t i o n

R-wave peak at (time 10:03.296)

10:03.4010:03.36

10:03.3210:03.28

10:03.2410:03.20

10:03.1610:03.12

10:03.0810:03.04

10:03.00

10:03.00 10:03.50

Multi-frame (cine)pixel data Waveform data

F i g u r e 2 - A n n o t a t i o n o f a T e m p o r a l R O I i n M u l t i - f r a m e I m a g e a n d W a v e f o r m ( s i n g l e S O PI n s t a n c e )

Content IntegrationAuthor: Harry Solomon

Miscellaneous Documents

• Teaching files

• Intradepartmental messages

• Quality control (e.g. densitometry, floods, ….)

Interpretation

Link Features to Description

New nodulesuperimposedwith rightfourth rib

Free air

10% PTX

Cavitation

Who’s talking?

Who said what

Persons and/or devices

DIRECT or QUOTED

OBSERVER CONTEXT

How good is the evidence?

Source (Study Instance UID)

CURRENT or OTHER

Audit trail

PROCEDURE CONTEXT

What are they talking about?

Patient? Data? Procedure?

Mother? Twin A? Twin B?

Slide: block

OBSERVATION SUBJECT

, cut , stain , re-stain

What is being said?

Document title

Heading for type of content

Concept name (coded label)

OBSERVATION CATEGORY

Anywhere in the document

Who’s talking

Source of evidence

Subject and scope talked about

Category of information

OBSERVATION CONTEXT

WE KNOW

Accountability

Referring physician and request

Evidence checklist: CURRENT, OTHER

Status (COMPLETE, VERIFIED)

Verifying Observer, organization

ADMINISTRATIVE CONTEXT

Delivery to Point of Care

• DICOM SR Documents in database• DICOM to PACS workstations• Web to enterprise

Analysis

Scientific research

Clinical trials

Performance evaluation

Education and training

Databaseable Reporting*

• Share knowledge

• Evaluate

Enhance understanding in consultation

Say it once!

Increase effectiveness

Increase efficiency

Improve outcomes

Chuck Thomas coined this term

Re-use clinical findings for training