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DICOM Strategic Direction DICOM Strategic Direction for for
Image DistributionImage Distribution
Cor Loef
co-chair DICOM Strategic Advisory Committee
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January 12, 2002 2
Contents
• Scope of DICOM Standards Committee
• Trends in Imaging-IT
• Standards in Imaging-IT
• Objects, Information, EPR, Web-distribution, Desktop
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Scope of DICOM Standards Committee
• Mission of DICOM– Create and maintain international standards for
communication of bio-medical diagnostic and therapeutic information
• Goals of DICOM– Achieve compatibility and improve workflow
efficiency between imaging systems and other information systems
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New: published in
DICOM 2000• Sup 23: Structured Reporting (Pre-reports, image measurements, analysis results, diagnostics reports with qualified image links)
• Sup 30: Waveform (sound, ECG, Electr. Physio.) synchronized with images
• Sup 31: Network Security (node authentication and transport encryption)
• Sup 33: Softcopy Presentation State• 42 Correction Items, Including:
– JPEG-LS, Thai & Korean, Time zones, Case Insensitive Name Queries
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Supplements approved in 2001
• Sup 40 DVD RAM Application Profiles • Sup 50 Mammography Comp. Aided Detect. Reports• Sup 52 General Purpose Worklist
– Reporting workflow management, image postprocessing, computer aided detection, filming, quality control, etc.
• Sup 53 Content Mapping Resource – codes and templates for Structured Reporting
• Sup 54 MIME Content Type– for e-mailing DICOM persistent objects (images reports,
presentation states, key object selection, etc.
• Sup 59 Key Object Selection
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New Work Items
• New generations of image objects:– Revised Secondary Capture Images (specific applications)
– Multiframe MR and CT (large number of dynamic dimensions)
• Sup 41 Digital Signature– secure transformation of images and reports
• Security on Storage Media (confidentiality)• Attribute Level Confidentiality (de-identification)
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Current Direction
• Present focus is to meet new end-user needs, adopt complementary and proven standards. Key areas are:
– Security,
– New imaging technology,and
– Image Distribution in the enterprise.
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Liaison with TC 215• Good liaison since April 99. Cross-representation may
be the effective next step beyond TC 215 DICOM Task Force.
• Procedure– TC 215 has agreed to rely on DICOM for Medical Imaging
Standardization– DICOM offers expertise in medical imaging, with world-wide
users and vendors representation.– Need to ensure coherence with other ISO standards group on
imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)
• DICOM is ready to further develop its relationship with TC 215.
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Trends in Imaging-IT:
Radiology
PACS
Cardiology
PACS
VL, US, NM
PACS
1. Horizontal IntegrationHIS
RIS
2. Vertical Integration
Electronic Patient Record
OtherClinicalSystem 3. Elect. Patient Record
At the desktop
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1. Horizontal Integration
• Image management system supports archiving/retrieving of all types of images (incl. visible light) and Structured Reports
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2. Vertical Integration
The Healthcare Enterprise
HISHIS
Order Placer
ADTPatient Registration
RISRIS
IMAGING:IMAGING:•• PACS / ArchivesPACS / Archives
•• WorkstationsWorkstations•• ModalitiesModalities
Image Archive
Image Manager
Image Creator
Image Display
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Modality Worklist
Patient Registration
New
Ord
er
Procedure Scheduled
ImagesStoredStorage
Commit
Q /RImages
PPSIn-Progress/ Completed
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Integration: not only back-office!
messagesmessages
ClinicalClinical
InformationInformation
SystemSystem
ClinicalClinical
InformationInformation
SystemSystem
Back-Office
IntegratedIntegrated
Clinical ViewingClinical Viewing
at the desktopat the desktop
Front Office
EfficiencyEfficiency
ImproveImproveClinicalClinicalDecisionsDecisions
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3. Electronic Patient Record• Image Management system and Departmental Information
System must be EPR-prepared (Queries)
• EPR: emphasis today on desktop integration, should become the integrated, secure, patient centric, source of health information
• Web front-end:
– viewing not only of images but also waveforms, measurements, reports, etc
– always need the capability to access the original medical images
– support for DICOM Structured Reporting
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Ultimate goal: All the information the user needs through one common and simple user interface
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ClinicalClinical
QuestionQuestion
Multi-MediaMulti-Media
Report withReport with
referencesreferences
4. Order and Results Management
PACSPACS
RISRIS
Other ClinicalOther ClinicalInformationInformation
SystemsSystems
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DICOM SR Creation - Example -Radiology
Report Type:
Findings:
Conclusions:
Image Refs.:
Header::RIS dataRIS data
Image dataImage data
from PACSfrom PACS
Report TemplatesReport TemplatesFrom DICOM From DICOM standard:standard:
Coding SchemesCoding Schemesbehind pop-up menusbehind pop-up menus
ThoraxThorax……....……....……....
MassMass……....……....
Daim.Daim.Infiltr.Infiltr.
……....……....
(Pointer)
select select
Report Creator Report Creator
applicationapplication
(DIC
OM
) S
R O
bjec
t(D
ICO
M)
SR
Obj
ect
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4. Orders and Results Management
• Great opportunities for IHE.
• Important roles for HL7 Clinical Document Architecture and DICOM Structured Reporting
• One should not consider DICOM SR as the only possibility to integrate multi-speciality information. Especially XML-based implementations should be considered.
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5. Security
At Modality
Web Viewer
PACS ViewingStation
Webserver
Security
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5. Security
• NEMA and COCIR address some major issues as a result of HIPAA, e.g. remote service.
• Security remains a challenge with connected systems, and is of course dependent on hospitals ensuring policies and procedures
• Use of Audit trial standards in a multi-vendor environment needs further detailing
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6. Freedom of Application Workspot
At ModalityPACS Viewing
Station
Web Viewer
Webserver
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January 12, 2002 21
Standards in Imaging-IT
1. Horizontal Integration DICOM
2. Vertical Integration IHE, DICOM, HL7
3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML
4. Orders and Results IHE, DICOM, HL7
Management
5. SecurityIHE,IETF,DICOM,HL7,ASTM
6. Freedom of Application ISO/CEN, CCOW, IETF,
Workspot DICOM, XML
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The (multi-vendor) Integrated The (multi-vendor) Integrated Imaging Imaging SolutionSolution
ImageImageServeServe
rr
CDCDExchangeExchange
DepartmenDepartmentt
Info ServerInfo Server
Diagnostic Diagnostic WorkstatiWorkstati
onon
Image Image ArchivArchiv
ee
Connection Connection to other to other NetworkNetworkand/or and/or
TeleCardioloTeleCardiologygy
secure transportdigital signature
HangingProtocols
Email attachmentDICOM URL
General PurposeWorklist
Structured Documents (XML)Numeric reportQCA, LVA
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The distribution problem
Electronic Patient Record
Radiology
PACS
Cardiology
PACS
VL, US, NM
PACS
HIS
RIS
OtherClinicalSystem
Web Viewers
Webserver
Report Type:Findings:
Conclusions: Ima
g
e
R
e
f
s
.
:
Header::ThoraxThorax……....……....……....MassMass……....…….... Daim.Daim.Infiltr.Infiltr.
……....……....(Poi
n
t
e
r
)
URL/URI?