1IHE Workshop – June 2006 What IHE Delivers
Kevin O’DonnellKevin O’Donnell
Toshiba Medical SystemsToshiba Medical Systems
Evidence Documents ProfileEvidence Documents Profile
2IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsProblemProblem
Cardiology is measurement intensive
More and more modalities and workstations provide digital measurements
More and more sites are doing electronic reporting
… to improve efficiency, turnaround time and reduce errors
Current “state of the art”?
-> Screen dump a paper report
Introduces multiple unnecessary error points: A series of numbers that could be misread, misspoken, misheard and
mistyped Introduces additional unnecessary effort Introduces additional unnecessary delay
3IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsProblemProblem
Other popular kludges Measurements handwritten onto a worksheet which is
later dictated / transcribed Measurements output to a printer port and intercepted
by an application that scrapes the values Measurements recorded as a screen capture then
later OCR (optical character recognition) extracts numbers and label strings
… brittle solutions
4IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsScopeScope
Covers creation, storage and retrieval of evidence documents
Evidence documents contain coded observations such as measurements, procedure logs, CAD results, etc.
Evidence Documents are not Diagnostic Reports
Evidence Documents are: Inputs to the interpretation process (like images) Generally created, managed and used entirely inside
Cardiology/Radiology Dept
Diagnostic Reports are: Outputs from the interpretation process Generally created inside Cardiology/Radiology and distributed outside
5IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsScopeScope
Creation:
Generally Acquisition Modality or workstation (aka Evidence Creator) Generally created during acquisition or post-processing workflow Creator supports appropriate SR objects/templates
Storage:
Stored and Committed to “Image” Manager/Archive
Retrieval:
Retrieved by “Image Display” May be retrieved for presentation/interpretation with images, for further
processing, and/or for insertion into electronic reports Image Display may be grouped with a Report Creator
6IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsUse CaseUse Case
Electronic Distribution of measurements, Electronic Distribution of measurements, CAD and other observationsCAD and other observations
Evidence Document Evidence Document StoredStored
Storage CommitmentStorage Commitment
Query / RetrieveQuery / Retrieve
…..
Findings:
Image Refs.:
Header:
Report Type: Echo
EF
…..WallMotion
7IHE Workshop – June 2006IHE Workshop – June 2006
Interpretation
Simple Image & Simple Image & Numeric ReportNumeric Report
Evidence Evidence DocumentsDocuments
…..
Findings:
Image Refs.:
Header:
Report Type: Echo
EFWall……..
Cardiology Report
Impressions:
...
Key Image NotesKey Image Notes
…..
Findings:
Image Refs.:
Header:
Report Type: Echo
EF
…..WallMotion
8IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsImage ReferencesImage References
Echocardiography Measurement
Patient: Doe, John Technologist: der Payd, N
Measurements:
Mitral valve diameter 3.1cm
- shown in image at [ ]
Ventricular length, diastolic 5.97 cm
- shown in image at [ ]
Ventricular volume, diastolic 14.1 ml
- inferred from [ ]
- inferred from VLZ algorithm
9IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsValue propositionValue proposition
Measurements are managed in same study folder as images
Data is structured and uses coded concepts and vocabulary
Coded data can be searched, processed, databased (locally, national registry), …
Avoids detour through “paper-space” extra handling, delay and potential loss of paper additional effort and errors
10IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsTechnical BasisTechnical Basis
Based on: DICOM Structured Report (SR) Objects Storage Commitment Query/Retrieve
Addresses creation/distribution of the content
Scheduling and progress reporting could easily be supported by also implementing an appropriate IHE workflow profile
11IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsCath Evidence OptionCath Evidence Option
Acquisition Modalities / Evidence Creators:
Shall support one or more of the following DICOM Objects: Enhanced SR Comprehensive SR Procedure Log
Shall use one or more of the following templates: 3001 Procedure Log 3202 Ventricular Analysis 3213 Quantitative Arterial Analysis 3250 Intravascular Ultrasound 3500 Hemodynamics
Image Displays:
Shall unambiguously render ALL of the above Includes providing visual emphasis for measurements flagged “abnormal” Support of the templates is implicit in support of the DICOM Objects Displays may optimize display for the templates
12IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsEcho Evidence OptionEcho Evidence Option
Acquisition Modalities / Evidence Creators:
Shall support one or more of the following DICOM Objects: Enhanced SR Comprehensive SR
Shall use one or more of the following templates: 5100 Vascular Ultrasound 5200 Echocardiography
Image Displays:
Shall unambiguously render ALL of the above Includes providing visual emphasis for measurements flagged “abnormal” Support of the templates is implicit in support of the DICOM Objects Displays may optimize display for the templates
13IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence DocumentsCath & Echo Evidence OptionsCath & Echo Evidence Options
Specific guidance provided on Completion Flag (0040,A491), E.g.: “Complete” requires the contents be attested/verified by an
identified user “Complete” means content includes all significant measurements
in the scope of the root Concept Name of the document A Requested Procedure may have multiple documents, each
covering a separate scope/topic
Specific guidance provided on Normality Flag (Template 3100) Allows flagging of measurements as Abnormal (high, low)
14IHE Workshop – June 2006IHE Workshop – June 2006
Evidence DocumentsEvidence Documents
Other Templates: 3900 CT/MR Cardiovascular Analysis 4000 Mammography CAD 4100 Chest CAD 4200 Breast Imaging Report 5000 OB-Gyn Ultrasound Report
15IHE Workshop – June 2006IHE Workshop – June 2006
Example Transaction FlowExample Transaction Flow
Image Display/Evidence Creator
Department System Scheduler/ Order Filler
Modality Procedure Step Completed [RAD-7]
Modality Procedure Step Completed [RAD-7]
ImageManager/
PPS Manager
Retrieve Images [CARD-4]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1] Perform/Update
Measurements & Analysis
Modality Images/ Evidence Stored [CARD-2]
Storage Commitment [CARD-3]
Image Display
Query Images [RAD-14]Query Evidence [RAD-44]Retrieve Images [CARD-4]
Acquisition Modality
Modality Procedure Step Completed [RAD-7]
Perform Acquisition & Measurements
Modality Procedure Step Completed [RAD-7]
Modality Images/ Evidence Stored [CARD-2]
Query Images [RAD-14]Query Evidence [RAD-44]
Image Display/Evidence Creator
Department System Scheduler/ Order Filler
Modality Procedure Step Completed [RAD-7]
Modality Procedure Step Completed [RAD-7]
ImageManager/
PPS Manager
Retrieve Images [CARD-4]
Modality Procedure Step In Progress [CARD-1]
Modality Procedure Step In Progress [CARD-1] Perform/Update
Measurements & Analysis
Modality Images/ Evidence Stored [CARD-2]
Storage Commitment [CARD-3]
Image Display
Query Images [RAD-14]Query Evidence [RAD-44]Retrieve Images [CARD-4]
Acquisition Modality
Modality Procedure Step Completed [RAD-7]
Perform Acquisition & Measurements
Modality Procedure Step Completed [RAD-7]
Modality Images/ Evidence Stored [CARD-2]
Query Images [RAD-14]Query Evidence [RAD-44]
16IHE Workshop – June 2006IHE Workshop – June 2006