Aspects of DICOM for Patient Safety

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Aspects of DICOMfor Patient Safety

• Helmut Koenig, Siemens Healthcare
• Harry Solomon, GE Healthcare
• Co-chairs, HL7/DICOM Imaging Integration WG

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Topics

• Brief Intro to DICOM
• Radiation Dose Reporting
• Substance Administration
• Adverse Event Reporting

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• Digital Imaging and Communications in Medicine
  (DICOM) is the International Standard for Medical
  Imaging and related information images,
  waveforms, derived measurements and assessments,
  image presentation control, and workflow
  management for the imaging department
• Published as NEMA PS3 and as ISO 12052

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Relationships

• Memorandum of Understanding with HL7
• Joint Working Group (Imaging Integration / WG-20)
• Type B Liaison with ISO TC215 Health Informatics
• DICOM is an ISO Standard by reference
• SDO Member of Integration the Healthcare
  Enterprise
• Liaison with International Health Terminology SDO
• SNOMED license as primary external vocabulary

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Key features of DICOM

• Focus on practical needs of biomedical imaging
• Object-oriented, persistent information objects
• Tagged data elements, binary encoding
• Client-server network services, service
  negotiation
• Image compression by encapsulation
• Conformance Statements

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DICOM Network Services

• Information object exchange
• Reliable object storage (commitment)
• Object repository (PACS) query / retrieve
• Modality worklist query
• Performed procedure step status notification
• Image print
• Others
• Network Services are denoted
• Service-Object Pair (SOP) Classes

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The DICOM Change Process

• Continuous process for evolution of the standard
• Its just DICOM, not DICOM 3.0, 3.1, etc.
• Conformance is to SOP Classes, not to a version
  of the Standard
• Change Proposals for minor corrections
• About 100 / year
• Supplements for major changes new object types,
  services, compression schemes
• About 10 / year
• Require Work Item approved by DICOM Standards
  Committee
• Consolidated edition published every 18 months
• Most recently, July 2011
• Available free at DICOM web site

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Radiation Dose Structured Reportand Radiology
Report Dose Summary
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Dose SR

• Radiation Dose Structured Report is a SOP Class
  (unit of conformance)
• Standard templates
• TID 10001 Projection X-Ray (including Mammo)
• TID 10011 CT
• Typically produced for each Study or for each
  Performed Procedure Step
• Each exposure event has a unique ID
• Associated workflow profiled in IHE Radiation
  Exposure Management (REM) Profile

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Templates

• Developed in conjunction with IEC and AAPM
• 80 discrete data elements
• Aligned with NEMA XR-25 CT Dose Check Standard
• Check parameters and authorizations captured

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Status

• Identified in ACR White Paper on Radiation Dose
• On FDA radar identified in Radiation Dose
  Reduction White Paper
• Commitments from NEMA members to implement
• Interoperability testing at IHE Connectathons

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Dose Summary

• Standard sub-template for radiology reports
• Specified as DICOM template
• Standard transcoding to CDA
• Conveys summary of radiation dose data
• Conforms to German, French, other national
  regulations on dose reporting, ACR best practice

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Substance Administration (Imaging Contrast)
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Substance Administration

• Patient safety issue five rights checking for
  imaging contrast agents
• Point of use verification for substances often
  out of the loop of hospital pharmacy systems
• Intended as DICOM interface to EHR / CDS
  functionality
• Typically via gateway
• Three DICOM SOP Classes

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SOP Classes

• Query Look up product characteristics
• Given a barcode ID (from contrast agent bottle),
  get name, active ingredient, concentration, etc.
• Contrast attributes may be included in DICOM
  image metadata
• Query Check for substance contra-indications
• Given agent, patient, route of administration
  get approval or warnings based on label and on
  patient record
• Report contrast used to Medication Administration
  Record

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Status

• Limited HL7 standards for these functions to
  which DICOM services may be mapped
• Currently each implementation needs custom
  development
• Possible standard query definition using pharmacy
  segments
• RASO17 for MAR submission
• Not included in any IHE Profiles
• No known product implementations

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Adverse Event Reporting
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Adverse Events

• No specific DICOM services related to adverse
  event reports
• Generally not considered within competency or
  scope of radiology technologists / exams
• Performed Procedure Step discontinuation codes
• Insufficient data to report nature of adverse
  event
• Optional