DICOM%20Structured%20Reporting%20Recent%20Standards%20Activity

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DICOM Structured ReportingRecent Standards
Activity

• Doug Sluis
• SPIE, Feb 18, 2003

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Overview

• Recent Template Supplements
• Interoperability Considerations
• Templates for Measurement Findings
• DCMR Developments

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Supplements
MRA/CTA (XX)
Key Object (59)
Vascular (71)
WG12
OB-GYN (26)
Fetal Ped. (78)
Echocardiography (72)
Cath, Hemo, ECG (66)
QCAQVA(76)
IVUS (77)
WG1
Chest CAD (65)
Patient History (75)
MammographyCAD (50)
WG15
Breast Report (79)
2001
2002
2003
2004
DCMR (53)
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Image Derived Findings
Report
/ Evidence
Findings
Analysis, CAD,Quantification, Observations
Recent Focus
Images
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Software Roles for Evidence Findings

• Streamline differential diagnosis, trending
• Task-optimized presentation
• Indices and ratios
• Compare to norms
• Ease data navigation
• Outcomes

Images
Measurements, estimations
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SR Interoperability Contrast to Image
UserDomain
ProductDomain
Product X
Product Z
Image

• Image SOPs
• Product, engineering realm
• IOD is one, or few discrete objects
• Behavior is simple display
• Interoperability mostly depends on data
  conformance

• SR SOPs
• User clinical realm
• Many discrete findings, many types
• Interoperability criteria depend on behavior
• Variety of product behavior

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Interoperability Comparable Findings

Product X
SR
Product Y

• Findings comparability is key goal
• Unambiguous, well defined Coded Concepts

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Comparable Concepts

Umbilical vein (portal)
Umbilical vein (fetal)
(T-F1820, SRT, umbilical vein)
(T-F8817, SNM3, umbilical vein)

• Phrase may evoke multiple concepts
• Comparability depends on concept oriented codes

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DCMR Role in Interoperability
Clinical Concepts
UserDomain
findings ?
? images
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Measurement Finding Concepts
AnatomyFinding site, Site Modifier,Laterality
PropertyDiameter, area, volume,blood velocity,
indices, ratios
Findings
DerivationMean, max, min Method/Technique
Physiological phaseCardiac - systole, diastole
Respiratory exp., insp.
AcquisitionImage viewImage mode
Procedural phaseInduced stress state
Intervention state
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Direct Concept Mapping
Clinical Concepts
Direct pre-coordinated concept Template has
marginal role
LOINC
Fetal femur length
DCMR
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Molecular Concepts
Clinical Concepts
PeakVelocity
Template binds concept atoms Based on model
(implicit)
Left
SRT
LN
SRT
Femoral Artery
DCMR
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Choosing Concept Atoms
Clinical Concepts

• Issues
• Coupled concepts
• Degrees of specificity
• Solution options
• Many Templates
• Mapping Annex (72)

Diastolic
Aortic Valve
Regurgitant
Peak Velocity
DCMR
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Quick Review
Value Types CONTAINER, NUM, CODE, IMAGE
Value Type Concept Name Value
relationship
relationship
Value Type Concept Name Value
Value Type Concept Name Value

• Concept Names and Values of type CODE are
  triplets
• Code Value
• Coding Scheme Designator
• Code Meaning (actually, just some text to evoke
  meaning to user)

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Typical Top Level Template Structure
Template specified title OB-GYN, Adult Echo,
IVUS Ultrasound Vascular, Cath/Hemo
CONTAINER Document Title
CONTAINER Patient Characteristics

CONTAINER Summary
CONTAINER
CONTAINER Findings Heading
CONTAINER Finding Heading
CONTAINER Finding Heading
TID 1002ObservationContext




SummaryFindings
Findings
Other Context e.g. procedure
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Document Headings
CONTAINER Document Title
The heading may have semanticsshared by children
findings
contains
CONTAINER Heading
Specific Exercise Challenge Generic
Findings

Findings
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Discrete Numeric Findings
Distributed semantics
CONTAINER Group
has concept modifier
CODE Modifier Concept
contains
Diameter, Area, Volume, Blood Velocity, Indices,
Ratios, Time Interval
NUM Measurement
or pre-coordinated concept BPD, FL
has concept modifier
Laterality, Finding Site, Anatomic Site Modifier,
Cardiac Phase
CODE Modifier Concept
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Vascular Content Hierarchy
CONTAINER Vascular Report
Document Title
contains
has concept modifier
CONTAINER Findings
Section Heading
CODE Laterality
contains
CONTAINER Anatomy
has concept modifier
Group
CODE Topographical Modifier
contains
Minimum Concepts
NUM Measurement
Discrete Finding
property
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
Right, Left, or Unilateral
TID 5103
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODELongitudinal Modifier
Optional specificity
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODEBranch Modifier
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODE Topographical Modifier
contains
NUM Measurement
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Findings Origin and Context
TID 300 Measurements
NUM Measurement
SCOORD
Coordinates
Inferred from
IMAGE
Image
Inferred from
NUM
Numeric dependency
Inferred from
CODE
Equation or Table
Inferred from
Image Mode Image View
CODE
has acquisition context
Normality, Significance Normal Range,
CODE, TEXT
has properties
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Harmonization
Sup 66
Sup 72
CONTAINER Echo Report
CONTAINER Hemo Report
Content Item Value Set
contains
has concept modifier
CONTAINER Findings
Left Ventriculography
CODE Procedure Reported
Wall Motion Analysis
contains
has concept modifier
CONTAINER Findings
CODE Finding Site
Myocardial Wall
contains
CODE Wall Segment
BCID 3717 Wall Segments
CODE Cardiac Wall Motion
DCID 3703 Wall Motion
has properties
CODE Associated Morphology
DCID 3704 Wall Morphology
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DCMR Usability

• Text format
• Needless translation step for development
• Hard to maintain!
• Quality impact

Product SW
Application Developer
DICOM Standard
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DCMR in XML
Information model
Maintenance Environment
Referential integrity
DCMR
PDF Interactive Web Access Product
configuration Web services
DCMR (XML)
DCMR Interchange Standard (XML Schema)
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Future

• 3D coordinates
• 3D shapes
• HL7 V3 Harmonization

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