DICOM Structured Reporting Current Status and Role in

DICOM Structured Reporting Current Status and Role in the Electronic Patient Record Harry Solomon Co-chair, DICOM WG 1 - Cardiovascular Information Solomon, DICOM SR European Society of Cardiology 2 September 2001 1

What is DICOM Structured Reporting? • A means of encoding structured information … • hierarchical tree of content items, using DICOM object syntax • For vendor-independent exchange between systems … • leveraging the DICOM object management infrastructure • Providing unambiguous documentation of meaning … • text, categorical codes, numeric measurements, inter-item relationships • For the image-intensive clinical environment • careful attention to clinical observation context • robust references to DICOM images, waveforms Solomon, DICOM SR European Society of Cardiology 2 September 2001 2

Structured Reporting is Not. . . • DICOM SR is not just “reports” – any structured data exchanged between systems – measurements, analyses, sonographer notes. . . • DICOM SR is not Structured Data Entry – Hierarchical pull-down menus to support report creation is often denoted “structured reporting” – DICOM does not standardize applications or data entry techniques – Structured data entry is a valuable means of creating SR content in certain circumstances Solomon, DICOM SR European Society of Cardiology 2 September 2001 3

Where Can Cardiology Use SR? • Clinical Reports (cath, echo, nuc, etc. ) – to go along with our pretty DICOM pictures • Analyses of raw image and waveform data – backing up the Clinical Report • Documentation of the procedure – provide context for the raw data and analyses • Input to a clinical database – for patient care over time, or outcomes analysis Solomon, DICOM SR European Society of Cardiology 2 September 2001 4

Cath Lab Example Procedure Log Cath Lab Report Patient 67 yr old male, history of … Ref prior ECG report Procedure Ref Log Narrative. . . Findings Hemodynamic Ref HD Report Narrative. . . Angiographic 70% stenosis. . . Ref image Intervention Stent placed in LAD … Ref image Complications Summary 11: 10 Patient prepped 11: 19 Percutaneous entry 11: 23 XA image acquired 11: 27 HD waveform acquired 11: 30 XA image acquired 11: 47 PTCA 11: 59 XA image acquired 12: 02 HD waveform acquired 12: 21 Pt released to holding 12: 24 HD Report Hemo Report Baseline Ref waveform Measurements … Post-intervention Ref waveform Measurements … Derived measurements Ref waveform Solomon, DICOM SR European Society of Cardiology 2 September 2001 5

Structured Reporting is the glue that makes possible construction of an electronic patient record for cardiology Solomon, DICOM SR European Society of Cardiology 2 September 2001 6

DICOM SR Status • Work began in 1994 – Championed by Dr. Dean Bidgood • Supplement 23: Structured Reporting - April 2000 – Defined general format for SR objects • DICOM header, hierarchical tree of content items • Concepts represented by coded terminology using external (non-DICOM) lexicons [e. g. , Reed codes, SNOMED anatomy, ICD-9/10 diagnosis or procedure codes, SCP-ECG lead IDs] – Defined general classes of clinical reports – Extremely flexible Solomon, DICOM SR European Society of Cardiology 2 September 2001 7

The Problem of Flexibility • A document creator can put in anything in any structure • A document reader must handle every possible document • Need to constrain the SR content to enable meaningful receiving applications – Structure – Content Solomon, DICOM SR European Society of Cardiology 2 September 2001 8

DICOM SR Status • Supplement 53: Content Mapping Resource - May 2001 – Defined general structure for templates: document patterns – Mechanism for terminology context groups: constrained vocabulary subsets – Fundamental templates for documenting clinical context and for basic reports – DICOM lexicon for vocabulary not externally available Solomon, DICOM SR European Society of Cardiology 2 September 2001 9

So Theoretically. . . • DICOM Structured Reporting is ready to be implemented for cardiology! But Pragmatically … Solomon, DICOM SR European Society of Cardiology 2 September 2001 10

Issues for Cardiology SR • Uses not well covered by “clinical report” model – Procedure logs, preliminary measurement reports • Many ways to encode the same information – Need consistent approach for interoperability • Need tailored subset of SR for developers – Reduce the learning curve Need Cardiology-specific SR Templates and consensus Terminology Solomon, DICOM SR European Society of Cardiology 2 September 2001 11

Cardiology SR Efforts • Supplement 66: Cath Lab SR (WG 1) – – – Procedure Log Hemodynamics Report ECG Report Quantitative Analysis Report Cath Lab Report • Supplement 26: Ultrasound SR (WG 12) – Echocardiography Report • Both to be released for Public Comment this autumn Solomon, DICOM SR European Society of Cardiology 2 September 2001 12

Procedure Log Issues • Structure - flat • Ordering - strictly time sequential • Linkage of events - associative Procedure Step / Action ID • SOP Class - distinct from reports • Remote entries - new Application Event Logging Service Class Solomon, DICOM SR European Society of Cardiology 2 September 2001 13

Hemodynamic Report Issues • SOP Class - Cath Lab Measurements (together with QCA, QVA, IVUS measurements, etc. ) – Distinction from report titles • Structure - deep hierarchy • Terminology - post-coordinated, context from hierarchy Solomon, DICOM SR European Society of Cardiology 2 September 2001 14

Hemo Report Structure Hemo Report CONTAINER Baseline Phase CONTAINER Patient State CONTAINER Arterial Measurements CONTAINER Anatomic Location = L Fem Art Ventricular Measurements CONTAINER Gradient Measurements CONTAINER Anatomic Location = Aorta Systolic Pres Diastolic Pres Mean Pres Solomon, DICOM SR Post-Intervention Phase CONTAINER Post-Contrast Phase CONTAINER European Society of Cardiology 2 September 2001 15

Find out more • http: //www. pixelmed. com/srbook. html – David Clunie’s excellent introduction to DICOM SR • ftp: //medical. nema. org/medical/dicom/supps – text of draft supplements • http: //www. dicomwg 12. org/structured_reporting – echocardiography SR • subscribe to WG 1 email list – send request to how_clark@nema. org Solomon, DICOM SR European Society of Cardiology 2 September 2001 16

Thank you Questions? mailto: //harry. solomon@med. ge. com Solomon, DICOM SR European Society of Cardiology 2 September 2001 17