DICOM Structured Reporting Recent Standards Activity Doug Sluis

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DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

Overview • • D Sluis Recent Template Supplements Interoperability Considerations Templates for Measurement Findings

Overview • • D Sluis Recent Template Supplements Interoperability Considerations Templates for Measurement Findings DCMR Developments 2

Supplements MRA/CTA (XX) Key Object (59) Vascular (71) OB-GYN (26) WG 12 Fetal &

Supplements MRA/CTA (XX) Key Object (59) Vascular (71) OB-GYN (26) WG 12 Fetal & Ped. (78) Echocardiography (72) Cath, Hemo, ECG (66) IVUS (77) QCA&QVA(76) WG 1 Chest CAD (65) Mammography CAD (50) 2001 DCMR (53) D Sluis 2002 Patient History (75) Breast Report (79) 2003 WG 15 2004 3

Image Derived Findings Report Norms Clinical History Sup 75 Findings / Evidence Analysis, CAD,

Image Derived Findings Report Norms Clinical History Sup 75 Findings / Evidence Analysis, CAD, Quantification, Observations Recent Focus Images D Sluis 4

Software Roles for Evidence & Findings • Streamline differential diagnosis, trending • Task-optimized presentation

Software Roles for Evidence & Findings • Streamline differential diagnosis, trending • Task-optimized presentation • Indices and ratios • Compare to norms • Ease data navigation • Outcomes D Sluis Images Measurements, estimations 5

SR Interoperability – Contrast to Image User Domain Findings Product Domain Product X Product

SR Interoperability – Contrast to Image User Domain Findings Product Domain Product X Product Z Image • • D Sluis Image SOP’s Product, engineering realm IOD is one, or few discrete objects Behavior is simple – display Interoperability mostly depends on data conformance • • SR SOP’s User clinical realm Many discrete findings, many types Interoperability criteria depend on behavior Variety of product behavior 6

Interoperability: Comparable Findings agree? Product X Product Y Product Z SR Compare Collate, Sort

Interoperability: Comparable Findings agree? Product X Product Y Product Z SR Compare Collate, Sort Match to norms • Findings comparability is key goal – Unambiguous, well defined Coded Concepts D Sluis 7

Comparable Concepts Umbilical vein (fetal) (T-F 1820, SRT, “umbilical vein”) Umbilical vein (portal) (T-F

Comparable Concepts Umbilical vein (fetal) (T-F 1820, SRT, “umbilical vein”) Umbilical vein (portal) (T-F 8817, SNM 3, “umbilical vein”) • Phrase may evoke multiple concepts • Comparability depends on concept oriented codes D Sluis 8

DCMR Role in Interoperability User Domain Clinical Concepts map to Product Domain findings Product

DCMR Role in Interoperability User Domain Clinical Concepts map to Product Domain findings Product X Concepts map to Standards Domain D Sluis map to images standard map DCMR Product Z Concepts map to SNOMED, LOINC NCDR, SCPECG … 9

Measurement Finding Concepts Anatomy Property Finding site, Site Modifier, Laterality Diameter, area, volume, blood

Measurement Finding Concepts Anatomy Property Finding site, Site Modifier, Laterality Diameter, area, volume, blood velocity, indices, ratios … Derivation Physiological phase Cardiac - systole, diastole … Respiratory – exp. , insp. … Findings Mean, max, min… Method/Technique Acquisition Procedural phase Induced stress state Intervention state D Sluis Image view Image mode 10

Direct Concept Mapping Clinical Concepts Direct pre-coordinated concept Template has marginal role LOINC Fetal

Direct Concept Mapping Clinical Concepts Direct pre-coordinated concept Template has marginal role LOINC Fetal femur length DCMR D Sluis 11

Molecular Concepts Clinical Concepts Peak Velocity LN Left SRT Template binds concept atoms Based

Molecular Concepts Clinical Concepts Peak Velocity LN Left SRT Template binds concept atoms Based on model (implicit) SRT Femoral Artery DCMR D Sluis 12

Choosing Concept Atoms Clinical Concepts Diastolic Aortic Valve Peak Velocity Regurgitant DCMR D Sluis

Choosing Concept Atoms Clinical Concepts Diastolic Aortic Valve Peak Velocity Regurgitant DCMR D Sluis Issues • Coupled concepts • Degrees of specificity Solution options • Many Templates • Mapping Annex (72) 13

Quick Review Value Types Value Type Concept Name = Value relationship Value Type Concept

Quick Review Value Types Value Type Concept Name = Value relationship Value Type Concept Name = Value CONTAINER, NUM, CODE, IMAGE … relationship 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) D Sluis 14

Typical Top Level Template Structure CONTAINER Document Title … OB-GYN, Adult Echo, IVUS Ultrasound

Typical Top Level Template Structure CONTAINER Document Title … OB-GYN, Adult Echo, IVUS Ultrasound Vascular, Cath/Hemo … CONTAINER Patient Characteristics CONTAINER Summary CONTAINER Findings Heading Finding. Heading … … TID 1002 Observation Context Other Context e. g. procedure D Sluis Template specified title Summary Findings 15

Document Headings CONTAINER Document Title contains CONTAINER Heading The heading may have semantics shared

Document Headings CONTAINER Document Title contains CONTAINER Heading The heading may have semantics shared by children findings Specific: “Exercise Challenge” Generic: “Findings” has concept modifier … CODE Concept Modifier “Laterality” = “Left” “Finding Site” = “Cerebral Vessels” Findings D Sluis 16

Discrete Numeric Findings Distributed semantics CONTAINER Group has concept modifier CODE Modifier Concept contains

Discrete Numeric Findings Distributed semantics CONTAINER Group has concept modifier CODE Modifier Concept contains NUM Measurement Diameter, Area, Volume, Blood Velocity, Indices, Ratios, Time Interval … or pre-coordinated concept: BPD, FL … has concept modifier CODE Modifier Concept D Sluis Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase … 17

Vascular Content Hierarchy Document Title Section Heading Group CONTAINER Vascular Report contains CONTAINER Findings

Vascular Content Hierarchy Document Title Section Heading Group CONTAINER Vascular Report contains CONTAINER Findings has concept modifier contains CONTAINER Anatomy has concept modifier CODE Laterality CODE Topographical Modifier contains NUM Discrete Finding Measurement D Sluis property Minimum Concepts 18

Vascular Templates CONTAINER Findings TID 5103 D Sluis has concept modifier CODE Laterality Content

Vascular Templates CONTAINER Findings TID 5103 D Sluis has concept modifier CODE Laterality Content Item Value Set Right, Left, or Unilateral 19

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy D Sluis has concept modifier Content Item

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy D Sluis has concept modifier Content Item Value Set CODE Laterality TID 5104 20

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy has concept modifier Content Item Value Set

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy has concept modifier Content Item Value Set CODE Laterality TID 5104 has concept modifier CODE Longitudinal Modifier Optional specificity D Sluis 21

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy has concept modifier Content Item Value Set

Vascular Templates CONTAINER Findings contains CONTAINER Anatomy has concept modifier Content Item Value Set CODE Laterality TID 5104 has concept modifier CODE Topographical Modifier contains NUM Measurement D Sluis 23

Findings Origin and Context NUM Measurement Inferred from SCOORD Inferred from IMAGE Inferred from

Findings Origin and Context NUM Measurement Inferred from SCOORD Inferred from IMAGE Inferred from NUM Inferred from CODE has acquisition context CODE has properties D Sluis TID 300 Measurements CODE, TEXT Coordinates Image Numeric dependency Equation or Table Image Mode Image View Normality, Significance Normal Range, … 24

Harmonization Sup 72 Sup 66 CONTAINER Echo Report CONTAINER Hemo Report contains CONTAINER has

Harmonization Sup 72 Sup 66 CONTAINER Echo Report CONTAINER Hemo Report contains CONTAINER has concept modifier Findings CODE Procedure Reported contains CONTAINER has concept modifier Findings CODE Finding Site contains CODE Wall Segment has properties Left Ventriculography Wall Motion Analysis Myocardial Wall BCID 3717 Wall Segments CODE Cardiac Wall Motion CODE Associated Morphology D Sluis Content Item Value Set DCID 3703 Wall Motion DCID 3704 Wall Morphology 25

DCMR Usability Text format Product SW • Needless translation step for development • Hard

DCMR Usability Text format Product SW • Needless translation step for development • Hard to maintain! • Quality impact Application Developer DICOM Standard D Sluis 26

DCMR in XML Referential integrity Information model Maintenance Environment DCMR Interchange Standard (XML Schema)

DCMR in XML Referential integrity Information model Maintenance Environment DCMR Interchange Standard (XML Schema) D Sluis DCMR (XML) PDF Interactive Web Access Product configuration Web services 27

Future • 3 D coordinates • 3 D shapes • HL 7 V 3

Future • 3 D coordinates • 3 D shapes • HL 7 V 3 Harmonization D Sluis 28