THE DICOM 2014 INTERNATIONAL THE DICOM 2014 Chengdu

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THE DICOM 2014 INTERNATIONAL THE DICOM 2014 Chengdu Workshop CONFERENCE & SEMINAR August 14

THE DICOM 2014 INTERNATIONAL THE DICOM 2014 Chengdu Workshop CONFERENCE & SEMINAR August 14 -16 25 March Chengdu, Bangalore, India China Reporting: Presentation & Interpretation Thomas Freier Nikolaus Wirsz, Ph. D Softgate Gmb. H SIEMENS AG – Healthcare Sector Erlangen, Germany Program Manager Standards & Interoperability Erlangen, Germany

Reporting: Presentation & Interpretation • Introduction • Standards Elements for Building Tools for Reading

Reporting: Presentation & Interpretation • Introduction • Standards Elements for Building Tools for Reading & Interpretation • IHE Profiles for Interpretation & Reporting • Conclusions August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 2

Introduction • Access to Images & Image Related Information Storage & Retrieval • Display

Introduction • Access to Images & Image Related Information Storage & Retrieval • Display & Presentation of Image Data • Interpretation Results • Report Generation • Putting them all together (the IHE way) August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 3

Access to Images and Image Related Information • Retrieval of Images upon Availability ►

Access to Images and Image Related Information • Retrieval of Images upon Availability ► ► Newly Acquired Images Prior Images for Comparison Evidence Documents Image Management (PACS) Interpretation Reviewing Workstation Q/R: C-FIND / C-MOVE New Images C-FIND/ C-MOVE Prior Images / Evidences • Interpretation Worklists for Radiology Staff sorted by: ► User (assigned Radiologist) ► Modality Type (all CT Exams) ► Specialties (CT Head) ► … Description Patient’s Name Patient ID Tag (0010, 0010) (0010, 0020) Type R U Study Date Study Time Accession Number Study ID (0008, 0020) (0008, 0030) (0008, 0050) (0020, 0010) R R Name of Physician(s) Reading Study (0008, 1060) O Modality (0008, 0060) R • Worklist Management - based on: ► ► Application Logic or Scheduling Data Provided by RIS/PACS • Images Sent to PACS from: ► ► ► Image Acquisition Modality Other Workplaces (e. g. Imaging Centers) Imported from brought-in Media August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation C-STORE & Storage Commitment Transfer Images ► 4

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #1: Differences in

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #1: Differences in Characteristics of Display Devices ► Images produced by same signal have different appearance on different display devices ► Difference in display luminance images don’t look the same (diagnostic quality impaired) Display 1 Display 2 • Grayscale Standard Display Function Standard (GSDF) (DICOM Part 14) ► Standard curve against which display devices can be calibrated (adjust their characteristic curve to the GSDF curve) ► GSDF facilitates similarity in (human) grayscale perception and appearance of images between displays of different luminance August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 5

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays Reporting Radiologist / Referring Physician Reporting Radiologist Area Of Interest Annotate Using GSDF Apply Grayscale Softcopy Presentation State (GSPS) Area Of Interest Consistent Image Presentation Zoom Flip Window Level Inconsistent Image Presentation Original Image August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 6

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays Reporting Radiologist Area Of Interest Grayscale Softcopy Presentation State (GSPS) Reporting Radiologist / Referring Physician ► GSPS objects contain only presentation parameters describing how to display images - Grayscale Transformation - Spatial Transformation Area Of Using GSDF / Annotations - Graphics Interest - Measurements … Apply Presentation State Link Grayscale to one or Softcopy more Images in Series / Studies (GSPS) ► Separation of Stored Images from Display Consistent Characteristics or Transformations Image Presentation ► Communication of Display Parameters using regular Storage and Query / Retrieve Services ► Annotate Zoom Benefits Flip Window Level ► ► Original Image August 2014 DICOM International Conference & Seminar Quality & Consistency of Images Preserved for Diagnostic Use Same Look an all Displays No need to duplicate Images (originals + transformations) apply Presentation States automatically before the Images Display Inconsistent Image Presentation Reporting: Presentation & Interpretation 7

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display

Image Display Consistency Ensuring Quality for Reviewing & Interpretation • Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays Reporting Radiologist / Referring Physician Reporting Radiologist Area Of Interest Annotate Using GSDF Area Of Interest Apply Grayscale Softcopy Presentation State (GSPS) Consistent Image Presentation Zoom Flip Window Level Inconsistent Image Presentation Original Image August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 8

Creating Evidences Collecting Information for Reporting DICOM Structured Reporting (SR) • “Multi-Purpose Tool” for

Creating Evidences Collecting Information for Reporting DICOM Structured Reporting (SR) • “Multi-Purpose Tool” for Capturing Image Accompanying Data • Records of Study Evidences (Findings) made during Image Interpretation ► Observations (Diagnostic Relevant Data) Standard DICOM Header Patient ► Measurements Study Series ► Procedure Logs Document ► Key Object Selection (Key Images) ► Contrast Administration ► Radiation Dose Administration ► CAD Results ► … useful Inputs for Generating (final) Diagnostic Imaging Reports (DIR) and Creation of Imaging Records • DICOM SR Objects are well Structured & Contain Coded Entries ► ► ► Relationships Meanings / Semantics References to Images or other Relevant Information August 2014 DICOM International Conference & Seminar Simple Image and Numeric Report Pattern (from IHE Technical Framework) Reporting: Presentation & Interpretation 9

Creating Evidences Collecting Information for Reporting • DICOM SR - a Powerful Mechanism with

Creating Evidences Collecting Information for Reporting • DICOM SR - a Powerful Mechanism with lots of “generic” Flexibility • Interpreting Applications easily overwhelmed by Diversity / Complexity • SR Templates - Defining Content Constraints for Specific Document Types (Specialties) DICOM Standard Part 16: Content Mapping Resource TID 2000 TID 2001 TID 2002 TID 2005 TID 2010 Basic Diagnostic Imaging Report Observations Report Narrative Transcribed Diagnostic Imaging Report Key Object Selection TID 3001 TID 3300 TID 3900 Procedure Log Stress Testing Report CT/MR Cardiovascular Analysis Report ► TID 4000 TID 4200 Mammography CAD Document Root Template Breast Imaging Report ► TID 5100 Vascular Ultrasound Report TID 10001 TID 10011 Projection X-Ray Radiation Dose CT Radiation Dose ► ► ► Key Image Note (KIN) Pattern (from IHE Technical Framework) • SR Objects can be Stored and Retrieved using the same Services as for Images August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 10

Report Generation Assembling DICOM Evidences for Clinical Use Interpretation Reviewing Workstation Image Management (PACS)

Report Generation Assembling DICOM Evidences for Clinical Use Interpretation Reviewing Workstation Image Management (PACS) Images - Presentation States Key Objects – Evidences - SR C-STORE Images Information System HIS C-FIND/ C-MOVE PS HL 7 CDA Diagnostic Imaging Report Radiology Results Annotations KIN Measurements DICOM Standard Objects for “internal” Use / Imaging Records August 2014 DICOM International Conference & Seminar HL 7 CDA-based Standard Documents for wider Distribution / Clinical Context Reporting: Presentation & Interpretation 11

Report Generation Assembling DICOM Evidences for Clinical Use DICOM SR / HL 7 CDA

Report Generation Assembling DICOM Evidences for Clinical Use DICOM SR / HL 7 CDA Transformation Inclusion of evidence document contents into final diagnostic imaging reports has been addressed in DICOM Part 20 “Transformation of DICOM to and from HL 7 Standards”, Annex A “SR Diagnostic Imaging Report Transformation Guide” Source: “DICOM & HL 7: Integration of Imaging and Information Systems” - Helmut König, MD (2013) August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 12

Integrating the Healthcare Enterprise • IHE: Standards Profiling Organization for Advancing Integration in Clinical

Integrating the Healthcare Enterprise • IHE: Standards Profiling Organization for Advancing Integration in Clinical Practice • Interoperability Frameworks for Implementing and Deploying Standards-Based (HL 7 & DICOM) Integrated Solutions • IHE Integration Profiles - Address Specific Integration Issues For Radiology: ► ► Content Profiles: Interoperable Information Objects exchangeable across systems for display, processing and re-use Presentation Profiles: Preserving Quality of Image Data reproducible views across systems / same “look” on any viewing application Workflow Profiles: Connecting Tasks from one Process Step to the Next Process Step automating the information flow and relieving users from unnecessary tasks Infrastructure Profiles: Consistent access to images and reports – network, media, cross-enterprise Reference to IHE Profiles Descriptions: www. ihe. net/profiles August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 13

Content & Presentation Pertinent to Presentation & Interpretation • ARI ► Key Image Notes

Content & Presentation Pertinent to Presentation & Interpretation • ARI ► Key Image Notes Mark significant images & add notes e. g. for referring physician, oncologist, surgeon … • ED ► Consistent Presentation of Images Consistent intensity & image transformations across softcopy (& hardcopy) devices • KIN ► ARI Access & share images, evidences & related data within a (DICOM) Network • CPI ► Access to Radiology Information Evidence Documents Encoding, exchange, management of measurements, procedure logs, CAD results … • SINR Simple Image and Numeric Report ► Encoding, exchange and management of Radiology Results (image references & numeric data) • MRRT Management of Radiology Report Templates (in development) ► Managing a pool of templates with pre-defined structure, content & terminology for Radiologists to re-use (e. g. RSNA Template Library) August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 14

Workflow Profiles Pertinent to Presentation & Interpretation • REM Radiation Exposure Monitoring ► ►

Workflow Profiles Pertinent to Presentation & Interpretation • REM Radiation Exposure Monitoring ► ► For X-Ray based imaging Patient dose reduction is of significance Integration of systems reporting dose and systems which receive, store or process those reports facilitate automated reporting Using DICOM SR, store, Q/R and FTP Reporting required in parts of U. S. and Europe National Registry some text: # Numerical Details 12. 2 14. 5 11. 8 7. 6 9. 5 10. 9 some text: # Numerical some. Details text: # Numerical 12. 2 14. 5 Details 11. 8 7. 6 12. 2 9. 5 14. 5 10. 9 11. 8 7. 6 9. 5 10. 9 some text: # Numerical some text: # Details Numerical 12. 2# 14. 5 some text: Details 11. 8 7. 6 Numerical 12. 2 14. 5 9. 5 10. 9 Details 11. 8 7. 6 12. 29. 514. 510. 9 11. 8 7. 6 9. 5 10. 9 Outlier: # Performing Phys. Over Target: 12. 2% some text: # some Numerical text: # Details Numerical Details 12. 2 14. 5 12. 2 11. 8 14. 5 7. 6 11. 8 9. 5 7. 6 10. 9 9. 5 10. 9 Archive some text: # Numerical Details 12. 2 14. 5 11. 8 7. 6 9. 5 10. 9 Dose Information Consumer / Reporter Source: “Monitoring Radiation Exposure” 2013, O´Donnell, Blendinger August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 15

Workflow Profiles Pertinent to Presentation & Interpretation • PAWF Post-Acquisition Workflow (in Trial Implementation)

Workflow Profiles Pertinent to Presentation & Interpretation • PAWF Post-Acquisition Workflow (in Trial Implementation) ► ► ► Managing, organizing and scheduling post-processing tasks in preparation of image interpretation & reporting Monitoring progress and completion of tasks performed during interpretation Worklist Management & Status Report + Launching of appropriate applications • Reporting Workflow ► in preparation … August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 16

Conclusions DICOM Standard Definitions: • Information Objects ► ► Images Structured Documents Display Characteristics

Conclusions DICOM Standard Definitions: • Information Objects ► ► Images Structured Documents Display Characteristics Presentation Information Interpretation Reviewing Workstation Image Management (PACS) C-FIND/ C-MOVE Images - Presentation States Key Objects – Evidences - SR C-STORE Images PS Radiology Results and Annotations • Services ► ► Query & Retrieve Storage for ► ► KIN Measurements Exchanging Processing Presentation and Management of imaging data consistently across multiple applications & systems August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 17

References http: //medical. NEMA. org/DICOM http: //www. HL 7. org/ http: //www. IHE. net/

References http: //medical. NEMA. org/DICOM http: //www. HL 7. org/ http: //www. IHE. net/ - Sources: DICOM® Standards Publication 2011, © NEMA - The DICOM Standard is under continuous maintenance, the current official version is available at http: //dicom. nema. org August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 18

Author Contact Nikolaus Wirsz, Ph. D SIEMENS AG - Healthcare Sector Imaging & Therapy

Author Contact Nikolaus Wirsz, Ph. D SIEMENS AG - Healthcare Sector Imaging & Therapy Division Hartmannstr. 16 91052 Erlangen, Germany nikolaus. wirsz@siemens. com Thank you for your attention ! August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 19

Presenter Contact Thomas Freier softgate Gmb. H Nägelsbachstr. 26 91052 Erlangen, Germany Thomas@soft-gate. de

Presenter Contact Thomas Freier softgate Gmb. H Nägelsbachstr. 26 91052 Erlangen, Germany Thomas@soft-gate. de Thank you for your attention ! August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation 20