Understanding the DICOM SR Supplement DICOM Structured Reporting

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Understanding the DICOM SR Supplement DICOM Structured Reporting Workshop March 29 -30, 2000 Donald

Understanding the DICOM SR Supplement DICOM Structured Reporting Workshop March 29 -30, 2000 Donald E. Van Syckle _____________ DICOM WG 6 Chairman Director, Merge. Link Professional Services Merge. Link™ / Donald E. Van Syckle 1 ã 2000, Merge Technologies Inc, All Rights Reserved m

DICOM Structured Reporting (SR) How About DICOM Reporting? • Results Management – Get Prior

DICOM Structured Reporting (SR) How About DICOM Reporting? • Results Management – Get Prior Reports – DICOM Since ‘ 93 But Not Widely Implemented • Structured Reporting – Standardized Early 2000 (April) – Simple Reporting • Basic and Enhanced – Complex Reporting • Comprehensive Merge. Link™ / Donald E. Van Syckle 2 ã 2000, Merge Technologies Inc, All Rights Reserved m

Today’s Reporting There is a 7 mm irregular, spiculated mass in the anterior 11:

Today’s Reporting There is a 7 mm irregular, spiculated mass in the anterior 11: 00 region of the left breast, associated with grouped heterogeneous and pleomorphic granular and fine linear branching casting calcifications. Impression: Malignant Lesion Free form text only Not linked with images or other clinical data Merge. Link™ / Donald E. Van Syckle 3 ã 2000, Merge Technologies Inc, All Rights Reserved m

DICOM Structured Report There is a 7 mm irregular, spiculated mass in the anterior

DICOM Structured Report There is a 7 mm irregular, spiculated mass in the anterior 11: 00 region of the left breast, associated with grouped heterogeneous and pleomorphicgranular and fine linear branching casting calcifications. Impression: Malignant Lesion Today Merge. Link™ / Donald E. Van Syckle MALIGNANCY Based on: MASS Size: 7 mm Shape: irregular Margin: spiculated Associated with: CALCIFICATION Type: Heterogeneous Type: Branching Distribution: Grouped Tomorrow 4 ã 2000, Merge Technologies Inc, All Rights Reserved m

What is Structured Report? • A “Databaseable Document” which: – Provide unambiguous “semantic” documentation

What is Structured Report? • A “Databaseable Document” which: – Provide unambiguous “semantic” documentation of diagnosis – Provide context such as: (scheduled procedure, observer, previous reports and images…) – Link text with images, waveforms, audio, measurements – Coded entry using standardized or private lexicons – Flexible enough to go beyond radiology imaging A“Databaseable Document” facilities computer outcome analysis Merge. Link™ / Donald E. Van Syckle 5 ã 2000, Merge Technologies Inc, All Rights Reserved m

What Isn’t DICOM SR? MALIGNANCY Based on: MASS Size: 7 mm Shape: irregular Margin:

What Isn’t DICOM SR? MALIGNANCY Based on: MASS Size: 7 mm Shape: irregular Margin: spiculated Associated with: CALCIFICATION Type: Heterogeneous Type: Branching Distribution: Grouped …it isn’t a document presentation standard! Merge. Link™ / Donald E. Van Syckle 6 ã 2000, Merge Technologies Inc, All Rights Reserved m

Key Concepts and Terms to Learn! • SR IOD • Query/Retrieve Model • Coded

Key Concepts and Terms to Learn! • SR IOD • Query/Retrieve Model • Coded Entries • Content Items • Value Types • Relationship Types • Observation Context Merge. Link™ / Donald E. Van Syckle 7 ã 2000, Merge Technologies Inc, All Rights Reserved m

Not Done Yet! Key Concepts and Terms to Learn • • • SR Document

Not Done Yet! Key Concepts and Terms to Learn • • • SR Document General SR Document Content Modification Rules Basic Structured Reporting Enhanced Structured Reporting • Comprehensive Structured Reporting Merge. Link™ / Donald E. Van Syckle 8 ã 2000, Merge Technologies Inc, All Rights Reserved m

Does DICOM SR IOD follow the same model as an image? • Yes! Merge.

Does DICOM SR IOD follow the same model as an image? • Yes! Merge. Link™ / Donald E. Van Syckle 9 ã 2000, Merge Technologies Inc, All Rights Reserved m

Image Information Object Definitions Patient Information Patient Module Image Pixel Module General Patient Study

Image Information Object Definitions Patient Information Patient Module Image Pixel Module General Patient Study Module* General Frame of General Series Reference Equipment Series Information Module Image Contrast/ Image General Image Plane Pixel Bolus Image Information Module VOI Image SOP Overlay LUT Module Common Plane Module* Module Study Information Merge. Link™ / Donald E. Van Syckle 10 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR IODs Patient Specimen Ident. Module Patient Information Study Information Series Information SR Document

SR IODs Patient Specimen Ident. Module Patient Information Study Information Series Information SR Document Information General Study Module SR Document Series Patient Study Module* General Equipment Module SR Document Tree MALIGNANCY Based on: MASS Size: 7 mm …. . SR SOP SR Document Common General Content Module Merge. Link™ / Donald E. Van Syckle 11 ã 2000, Merge Technologies Inc, All Rights Reserved m

SOP Instances Linked Patient ID Patient Information Study Inst. UID Study Information Series Inst.

SOP Instances Linked Patient ID Patient Information Study Inst. UID Study Information Series Inst. UID Series Information Image Presentation State SR Document Information SOP Inst. UID Series Information Other Composite IODs Images, SR Documents, Presentation States, Stored Print, etc. can exist in same Study Merge. Link™ / Donald E. Van Syckle 12 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR IOD and Query/Retrieve Model • SR IODs mirror the Composite IOD model (i.

SR IOD and Query/Retrieve Model • SR IODs mirror the Composite IOD model (i. e. images). • SR objects are able to be linked to images, waveforms, stored print, presentations state, RT plans… • “Pushing” SR SOP Instances accomplished via C-STORE • “Pulling” SR SOP Instances accomplished via currently defined Query/Retrieve SOP classes. Merge. Link™ / Donald E. Van Syckle 13 ã 2000, Merge Technologies Inc, All Rights Reserved m

An Illustration……. . . Chest, PA & Lateral (GCS, T 78) George Jones ….

An Illustration……. . . Chest, PA & Lateral (GCS, T 78) George Jones …. . . Dr Andrew Smith ……. Procedure PA and Lateral radiographs were ……. Findings The PA demonstrates … A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Conclusions Possible Mass (ICD, XXX) Merge. Link™ / Donald E. Van Syckle 14 ã 2000, Merge Technologies Inc, All Rights Reserved m

How do I build the SR document? • Content Items • Relationships Merge. Link™

How do I build the SR document? • Content Items • Relationships Merge. Link™ / Donald E. Van Syckle 15 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 16 m

SR Document Tree Root Content Item • Single Root Content Item • Followed by

SR Document Tree Root Content Item • Single Root Content Item • Followed by nested Content Items Content Item Merge. Link™ / Donald E. Van Syckle 17 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items Merge. Link™ / Donald E. Van Syckle 18 ã 2000, Merge Technologies

Content Items Merge. Link™ / Donald E. Van Syckle 18 ã 2000, Merge Technologies Inc, All Rights Reserved m

Types of Content Items (called Value Types) • CONTAINER • IMAGE • TEXT •

Types of Content Items (called Value Types) • CONTAINER • IMAGE • TEXT • WAVEFORM • PNAME • COMPOSITE • DATETIME • UIDREF • DATE • SCOORD • TIME • TCOORD • NUM • CODE Merge. Link™ / Donald E. Van Syckle 19 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 20 m

The Root Content Item and CONTAINER Value Type Document Title ‘Chest PA & LAT’

The Root Content Item and CONTAINER Value Type Document Title ‘Chest PA & LAT’ (GCS, T 78) • Root Content Item conveys Document Title • Root Content Item is of type “CONTAINER” • Containers used to convey headings and sub-headings • Containers use Concept Name Code Sequence • Concept Name =‘Chest PA & LAT’ Merge. Link™ / Donald E. Van Syckle 21 ã 2000, Merge Technologies Inc, All Rights Reserved m

How do I encode CONTAINERS? • In a “Coded Entry” Sequence – Code Value

How do I encode CONTAINERS? • In a “Coded Entry” Sequence – Code Value – Code Scheme Designator – Code Meaning Merge. Link™ / Donald E. Van Syckle 22 ã 2000, Merge Technologies Inc, All Rights Reserved m

Coded Entries - Triplet Encoding • Required attributes are: > Code Value - computer

Coded Entries - Triplet Encoding • Required attributes are: > Code Value - computer readable and searchable identifier that is unique within the Coding Scheme > Code Scheme Designator - identifies the organization responsible for the code being used > Code Meaning - human readable text provided for the convenience of users (64 maximum characters) The Code Scheme Designator plus the Code Value uniquely identify the code Merge. Link™ / Donald E. Van Syckle 23 ã 2000, Merge Technologies Inc, All Rights Reserved m

Document Title ‘Chest PA & LAT’ (GCS, T 78) Merge. Link™ / Donald E.

Document Title ‘Chest PA & LAT’ (GCS, T 78) Merge. Link™ / Donald E. Van Syckle 24 ã 2000, Merge Technologies Inc, All Rights Reserved m

Coded Sequence Used to Define All Codes “Requested Procedure = Chest X-Ray” Merge. Link™

Coded Sequence Used to Define All Codes “Requested Procedure = Chest X-Ray” Merge. Link™ / Donald E. Van Syckle 25 ã 2000, Merge Technologies Inc, All Rights Reserved m

DICOM Defines the Ability To: • More precisely define the Coding Scheme Designator •

DICOM Defines the Ability To: • More precisely define the Coding Scheme Designator • Extend existing Coding Schemes • Define “Private Coding Schemes” Merge. Link™ / Donald E. Van Syckle 26 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 27 m

‘PNAME’ Value Type Recording Observer Name ‘Smith^Andrew^^Dr’ • Name/Value Pair – the name is

‘PNAME’ Value Type Recording Observer Name ‘Smith^Andrew^^Dr’ • Name/Value Pair – the name is a single Concept Name Code Sequence – the value is the Person’s Name • Concept Name Code Sequence = Recording Observer Name • PNAME = ‘Smith^Andrew^^Dr’ Concept Name Merge. Link™ / Donald E. Van Syckle PNAME Value Type Concept Value 28 ã 2000, Merge Technologies Inc, All Rights Reserved m

Recording Observer Name = ‘Smith^Andrew^^Dr’ Merge. Link™ / Donald E. Van Syckle 29 ã

Recording Observer Name = ‘Smith^Andrew^^Dr’ Merge. Link™ / Donald E. Van Syckle 29 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 30 m

‘TEXT’ Value Type Procedure (GCS, H 12) ‘PA and Lateral radiographs were ……. ’

‘TEXT’ Value Type Procedure (GCS, H 12) ‘PA and Lateral radiographs were ……. ’ • Name/Value Pair Concept Name TEXT Value Type Concept Value • Concept Name Code Sequence = Procedure • TEXT = ‘PA and Lateral radiographs were …. . . ’ Merge. Link™ / Donald E. Van Syckle 31 ã 2000, Merge Technologies Inc, All Rights Reserved m

Procedure = ‘PA and Lateral radiographs …. Merge. Link™ / Donald E. Van Syckle

Procedure = ‘PA and Lateral radiographs …. Merge. Link™ / Donald E. Van Syckle 32 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 33 m

‘IMAGE’ Value Type Image Reference Instance UID=3. 56. 18. 9 • If defining the

‘IMAGE’ Value Type Image Reference Instance UID=3. 56. 18. 9 • If defining the “Purpose of Reference” then the Concept Name Code Sequence is used (i. e. Name/Value Pair) • If not defining the “Purpose of Reference” then only the value is conveyed (i. e. image reference) • IMAGE = ‘Instance UID = 3. 56. 18. 9. . . ’ Merge. Link™ / Donald E. Van Syckle 34 ã 2000, Merge Technologies Inc, All Rights Reserved m

Key Image = ‘ 3. 56. 18. 19 …. ’ Merge. Link™ / Donald

Key Image = ‘ 3. 56. 18. 19 …. ’ Merge. Link™ / Donald E. Van Syckle 35 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 36 m

‘CODE’ Value Type Code Conclusions (GCS, H 56) ‘Possible Mass’ (ICD, XXX)’ • Name/Value

‘CODE’ Value Type Code Conclusions (GCS, H 56) ‘Possible Mass’ (ICD, XXX)’ • Name/Value Pair • Concept Name Code Sequence = Conclusions • CODE = ‘Possible Mass’ (ICD, XXX)’ Merge. Link™ / Donald E. Van Syckle 37 ã 2000, Merge Technologies Inc, All Rights Reserved m

Code = ‘Possible Mass’ (ICD, XXX) Merge. Link™ / Donald E. Van Syckle 38

Code = ‘Possible Mass’ (ICD, XXX) Merge. Link™ / Donald E. Van Syckle 38 ã 2000, Merge Technologies Inc, All Rights Reserved m

Value Types • CONTAINER - Headings or categories (i. e. titles, sub-headings. . .

Value Types • CONTAINER - Headings or categories (i. e. titles, sub-headings. . . ) – Document Title or Document section heading e. g. “Conclusions (GCS, H 56)” • PNAME - Name of the person whose role is described by the Concept – Role of person e. g. name of the Recording Observer is “Smith^Andrew^^Dr. ” • TEXT - Free form textual expression of the concept (unlimited length) – Type of text e. g. procedure (GCS, H 12) = PA and Lateral radiographs were …’ • IMAGE - UID references to Image SOP Instances – Reference = SOP Class 1. 2. 840. 10008. . Instance UID 3. 56. 18. 9. . . • CODE - Coded expression of the concept – Type of code e. g. ‘Conclusion (GCS H 56) = ‘Possible Mass’ (ICD, XXX) Merge. Link™ / Donald E. Van Syckle 39 ã 2000, Merge Technologies Inc, All Rights Reserved m

Value Types • NUM - Numeric value or measurement with associated units – Type

Value Types • NUM - Numeric value or measurement with associated units – Type of code e. g. “Diameter (GCS, H 24) = 1. 3 CM” • DATE - Calendar date of occurrence – Type of date e. g. “Time of Blood Pressure (GCS, H 73) = March 3, 2000” • TIME - Time of day of occurrence – Type of time e. g. “Date of Blood Pressure (GCS, H 73) = 8: 30 am” • DATETIME - Concentrated Date and Time of occurrence – Type of Date. Time e. g. “Date and Time of Blood Pressure (GCS, H 73) = March 3, 2000 at 8: 30 am” • WAVEFORM - UID references to Waveform SOP Instances – Reference = SOP Class 1. 2. 840. 10008. . Instance UID 2. 776. 188. 903. . Merge. Link™ / Donald E. Van Syckle 40 ã 2000, Merge Technologies Inc, All Rights Reserved m

Value Types • COMPOSITE - UID references to Composite SOP Instances that are not

Value Types • COMPOSITE - UID references to Composite SOP Instances that are not images or waveforms – Reference = SOP Class 1. 2. 840. 10008. . SOP Instance UID 2. 345. 188. 473. . • UIDREF- Unique Identifier identified by concept name – Type of UID e. g. “Study Instance UID of Evidence Directly Examined by RO (GCS, H 92) = “ 3. 6. 889. 12345…. ” • SCOORD - Spatial coordinates of a geometric ROI in Images – "CLOSED 1, 1 5, 10" {SELECTED FROM: IMAGE xx}. • TCOORD - Temporal coordinates of a ROI in Waveforms – SEGMENT 60 -200 m. S" {SELECTED FROM: WAVEFORM xx}. Merge. Link™ / Donald E. Van Syckle 41 ã 2000, Merge Technologies Inc, All Rights Reserved m

How are the Content Items linked together in the SR Tree? • Relationship Types

How are the Content Items linked together in the SR Tree? • Relationship Types Merge. Link™ / Donald E. Van Syckle 42 ã 2000, Merge Technologies Inc, All Rights Reserved m

Source and Target Content Items Relationship Source Content Item Root Content Item Target Content

Source and Target Content Items Relationship Source Content Item Root Content Item Target Content Item Merge. Link™ / Donald E. Van Syckle 43 ã 2000, Merge Technologies Inc, All Rights Reserved m

Relationship Types • Parent/Child relationship between Source and Target Source Content Item Relationship Target

Relationship Types • Parent/Child relationship between Source and Target Source Content Item Relationship Target Content Item CONTAINER “Conclusions” contains CODE “conclusions = Possible Mass” IODs may specify constraints on relationships Merge. Link™ / Donald E. Van Syckle 44 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 45 m

Relationship Types • HAS OBS CONTEXT - Target conveying specialization of Observation Context needed

Relationship Types • HAS OBS CONTEXT - Target conveying specialization of Observation Context needed for documentation of Source – CONTAINER: “Chest PA and Lateral” {HAS OBS CONTEXT: PNAME: Recording Observer = “Smith^Andrew^^Dr. ”} • CONTAINS - Source contains Target – CONTAINER “Findings” {CONTAIN: TEXT “Findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in. . . ”} Merge. Link™ / Donald E. Van Syckle 46 ã 2000, Merge Technologies Inc, All Rights Reserved m

Relationship Types • HAS CONCEPT MOD - Qualifies or describe the Concept Name of

Relationship Types • HAS CONCEPT MOD - Qualifies or describe the Concept Name of the Source; also used to quantify data greater than 64 characters – CODE: “Chest X-Ray” {HAS CONCEPT MOD: TEXT “View = PA and Lateral”} • HAS PROPERTIES - Description of properties of the Source – CODE: “Mass” {HAS PROPERTIES: CODE: “diameter”} • HAS ACQ CONTEXT - Target describes the condition present during data acquisition of the Source – IMAGE: “ 36” {HAS ACQ CONTEXT : CODE “contrast agent”} Merge. Link™ / Donald E. Van Syckle 47 ã 2000, Merge Technologies Inc, All Rights Reserved m

Relationship Types • SELECTED FROM - Source Item conveys spatial or temporal coordinates selected

Relationship Types • SELECTED FROM - Source Item conveys spatial or temporal coordinates selected from Target(s) – SCOORD: “CLOSED 1, 1, 5, 10” {SELECTED FROM: IMAGE: “ 36”} • INFERRED FROM - Source conveys a measurement or other inference made from Target – CODE: “Malignancy” {INFERRED FROM: CODE: “Mass”} Merge. Link™ / Donald E. Van Syckle 48 ã 2000, Merge Technologies Inc, All Rights Reserved m

Observation Context • Describes who or what is performing the interpretations • Whether the

Observation Context • Describes who or what is performing the interpretations • Whether the examination of evidence is direct or quoted • What procedure generated the evidence that is being interpreted • Who or what is the subject of the evidence that is being interpreted Observation Context is encoded in a Content Item Merge. Link™ / Donald E. Van Syckle 49 ã 2000, Merge Technologies Inc, All Rights Reserved m

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording

Content Items and Relationship Document Title ‘Chest PA & LAT’ (GCS, T 78) Recording Observer Name ‘Smith^Andrew^^Dr’ Has Obs. Context Contains Document Heading ‘Procedures’ (GCS, H 12) Contains Text ‘procedure (GCS, H 12) = PA and Lateral radiographs were ……. ’ Document Heading ‘Findings’ (GCS, H 34) Contains Observation Subject ‘Jones^George’ Text ‘findings (GCS, H 34) = The PA demonstrates… A small opacity is visible in the base of lung in lateral view. CT recommended. ’ Document Heading ‘Conclusions’ (GCS, H 56) Contains Merge. Link™ / Donald E. Van Syckle Inferred From Code ‘conclusions (GCS H 56) = Possible Mass’ (ICD, XXX)’ ã 2000, Merge Technologies Inc, All Rights Reserved Image Reference Instance UID=3. 56. 18. 9 50 m

Observation Context Examples Merge. Link™ / Donald E. Van Syckle 51 ã 2000, Merge

Observation Context Examples Merge. Link™ / Donald E. Van Syckle 51 ã 2000, Merge Technologies Inc, All Rights Reserved m

Initial Observation Context • Defined outside the SR Document Content Tree • Applies to

Initial Observation Context • Defined outside the SR Document Content Tree • Applies to all Content Items in SR tree Patient Information Study Information Patient Name Patient ID Patient Date of Birth Patient Sex. . . Series Information Patient’s Weight Referring Physician's Name Accession Number Study Instance UID. . . SR Document Information ……. Merge. Link™ / Donald E. Van Syckle 52 ã 2000, Merge Technologies Inc, All Rights Reserved m

Inheritance Rules in SR Tree • All inherit initial Ob. Co. Node 1 •

Inheritance Rules in SR Tree • All inherit initial Ob. Co. Node 1 • HAS OBS CTX adds to Ob. Co. of parent node Has Obs Ctx Contains • Node 1 extended by Node. C 1 (e. g. Recording Observer) Node C 1 Node 2 • Node 2 inherits Ob. Co. of Node 1 Has Obs Ctx Contains Node C 2 Node C 3 Node 3 Merge. Link™ / Donald E. Van Syckle • Node 2 extended by Nodes C 2 & C 3 53 ã 2000, Merge Technologies Inc, All Rights Reserved m

Inheritance Rules • HAS OBS CTX inherited by all by-value descendant nodes of parent

Inheritance Rules • HAS OBS CTX inherited by all by-value descendant nodes of parent regardless of relationship between parent and descendant Node 1 Has Obs Ctx Contains Node C 1 • Node 3 and its descendents inherits Node 2 (1, C 2, C 3) Node 2 Has Obs Ctx Contains Node C 2 Node C 3 Node 3 Merge. Link™ / Donald E. Van Syckle : : • Ob. Ctx. is never replaced (i. e. tree of Content Items traversed top down from root) • Ob. Ctx. shall not be inherited across by-reference relationships ã 2000, Merge Technologies Inc, All Rights Reserved 54 m

By Reference Content Items • Allows referencing to other Content Items • Document Relationship

By Reference Content Items • Allows referencing to other Content Items • Document Relationship and Document Content Marcos are not included • For example: CODE: “Probable Malignancy” {INFERRED FROM: CODE: “Mass”} Code ‘Findings (GCS H 34) = Mass’ (ICD, XXX)’ Inferred From Merge. Link™ / Donald E. Van Syckle Code ‘conclusions (GCS H 56) = Probable Malignancy (ICD, YYY)’ 55 ã 2000, Merge Technologies Inc, All Rights Reserved m

Reference Content Item Identifier • Ordered set of integers Root Content Item Cont. Item

Reference Content Item Identifier • Ordered set of integers Root Content Item Cont. Item ID 01 01 01 Content Item Cont. Item ID 01 02 01 • Root Content Item = 1 • Each subsequent integer represents ordinal position of the Content Item in which Content Sequence it belongs • Walk through tree to determine ID Not allowed for the simple Basic and Enhanced SOP Classes Merge. Link™ / Donald E. Van Syckle 56 ã 2000, Merge Technologies Inc, All Rights Reserved m

“Probable Malignancy” {INFERRED FROM: CODE: “Mass”} Merge. Link™ / Donald E. Van Syckle 57

“Probable Malignancy” {INFERRED FROM: CODE: “Mass”} Merge. Link™ / Donald E. Van Syckle 57 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR Document General & SR Document Content Modules How do I read the SR

SR Document General & SR Document Content Modules How do I read the SR specific Modules? • Same as other DICOM Modules • Except new documentation convention called “Macros” Merge. Link™ / Donald E. Van Syckle 58 ã 2000, Merge Technologies Inc, All Rights Reserved m

Macros - a new convention for DICOM documentation. . . Easy way to document

Macros - a new convention for DICOM documentation. . . Easy way to document codes, measurements, spatial coordinates, image references, etc. Merge. Link™ / Donald E. Van Syckle 59 ã 2000, Merge Technologies Inc, All Rights Reserved m

Numeric Measurement Macro Merge. Link™ / Donald E. Van Syckle 60 ã 2000, Merge

Numeric Measurement Macro Merge. Link™ / Donald E. Van Syckle 60 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR Document General Module • Attributes identify the SR Document and provide context for

SR Document General Module • Attributes identify the SR Document and provide context for the entire document • Attributes are outside the SR Document Tree which simplifies Query access • See SR Supplement Table C. 17 -2 Merge. Link™ / Donald E. Van Syckle 61 ã 2000, Merge Technologies Inc, All Rights Reserved m

Identification Attributes • SOP Class UID and SOP Instance UID (from SOP Common) •

Identification Attributes • SOP Class UID and SOP Instance UID (from SOP Common) • Instance Number • Content Date (same attribute as Image Date) • Content Time (same attribute as Image Time) All Type 1 Fields Date/Time important for managing reports Merge. Link™ / Donald E. Van Syckle 62 ã 2000, Merge Technologies Inc, All Rights Reserved m

Status and Verifying Attributes • Completion Flag - PARTIAL or COMPLETE – how to

Status and Verifying Attributes • Completion Flag - PARTIAL or COMPLETE – how to set the flag is open to implementation • Completion Flag Description - free form text • Verification Flag - UNVERIFIED or VERIFIED • Verifying Observer Sequence – identifies person(s) verifying the document and organization(s); required if flag = VERIFIED Prevailing final version = most recent Verification Date. Time, VERIFIED, COMPLETE Merge. Link™ / Donald E. Van Syckle 63 ã 2000, Merge Technologies Inc, All Rights Reserved m

Reference Request Sequence • Identifies Requested Procedure(s) being fulfilled by the SR document –

Reference Request Sequence • Identifies Requested Procedure(s) being fulfilled by the SR document – Study Instance UID – Referenced Study Sequence – Requested Procedure ID, Accession Number – Requested and Performed Procedure Codes – …. One SR document may cover multiple Requested Procedures Merge. Link™ / Donald E. Van Syckle 64 ã 2000, Merge Technologies Inc, All Rights Reserved m

Related Document/Object Pointers • Predecessor Document Sequence – SRs whose content has been included

Related Document/Object Pointers • Predecessor Document Sequence – SRs whose content has been included into document (prior reports, amendments, etc. ) • Current Requested Procedure Evidence Sequence – All Composite SOP Instances created to satisfy the current requested Procedure(s) being reported upon • Pertinent Other Evidence – All Other SOP Instances considered pertinent to document and not listed in “Cur. Req. Proc. Evid. Seq. ” Same SOP Instance cannot be in Current or Pertinent Sequences Merge. Link™ / Donald E. Van Syckle ã 2000, Merge Technologies Inc, All Rights Reserved 65 m

Identical Documents Sequence • References all identical SR documents • Entire SR document is

Identical Documents Sequence • References all identical SR documents • Entire SR document is the same except for UIDs (i. e. Study Instance, Series Instance, SOP Instance) • When modifying an “Identical Document” the implementation must modify all “Identical Documents” or the new “modified” report is no longer an “Identical Document” All “Identical” SR documents reference each other Merge. Link™ / Donald E. Van Syckle 66 ã 2000, Merge Technologies Inc, All Rights Reserved m

Three Identical Documents Identical Doc Seq. Original Doc 1 Predecessor Doc Seq. Modified Doc

Three Identical Documents Identical Doc Seq. Original Doc 1 Predecessor Doc Seq. Modified Doc 1 Original Doc 2 Original Doc 3 Modified Doc 2 Modified Doc 3 Identical Doc Seq. Merge. Link™ / Donald E. Van Syckle 67 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR Document Content Module • Attributes convey content of the SR Document • Provides

SR Document Content Module • Attributes convey content of the SR Document • Provides the “Root Content Item” (i. e. Document Title) • Nests Content Sequences for all other Content Items • See SR Supplement Table C. 17. 3 – Document Relationship Macro – Document Content Macro Merge. Link™ / Donald E. Van Syckle 68 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR SOP Instance Modification Rules Patient Specimen Ident. Module Patient Information – SR Document

SR SOP Instance Modification Rules Patient Specimen Ident. Module Patient Information – SR Document General Study Module Study Information Series Information SR Document Information • New SOP Instance if modify: SR Document Series Patient Study Module* General Equipment Module – SR Document Content – Series Instance UID – Study Instance UID SR SOP SR Document Common General Content Module Merge. Link™ / Donald E. Van Syckle 69 ã 2000, Merge Technologies Inc, All Rights Reserved m

SR IODs • Basic Text SR IOD – Minimal usage of coded entries –

SR IODs • Basic Text SR IOD – Minimal usage of coded entries – Reference to SOP Instances restricted to leaves from text tree – No by-reference Content Items (i. e. by-value only) • Enhanced SR IOD – superset of Basic Text but extended to include spatial and temporal regions of interest • Comprehensive SR IOD – superset of Basic Text and Enhanced, references to leaves not restricted and includes by-reference Content Items Merge. Link™ / Donald E. Van Syckle 70 ã 2000, Merge Technologies Inc, All Rights Reserved m

Basic SR Relationship Restrictions (table A. 35. 1 -2) Merge. Link™ / Donald E.

Basic SR Relationship Restrictions (table A. 35. 1 -2) Merge. Link™ / Donald E. Van Syckle 71 ã 2000, Merge Technologies Inc, All Rights Reserved m

Enhanced SR Relationship Restrictions (table A. 35. 2 -2) Merge. Link™ / Donald E.

Enhanced SR Relationship Restrictions (table A. 35. 2 -2) Merge. Link™ / Donald E. Van Syckle 72 ã 2000, Merge Technologies Inc, All Rights Reserved m

Comprehensive SR Relationship Restrictions (table A. 35. 3 -2) Merge. Link™ / Donald E.

Comprehensive SR Relationship Restrictions (table A. 35. 3 -2) Merge. Link™ / Donald E. Van Syckle 73 ã 2000, Merge Technologies Inc, All Rights Reserved m

DICOM Structured Reporting • Fits within the normal DICOM structure • New ideas such

DICOM Structured Reporting • Fits within the normal DICOM structure • New ideas such as Content Items and Relationships • Simple for Basic Text and Enhanced • More Complex for Comprehensive Not just for Radiology and Cardiology but can be used for all “ologies” Merge. Link™ / Donald E. Van Syckle 74 ã 2000, Merge Technologies Inc, All Rights Reserved m

Thank You! Merge. Link™ / Donald E. Van Syckle 75 ã 2000, Merge Technologies

Thank You! Merge. Link™ / Donald E. Van Syckle 75 ã 2000, Merge Technologies Inc, All Rights Reserved m