Combined DICOM and HL7 viewer in support of a bridge from content-based image

retrieval to computer-aided diagnosis

Welter PWelter P11, Topal F, Topal F11, Jansen S, Jansen S11, Deserno TM, Deserno TM11, , Riesmeier JRiesmeier J22, Grouls C, Grouls C33, Günther RW, Günther RW33

11Dept. of Medical Informatics, RWTH Aachen UniversityDept. of Medical Informatics, RWTH Aachen University 22ICSMED AGICSMED AG,, OldenburgOldenburg

33Dept. of Diagnostic Radiology, RWTH Aachen UniversityDept. of Diagnostic Radiology, RWTH Aachen University

- ITiB - - ITiB - June 7, 2010June 7, 2010

Content-Based Image Retrieval (CBIR)Content-Based Image Retrieval (CBIR)

Search in large image repositoriesSearch in large image repositoriesusing features describing the image contentusing features describing the image content

extraction of featuresextraction of features

texturetextureshapeshape

gray valuegray value……

DBDBcomparison of featurescomparison of features

CBIR systemCBIR system

query by query by exampleexample

result imagesresult images

CBIR for Computer-Aided DiagnosisCBIR for Computer-Aided Diagnosis

fat embolismfat embolism

silicosissilicosis

Goodpasture’ssyndrome

Goodpasture’ssyndrome

22ndnd opinion opinion

IRMAIRMA

IRMA:IRMA: I Image mage RRetrieval in etrieval in MMedical edical AApplicationspplications

Challenge: Handling of CBIR ResultsChallenge: Handling of CBIR Results

Aim Aim use of open standards integration with a hospital-wide

communication structure

DICOM Structured ReportDICOM Structured Report

CBIR-CBIR-SystemSystem

Hospital Information System (HIS)Hospital Information System (HIS)Picture archiving and communication system (PACS)Picture archiving and communication system (PACS)Radiology Information System (RIS)Radiology Information System (RIS)

Welter P, Deserno TM, Gülpers R et al. (2010) Exemplary Design of a DICOM Structured Report Template for CBIR Integration into Radiological Routine. Procs SPIE Medical Imaging 7628.

Challenge: Handling of CBIR ResultsChallenge: Handling of CBIR Results

Aim Aim use of open standards integration with a hospital-wide

communication structure

DICOM Structured ReportDICOM Structured Report comprehensive and complete comprehensive and complete

representationrepresentation

QueryQueryexaminationexamination

imageimage

IdentifiedIdentifiedsimilar examinationsimilar examination

imagesimagesPatientPatient

informationinformation

DiagnosticDiagnosticfindingsfindings

State of the Art RepresentationState of the Art Representation

OFFIS, DICOMscope DICOM viewer, http://dicom.offis.de

DICOMscope (2)DICOMscope (2)

PACS

DB

CBIR system

CBIR based CADx schemeCBIR based CADx scheme

HIS

DB

Transfer of Transfer of patient contextpatient context

Central storage of Central storage of CBIR resultsCBIR results

Retrieval of Retrieval of CBIR resultsCBIR results

Retrieval of Retrieval of diagnostic diagnostic

findingsfindings

Retrieval of Retrieval of similar similar

examinationsexaminations

diagnostic workstation

Flow of data from source to destination

PACS

DB

System designSystem design

HIS

DB

diagnostic workstation

IRMACONViewer

SR

Findings

HL7DICOM PHP/HTML

PACS

DB

ImplementationImplementation

HIS

DB

diagnostic workstation

IRMACONViewer

C-MOVEC-MOVE

QRY^R02QRY^R02

ORF^R04ORF^R04

HAPI, http://hl7api.sourceforge.net/DCMTK, http://dicom.offis.de/dcmtk.php.de

XMLXMLPNGPNGPHP, Smarty TemplatesPHP, Smarty TemplatesMapping Mapping

DICOM - HL7DICOM - HL7

Mapping DICOM - HL7 Mapping DICOM - HL7

…Patienten-ID (0010,0020)Accession-Number (0008,0050)…

…QRD|201004180943|R|I|Q4412|||10^RD|0123456-1|RES|9312345…

QRD-10Order-No

QRD-8Patienten-ID

QRD-9 Query for

resultsCBIR SR-Document

HL7 QRY^R02

Exemplary HL7 messagesExemplary HL7 messagesQuery for results of observation QRY^R02MSH|^~\&|IRMACON||EKG||||QRY^R02|CDB22222|P|2.5QRD|201004180943|R|I|Q4412|||10^RD|0123456-1|RES|9312345QRF|EKG||200801010000

Response ORF^R04MSH|^~\&|EKG||IRMACON||||ORF^R04|X981672|P…OBX|1|ST|93000.1^VENTRICULAR RATE(EKG)||91|/MIN|60-100…OBX|10|FT|93000&ADT^EKG COMMENT||\.br\ 1. Ein Vergleich

mit einem EKG vom 31.10.2001 zeigt, dass die ventrikuläre Frequenz um 30 bpm gestiegen ist.\.br\2. Die Kriterien für einen Seitenwandinfarkt sind nicht länger gegeben.

IRMACON ViewerIRMACON Viewer

IRMACON Viewer (Detail)IRMACON Viewer (Detail)

IRMACON Viewer (Findings)IRMACON Viewer (Findings)

SummarySummary

Aim: Integration of CBIR results into radiological Aim: Integration of CBIR results into radiological clinical routine for CADxclinical routine for CADx

Solution: Novel IRMACON viewerSolution: Novel IRMACON viewer CBIR results (DICOM SR documents)CBIR results (DICOM SR documents) diagnostic findings (HL7 results of observation)diagnostic findings (HL7 results of observation)

AchievementAchievement standardized and comprehensive representation standardized and comprehensive representation evidences sourced from CBIR, PACS and HIS convenient integration into clinical environmentsconvenient integration into clinical environments improvement of radiologist’s workflow and medical improvement of radiologist’s workflow and medical

diagnosisdiagnosis

OutlookOutlook

Extension of test settings: HIS Processing region of interest: restricting CBIR to a

certain phenomenon

AcknowledgmentsAcknowledgments

FundFund German Research German Research FoundationFoundation ((DFGDFG))

grants Le 1108/9grants Le 1108/9

http://irma-project.orghttp://irma-project.org

Possible Format SolutionsPossible Format Solutions

Standard file formats (e.g., PDF)Standard file formats (e.g., PDF) include layout directivesinclude layout directives no automatic processing no automatic processing

HL7 Clinical Document Architecture (CDA)HL7 Clinical Document Architecture (CDA) XML format supports automatic processing XML format supports automatic processing no layout directivesno layout directives

DICOM Structured Reporting (DICOM-SR)DICOM Structured Reporting (DICOM-SR) supports automatic processing supports automatic processing no layout directivesno layout directives DICOM is standard for communication in PACSDICOM is standard for communication in PACS used in integration profiles of the Integrating the Healthcare used in integration profiles of the Integrating the Healthcare

Enterprise (IHE)Enterprise (IHE)

Welter P, Deserno TM, Gülpers R et al. (2010) Exemplary Design of a DICOM Structured Report Template for CBIR Integration into Radiological Routine. Procs SPIE Medical Imaging 7628.