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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

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Page 1: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

DICOM Structured ReportingRecent Standards Activity

Doug SluisSPIE, Feb 18, 2003

Page 2: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 2

Overview

• Recent Template Supplements• Interoperability Considerations• Templates for Measurement Findings• DCMR Developments

Page 3: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 3

WG15

WG12

WG1

Supplements

2001 2002 2003

2004

Breast Report (79)

MammographyCAD (50)

Key Object (59)

OB-GYN (26)

Patient History (75)

Chest CAD (65)

QCA&QVA(76)Cath, Hemo, ECG (66)

Echocardiography (72)

IVUS (77)

Vascular (71)

MRA/CTA (XX)

Fetal &Ped. (78)

DCMR (53)

Page 4: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 4

Image Derived Findings

FindingsAnalysis, CAD,Quantification,Observations

Norms

Report

Images

Recent Focus

/ EvidenceClinicalHistory

Sup 75

Page 5: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 5

Software Roles for Evidence & Findings• Streamline

differential diagnosis, trending

• Task-optimized presentation

• Indices and ratios• Compare to norms• Ease data navigation• Outcomes

Images

Measurements, estimations

Page 6: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 6

SR Interoperability – Contrast to Image

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

Product XProductDomain

Image

UserDomain

Findings

Product Z

Page 7: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 7

Interoperability: Comparable Findings

• Findings comparability is key goal– Unambiguous, well defined Coded Concepts

Product X

Product Y

SRProduct Z

CompareCollate, SortMatch to norms

agree?

Page 8: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 8

Comparable Concepts

• Phrase may evoke multiple concepts• Comparability depends on concept

oriented codes

Umbilical vein(fetal)

Umbilical vein(portal)

(T-F1820, SRT, “umbilical vein”)(T-F8817, SNM3, “umbilical vein”)

Page 9: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 9

DCMR Role in Interoperability

Clinical Concepts

UserDomain

Product XConcepts

ProductDomain

Product ZConcepts

findings

images

map to map to

map to map to

DCMR

standardmap

StandardsDomain

SNOMED, LOINCNCDR, SCPECG

Page 10: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 10

Measurement Finding Concepts

Findings

PropertyDiameter, area, volume,blood velocity, indices, ratios …

AnatomyFinding site, Site Modifier,Laterality

Physiological phaseCardiac - systole, diastole … Respiratory – exp., insp. …

Procedural phaseInduced stress state Intervention state

AcquisitionImage viewImage mode

DerivationMean, max, min… Method/Technique

Page 11: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 11

Direct Concept Mapping

Clinical Concepts

DCMR

LOINCFetal femur length

Direct pre-coordinated conceptTemplate has marginal role

Page 12: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 12

DCMR

Molecular Concepts

Clinical Concepts

LNSRT

SRTLeft

PeakVelocity

Template binds concept atomsBased on model (implicit)

Femoral Artery

Page 13: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 13

DCMR

Choosing Concept Atoms

Clinical Concepts

Peak Velocity

Issues• Coupled concepts• Degrees of specificity

Solution options• Many Templates• Mapping Annex (72)

Aortic ValveDiastolic

Regurgitant

Page 14: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 14

Quick Review

Value TypeConcept Name = Value

relationshipValue Type

Concept Name = Value

Value Types CONTAINER, NUM, CODE, IMAGE …

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)

relationshipValue Type

Concept Name = Value

Page 15: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 15

CONTAINERFinding Heading

CONTAINERFinding Heading

Typical Top Level Template Structure

CONTAINERDocument Title

CONTAINERPatient

Characteristics

Template specified titleOB-GYN, Adult Echo, IVUSUltrasound Vascular, Cath/Hemo …

TID 1002ObservationContext

CONTAINERSummary

Other Contexte.g. procedure

CONTAINER…

SummaryFindings

CONTAINERFindings Heading

Findings

Page 16: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 16

Document Headings

CONTAINERHeading

Findings

CONTAINERDocument Title

The heading may have semanticsshared by children findings

Specific: “Exercise Challenge” Generic: “Findings”

“Laterality” = “Left”“Finding Site” = “Cerebral Vessels”

CODEConcept Modifier

has concept modifier

contains

Page 17: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 17

Discrete Numeric Findings

CONTAINERGroup

NUMMeasurement

Diameter, Area, Volume, Blood Velocity, Indices, Ratios, Time Interval …or pre-coordinated concept: BPD, FL …

CODEModifier Concept

has concept modifier

CODEModifier Concept

has concept modifier

Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase …

contains

Distributed semantics

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

D Sluis 18

Vascular Content Hierarchy

CONTAINERAnatomy

CONTAINERFindings

CODELaterality

has concept modifier

has concept modifier

NUMMeasurement

CODETopographical Modifier

contains

contains

CONTAINERVascular Report

Document Title

Section Heading

Group

Discrete FindingMinimumConcepts

contains

property

Page 19: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 19

Vascular Templates

CONTAINERFindings

CODELaterality

has concept modifier

TID 5103

Content Item Value Set

Right, Left, or Unilateral

Page 20: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 20

TID 5104

Vascular Templates

CONTAINERAnatomy

CONTAINERFindings

CODELaterality

has concept modifier

contains

Content Item Value Set

Page 21: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 21

TID 5104

Vascular Templates

CONTAINERAnatomy

CONTAINERFindings

CODELaterality

has concept modifier

CODELongitudinal Modifier

has concept modifiercontains

Optional specificity

Content Item Value Set

Page 22: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 23

Vascular Templates

CONTAINERAnatomy

CONTAINERFindings

CODELaterality

has concept modifier

has concept modifier

NUMMeasurement

CODETopographical Modifier

contains

contains TID 5104

Content Item Value Set

Page 23: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 24

Findings Origin and ContextNUM

Measurement

SCOORDInferred from

IMAGE

CODE

CODE

Inferred from

Equation or TableInferred from

has acquisition context Image ModeImage View

CODE, TEXT Normality, SignificanceNormal Range, …

has properties

Coordinates

Image

NUMInferred from Numeric dependency

TID 300 Measurements

Page 24: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 25

Harmonization

CONTAINERFindings

CONTAINERFindings

CODEProcedure Reported

has concept modifier

has concept modifier

CODEWall Segment

CODEFinding Site

contains

contains

CONTAINEREcho Report

Myocardial Wall

Left Ventriculography

Wall Motion Analysis

contains

CONTAINERHemo Report

CODECardiac Wall Motion

CODEAssociated Morphology

DCID 3704 Wall Morphology

DCID 3703 Wall Motionhas properties

BCID 3717 Wall Segments

Sup 66Sup 72

Content Item Value Set

Page 25: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 26

DCMR Usability

Text format• Needless

translation step for development

• Hard to maintain!• Quality impact

DICOMStandard

Application

Developer

Product SW

Page 26: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 27

DCMR in XML

Referentialintegrity

DCMR InterchangeStandard

(XML Schema)

PDFInteractive Web AccessProduct configurationWeb services

DCMR

MaintenanceEnvironment

DCMR (XML)

Information model

Page 27: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003

D Sluis 28

Future

• 3D coordinates• 3D shapes

• HL7 V3 Harmonization

Page 28: DICOM Structured Reporting Recent Standards Activity Doug Sluis SPIE, Feb 18, 2003