1June, 2006 What IHE Delivers

Donald Van SyckleDonald Van SycklePresident, DVS Consulting, Inc.President, DVS Consulting, Inc.www.dvsconsult.comwww.dvsconsult.com

IHE Eye CareIHE Eye Care

“Evidence Documents”“Evidence Documents”

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Evidence DocumentsEvidence Documents

An extension of the Eye Care SWF profileAn extension of the Eye Care SWF profile(i.e. actors must support SWF before supporting (i.e. actors must support SWF before supporting Eye Care ED)Eye Care ED)

Measurements, observations and coded data Measurements, observations and coded data created using DICOM objectscreated using DICOM objects

Typically created by either an Acquisition Modality Typically created by either an Acquisition Modality or Evidence Creatoror Evidence Creator(i.e. eye care instruments, standalone (i.e. eye care instruments, standalone workstations, EMRs, etc.)workstations, EMRs, etc.)

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Evidence DocumentsEvidence Documents

Produced during acquisition or post-processing Produced during acquisition or post-processing workflowsworkflows

May be Interpreted along with imagesMay be Interpreted along with imagesor stand aloneor stand alone

Either DICOM Structured Reports (SR) or DICOM Either DICOM Structured Reports (SR) or DICOM Encapsulated PDFEncapsulated PDF

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Eye Care EvidenceEye Care EvidenceDocuments ExamplesDocuments Examples

Glaucoma progression analysis performed on visual field Glaucoma progression analysis performed on visual field analyzersanalyzers

RNFL analysis performed on an OCT device RNFL analysis performed on an OCT device

Measurements on fundus imagesMeasurements on fundus images

Measurements on anteriour chamber OCT images for Measurements on anteriour chamber OCT images for phakis IOL implantation planningphakis IOL implantation planning

Corneal ablation planning based on corneal topography Corneal ablation planning based on corneal topography mapsmaps

Others….Others….

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DICOM Structured Report (SR)DICOM Structured Report (SR)

The DICOM object used by IHE for reportingThe DICOM object used by IHE for reporting

Reports that include actual measurement values, Reports that include actual measurement values, observations and/or coded data to describe eye care observations and/or coded data to describe eye care evidenceevidence

Eye Care specific DICOM SRs being defined by WG9 – IHE Eye Care specific DICOM SRs being defined by WG9 – IHE will adopt upon completionwill adopt upon completion Keratometer, Autorefractor, Lensometer, biometry, visual fieldsKeratometer, Autorefractor, Lensometer, biometry, visual fields

Note: Fundus measurements may be possible using Simple Image and Note: Fundus measurements may be possible using Simple Image and Numeric DICOM SR, but has yet to be reviewed by WG9Numeric DICOM SR, but has yet to be reviewed by WG9

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Eye Care ExtensionEye Care ExtensionDICOM Encapsulated PDFDICOM Encapsulated PDF

Also includes measurement values, observations Also includes measurement values, observations and/or coded data to describe eye care evidenceand/or coded data to describe eye care evidence

However, DICOM Encapsulated PDF is a “display However, DICOM Encapsulated PDF is a “display only” solutiononly” solution

Is used when no specific DICOM SR solution is Is used when no specific DICOM SR solution is defineddefined

Note - since there are no current DICOM SRs defined for Note - since there are no current DICOM SRs defined for Eye Care, it is expected that only DICOM Encapsulated Eye Care, it is expected that only DICOM Encapsulated PDF will be used in the AAO showcasePDF will be used in the AAO showcase

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Evidence DocumentsEvidence Documents

Query / RetrieveQuery / Retrieve

Storage CommitmentStorage Commitment

Evidence Document Evidence Document StoredStored

June, 2006 8ImagesImages

Evidence Evidence DocumentsDocuments

Professional Professional ReportReport

…..

Findings:

Image Refs.:

Header:

Report Type: ……

Retinal.. ...…..

Eye Care

Impressions: …….…

...

Interpretation

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Managed Like ImagesManaged Like ImagesEvidence Documents can be transferred, stored, and Evidence Documents can be transferred, stored, and query/retrieve just like imagesquery/retrieve just like images

Exists in the same study as imagesExists in the same study as images

Patient Patient InformationInformation

Study Study InformationInformation

Series Series InformationInformation

ImageImage

Series Series InformationInformation

SR Evidence SR Evidence Document Document

Series Series InformationInformation

DICOM Encp.DICOM Encp.PDFPDF

Series Series InformationInformation

OtherOtherComposite IODsComposite IODs

Patient IDPatient ID

Study Inst. UIDStudy Inst. UID

Series Inst. UIDSeries Inst. UID

SOP Inst. UIDSOP Inst. UID

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ED a Part of Performed Procedure Step`ED a Part of Performed Procedure Step`

Image

PatientPatient

Imaging Serv. Req. (Order)Imaging Serv. Req. (Order)

RequestedRequestedProcedureProcedure

ScheduledScheduledProcedure StepProcedure Step

Study MgtStudy Mgt

PerformedPerformedProcedure StepProcedure Step

Study

Series

Series

EDEDImage

ImageA PPS is an “Atomic Imaging/Measurements Exam”A PPS is an “Atomic Imaging/Measurements Exam”

• A PPS Starts and Ends. It is never resumed !A PPS Starts and Ends. It is never resumed !• A PPS produces one or more series of images/evidence documentsA PPS produces one or more series of images/evidence documents• Once a PPS is completed, images/evidence documents cannot be added to a seriesOnce a PPS is completed, images/evidence documents cannot be added to a series• Additional PPS can always be performedAdditional PPS can always be performed• A Study usually holds the work product for a Requested ProcedureA Study usually holds the work product for a Requested Procedure• A Study may be multi-modality (I.e. multiple instruments)A Study may be multi-modality (I.e. multiple instruments)

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WorkflowWorkflow

CARD-3: Storage Commitment

EYECARE-2 Modality Images/Evidence Stored

Evidence Creator

Acquisition Modality

Image Manager

Image Archive

Image Display

EYECARE-2 Modality Images/Evidence Stored

CARD-3: Storage Commitment EYECARE-4: Query Evidence

Documents [RAD45]: Retrieve Evidence Documents

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Example – Acquisition ModalityExample – Acquisition Modality

Images have been taken at an Acquisition ModalityImages have been taken at an Acquisition Modality

After image acquisition, the Acquisition Modality performs post After image acquisition, the Acquisition Modality performs post processing such as:processing such as: a glaucoma progression analysisa glaucoma progression analysis RNFL analysis performed on an OCT deviceRNFL analysis performed on an OCT device Others…..Others…..

Evidence Documents are created using DICOM SR or DICOM Evidence Documents are created using DICOM SR or DICOM Encapsulated PDFEncapsulated PDF

Evidence Documents are:Evidence Documents are: stored in the same Study as the images (in a separate series)stored in the same Study as the images (in a separate series) tracked using DICOM MPPStracked using DICOM MPPS sent to the storage serversent to the storage server securely stored using Storage Commitmentsecurely stored using Storage Commitment

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Example – Workstation, EMRExample – Workstation, EMRUnscheduled post-processing done after the acquisition, products Unscheduled post-processing done after the acquisition, products support both the Image Display Actor and Evidence Creator Actorsupport both the Image Display Actor and Evidence Creator Actor

Use DICOM query/retrieve to acquire previous images and/or Use DICOM query/retrieve to acquire previous images and/or measurements then perform post-processingmeasurements then perform post-processing measurements on fundus imagesmeasurements on fundus images corneal ablation planning based on corneal topography mapscorneal ablation planning based on corneal topography maps measurements on anterior chamber OCT images for phakic IOL implantation measurements on anterior chamber OCT images for phakic IOL implantation

planningplanning Others…Others…

Evidence documents are:Evidence documents are: either DICOM SR or DICOM Encapsulated PDFeither DICOM SR or DICOM Encapsulated PDF stored in the same study as created by the Acquisition Modalitystored in the same study as created by the Acquisition Modality sent to the storage serversent to the storage server securely stored using Storage Commitmentsecurely stored using Storage Commitment

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IHE Generic IHE Generic Keys for Keys for Query Query

Retrieve of:Retrieve of:- Images- Images

- Evid. Doc.- Evid. Doc.- SR- SR

Query Keys Matching Query Keys ReturnAttributes Name Tag

SCU SCP SCU SCP

Study Level

Study Date (0008,0020) R+ R R+ R

Study Time (0008,0030) R+ R R+ R

Accession Number (0008,0050) R+ R R+ R

Patient Name (0010,0010) R+ R R+ R

Patient ID (0010,0020) R+ R R+ R

Study ID (0020,0010) R+ R R+ R

Study Instance UID (0020,000D) R+ R O R

Modalities in Study (0008,0061) R+ R+ R+ R+

Referring Physician’s Name (0008,0090) R+ R+ R+ R+

Patient’s Birth Date (0010,0030) O O R+ R+

Patient’s Sex (0010,0040) O O R+ R+

Number of Study Related Series (0020,1206) N/A N/A O R+

Number of Study Related Instances (0020,1208) N/A N/A O R+

Series Level

Modality (0008,0060) R+ R R+ R

Series Number (0020,0011) R+ R R+ R

Series Instance UID (0020,000E) R+ R O R

Number of Series Related Instances (0020,1209) N/A N/A O R

Request Attribute Sequence (0040,0275) R+ R+ R+ R+

>Requested Procedure ID (0040,1001) R+ R+ R+ R+

>Scheduled Procedure Step ID (0040,0009) R+ R+ R+ R+

Performed Procedure Step Start Date (0040,0244) R + R+ R+ R+

Performed Procedure Step Start Time (0040,0245) R + R+ R+ R+

Composite Object Instance Level

Instance Number (0020,0013) R R O R

SOP Instance UID (0008,0018) R+ R O R

SOP Class UID (0008,0016) O R O R+

R = Required and the R = Required and the SCU shall be able SCU shall be able to display to display

R+ = IHE RequirementR+ = IHE Requirement on top of DICOM on top of DICOM

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Extension for PDF QueryExtension for PDF Query

How to store, query, retrieve for Evidence How to store, query, retrieve for Evidence Documents is defined by SWFDocuments is defined by SWF

DICOM SR queries for Evidence Documents DICOM SR queries for Evidence Documents have been defined by radiologyhave been defined by radiology

Eye Care added the storage and query for Eye Care added the storage and query for DICOM Encapsulated PDFDICOM Encapsulated PDF Added a new display field for the Image Display actors Added a new display field for the Image Display actors

from query, the PDF “Document Title”from query, the PDF “Document Title”

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More information….More information….IHE Web siteIHE Web site: : www.ihe.net

Technical FrameworksTechnical Frameworks ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version)ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version)ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology)ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology)ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) ihe_CARD_tf_vol2_2.1_FT (Cardiology)ihe_CARD_tf_vol2_2.1_FT (Cardiology)

Standards used by IHE Eye CareStandards used by IHE Eye Care DICOM StandardDICOM Standard www.nema.medical.org HL7 StandardHL7 Standard www.hl7.org

IHEIHE Connectathon Oct. 2006 at RSNA HQConnectathon Oct. 2006 at RSNA HQ

IHEIHE Showcase at Nov. 2006 AAO ConferenceShowcase at Nov. 2006 AAO Conference

Vendor Products Integration StatementsVendor Products Integration Statements

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