Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 1
DICOM Structured ReportingCurrent Status and Role
in the Electronic Patient Record
DICOM Structured ReportingCurrent Status and Role
in the Electronic Patient Record
Harry SolomonCo-chair, DICOM WG1 - Cardiovascular Information
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 2
What is DICOM Structured Reporting?
• A means of encoding structured information …• hierarchical tree of content items, using DICOM object syntax
• For vendor-independent exchange between systems …• leveraging the DICOM object management infrastructure
• Providing unambiguous documentation of meaning …• text, categorical codes, numeric measurements, inter-item relationships
• For the image-intensive clinical environment • careful attention to clinical observation context
• robust references to DICOM images, waveforms
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 3
Structured Reporting is Not...• DICOM SR is not just “reports”
– any structured data exchanged between systems– measurements, analyses, sonographer notes ...
• DICOM SR is not Structured Data Entry– Hierarchical pull-down menus to support report creation
is often denoted “structured reporting”
– DICOM does not standardize applications or data entry techniques
– Structured data entry is a valuable means of creating SR content in certain circumstances
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 4
Where Can Cardiology Use SR?
• Clinical Reports (cath, echo, nuc, etc.)– to go along with our pretty DICOM pictures
• Analyses of raw image and waveform data– backing up the Clinical Report
• Documentation of the procedure– provide context for the raw data and analyses
• Input to a clinical database– for patient care over time, or outcomes analysis
Hemo ReportBaseline Ref waveform Measurements …Post-intervention Ref waveform Measurements … Derived measurements
Ref waveform
Procedure Log11:10 Patient prepped
Cath Lab ReportPatient67 yr old male, history of … Ref prior ECG reportProcedureRef LogNarrative ...Findings
HemodynamicRef HD ReportNarrative ...Angiographic70% stenosis ... Ref image
InterventionStent placed in LAD … Ref imageComplicationsSummary
Cath Lab ExampleProcedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired
Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired
Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired
Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired
Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired12:02 HD waveform acquired
Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired12:02 HD waveform acquired12:21 Pt released to holding 12:24 HD Report
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 6
Structured Reporting is the glue that makes possible construction
of an electronic patient record for cardiology
Structured Reporting is the glue that makes possible construction
of an electronic patient record for cardiology
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 7
DICOM SR Status• Work began in 1994
– Championed by Dr. Dean Bidgood
• Supplement 23: Structured Reporting - April 2000– Defined general format for SR objects
• DICOM header, hierarchical tree of content items
• Concepts represented by coded terminology using external (non-DICOM) lexicons [e.g., Reed codes, SNOMED anatomy, ICD-9/10 diagnosis or procedure codes, SCP-ECG lead IDs]
– Defined general classes of clinical reports
– Extremely flexible
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 8
The Problem of Flexibility
• A document creator can put in anything in any structure
• A document reader must handle every possible document
• Need to constrain the SR content to enable meaningful receiving applications– Structure– Content
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 9
DICOM SR Status
• Supplement 53: Content Mapping Resource - May 2001– Defined general structure for templates: document patterns
– Mechanism for terminology context groups: constrained vocabulary subsets
– Fundamental templates for documenting clinical context and for basic reports
– DICOM lexicon for vocabulary not externally available
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 10
So Theoretically ...
• DICOM Structured Reporting is ready to be implemented for cardiology!
But Pragmatically …
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 11
Issues for Cardiology SR
• Uses not well covered by “clinical report” model– Procedure logs, preliminary measurement reports
• Many ways to encode the same information– Need consistent approach for interoperability
• Need tailored subset of SR for developers– Reduce the learning curve
Need Cardiology-specific SR Templatesand consensus Terminology
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 12
Cardiology SR Efforts
• Supplement 66: Cath Lab SR (WG1)– Procedure Log
– Hemodynamics Report
– ECG Report
– Quantitative Analysis Report
– Cath Lab Report
• Supplement 26: Ultrasound SR (WG12)– Echocardiography Report
• Both to be released for Public Comment this autumn
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 13
Procedure Log Issues
• Structure - flat • Ordering - strictly time sequential• Linkage of events - associative Procedure Step /
Action ID • SOP Class - distinct from reports• Remote entries - new Application Event Logging
Service Class
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 14
Hemodynamic Report Issues
• SOP Class - Cath Lab Measurements (together with QCA, QVA, IVUS measurements, etc.)– Distinction from report titles
• Structure - deep hierarchy• Terminology - post-coordinated, context from
hierarchy
Hemo Report StructureHemo ReportCONTAINER
Baseline PhaseCONTAINER
Post-Contrast PhaseCONTAINER
Arterial MeasurementsCONTAINER
Ventricular MeasurementsCONTAINER
Gradient MeasurementsCONTAINER
AnatomicLocation =L Fem Art
Patient StateCONTAINER
Patient StateCONTAINER
Systolic Pres
Diastolic Pres
Mean Pres
Arterial MeasurementsCONTAINER
AnatomicLocation =
Aorta
Systolic Pres
Diastolic Pres
Mean Pres
Post-Intervention PhaseCONTAINER
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 16
Find out more
• http://www.pixelmed.com/srbook.html– David Clunie’s excellent introduction to DICOM SR
• ftp://medical.nema.org/medical/dicom/supps– text of draft supplements
• http://www.dicomwg12.org/structured_reporting– echocardiography SR
• subscribe to WG1 email list – send request to [email protected]
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 17
Thank you
Questions?
mailto://[email protected]