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DICOM Strategic Direction DICOM Strategic Direction for for
Image DistributionImage Distribution
Cor Loef
co-chair DICOM Strategic Advisory Committee
January 12, 2002 2
Contents
• Scope of DICOM Standards Committee
• Trends in Imaging-IT
• Standards in Imaging-IT
• Objects, Information, EPR, Web-distribution, Desktop
January 12, 2002 3
Scope of DICOM Standards Committee
• Mission of DICOM– Create and maintain international standards for
communication of bio-medical diagnostic and therapeutic information
• Goals of DICOM– Achieve compatibility and improve workflow
efficiency between imaging systems and other information systems
January 12, 2002 4
New: published in
DICOM 2000• Sup 23: Structured Reporting (Pre-reports, image measurements, analysis results, diagnostics reports with qualified image links)
• Sup 30: Waveform (sound, ECG, Electr. Physio.) synchronized with images
• Sup 31: Network Security (node authentication and transport encryption)
• Sup 33: Softcopy Presentation State• 42 Correction Items, Including:
– JPEG-LS, Thai & Korean, Time zones, Case Insensitive Name Queries
January 12, 2002 5
Supplements approved in 2001
• Sup 40 DVD RAM Application Profiles • Sup 50 Mammography Comp. Aided Detect. Reports• Sup 52 General Purpose Worklist
– Reporting workflow management, image postprocessing, computer aided detection, filming, quality control, etc.
• Sup 53 Content Mapping Resource – codes and templates for Structured Reporting
• Sup 54 MIME Content Type– for e-mailing DICOM persistent objects (images reports,
presentation states, key object selection, etc.
• Sup 59 Key Object Selection
January 12, 2002 6
New Work Items
• New generations of image objects:– Revised Secondary Capture Images (specific applications)
– Multiframe MR and CT (large number of dynamic dimensions)
• Sup 41 Digital Signature– secure transformation of images and reports
• Security on Storage Media (confidentiality)• Attribute Level Confidentiality (de-identification)
January 12, 2002 7
Current Direction
• Present focus is to meet new end-user needs, adopt complementary and proven standards. Key areas are:
– Security,
– New imaging technology,and
– Image Distribution in the enterprise.
January 12, 2002 8
Liaison with TC 215• Good liaison since April 99. Cross-representation may
be the effective next step beyond TC 215 DICOM Task Force.
• Procedure– TC 215 has agreed to rely on DICOM for Medical Imaging
Standardization– DICOM offers expertise in medical imaging, with world-wide
users and vendors representation.– Need to ensure coherence with other ISO standards group on
imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)
• DICOM is ready to further develop its relationship with TC 215.
January 12, 2002 9
Trends in Imaging-IT:
Radiology
PACS
Cardiology
PACS
VL, US, NM
PACS
1. Horizontal IntegrationHIS
RIS
2. Vertical Integration
Electronic Patient Record
OtherClinicalSystem 3. Elect. Patient Record
At the desktop
January 12, 2002 10
1. Horizontal Integration
• Image management system supports archiving/retrieving of all types of images (incl. visible light) and Structured Reports
January 12, 2002 11
2. Vertical Integration
The Healthcare Enterprise
HISHIS
Order Placer
ADTPatient Registration
RISRIS
IMAGING:IMAGING:•• PACS / ArchivesPACS / Archives
•• WorkstationsWorkstations•• ModalitiesModalities
Image Archive
Image Manager
Image Creator
Image Display
AcquisitionModality
DepartmentSystem Scheduler– Order Filler –
Modality Worklist
Patient Registration
New
Ord
er
Procedure Scheduled
ImagesStoredStorage
Commit
Q /RImages
PPSIn-Progress/ Completed
January 12, 2002 12
Integration: not only back-office!
messagesmessages
ClinicalClinical
InformationInformation
SystemSystem
ClinicalClinical
InformationInformation
SystemSystem
Back-Office
IntegratedIntegrated
Clinical ViewingClinical Viewing
at the desktopat the desktop
Front Office
EfficiencyEfficiency
ImproveImproveClinicalClinicalDecisionsDecisions
January 12, 2002 13
3. Electronic Patient Record• Image Management system and Departmental Information
System must be EPR-prepared (Queries)
• EPR: emphasis today on desktop integration, should become the integrated, secure, patient centric, source of health information
• Web front-end:
– viewing not only of images but also waveforms, measurements, reports, etc
– always need the capability to access the original medical images
– support for DICOM Structured Reporting
January 12, 2002 14
Ultimate goal: All the information the user needs through one common and simple user interface
January 12, 2002 15
ClinicalClinical
QuestionQuestion
Multi-MediaMulti-Media
Report withReport with
referencesreferences
4. Order and Results Management
PACSPACS
RISRIS
Other ClinicalOther ClinicalInformationInformation
SystemsSystems
January 12, 2002 16
DICOM SR Creation - Example -Radiology
Report Type:
Findings:
Conclusions:
Image Refs.:
Header::RIS dataRIS data
Image dataImage data
from PACSfrom PACS
Report TemplatesReport TemplatesFrom DICOM From DICOM standard:standard:
Coding SchemesCoding Schemesbehind pop-up menusbehind pop-up menus
ThoraxThorax……....……....……....
MassMass……....……....
Daim.Daim.Infiltr.Infiltr.
……....……....
(Pointer)
select select
Report Creator Report Creator
applicationapplication
(DIC
OM
) S
R O
bjec
t(D
ICO
M)
SR
Obj
ect
January 12, 2002 17
4. Orders and Results Management
• Great opportunities for IHE.
• Important roles for HL7 Clinical Document Architecture and DICOM Structured Reporting
• One should not consider DICOM SR as the only possibility to integrate multi-speciality information. Especially XML-based implementations should be considered.
January 12, 2002 18
5. Security
At Modality
Web Viewer
PACS ViewingStation
Webserver
Security
January 12, 2002 19
5. Security
• NEMA and COCIR address some major issues as a result of HIPAA, e.g. remote service.
• Security remains a challenge with connected systems, and is of course dependent on hospitals ensuring policies and procedures
• Use of Audit trial standards in a multi-vendor environment needs further detailing
January 12, 2002 20
6. Freedom of Application Workspot
At ModalityPACS Viewing
Station
Web Viewer
Webserver
January 12, 2002 21
Standards in Imaging-IT
1. Horizontal Integration DICOM
2. Vertical Integration IHE, DICOM, HL7
3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML
4. Orders and Results IHE, DICOM, HL7
Management
5. SecurityIHE,IETF,DICOM,HL7,ASTM
6. Freedom of Application ISO/CEN, CCOW, IETF,
Workspot DICOM, XML
January 12, 2002 22
The (multi-vendor) Integrated The (multi-vendor) Integrated Imaging Imaging SolutionSolution
ImageImageServeServe
rr
CDCDExchangeExchange
DepartmenDepartmentt
Info ServerInfo Server
Diagnostic Diagnostic WorkstatiWorkstati
onon
Image Image ArchivArchiv
ee
Connection Connection to other to other NetworkNetworkand/or and/or
TeleCardioloTeleCardiologygy
secure transportdigital signature
HangingProtocols
Email attachmentDICOM URL
General PurposeWorklist
Structured Documents (XML)Numeric reportQCA, LVA
January 12, 2002 23
The distribution problem
Electronic Patient Record
Radiology
PACS
Cardiology
PACS
VL, US, NM
PACS
HIS
RIS
OtherClinicalSystem
Web Viewers
Webserver
Report Type:Findings:
Conclusions: Ima
g
e
R
e
f
s
.
:
Header::ThoraxThorax……....……....……....MassMass……....…….... Daim.Daim.Infiltr.Infiltr.
……....……....(Poi
n
t
e
r
)
URL/URI?
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