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DICOM Structured ReportingRecent Standards Activity
Doug SluisSPIE, Feb 18, 2003
D Sluis 2
Overview
• Recent Template Supplements• Interoperability Considerations• Templates for Measurement Findings• DCMR Developments
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)
D Sluis 4
Image Derived Findings
FindingsAnalysis, CAD,Quantification,Observations
Norms
Report
Images
Recent Focus
/ EvidenceClinicalHistory
Sup 75
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
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
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?
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”)
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
…
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
D Sluis 11
Direct Concept Mapping
Clinical Concepts
DCMR
LOINCFetal femur length
Direct pre-coordinated conceptTemplate has marginal role
D Sluis 12
DCMR
Molecular Concepts
Clinical Concepts
LNSRT
SRTLeft
PeakVelocity
Template binds concept atomsBased on model (implicit)
Femoral Artery
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
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
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
…
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
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
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
D Sluis 19
Vascular Templates
CONTAINERFindings
CODELaterality
has concept modifier
TID 5103
Content Item Value Set
Right, Left, or Unilateral
D Sluis 20
TID 5104
Vascular Templates
CONTAINERAnatomy
CONTAINERFindings
CODELaterality
has concept modifier
contains
Content Item Value Set
D Sluis 21
TID 5104
Vascular Templates
CONTAINERAnatomy
CONTAINERFindings
CODELaterality
has concept modifier
CODELongitudinal Modifier
has concept modifiercontains
Optional specificity
Content Item Value Set
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
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
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
D Sluis 26
DCMR Usability
Text format• Needless
translation step for development
• Hard to maintain!• Quality impact
DICOMStandard
Application
Developer
Product SW
D Sluis 27
DCMR in XML
Referentialintegrity
DCMR InterchangeStandard
(XML Schema)
PDFInteractive Web AccessProduct configurationWeb services
DCMR
MaintenanceEnvironment
DCMR (XML)
Information model
D Sluis 28
Future
• 3D coordinates• 3D shapes
• HL7 V3 Harmonization