Evidence Documents Profile ED

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Evidence Documents Profile (ED)
Marco Eichelberg OFFIS Technical Manager, IHE
Europe Cardiology Slides by Harry Solomon,
Co-chair, IHE Cardiology Technical Committee
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What are Evidence Documents?

• Intermediate products between acquisition and
  clinical reporting
• Data derived from primary evidence (images,
  waveforms), such as measurements
• Manually and/or automatically derived
• Data associated with performance of acquisition
  steps
• Procedure logs
• Created by either Acquisition Modality or
  Evidence Creator (workstation or automated
  process)
• Produced during acquisition or post-processing
  workflows
• Interpreted along with the images and other
  acquired data in the production of the clinical
  report

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The State of the Art
The State of the Kludge

• Measurements made on modality or workstation, and
  written onto a paper worksheet, then transcribed
  into a report
• Measurements output to a printer port,
  intercepted by an application that scrapes the
  values
• Screen capture of measurements sent to a
  reporting system, which uses OCR (optical
  character recognition) to reconstruct the
  original measurement names and numbers

• Error-prone, inefficient, hard to configure, hard
  to manage

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Evidence Documents Profile Abstract / Scope

• Management of DICOM Structured Report (SR)
  formatted measurements, logs, CAD results
• Creation, storage, and review
• Inclusion of measurements into reports

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DICOM SR ExampleMeasurement
Echocardiography Measurement Patient Doe, John
Technologist der Payd, N Measurements Mitral
valve diameter 3.1cm - shown in image at
Ventricular length, diastolic 5.97 cm - shown
in image at Ventricular volume, diastolic
14.1 ml - inferred from - inferred from VLZ
algorithm
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DICOM SR ExampleProcedure Log
Catheterization Procedure Log Patient Doe, John
Technologist Logger, H. Moe 111537 Patient
admitted 111839 Physician arrived - ver Payd,
O 112046 Patient prepped and draped 112207
Drug administered - Agent D51/2NS - Volume
400 ml - Rate 30 ml/hr - Route IV 112213
Vital signs - NIBP Systolic 105 mm(Hg) - NIBP
Diastolic 59 mm(Hg) - HR 101 /min - Resp 21
/min 112316 Consumable 7Fr sheath 112411
Sheath inserted - Right Femoral Artery ...
114108 Catheter placed - Left
Ventricle 114121 Waveform acquired -
Modality HD - Technique Aortic valve
pullback 114311 Drug administered - Agent
Omnipaque - Volume 30 ml - Rate 20 ml/s -
Route power injection 114329 Image acquired
- Modality XA - Number of frames 77 -
Positioner primary angle 30 deg - Positioner
secondary angle 60 deg ...
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DICOM SR ExampleComputer Aided Detection
Mammography CAD Results Patient Doe,
Jane Overall Findings Successful analysis -
Suspicious abnormality, biopsy should be
considered - Follow-up immediately Feature
Mass Scope Detected on multiple
images Algorithm Lesion Analyzer
V.1.3 Pathology Lobular carcinoma in
situ Image Feature Calcification ...
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DICOM SR Features

• Structured content
• Lists, hierarchies and relationships
• Numeric measurements, coded values
• Automatically extractable for database, data
  mining
• References to images, waveforms, other objects
• Explicit contextual information
• Unambiguous documentation of meaning

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The SR Content Tree

• Data structured in hierarchical Content Item Tree
• Structure of tree, relationships between items,
  and concepts and values encoded in items are
  constrained by Templates

Root Content Item Document Title
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
Content Item
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Evidence Documents Profile Value Proposition

• DICOM SR provides a standard interface for
  measurements, procedure logs, and CAD results
• Eliminates manual recording/transcribing steps
• Minimizes vendor-specific configuration
• DICOM Templates define semantically interoperable
  measurement names and consistent hierarchical
  structuring
• Allows automated processing on creator and
  receiver
• The Evidence Documents Profile specifies actors
  and transactions for exchanging measurements,
  leveraging the image exchange data flow
• Consistent with Scheduled Workflow, Cath, and
  Echo Profiles

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Evidence Documents ProfileTransaction Diagram
Report
Evidence Creator
Image Display
Creator

RAD-10 Storage

RAD-43 Evidence



RAD-44 Query Evidence Documents

Documents Stored
Commitment

RAD-45 Retrieve Evidence Documents


Image
Image
Manager
Archive

RAD-43 Evidence
RAD-10 Storage


Documents Stored


Commitment
Acquisition Modality
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Evidence Documents ProfileActors

• Acquisition Modality A system that acquires and
  creates medical images or waveforms while a
  patient is present, and that may also create
  other evidence objects such as measurements.
• Evidence Creator A system that creates
  additional evidence objects, such as derived
  images or measurements.
• Image Manager / Image Archive A system that
  provides long term storage and management of
  images and other evidence objects.
• Image Display A system that offers browsing of
  patients studies, and the retrieval and display
  of selected images and other evidence objects.
• Report Creator A system that generates and
  transmits clinical reports. Must be grouped with
  Image Display in this Profile.

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Evidence Documents ProfileStandards Used

• DICOM Services
• Structured Report Storage
• Enhanced
• Comprehensive
• Procedure Log
• CAD
• Storage Commitment
• Query
• Retrieve
• DICOM SR Templates

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Evidence Documents Profile Options

• Cath Evidence option Modality / Evidence
  Creator must support at least one specified Cath
  Template
• 3001 Procedure Log
• 3202 Ventricular Analysis
• 3213 Quantitative Arterial Analysis
• 3250 Intravascular Ultrasound
• 3500 Hemodynamics
• Echo Evidence option Modality / Evidence
  Creator must support at least one specified Echo
  Template
• 5100 Vascular Ultrasound
• 5200 Echocardiography

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Image Display Issues

• Image Display actors must follow DICOM SR display
  rules
• Render complete content tree of any SR object in
  supported SOP Class, regardless of Template
• Report Creator must be grouped with Image Display
  and must copy some content from Evidence Document
• Image Display actor retrieves the documents from
  the Image Manager/Archive
• Report Creator also appears in Simple Image and
  Numeric Report Profile (SINR), and in Displayable
  Reports Profile (DRPT)
• Claiming support of the ED Profile Report Creator
  is how the product asserts that it extracts data
  content from the Evidence Documents and puts it
  in the clinical report
• Workstation that revises Evidence Documents
  should claim Image Display and Evidence Creator
  actors
• E.g., for updating preliminary measurements and
  storing updates back to the Image Manager/Archive

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Relationship to Workflow Profiles

• Evidence Creator actor also appears in Scheduled
  Workflow, Cath Workflow, and Echo Workflow
  Profiles
• Performance of evidence creation reported through
  Modality Performed Procedure Step in those
  Profiles
• Scheduled Procedure Step identified in the
  analyzed images may be used as the referenced SPS
  for the evidence documents created
• Evidence Creator actor also appears in
  Post-Processing Workflow Profile
• Performance of evidence creation managed through
  General Purpose Worklist and General Purpose
  Performed Procedure Step in that Profile

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Cath Templates Scope

• 3001 Procedure Log
• Time stamped event log, with codes defined for
  common events, and free text entries allowed
• 3202 Ventricular Analysis
• Quantitative measurements of heart chambers,
  including wall motion by any of three types of
  analysis
• 3213 Quantitative Arterial Analysis
• Angiographic arterial measurements and findings
  organized by vessel
• 3250 Intravascular Ultrasound
• IVUS arterial measurements and findings organized
  by vessel
• 3500 Hemodynamics
• Pressure and flow measurements organized by
  procedure phase and measurement location

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Echo Templates Scope

• 5100 Vascular Ultrasound
• Vascular measurements and findings organized by
  anatomic region
• 5200 Echocardiography
• Measurements of heart chambers, valves, and
  adjacent vessels and assessment of wall motion

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More information.

• IHE Web sites www.ihe.net
• Technical Frameworks, Supplements
• Radiology Technical Framework
• Cardiology Technical Framework
• Cath and Echo Options for Evidence Documents
  Supplement
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

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• Providers and Vendors
• Working Together to Deliver
• Interoperable Health Information Systems
• In the Enterprise
• and Across Care Settings