Solomon,%20DICOM%20SREuropean%20Society%20of%20Cardiology2%20September%202001

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DICOM Structured ReportingCurrent Status and
Role in the Electronic Patient Record

• Harry Solomon
• Co-chair, DICOM WG1 - Cardiovascular Information

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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

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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

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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

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Cath Lab Example
Procedure Log 1110 Patient prepped
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired 1127
HD waveform acquired 1130 XA image
acquired 1147 PTCA 1159 XA image acquired 1202
HD waveform acquired
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired 1127
HD waveform acquired
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired 1127
HD waveform acquired 1130 XA image acquired
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired 1127
HD waveform acquired 1130 XA image
acquired 1147 PTCA 1159 XA image acquired
Procedure Log 1110 Patient prepped 1119
Percutaneous entry 1123 XA image acquired 1127
HD waveform acquired 1130 XA image
acquired 1147 PTCA 1159 XA image acquired 1202
HD waveform acquired 1221 Pt released to holding
1224 HD Report
Cath Lab Report Patient 67 yr old male, history
of Ref prior ECG report Procedure Ref
Log Narrative ... Findings Hemodynamic Ref HD
Report Narrative ... Angiographic 70 stenosis
... Ref image Intervention Stent placed in
LAD Ref image Complications Summary
Hemo Report Baseline Ref waveform
Measurements Post-intervention Ref waveform
Measurements Derived measurements Ref
waveform
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Structured Reporting is the glue that makes
possible construction of an electronic patient
record for cardiology
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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

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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

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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

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So Theoretically ...

• DICOM Structured Reporting is ready to be
  implemented for cardiology!
• But Pragmatically

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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
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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

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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

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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

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Hemo Report Structure
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Find out more

• http//www.pixelmed.com/srbook.html
• David Clunies 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 how_clark_at_nema.org

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Thank you

• Questions?
• mailto//harry.solomon_at_med.ge.com