Application of DICOM Structured Report

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Application of DICOM Structured Report

• Andrei Leontiev
• Dynamic Imaging

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DICOM Structured Report

• Encoding for structured observations
• Universal mechanism
• Generic Applications
• Basic Text, Enhanced, Comprehensive
• Specialty Applications
• Key Object Selection
• CAD, US measurements,
• Patient Relevant Information Query

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Encoding of Structured Reports
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SR Intent

• Support measurements by imaging devices
• Enable collaborative reporting by any number of
  persons or devices
• Enable links to key images
• Enable links to regions of interest within images
  and waveforms
• Template-driven content and structure

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Simple Example of SR

• Shows example of simple diagnostic report
• Multi-level structure
• Text, codes, pointers to images

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Report of Chest X-Ray (PA and LateralViews) Patie
nt Jane Homer Study 123456 Recorded by Dr. John
Smith The finding is a mass measuring 1.3 cm in
diameter with an infiltrative margination. The
baseline image is shown at Conclusions The
conclusion is a probable malignancy, inferred
from the infiltrative margination of the mass and
the appearance shown by the best illustration of
findings. Specific Image Findings The best
illustration of findings is
(Click to view)
(Click to view)
Slide by D. Clunie
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Chest X-Ray has concept modifier ViewsPA and
Lateral Recording ObserverSmithJohnDr Study
Instance UID 1.2.3.4.5.6.7.100 Patient-Data-Acqu
isition-SubjectHomerJane FindingMass has
properties diameter1.3 cm has properties
marginationinfiltrative (1.4.2) Baseline
Image Conclusions conclusionprobable
malignancy inferred from 1.4.2 inferred from
1.7.1 Specific Image Findings best illustration
of findings(1.7.1) .
Slide by D. Clunie
9
contains relationship not shown
Chest X-Ray has concept modifier ViewsPA and
Lateral Recording ObserverSmithJohnDr Study
Instance UID 1.2.3.4.5.6.7.100 Patient-Data-Acqu
isition-SubjectHomerJane FindingMass has
properties diameter1.3 cm has properties
marginationinfiltrative (1.4.2) Baseline
Image Conclusions conclusionprobable
malignancy inferred from 1.4.2 inferred from
1.7.1 Specific Image Findings best illustration
of findings(1.7.1) .
Slide by D. Clunie
10
Concept Name /Value pairs used
Chest X-Ray has concept modifier ViewsPA and
Lateral Recording ObserverSmithJohnDr Study
Instance UID 1.2.3.4.5.6.7.100 Patient-Data-Acqu
isition-SubjectHomerJane FindingMass has
properties diameter1.3 cm has properties
marginationinfiltrative (1.4.2) Baseline
Image Conclusions conclusionprobable
malignancy inferred from 1.4.2 inferred from
1.7.1 Specific Image Findings best illustration
of findings(1.7.1) .
Slide by D. Clunie
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Concept Name without a value used as a heading
(container)
Chest X-Ray has concept modifier ViewsPA and
Lateral Recording ObserverSmithJohnDr Study
Instance UID 1.2.3.4.5.6.7.100 Patient-Data-Acqu
isition-SubjectHomerJane FindingMass has
properties diameter1.3 cm has properties
marginationinfiltrative (1.4.2) Baseline
Image Conclusions conclusionprobable
malignancy inferred from 1.4.2 inferred from
1.7.1 Specific Image Findings best illustration
of findings(1.7.1) .
Slide by D. Clunie
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Concept Name without a value used as Purpose of
Reference for IMAGE, SCOORD
Chest X-Ray has concept modifier ViewsPA and
Lateral Recording ObserverSmithJohnDr Study
Instance UID 1.2.3.4.5.6.7.100 Patient-Data-Acqu
isition-SubjectHomerJane FindingMass has
properties diameter1.3 cm has properties
marginationinfiltrative (1.4.2) Baseline
Image Conclusions conclusionprobable
malignancy inferred from 1.4.2 inferred from
1.7.1 Specific Image Findings best illustration
of findings(1.7.1) .
Slide by D. Clunie
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Chest X-Ray
CONTAINER
Context
Recording ObserverSmithJohnDr
PNAME
1.1
Context
Study Instance UID ...1.2.3.4.5.6.7.100
UIDREF
1.2
Context
Acquisition SubjectHomerJane
PNAME
1.3
Contains
CODE
FindingMass
1.4
Properties
diameter1.3 cm
NUM
1.4.1
1.6.1.1
Properties
Infd From
CODE
marginationinfiltrative
1.4.2
Contains
Baseline
IMAGE
1.5
Contains
Conclusions
CONTAINER
1.6
Contains
CODE
conclusionprobable malignancy
1.6.1
Contains
Specific Image Findings
CONTAINER
1.7
Contains
SCOORD
best illustration of findings
1.7.1
Infd From
Seld From
IMAGE
1.7.1.1
1.6.1.2
Modifier
ViewsPA and Lateral
CODE
1.8
Slide by D. Clunie
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Chest X-Ray
CONTAINER
Contains
CODE
FindingMass
1.4
1.4.1
1.6.1.1
Properties
Infd From
CODE
marginationinfiltrative
1.4.2
Contains
Conclusions
CONTAINER
1.6
Contains
CODE
conclusionprobable malignancy
1.6.1
Contains
Specific Image Findings
CONTAINER
1.7
Contains
SCOORD
best illustration of findings
1.7.1
Infd From
1.6.1.2
Slide by D. Clunie
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The numbering of items is implicit !
Chest X-Ray
1
Recording ObserverSmithJohnDr
1.1
Study Instance UID ...1.2.3.4.5.6.7.100
1.2
Acquisition SubjectHomerJane
1.3
FindingMass
1.4
diameter1.3 cm
1.4.1
marginationinfiltrative
1.4.2
Baseline
1.5
Conclusions
1.6
conclusionprobable malignancy
1.6.1
Specific Image Findings
1.7
best illustration of findings
1.7.1
1.7.1.1
ViewsPA and Lateral
1.8
Slide by D. Clunie
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Inheritance of Context

• Observation Context
• includes top-level attributes of Composite IOD
• may be attached to root node CONTAINER
• is inherited along by-value relationships
• is not inherited along by-reference relationships
• may be extended (but not replaced) in children
• may be attached to any content item, not just
  CONTAINER

Slide by D. Clunie
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General Patient Module Patient
NameHomerJane Patient
ID234567 Patient SexF Patient
DOB19991109
SR Comprehensive SOP Instance
General Study Module Accession
Number123456 Study ID345678
Slide by D. Clunie
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Chest X-Ray
Context
Recording ObserverSmithJohnDr
Context
Study Instance UID ...1.2.3.4.5.6.7.100
Context
Acquisition SubjectHomerJane
Contains
FindingMass
Properties
diameter1.3 cm
Properties
Infd From
marginationinfiltrative
Contains
Baseline
Contains
Conclusions
Contains
conclusionprobable malignancy
Contains
Specific Image Findings
Contains
best illustration of findings
Infd From
Seld From
Modifier
ViewsPA and Lateral
Slide by D. Clunie
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Obstetric Ultrasound
Obsn Context
Mother of FetusHomerJane
Contains
Findings for Fetus
Obsn Context
Fetus IdentifierFetus A
Properties
Gestational Age16 weeks
Infd From
BPD27 mm
Contains
Findings for Fetus
Obsn Context
Fetus IdentifierFetus B
Properties
Gestational Age16 weeks
Slide by D. Clunie
Infd From
BPD28 mm
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Obstetric Ultrasound
Obsn Context
Mother of FetusHomerJane
Contains
Findings for Fetus
Obsn Context
Fetus IdentifierFetus A
Properties
Gestational Age16 weeks
Infd From
BPD27 mm
Inferred from relationships may be by-value as
well as by-reference, and are often more
appropriate then has properties or contains.
Slide by D. Clunie
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Post-CoordinationHAS CONCEPT MOD

• Elaborates on meaning of Concept Name in
• CONTAINER (headings)
• CODE, TEXT, NUM
• May
• qualify meaning further
• describe meaning
• provide translations

Slide by D. Clunie
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Chest X-Ray
CONTAINER
Modifier
ViewsPA and Lateral
CODE
Modifier
Full DescriptionThis is a reporton a
two-view (PA and lateral) ChestX-Ray
examination.
TEXT
Modifier
Equivalent Meaning in ItalianRadiografia del
...
TEXT
Slide by D. Clunie
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Post-coordinated ...
FindingMass
CODE
Properties
diameter1.3 cm
NUM
Modifier
methodSmith
CODE
Modifier
threshold75 HU
NUM
Pre-coordinated ...
FindingMass
CODE
Properties
diameter by Smith method _at_ 75HU threshold
1.3 cm
NUM
Slide by D. Clunie
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SR Applications
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Three Base SR Classes

• Three base SR classes are defined to allow encode
  any type of structured information
• Basic Text SR
• Enhanced SR
• Comprehensive SR
• Distinguished by Value Types and Relationships
  supported

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SR Templates

• To define appropriate structure for specialized
  applications, DICOM defines templates.
• Templates may be applied to
• Generic SOP Classes (Basic Text, Enhanced,
  Comprehensive)
• Specialized SOP Classes (Mammo CAD, Chest CAD
• Templates may be extensible and non-extensible

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Evidence Documents
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Evidence Documents

• Measurements and coded data
• DICOM SR document
• Created by either Acquisition Modality or
  Workstation
• Produced during acquisition or post-processing
  workflows
• Interpreted along with the images

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Evidence Documents Examples

• Mammography CAD
• Chest CAD
• OB-Gyn Ultrasound Measurements
• Vascular Ultrasound Measurements
• Vascular Intervention Results
• Echocardiography Measurements

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Typical Ultrasound SR

• Based on one of generic SR SOP Classes
• Intended to precisely convey measurements and
  findings, relationships between them
• Each specialized report uses its own template

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Legend for templates
Value Types CONTAINER, NUM, CODE, IMAGE
Value Type Concept Name Value
relationship
relationship
Value Type Concept Name Value
Value Type Concept Name Value

• 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)

Slide by D. Sluis
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Typical Top Level Template Structure
Template specified title OB-GYN, Adult Echo,
IVUS Ultrasound Vascular, Cath/Hemo
CONTAINER Document Title
CONTAINER Patient Characteristics

CONTAINER Summary
CONTAINER
CONTAINER Findings Heading
CONTAINER Finding Heading
CONTAINER Finding Heading
TID 1002ObservationContext




SummaryFindings
Findings
Other Context e.g. procedure
Slide by D. Sluis
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Document Headings
CONTAINER Document Title
The heading may have semanticsshared by children
findings
contains
CONTAINER Heading
Specific Exercise Challenge Generic
Findings

Findings
Slide by D. Sluis
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Discrete Numeric Findings
Distributed semantics
CONTAINER Group
has concept modifier
CODE Modifier Concept
contains
Diameter, Area, Volume, Blood Velocity, Indices,
Ratios, Time Interval
NUM Measurement
or pre-coordinated concept BPD, FL
has concept modifier
Laterality, Finding Site, Anatomic Site Modifier,
Cardiac Phase
CODE Modifier Concept
Slide by D. Sluis
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Vascular Content Hierarchy
CONTAINER Vascular Report
Document Title
contains
has concept modifier
CONTAINER Findings
Section Heading
CODE Laterality
contains
CONTAINER Anatomy
has concept modifier
Group
CODE Topographical Modifier
contains
Minimum Concepts
NUM Measurement
Discrete Finding
property
Slide by D. Sluis
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
Right, Left, or Unilateral
TID 5103
Slide by D. Sluis
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
Slide by D. Sluis
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODELongitudinal Modifier
Optional specificity
Slide by D. Sluis
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODEBranch Modifier
Slide by D. Sluis
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Vascular Templates
has concept modifier
Content Item Value Set
CONTAINER Findings
CODE Laterality
TID 5104
contains
CONTAINER Anatomy
has concept modifier
CODE Topographical Modifier
contains
NUM Measurement
Slide by D. Sluis
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Findings Origin and Context
TID 300 Measurements
NUM Measurement
SCOORD
Coordinates
Inferred from
IMAGE
Image
Inferred from
NUM
Numeric dependency
Inferred from
CODE
Equation or Table
Inferred from
Image Mode Image View
CODE
has acquisition context
Normality, Significance Normal Range,
CODE, TEXT
has properties
Slide by D. Sluis
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Dx Reports

• Based on DICOM SR
• Allows to include without transcription-
  measurements- image links- structured content

• Integrated with the imaging workflow
• Friendly to XML implementations
• Easy to export to the EPR (HL7)

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Simple Structure

• Minimal Structure Coded Title and Headings
• Full image links from specific sections of report
• Observation Context (who, what, when) may be
  section specific

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Added Measurements
Simply adds Measurements to Simple Image Reports
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Key Object Selection Documents

• Initiated by the desire to have simple Key Image
  Note
• Developed as generic manifest collection of
  pointers to images (or even specific frames)
• Specifies intent of selection, simple textual
  note
• Non-extensible template

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for referring physician Here you can see the
renal osteopathy.
For teaching Fibroosteoclasia
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Different notes on different images
Same note on different images
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Title of KOSD is a Code
The note title defines the semantics of the
reason of significance. Key Image Notes can be
queried by code. The user comments are meant to
be informal.
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Key Image Notes

• One use of KOSD is to attach  electronic
  post-it  to images to communicate
• specific examination events
• image quality issues
• consultancy
• KOSD can be stored in the archive and later
  retrieved

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Workflow of SR objects
Evidence Documents

• Interpretation

Dx Report
Key Image Notes
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Patient Information Query

• A simple query that allows retrieve ANY patient
  information, provided SCP can format it using
  specified template
• Useful for retrieval of relevant information
  about patient, e.g., from HIS
• Intended for use on Modalities and other
  equipment that is already DICOM enabled

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Patient Information Query

• Few matching keys
• Patient Name
• Patient ID
• Template identifier
• Useful for retrieval of relevant information
  about patient, e.g., from HIS

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Patient Information Query

• Several Template identified for this purpose
• General Relevant Patient Info
• Relevant Patient Info for Breast Imaging

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Questions?