Application of DICOM Structured Report Andrei Leontiev Dynamic Imaging.

Application of DICOM Application of DICOM Structured ReportStructured Report

Andrei LeontievAndrei Leontiev

Dynamic ImagingDynamic Imaging

April 1, 2005April 1, 2005 DICOM Seminar – Singapore 2005DICOM Seminar – Singapore 2005

DICOM Structured DICOM Structured ReportReport Encoding for structured observationsEncoding for structured observations

– Universal mechanismUniversal mechanism Generic ApplicationsGeneric Applications

– Basic Text, Enhanced, ComprehensiveBasic Text, Enhanced, Comprehensive Specialty ApplicationsSpecialty Applications

– Key Object SelectionKey Object Selection– CAD, US measurements, …CAD, US measurements, …– Patient Relevant Information QueryPatient Relevant Information Query

Encoding of Encoding of Structured ReportsStructured Reports


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


Simple Example of SRSimple Example of SR

Shows example of simple Shows example of simple diagnostic reportdiagnostic report

Multi-level structureMulti-level structure Text, codes, pointers to imagesText, codes, pointers to images


Document Root Node CONTAINER"Chest X-ray" (Document Title)

Has obs context

Content Node PNAME"Recording Observer =

Smith^John^^Dr^"* Relationship Modes = By-value = By-reference

contains

contains contains

inferred from

Content Node CODE"finding = mass"

Heading NodeCONTAINER"Conclusions"

Heading NodeCONTAINER "Specific

Image Findings"

Content Node CODE"conclusion = probable

malignancy"

Content node SCOORD"best illustration of

findings"

Leaf Node IMAGE "Baseline"

contains contains contains

Leaf Node NUM"diameter = 1.3 cm"

Leaf Node CODE"margination = infiltrative"

has properties has properties

inferred from

Leaf Node IMAGE

selected from

Has obs context

Content Node UIDREF"Study Instance UID of

Evidence Directly Examinedby RO = 1.2.3.4.5.6.7.100"

Has obs context

Content Node PNAME"Patient-Data-Acquisition

Subject = Homer^Jane^^^"

has concept modLeaf Node CODE

"Views = PA and Lateral"


Report of Chest X-Ray (PA and LateralViews)

Patient Jane HomerStudy # 123456Recorded 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

ConclusionsThe 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 FindingsThe best illustration of findings is

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.



(Click to view)

(Click to view)

Slide by D. Clunie


Chest X-Rayhas concept modifier Views=PA and LateralRecording Observer=Smith^John^^Dr^Study Instance UID …=1.2.3.4.5.6.7.100Patient-Data-Acquisition-Subject=Homer^Jane^^^Finding=Mass

has properties diameter=1.3 cmhas properties margination=infiltrative (1.4.2)

Baseline ImageConclusions

conclusion=probable malignancyinferred from 1.4.2inferred from 1.7.1

Specific Image Findingsbest illustration of findings(1.7.1)

.





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.





“contains” relationship not shown

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.





Concept Name /Value pairs used

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.





Concept Name without a value used as a heading (container)

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.





Concept Name without a value used as Purpose of Reference for IMAGE, SCOORD

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CODE

SCOORD

CODE

“Chest X-Ray”

“Recording Observer”=“Smith^John^^Dr^”

“Study Instance UID ...”=“1.2.3.4.5.6.7.100”

Context

“… Acquisition Subject”=“Homer^Jane^^^”

“Finding”=“Mass”Contains

“Baseline”=ContainsQuickTime™ and a

TIFF (LZW) decompressorare needed to see this picture.

“Conclusions”Contains

“Specific Image Findings”Contains

“Views”=“PA and Lateral”Modifier

Context

Context

“diameter”=“1.3” “cm”Properties

“margination”=“infiltrative”Properties

“conclusion”=“probable malignancy”Contains

“best illustration of findings”=Contains

Seld FromQuickTime™ and a


Infd From

Infd From

CONTAINER

CONTAINER

CONTAINER

PNAME

UIDREF

PNAME

CODE

NUM

IMAGE

IMAGE

CODE

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.4.1

1.4.2

1.6.1

1.7.1

1.7.1.1

1.6.1.1

1.6.1.2

Slide by D. Clunie


CODE

SCOORD

CODE

“Chest X-Ray”







Infd From

Infd From

CONTAINER

CONTAINER

CONTAINER

CODE1.4

1.6

1.7

1.4.1

1.4.2

1.6.1

1.7.1

1.6.1.1

1.6.1.2

Slide by D. Clunie


“Chest X-Ray”




“Finding”=“Mass”

“Baseline”= QuickTime™ and aTIFF (LZW) decompressor


“Conclusions”

“Specific Image Findings”

“Views”=“PA and Lateral”

“diameter”=“1.3” “cm”

“margination”=“infiltrative”

“conclusion”=“probable malignancy”

“best illustration of findings”=



1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.4.1

1.4.2

1.6.1

1.7.1

1.7.1.1

1 The numbering of items is implicit !

Slide by D. Clunie


Inheritance of ContextInheritance of Context

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

CONTAINERCONTAINER

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“Chest X-Ray”



Context



Context

Context

General Patient Module:“Patient Name”=“Homer^Jane^^^”“Patient ID”=“234567”“Patient Sex”=“F”“Patient DOB”=“19991109”

General Study Module:“Accession Number”=“123456”“Study ID”=“345678”

SR ComprehensiveSOP Instance

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“Chest X-Ray”



Context



“Baseline”=ContainsQuickTime™ and a





Context

Context





Seld FromQuickTime™ and a


Infd From

Infd From

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“Obstetric Ultrasound”

“Mother of Fetus”=“Homer^Jane^^^”

“Fetus Identifier”=“Fetus A”

“BPD”=“27” “mm”

“Findings for Fetus”

Obsn Context

Contains

Obsn Context

“Gestational Age”=“16” “weeks”Properties

Infd From

“Fetus Identifier”=“Fetus B”

“BPD”=“28” “mm”

“Findings for Fetus”Contains

Obsn Context


Infd From

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“Obstetric Ultrasound”

“Mother of Fetus”=“Homer^Jane^^^”

“Fetus Identifier”=“Fetus A”

“BPD”=“27” “mm”

“Findings for Fetus”

Obsn Context

Contains

Obsn Context


Infd From

“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


Post-Coordination:Post-Coordination:HAS CONCEPT MODHAS CONCEPT MOD Elaborates on meaning of Elaborates on meaning of

Concept Name inConcept Name in– CONTAINER (headings)CONTAINER (headings)– CODE, TEXT, NUM …CODE, TEXT, NUM …

May:May:– qualify meaning furtherqualify meaning further– describe meaningdescribe meaning– provide translationsprovide translations

Slide by D. Clunie


“Chest X-Ray”


CONTAINER

CODE

“Full Description”=“This is a reporton a two-view (PA and lateral) ChestX-Ray examination.”

Modifier TEXT

“Equivalent Meaning in Italian”=“Radiografia del ...”Modifier TEXT

Slide by D. Clunie




CODE

NUM

“method”=“Smith”Modifier CODE

Modifier“threshold”=“75” “HU” NUM


“diameter by Smith method @ 75HU threshold” = “1.3” “cm”

Properties

CODE

NUM

Post-coordinated ...

Pre-coordinated ...

Slide by D. Clunie

SR ApplicationsSR Applications


Three Base SR ClassesThree Base SR Classes

Three base SR classes are defined Three base SR classes are defined to allow encode any type of to allow encode any type of structured information:structured information:– Basic Text SRBasic Text SR– Enhanced SREnhanced SR– Comprehensive SRComprehensive SR

Distinguished by Value Types and Distinguished by Value Types and Relationships supportedRelationships supported


SR TemplatesSR Templates

To define appropriate structure for To define appropriate structure for specialized applications, DICOM specialized applications, DICOM defines templates.defines templates.

Templates may be applied to:Templates may be applied to:– Generic SOP Classes (Basic Text, Generic SOP Classes (Basic Text,

Enhanced, Comprehensive)Enhanced, Comprehensive)– Specialized SOP Classes (Mammo CAD, Specialized SOP Classes (Mammo CAD,

Chest CADChest CAD Templates may be extensible and non-Templates may be extensible and non-

extensibleextensible


Evidence DocumentsEvidence Documents

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD...…..

StorageStorage

Storage CommitmentStorage Commitment

Query / RetrieveQuery / Retrieve


Evidence DocumentsEvidence Documents

Measurements and coded data Measurements and coded data – DICOM SR document DICOM SR document

Created by either Acquisition Created by either Acquisition Modality or WorkstationModality or Workstation

Produced during acquisition or Produced during acquisition or post-processing workflowspost-processing workflows

Interpreted along with the imagesInterpreted along with the images


Evidence Documents Evidence Documents ExamplesExamples Mammography CADMammography CAD Chest CADChest CAD OB-Gyn Ultrasound MeasurementsOB-Gyn Ultrasound Measurements Vascular Ultrasound MeasurementsVascular Ultrasound Measurements Vascular Intervention ResultsVascular Intervention Results Echocardiography MeasurementsEchocardiography Measurements


Typical Ultrasound SRTypical Ultrasound SR

Based on one of generic SR SOP Based on one of generic SR SOP ClassesClasses

Intended to precisely convey Intended to precisely convey measurements and findings, measurements and findings, relationships between themrelationships between them

Each specialized “report” uses its Each specialized “report” uses its own templateown template


Legend for templatesLegend for templates

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

Slide by D. Sluis


CONTAINERFinding Heading

CONTAINERFinding Heading

Typical Top Level Typical Top Level Template StructureTemplate 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

…

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Document HeadingsDocument 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

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Discrete Numeric Discrete Numeric FindingsFindingsCONTAINER

Group

NUMMeasurement

Diameter, Area, Volume, Blood Velocity, Indices, Ratios, Time Interval …or pre-coordinated concept: BPD, FL …

CODEModifier Concept


CODEModifier Concept


Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase …

contains

Distributed semantics

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Vascular Content Vascular Content HierarchyHierarchy

CONTAINERAnatomy

CONTAINERFindings

CODELaterality



NUMMeasurement

CODETopographical Modifier

contains

contains

CONTAINERVascular Report

Document Title

Section Heading

Group

Discrete FindingMinimumConcepts

contains

propertySlide by D. Sluis


Vascular TemplatesVascular Templates

CONTAINERFindings

CODELaterality


TID 5103

Content Item Value Set

Right, Left, or Unilateral

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TID 5104


CONTAINERAnatomy

CONTAINERFindings

CODELaterality


contains


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TID 5104


CONTAINERAnatomy

CONTAINERFindings

CODELaterality


CODELongitudinal Modifier

has concept modifiercontains

Optional specificity


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CONTAINERAnatomy

CONTAINERFindings

CODELaterality



NUMMeasurement

CODETopographical Modifier

contains

contains TID 5104


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Findings Origin and Findings Origin and ContextContext

NUMMeasurement

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

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Dx ReportsDx Reports

• Based on DICOM SRBased on DICOM SR

• Allows to include Allows to include without transcription:without transcription:- measurements- measurements- image links- image links- structured content - structured content

• Integrated with the Integrated with the imaging workflowimaging workflow

• Friendly to XML Friendly to XML implementationsimplementations

• Easy to export to the Easy to export to the EPR (HL7)EPR (HL7)


Simple StructureSimple Structure

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

0-n

CONTAINS 1

CONTAINS

0-n

0-n

INFERRED FROM

Report Text

Image Reference

Observation Context

(See section 5.3.2.3) 1-n

Section Heading

Document Title

Image Reference

0-1

Observation Context

(See section 5.3.2.3)

0-n

Coded Entry

0-n

INFERRED FROM

Image Reference


Added MeasurementsAdded Measurements

Simply adds Measurements to Simple Image ReportsSimply adds Measurements to Simple Image Reports

0-n

CONTAINS

HAS OBS CONTEXT

1

CONTAINS

0-n

Report Text

Image Reference

Observation Context

(See section 5.3.2.3) 1-n

Section Heading

Document Title

HAS OBS CONTEXT

0-1

Observation Context

(See section 5.3.2.3)

0-n

Coded Entry

0-n

0-n

INFERRED FROM

Image Reference

Measurement

0-n

Measurement

0-n

INFERRED FROM

Image Reference

Measurement

0-n


Key Object Selection Key Object Selection DocumentsDocuments Initiated by the desire to have Initiated by the desire to have

simple Key Image Notesimple Key Image Note Developed as generic “manifest” Developed as generic “manifest”

– collection of pointers to images – collection of pointers to images (or even specific frames)(or even specific frames)

Specifies intent of selection, Specifies intent of selection, simple textual notesimple textual note

Non-extensible templateNon-extensible template


for referring physicianHere you can see the renal osteopathy.

For teachingFibroosteoclasia


Different notes on different images

Same note on different images

for referring physicianHere you can see the renal rupture.

Note1for referring physicianThis is the hematoma.

Note2

for refering physicianHere you can see the renal rupture.

Note1for refering physicianThis is the hematoma.

Note2

for refering physicianHematoma everywhere

Note3 for refering physicianHematoma everywhere

Note3for refering physicianHematoma everywhere

Note3 for refering physicianHematoma everywhere

Note3

for referring physicianHematoma everywhere

Note3


Title of KOSD is a CodeTitle of KOSD is a Code

The note title defines the semantics The note title defines the semantics of the reason of significance.of the reason of significance.

Key Image Notes cKey Image Notes can be queried by an be queried by code.code.

The user comments are meant to be The user comments are meant to be informalinformal..

CodesOf Interest

Rejected for Quality Reasons

For Referring Provider

For Surgery

For Teaching

For Conference

For Therapy

For Patient

For Peer Review

For Research

Quality Issue

Reporting


Key Image NotesKey Image Notes

One use of KOSD is to attach One use of KOSD is to attach « electronic post-it™ » to images « electronic post-it™ » to images to communicate:to communicate:– specific examination eventsspecific examination events– image quality issues image quality issues – consultancyconsultancy

KOSD can be stored in the archive KOSD can be stored in the archive and later retrievedand later retrieved


Workflow of SR objectsWorkflow of SR objects

InterpretationInterpretation

…..

Findings:

Image Refs.:

Header:


BPD ...…..

Dx ReportDx Report

Evidence Evidence DocumentsDocuments …..

Findings:

Image Refs.:

Header:


BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Key Image NotesKey Image Notes


Patient Information Patient Information QueryQuery A simple query that allows retrieve A simple query that allows retrieve

ANY patient information, provided SCP ANY patient information, provided SCP can format it using specified templatecan format it using specified template

Useful for retrieval of relevant Useful for retrieval of relevant information about patient, e.g., from information about patient, e.g., from HISHIS

Intended for use on Modalities and Intended for use on Modalities and other equipment that is already DICOM other equipment that is already DICOM enabledenabled


Patient Information Patient Information QueryQuery Few matching keys:Few matching keys:

– Patient NamePatient Name– Patient IDPatient ID– Template identifierTemplate identifier

Useful for retrieval of relevant Useful for retrieval of relevant information about patient, e.g., information about patient, e.g., from HISfrom HIS


Patient Information Patient Information QueryQuery Several Template identified for Several Template identified for

this purposethis purpose– General Relevant Patient InfoGeneral Relevant Patient Info– Relevant Patient Info for Breast Relevant Patient Info for Breast

ImagingImaging


Questions?Questions?

Application of DICOM Structured Report Andrei Leontiev Dynamic Imaging.

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Transcript of Application of DICOM Structured Report Andrei Leontiev Dynamic Imaging.