Structured ReportingDICOM Structured Reporting (SR) is an encoding for non-imaging content:evidence information generated in a course of medical imaging acquisition, diagnostic reports,other types of documentation

DICOM SR DocumentEach SR object represents a document; the content of a document is a tree of Content Items connected via different types of relationships As other DICOM objects, SR Document is composite object fitting Patient-Study-Series hierarchical model

Content Items and RelationshipsThe Content Item is a node of the SR Document Provides a name-value pair, i.e., a Concept Name, and a Concept Value. The Concept Name is a code identifying the concept the Content Item representsThe Concept Value may be of different Value Type, including text, personal name, numeric, and coded concept values.

Data TypesContent Items may represent:Text (words, sentences or paragraphs)NUMERIC (measurements)Dates, timesPerson NamesReferences to images and other objectsSpatial and time coordinatesCodesContainers (groups of other items)

Coded EntriesCoded values for Content Items provide for ability to use vocabularies to convey contentVocabularies used:DICOM Content Mapping ResourceSNOMEDSubject-specific coded schemes

SR Tree

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

Heading Node CONTAINER "Specific Image Findings"

contains

Heading Node CONTAINER "Conclusions"

Leaf Node NUM "diameter = 1.3 cm"

Content Node CODE "finding = mass"

has properties

Content node SCOORD"best illustration of findings"

Content Node CODE "conclusion = probable malignancy"

contains

contains

has properties

Leaf Node CODE "margination = infiltrative"

contains

Leaf Node IMAGE

"Baseline"

inferred from

* Relationship Modes

= By-value

= By-reference

Leaf Node CODE

"Views = PA and Lateral"

contains

has concept mod

Content Node PNAME"Patient-Data-Acquisition Subject = Homer^Jane^^^"

contains

Has obs context

Content Node UIDREF"Study Instance UID of Evidence Directly Examined by RO = 1.2.3.4.5.6.7.100"

Has obs context

selected from

Leaf Node IMAGE

inferred from

Content Node PNAME "Recording Observer = Smith^John^^Dr^"

Has obs context

Sample ReportChest 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=Masshas properties diameter=1.3 cmhas properties margination=infiltrative (1.4.2)Baseline ImageConclusionsconclusion=probable malignancyinferred from 1.4.2inferred from 1.7.1Specific Image Findingsbest illustration of findings(1.7.1).Slide by D. Clunie

CODESCOORDCODEChest X-RayRecording Observer=Smith^John^^Dr^Study Instance UID ...=1.2.3.4.5.6.7.100Context Acquisition Subject=Homer^Jane^^^Finding=MassContainsBaseline=ContainsConclusionsContainsSpecific Image FindingsContainsViews=PA and LateralModifierContextContextdiameter=1.3 cmPropertiesmargination=infiltrativePropertiesconclusion=probable malignancyContainsbest illustration of findings=ContainsSeld FromInfd FromInfd FromCONTAINERCONTAINERCONTAINERPNAMEUIDREFPNAMECODENUMIMAGEIMAGECODE1.11.21.31.41.51.61.71.81.4.11.4.21.6.11.7.11.7.1.11.6.1.11.6.1.2Slide by D. Clunie

RelationshipsRelationships between nodes convey meanings of:ContainmentObservation ContextModification/clarification of the Concept CodeDerivation of content of one Item from other item(s)

Observation ContextThe content of an SR document exists in Observation Context Initially provided by Patient/Study/Series/Instance level attributesInherited by all nodes in tree hierarchyCan be overridden for each node

TemplatesTo 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 CADTemplates may be extensible and non-extensible

Typical Top Level Template StructureCONTAINERFinding HeadingCONTAINERFinding HeadingCONTAINERDocument TitleCONTAINERPatientCharacteristicsTemplate specified titleOB-GYN, Adult Echo, IVUSUltrasound Vascular, Cath/Hemo TID 1002 Observation ContextCONTAINERSummaryOther Contexte.g. procedureCONTAINERSummary FindingsCONTAINERFindings HeadingFindingsSlide by D. Sluis

Key Object Selection DocumentsInitiated by the desire to have simple Key Image NoteDeveloped as generic manifest collection of pointers to images (or even specific frames)Specifies intent of selection, simple textual noteNon-extensible template

Key Image NotesOne use of KOSD is to attach electronic post-it to images to communicate:specific examination eventsimage quality issues consultancyKOSD can be stored in the archive and later retrieved

Evidence DocumentsMeasurements and coded data DICOM SR document Created by either Acquisition Modality or WorkstationProduced during acquisition or post-processing workflowsInterpreted along with the images

Evidence Documents ExamplesMammography CADChest CADOB-Gyn Ultrasound MeasurementsVascular Ultrasound MeasurementsVascular Intervention ResultsEchocardiography Measurements

Diagnostic ReportsSR infrastructure supports creation and interchange diagnostic report documents:Simple structure of section headings and paragraphsMore coded entries on different levels to support data mining and statistical analysisMeasurements, image references, etc.

Simple Dx Report Minimal Structure : Coded Title and HeadingsFull image links from specific sections of reportObservation Context (who, what, when) may be section specific

Image Reference

INFERRED FROM

0-n

Coded Entry

0-n

Observation Context

(See section 5.3.2.3)

0-1

Image Reference

Document Title

Section Heading

1-n

Observation Context

(See section 5.3.2.3)

Image Reference

Report Text

INFERRED FROM

0-n

0-n

CONTAINS

1

CONTAINS

0-n

Added MeasurementsAdds Measurements to Simple Image Reports

Image Reference

INFERRED FROM

0-n

Coded Entry

0-n

Observation Context

(See section 5.3.2.3)

0-1

HAS OBS CONTEXT

Document Title

Section Heading

1-n

Observation Context

(See section 5.3.2.3)

Image Reference

Report Text

0-n

Measurement

0-n

CONTAINS

1

HAS OBS CONTEXT

CONTAINS

0-n

Measurement

0-n

Measurement

Image Reference

INFERRED FROM

0-n

0-n

Workflow of SR objectsInterpretationDx ReportEvidence DocumentsKey Image Notes

Link into IT worldDICOM SR structure can be transcoded into HL7 CDA XML-based document structureAllows for creation of DICOM SR documents with subsequent emnterprise distribution as CDA documentsBoth structures allow cross-referencing of documents (images, reports, etc.) in other encoding.

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