DICOM SR: Evidence DocumentsKey Image Notes Simple Image and Numeric Reports

Rita Noumeir, Ph.D. Rita Noumeir, Ph.D. Professor, University of Quebec

Evidence Documents

Evidence DocumentsValue proposition

• Measurements and coded data – DICOM SR document

• Created by either Acquisition Modality or Evidence Creator

• Produced during acquisition or post-processing workflows

• Interpreted along with the images

Evidence DocumentsWorkflow

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD...…..

Evidence Document Evidence Document StoredStored

Storage CommitmentStorage Commitment

Query / RetrieveQuery / Retrieve

Evidence DocumentsExamples

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

Key Image Notes

Key Image Notes Value proposition

• There is more to teamwork than images and reports

• With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between:

– The Technologist and the Radiologist about specific examination events

– The Radiologist and the Technologist about image quality issues

– The Radiologist and other department clinicians (surgeon, orthopedist,..)

– The Radiologist and collegues about selecting images for conferences

– The Radiologist to the Referring Provider, …..etc.

• Query for the KIN using title codes

Key Image NotesUse cases

• “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me”– Thinking… “#$@%!%# You”, says “Sure”

• “Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those”

• Tech to radiologist: “The patient wouldn’t hold still”

for referring physicianHere you can see the renal osteopathy.

For teachingFibroosteoclasia

Different notes 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

Same note on different images

Key Image NotesTitles & Codes

Defined by DICOM. May be extended

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.

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

For Reporting

Simple Image & Numeric Report

Simple Image & Numeric Report

Can you make a report like this:

Institution IdentificationPatient IdentificationStudy Identification

Technique IdentificationDiscussion

The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal.

ImpressionCT of the abdomen within normal limits

Signature

Simple Image & Numeric Report

Or like this:

DiscussionComparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal.

ImpressionWorsening L Paratracheal adenopathy.

Signature

Simple Image & Numeric ReportValue proposition

• Reports’ content is more than words…• 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 with HL7

Simple Image & Numeric Report Pattern – Simple Image Report

• 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

Simple Image & Numeric ReportPattern

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

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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

Simple Image & Numeric

Report

an illustration

Evidence DocumentsKey Image Notes

Simple Image & Numeric Report

Interpretation

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Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD ...…..

Simple Image & Numeric ReportSimple Image & Numeric ReportEvidence DocumentsEvidence Documents

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Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Key Image NotesKey Image Notes