DICOM Structured Reporting Current Status and Role in the Electronic Patient Record

Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 1

DICOM Structured ReportingCurrent Status and Role

in the Electronic Patient Record

DICOM Structured ReportingCurrent Status and Role

in the Electronic Patient Record

Harry SolomonCo-chair, DICOM WG1 - Cardiovascular Information


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


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


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

Hemo ReportBaseline Ref waveform Measurements …Post-intervention Ref waveform Measurements … Derived measurements

Ref waveform

Procedure Log11:10 Patient prepped

Cath Lab ReportPatient67 yr old male, history of … Ref prior ECG reportProcedureRef LogNarrative ...Findings

HemodynamicRef HD ReportNarrative ...Angiographic70% stenosis ... Ref image

InterventionStent placed in LAD … Ref imageComplicationsSummary

Cath Lab ExampleProcedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired

Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired

Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired

Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired

Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired12:02 HD waveform acquired

Procedure Log11:10 Patient prepped11:19 Percutaneous entry11:23 XA image acquired11:27 HD waveform acquired11:30 XA image acquired11:47 PTCA11:59 XA image acquired12:02 HD waveform acquired12:21 Pt released to holding 12:24 HD Report


Structured Reporting is the glue that makes possible construction

of an electronic patient record for cardiology

Structured Reporting is the glue that makes possible construction

of an electronic patient record for cardiology


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


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


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


So Theoretically ...

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

But Pragmatically …


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


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


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


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

Hemo Report StructureHemo ReportCONTAINER

Baseline PhaseCONTAINER

Post-Contrast PhaseCONTAINER

Arterial MeasurementsCONTAINER

Ventricular MeasurementsCONTAINER

Gradient MeasurementsCONTAINER

AnatomicLocation =L Fem Art

Patient StateCONTAINER

Patient StateCONTAINER

Systolic Pres

Diastolic Pres

Mean Pres

Arterial MeasurementsCONTAINER

AnatomicLocation =

Aorta

Systolic Pres

Diastolic Pres

Mean Pres

Post-Intervention PhaseCONTAINER


Find out more

• http://www.pixelmed.com/srbook.html– David Clunie’s 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 [email protected]


Thank you

Questions?

mailto://[email protected]

DICOM Structured Reporting Current Status and Role in the Electronic Patient Record

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