Evidence Documents Profile (ED) Harry Solomon GE Healthcare Co-chair, IHE Cardiology Technical...

Evidence Documents Profile (ED)

Evidence Documents Profile (ED)

Harry SolomonGE Healthcare

Co-chair, IHE Cardiology Technical Committee

June 28-29, 2005 Interoperability Strategy Workshop2

What are Evidence Documents?What are Evidence Documents?

• Intermediate products between acquisition and clinical reporting– Data derived from primary evidence (images, waveforms), such as

measurements– Manually and/or automatically derived

• Data associated with performance of acquisition steps– Procedure logs

• Created by either Acquisition Modality or Evidence Creator (workstation or automated process)– Produced during acquisition or post-processing workflows

• Interpreted along with the images and other acquired data in the production of the clinical report


The State of the ArtThe State of the Art

• Measurements made on modality or workstation, and written onto a paper worksheet, then transcribed into a report

• Measurements output to a printer port, intercepted by an application that scrapes the values

• Screen capture of measurements sent to a reporting system, which uses OCR (optical character recognition) to reconstruct the original measurement names and numbers

The State of the KludgeThe State of the Kludge

• Error-prone, inefficient, hard to configure, hard to manage


Evidence Documents Profile Evidence Documents Profile Abstract / ScopeAbstract / Scope

• Management of DICOM Structured Report (SR) formatted measurements, logs, CAD results

• Creation, storage, and review

• Inclusion of measurements into reports


DICOM SR ExampleDICOM SR ExampleMeasurementMeasurement

Echocardiography Measurement

Patient: Doe, John Technologist: der Payd, N

Measurements:

Mitral valve diameter 3.1cm

- shown in image at [ ]

Ventricular length, diastolic 5.97 cm

- shown in image at [ ]

Ventricular volume, diastolic 14.1 ml

- inferred from [ ]

- inferred from VLZ algorithm


DICOM SR ExampleDICOM SR ExampleProcedure LogProcedure Log

Catheterization Procedure Log

Patient: Doe, John Technologist: Logger, H. Moe

11:15:37 Patient admitted

11:18:39 Physician arrived

- ver Payd, O

11:20:46 Patient prepped and draped

11:22:07 Drug administered

- Agent: D51/2NS

- Volume: 400 ml

- Rate: 30 ml/hr

- Route: IV

11:22:13 Vital signs

- NIBP Systolic: 105 mm(Hg)

- NIBP Diastolic: 59 mm(Hg)

- HR: 101 /min

- Resp: 21 /min

11:23:16 Consumable: 7Fr sheath

11:24:11 Sheath inserted

- Right Femoral Artery

...

11:41:08 Catheter placed

- Left Ventricle

11:41:21 Waveform acquired [ ]

- Modality: HD

- Technique: Aortic valve pullback

11:43:11 Drug administered

- Agent: Omnipaque

- Volume: 30 ml

- Rate: 20 ml/s

- Route: power injection

11:43:29 Image acquired [ ]

- Modality: XA

- Number of frames: 77

- Positioner primary angle: 30 deg

- Positioner secondary angle: 60 deg

...


DICOM SR ExampleDICOM SR ExampleComputer Aided DetectionComputer Aided Detection

Mammography CAD Results

Patient: Doe, Jane

Overall Findings: Successful analysis

- Suspicious abnormality, biopsy should be considered

- Follow-up immediately

Feature: Mass

Scope: Detected on multiple images

Algorithm: Lesion Analyzer V.1.3

Pathology: Lobular carcinoma in situ

Image: [ ]

Feature: Calcification

...


DICOM SR FeaturesDICOM SR Features

• Structured content– Lists, hierarchies and relationships

• Numeric measurements, coded values– Automatically extractable for database, data mining

• References to images, waveforms, other objects• Explicit contextual information

– Unambiguous documentation of meaning


The SR Content TreeThe SR Content Treeand SR Templatesand SR Templates

• Data structured in hierarchical Content Item Tree• Structure of tree, relationships between items, and concepts

and values encoded in items are constrained by Templates

Root Content Item

Document Title

Content Item Content Item


Content Item


NL Rel withParent

VT Concept Name VM ReqType

Condition Value Set Constraint

CONTAINER DT (DCM, D-640-017),“Thermal Cardiac Output

Technique Properties”CONTAINS CODE DT (DCM, D-640-018),

“Thermal Cardiac OutputMethod”

1 M DCID (CID 618) “ThermalCardiac Output Methods”

CONTAINS NUM DT (DCM, D-640-019,“Catheter Size”)

1 M UNITS = DT (UCUM, [Ch],“French”

CONTAINS NUM DT (DCM, D-640-020,“Injectate Temperature”

1 M UNITS = DT (UCUM, Cel,“°C”)

CONTAINS NUM DT (DCM, D-640-021,“Injectate Volume”

1 M UNITS = DT (UCUM, ml,“milliliter”)

CONTAINS NUM DT (DCM, D-640-022,“Calibration Factor”

1 M UNITS = DT (UCUM, 1,“unary, no units”)


Evidence Documents Profile Evidence Documents Profile Value PropositionValue Proposition

• DICOM SR provides a standard interface for measurements, procedure logs, and CAD results– Eliminates manual recording/transcribing steps

– Minimizes vendor-specific configuration

• DICOM Templates define semantically interoperable measurement names and consistent hierarchical structuring– Allows automated processing on creator and receiver

• The Evidence Documents Profile specifies actors and transactions for exchanging measurements leveraging the image exchange data flow – Consistent with Scheduled Workflow, Cath, and Echo Profiles


Evidence Documents ProfileEvidence Documents ProfileTransaction DiagramTransaction Diagram

RAD-44: Query Evidence Documents RAD-45: Retrieve Evidence Documents

Report Creator

RAD-10: Storage

Commitment

RAD-43: Evidence Documents Stored

Evidence Creator

Acquisition Modality

Image Manager

Image Archive

Image Display

RAD-43: Evidence Documents Stored

RAD-10: StorageCommitment


Evidence Documents ProfileEvidence Documents ProfileActorsActors

• Acquisition ModalityAcquisition Modality – A system that acquires and creates medical images or waveforms while a patient is present, and that may also create other evidence objects such as measurements.

• Evidence CreatorEvidence Creator – A system that creates additional evidence objects, such as derived images or measurements.

• Image Manager / Image ArchiveImage Manager / Image Archive – A system that provides long term storage and management of images and other evidence objects.

• Image DisplayImage Display – A system that offers browsing of patients’ studies, and the retrieval and display of selected images and other evidence objects.

• Report CreatorReport Creator – A system that generates and transmits clinical reports. Must be grouped with Image Display in this Profile.


Evidence Documents ProfileEvidence Documents ProfileStandards UsedStandards Used

• DICOM Services– Structured Report Storage

• Enhanced

• Comprehensive

• Procedure Log

• CAD

– Storage Commitment

– Query

– Retrieve

• DICOM SR Templates


Evidence Documents Profile Evidence Documents Profile OptionsOptions

• Cath Evidence optionCath Evidence option – Modality / Evidence Creator must support at least one specified Cath Template– 3001 Procedure Log– 3202 Ventricular Analysis– 3213 Quantitative Arterial Analysis– 3250 Intravascular Ultrasound– 3500 Hemodynamics

• Echo Evidence optionEcho Evidence option – Modality / Evidence Creator must support at least one specified Echo Template– 5100 Vascular Ultrasound– 5200 Echocardiography


Image Display IssuesImage Display Issues

• Image Display actors must follow DICOM SR display rules– Render complete content tree of SR object, regardless of Template

• ED Report Creator actor is the product assertion that it uses data from Evidence Documents in the clinical report – Report Creator must be grouped with Image Display to retrieve

documents from the Image Manager/Archive– Report Creator also appears in Simple Image and Numeric Report

Profile (SINR), and in Displayable Reports Profile (DRPT) to create clinical report

• Workstation that revises Evidence Documents should claim Image Display and Evidence Creator actors– E.g., for updating preliminary measurements and storing updates

back to the Image Manager/Archive


Relationship to Workflow ProfilesRelationship to Workflow Profiles

• Evidence Creator actor also appears in Scheduled Workflow, Cath Workflow, and Echo Workflow Profiles– Performance of evidence creation reported through Modality

Performed Procedure Step in those Profiles

– Scheduled Procedure Step identified in the analyzed images may be used as the referenced SPS for the evidence documents created

• Evidence Creator actor also appears in Post-Processing Workflow Profile– Performance of evidence creation managed through General

Purpose Worklist and General Purpose Performed Procedure Step in that Profile


Cath Templates ScopeCath Templates Scope

• 3001 Procedure Log– Time stamped event log, with codes defined for common events,

and free text entries allowed• 3202 Ventricular Analysis

– Quantitative measurements of heart chambers, including wall motion by any of three types of analysis

• 3213 Quantitative Arterial Analysis– Angiographic arterial measurements and findings organized by

vessel• 3250 Intravascular Ultrasound

– IVUS arterial measurements and findings organized by vessel• 3500 Hemodynamics

– Pressure and flow measurements organized by procedure phase and measurement location


Echo Templates ScopeEcho Templates Scope

• 5100 Vascular Ultrasound– Vascular measurements and findings organized by

anatomic region

• 5200 Echocardiography– Measurements of heart chambers, valves, and adjacent

vessels; and assessment of wall motion


More information….More information….

• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements

• Radiology Technical Framework

• Cardiology Technical Framework

• Cath and Echo Options for Evidence Documents Supplement

• Non-Technical Brochures :• Calls for Participation

• IHE Fact Sheet and FAQ

• IHE Integration Profiles: Guidelines for Buyers

• IHE Connect-a-thon Results

• Vendor Products Integration Statements

http://www.ihe.net/


W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information SystemsIn the Enterprise

and Across Care Settings

Evidence Documents Profile (ED) Harry Solomon GE Healthcare Co-chair, IHE Cardiology Technical...

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