Reporting: Presentation & Interpretation - DICOM...Reporting: Presentation & Interpretation 8...

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THE DICOM 2014 Chengdu Workshop August 25 Chengdu, China Reporting: Presentation & Interpretation Nikolaus Wirsz, PhD SIEMENS AG Healthcare Sector Program Manager Standards & Interoperability Erlangen, Germany Thomas Freier Softgate GmbH Erlangen, Germany

Transcript of Reporting: Presentation & Interpretation - DICOM...Reporting: Presentation & Interpretation 8...

Page 1: Reporting: Presentation & Interpretation - DICOM...Reporting: Presentation & Interpretation 8 •Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed

THE DICOM 2014 INTERNATIONAL

CONFERENCE & SEMINAR March 14-16 Bangalore, India

THE DICOM 2014 Chengdu Workshop

August 25 Chengdu, China

Reporting:

Presentation & Interpretation

Nikolaus Wirsz, PhD

SIEMENS AG – Healthcare

Sector Program Manager Standards &

Interoperability

Erlangen, Germany

Thomas Freier

Softgate GmbH Erlangen, Germany

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Reporting:

Presentation & Interpretation

• Introduction

• Standards Elements for Building

Tools for Reading & Interpretation

• IHE Profiles for Interpretation & Reporting

• Conclusions

Reporting: Presentation & Interpretation 2 August 2014 DICOM International Conference & Seminar

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Introduction

Reporting: Presentation & Interpretation 3

• Access to Images & Image Related Information - Storage & Retrieval

• Display & Presentation of Image Data

• Interpretation Results

• Report Generation

• Putting them all together (the IHE way)

August 2014 DICOM International Conference & Seminar

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Access to Images and

Image Related Information

• Retrieval of Images upon Availability

► Newly Acquired Images

► Prior Images for Comparison

► Evidence Documents

• Interpretation Worklists for Radiology Staff sorted by:

► User (assigned Radiologist)

► Modality Type (all CT Exams)

► Specialties (CT Head)

► …

• Worklist Management - based on:

► Application Logic or

► Scheduling Data Provided by RIS/PACS

• Images Sent to PACS from:

► Acquisition Modality

► Other Workplaces (e.g. Imaging Centers)

► Imported from brought-in Media

Reporting: Presentation & Interpretation 4

Image

Management

(PACS) Interpretation

Reviewing

Workstation

Q/R: C-FIND / C-MOVE

C-FIND/ C-MOVE

New Images

Prior Images / Evidences

Image

Acquisition

Modality

C-S

TO

RE &

Sto

rag

e C

om

mit

men

t Tran

sfe

r I

mag

es

Description Tag Type

Patient’s Name (0010,0010) R

Patient ID (0010,0020) U

Study Date (0008,0020) R

Study Time (0008,0030) R

Accession Number (0008,0050) R

Study ID (0020,0010) R

Name of Physician(s) Reading Study (0008,1060) O

Modality (0008,0060) R

August 2014 DICOM International Conference & Seminar

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Image Display Consistency -

Ensuring Quality for Reviewing & Interpretation

Reporting: Presentation & Interpretation 5

• Issue #1: Differences in Characteristics of Display Devices

► Images produced by same signal have different appearance on different display devices

► Difference in display luminance images don’t look the same (diagnostic quality impaired)

Display 1 Display 2

• Grayscale Standard Display Function Standard (GSDF) (DICOM Part 14)

► Standard curve against which display devices can be calibrated (adjust their characteristic curve to the GSDF curve)

► GSDF facilitates similarity in (human) grayscale perception and appearance of images between displays of different luminance

August 2014 DICOM International Conference & Seminar

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Image Display Consistency -

Ensuring Quality for Reviewing & Interpretation

Reporting: Presentation & Interpretation 6

• Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays

Reporting Radiologist

Original Image

Window Level

Flip

Area Of

Interest

Consistent Image Presentation

Using GSDF

Apply Grayscale Softcopy Presentation State

(GSPS)

Zoom

Area Of

Interest

Annotate

Inconsistent Image Presentation

Reporting Radiologist / Referring Physician

August 2014 DICOM International Conference & Seminar

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Inconsistent Image Presentation

Using GSDF

Apply Grayscale Softcopy Presentation State

(GSPS)

Grayscale Softcopy Presentation State (GSPS)

► GSPS objects contain only presentation parameters describing how to display images - Grayscale Transformation - Spatial Transformation - Graphics / Annotations - Measurements …

► Link to one or more Images in Series / Studies

► Separation of Stored Images from Display Characteristics or Transformations

► Communication of Display Parameters using regular Storage and Query / Retrieve Services

Benefits

► Quality & Consistency of Images Preserved for Diagnostic Use -Same Look an all Displays

► No need to duplicate Images (originals + transformations) - apply Presentation States automatically before the Images Display

Image Display Consistency -

Ensuring Quality for Reviewing & Interpretation

Reporting: Presentation & Interpretation 7

• Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays

Reporting Radiologist

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Consistent Image Presentation

Reporting Radiologist / Referring Physician

Area Of

Interest

Annotate

August 2014 DICOM International Conference & Seminar

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Inconsistent Image Presentation

Using GSDF

Apply Grayscale Softcopy Presentation State

(GSPS)

Image Display Consistency -

Ensuring Quality for Reviewing & Interpretation

Reporting: Presentation & Interpretation 8

• Issue #2: Image Display Set-Ups, Transformations and Annotations get Lost when Viewed on Different Displays

Reporting Radiologist

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

Area Of

Interest

Consistent Image Presentation

Reporting Radiologist / Referring Physician

August 2014 DICOM International Conference & Seminar

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Simple Image and Numeric Report Pattern (from IHE Technical Framework)

Standard DICOM Header Patient Study Series Document

Creating Evidences -

Collecting Information for Reporting

Reporting: Presentation & Interpretation 9

DICOM Structured Reporting (SR)

• “Multi-Purpose Tool” for Capturing Image Accompanying Data

• Records of Study Evidences (Findings) made during Image Interpretation

► Observations (Diagnostic Relevant Data)

► Measurements

► Procedure Logs

► Key Object Selection (Key Images)

► Contrast Administration

► Radiation Dose Administration

► CAD Results

► …

useful Inputs for Generating (final) Diagnostic Imaging Reports (DIR) and Creation of Imaging Records

• DICOM SR Objects are well Structured & Contain Coded Entries

► Relationships

► Meanings / Semantics

► References to Images or other Relevant Information

August 2014 DICOM International Conference & Seminar

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Creating Evidences -

Collecting Information for Reporting

Reporting: Presentation & Interpretation 10

• DICOM SR - a Powerful Mechanism with lots of “generic” Flexibility

• Interpreting Applications easily overwhelmed by Diversity / Complexity

• SR Templates - Defining Content Constraints for Specific Document Types (Specialties)

DICOM Standard Part 16: Content Mapping Resource

► TID 2000 Basic Diagnostic Imaging Report

► TID 2001 Basic Diagnostic Imaging Report Observations

► TID 2002 Report Narrative

► TID 2005 Transcribed Diagnostic Imaging Report

► TID 2010 Key Object Selection

► TID 3001 Procedure Log

► TID 3300 Stress Testing Report

► TID 3900 CT/MR Cardiovascular Analysis Report

► TID 4000 Mammography CAD Document Root Template

► TID 4200 Breast Imaging Report

► TID 5100 Vascular Ultrasound Report

► TID 10001 Projection X-Ray Radiation Dose

► TID 10011 CT Radiation Dose

• SR Objects can be Stored and Retrieved using the same Services as for Images

Key Image Note (KIN) Pattern (from IHE Technical Framework)

August 2014 DICOM International Conference & Seminar

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Report Generation

Reporting: Presentation & Interpretation 11

Assembling DICOM Evidences for Clinical Use

Image

Management

(PACS) Interpretation

Reviewing

Workstation C-FIND/ C-MOVE

C-STORE

Images - Presentation States Key Objects – Evidences - SR

Images PS

KIN

Annotations

Measurements

Radiology Results

Information

System

HIS

DICOM Standard Objects

for “internal” Use / Imaging Records HL7 CDA-based Standard Documents

for wider Distribution / Clinical Context

HL7 CDA Diagnostic Imaging Report

August 2014 DICOM International Conference & Seminar

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Report Generation

Reporting: Presentation & Interpretation 12

Assembling DICOM Evidences for Clinical Use

Post

Processing

Selection/Annotation of Relevant

Images

Measurements, e.g.

based on Pattern/Object

Recognition

Dictation

Transcription

Diagnostic

Imaging Report

(DIR)

Evidence

Document

KOS

Interpretation

Clinical Report

HL7 CDA

DICOM SR HL7 CDA

Inclusion of results

Inclusion of

results /

summary

Inclusion of evidence document contents into final diagnostic imaging reports has been addressed in

DICOM Part 20 “Transformation of DICOM to and from HL7 Standards”,

Annex A “SR Diagnostic Imaging Report Transformation Guide”

Source: “DICOM & HL7: Integration of Imaging and Information Systems” - Helmut König, MD (2013)

DICOM SR / HL7 CDA Transformation

August 2014 DICOM International Conference & Seminar

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Integrating the

Healthcare Enterprise

• IHE: Standards Profiling Organization for Advancing Integration in Clinical Practice

• Interoperability Frameworks for Implementing and Deploying Standards-Based (HL7 & DICOM) Integrated Solutions

• IHE Integration Profiles - Address Specific Integration Issues For Radiology:

► Content Profiles:

Interoperable Information Objects - exchangeable across systems for display, processing and re-use

► Presentation Profiles: Preserving Quality of Image Data - reproducible views across systems / same “look” on any viewing application

► Workflow Profiles:

Connecting Tasks from one Process Step to the Next Process Step - automating the information flow and relieving users from unnecessary tasks

► Infrastructure Profiles:

Consistent access to images and reports – network, media, cross-enterprise

Reference to IHE Profiles Descriptions: www.ihe.net/profiles

13 August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation

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Content & Presentation

Pertinent to Presentation & Interpretation • ARI Access to Radiology Information

► Access & share images, evidences & related data within a (DICOM) Network

• CPI Consistent Presentation of Images ► Consistent intensity & image transformations

across softcopy (& hardcopy) devices

• KIN Key Image Notes ► Mark significant images & add notes e.g. for

referring physician, oncologist, surgeon …

• ED Evidence Documents ► Encoding, exchange, management of

measurements, procedure logs, CAD results …

• SINR Simple Image and Numeric Report ► Encoding, exchange and management of Radiology Results

(image references & numeric data)

• MRRT Management of Radiology Report Templates (in development)

► Managing a pool of templates with pre-defined structure, content & terminology for Radiologists to re-use (e.g. RSNA Template Library)

Reporting: Presentation & Interpretation 14

ARI

August 2014 DICOM International Conference & Seminar

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Workflow Profiles

Pertinent to Presentation & Interpretation

• REM Radiation Exposure Monitoring

► For X-Ray based imaging Patient dose reduction is of significance

► Integration of systems reporting dose and systems which receive, store or process those reports facilitate automated reporting

► Using DICOM SR, store, Q/R and FTP

► Reporting required in parts of U.S. and Europe

Reporting: Presentation & Interpretation 15 August 2014 DICOM International Conference & Seminar

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

National Registry

Archive Dose Information

Consumer / Reporter

Outlier: #

Performing

Phys.

Over Target:

12.2%

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

some text: #

Numerical

Details

12.2 14.5

11.8 7.6

9.5 10.9

TID 1002

Observer Context

TID Tx10011 Irradiation Event

X -

TID Tx10010 Accumulated

X - Ray Dose Data

TID Tx10001

Projection X - Ray

Radiation Dose

TID 1002

Observer Context

TID 10003 Irradiation Event

X - Ray Data

TID 10002 Accumulated

X - Ray Dose Data

TID 10001

Projection X - Ray

Radiation Dose

TID 10004

Accumulated

Projection X-Ray

Dose

TID 10005

Accumulated

Mammography

X-Ray Dose

TID 10006

Accumulated

Cassette-based

Projection

Radiography Dose

TID 10007

Accumulated

Integrated

Projection

Radiography Dose

TID 1021

Device Participant

TID 1020

Person Participant

TID 4007

Mammography

CAD Breast

Composition

TID 10003a

Irradiation Event

X-Ray Detector

Data

TID 10003b

Irradiation Event

X-Ray Source Data

TID 10003c

Irradiation Event

X-Ray Mechanical

Data

TID 1020

Person Participant

Source: “Monitoring Radiation Exposure” 2013, O´Donnell, Blendinger

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Workflow Profiles

Pertinent to Presentation & Interpretation

• PAWF Post-Acquisition Workflow (in Trial Implementation)

► Managing, organizing and scheduling post-processing tasks in preparation of image interpretation & reporting

► Monitoring progress and completion of tasks performed during interpretation

► Worklist Management & Status Report

+ Launching of appropriate applications

• Reporting Workflow

► in preparation …

Reporting: Presentation & Interpretation 16 August 2014 DICOM International Conference & Seminar

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Conclusions

DICOM Standard Definitions:

• Information Objects

► Images

► Structured Documents

► Display Characteristics

► Presentation Information

and

• Services

► Query & Retrieve

► Storage

for

► Exchanging

► Processing

► Presentation and

► Management

of imaging data consistently across multiple applications & systems

Reporting: Presentation & Interpretation 17

Image

Management

(PACS) Interpretation

Reviewing

Workstation C-FIND/ C-MOVE

C-STORE

Images - Presentation States Key Objects – Evidences - SR

Images PS

KIN

Annotations

Measurements

Radiology Results

August 2014 DICOM International Conference & Seminar

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References

http://www.HL7.org/

http://www.IHE.net/

http://medical.NEMA.org/DICOM

Reporting: Presentation & Interpretation 18

- Sources: DICOM® Standards Publication 2011, © NEMA - The DICOM Standard is under continuous maintenance,

the current official version is available at http://dicom.nema.org

August 2014 DICOM International Conference & Seminar

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Author Contact

Reporting: Presentation & Interpretation 19

Nikolaus Wirsz, PhD

SIEMENS AG - Healthcare Sector

Imaging & Therapy Division

Hartmannstr. 16

91052 Erlangen, Germany

[email protected]

Thank you for your attention !

August 2014 DICOM International Conference & Seminar

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Presenter Contact

Reporting: Presentation & Interpretation 20

Thomas Freier

softgate GmbH

Nägelsbachstr. 26

91052 Erlangen, Germany

[email protected]

Thank you for your attention !

August 2014 DICOM International Conference & Seminar