DICOM Strategic Direction DICOM Strategic Direction for for

Image DistributionImage Distribution

Cor Loef

co-chair DICOM Strategic Advisory Committee

January 12, 2002 2

Contents

• Scope of DICOM Standards Committee

• Trends in Imaging-IT

• Standards in Imaging-IT

• Objects, Information, EPR, Web-distribution, Desktop

January 12, 2002 3

Scope of DICOM Standards Committee

• Mission of DICOM– Create and maintain international standards for

communication of bio-medical diagnostic and therapeutic information

• Goals of DICOM– Achieve compatibility and improve workflow

efficiency between imaging systems and other information systems

January 12, 2002 4

New: published in

DICOM 2000• Sup 23: Structured Reporting (Pre-reports, image measurements, analysis results, diagnostics reports with qualified image links)

• Sup 30: Waveform (sound, ECG, Electr. Physio.) synchronized with images

• Sup 31: Network Security (node authentication and transport encryption)

• Sup 33: Softcopy Presentation State• 42 Correction Items, Including:

– JPEG-LS, Thai & Korean, Time zones, Case Insensitive Name Queries

January 12, 2002 5

Supplements approved in 2001

• Sup 40 DVD RAM Application Profiles • Sup 50 Mammography Comp. Aided Detect. Reports• Sup 52 General Purpose Worklist

– Reporting workflow management, image postprocessing, computer aided detection, filming, quality control, etc.

• Sup 53 Content Mapping Resource – codes and templates for Structured Reporting

• Sup 54 MIME Content Type– for e-mailing DICOM persistent objects (images reports,

presentation states, key object selection, etc.

• Sup 59 Key Object Selection

January 12, 2002 6

New Work Items

• New generations of image objects:– Revised Secondary Capture Images (specific applications)

– Multiframe MR and CT (large number of dynamic dimensions)

• Sup 41 Digital Signature– secure transformation of images and reports

• Security on Storage Media (confidentiality)• Attribute Level Confidentiality (de-identification)

January 12, 2002 7

Current Direction

• Present focus is to meet new end-user needs, adopt complementary and proven standards. Key areas are:

– Security,

– New imaging technology,and

– Image Distribution in the enterprise.

January 12, 2002 8

Liaison with TC 215• Good liaison since April 99. Cross-representation may

be the effective next step beyond TC 215 DICOM Task Force.

• Procedure– TC 215 has agreed to rely on DICOM for Medical Imaging

Standardization– DICOM offers expertise in medical imaging, with world-wide

users and vendors representation.– Need to ensure coherence with other ISO standards group on

imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)

• DICOM is ready to further develop its relationship with TC 215.

January 12, 2002 9

Trends in Imaging-IT:

Radiology

PACS

Cardiology

PACS

VL, US, NM

PACS

1. Horizontal IntegrationHIS

RIS

2. Vertical Integration

Electronic Patient Record

OtherClinicalSystem 3. Elect. Patient Record

At the desktop

January 12, 2002 10

1. Horizontal Integration

• Image management system supports archiving/retrieving of all types of images (incl. visible light) and Structured Reports

January 12, 2002 11

2. Vertical Integration

The Healthcare Enterprise

HISHIS

Order Placer

ADTPatient Registration

RISRIS

IMAGING:IMAGING:•• PACS / ArchivesPACS / Archives

•• WorkstationsWorkstations•• ModalitiesModalities

Image Archive

Image Manager

Image Creator

Image Display

AcquisitionModality

DepartmentSystem Scheduler– Order Filler –

Modality Worklist

Patient Registration

New

Ord

er

Procedure Scheduled

ImagesStoredStorage

Commit

Q /RImages

PPSIn-Progress/ Completed

January 12, 2002 12

Integration: not only back-office!

messagesmessages

ClinicalClinical

InformationInformation

SystemSystem

ClinicalClinical

InformationInformation

SystemSystem

Back-Office

IntegratedIntegrated

Clinical ViewingClinical Viewing

at the desktopat the desktop

Front Office

EfficiencyEfficiency

ImproveImproveClinicalClinicalDecisionsDecisions

January 12, 2002 13

3. Electronic Patient Record• Image Management system and Departmental Information

System must be EPR-prepared (Queries)

• EPR: emphasis today on desktop integration, should become the integrated, secure, patient centric, source of health information

• Web front-end:

– viewing not only of images but also waveforms, measurements, reports, etc

– always need the capability to access the original medical images

– support for DICOM Structured Reporting

January 12, 2002 14

Ultimate goal: All the information the user needs through one common and simple user interface

January 12, 2002 15

ClinicalClinical

QuestionQuestion

Multi-MediaMulti-Media

Report withReport with

referencesreferences

4. Order and Results Management

PACSPACS

RISRIS

Other ClinicalOther ClinicalInformationInformation

SystemsSystems

January 12, 2002 16

DICOM SR Creation - Example -Radiology

Report Type:

Findings:

Conclusions:

Image Refs.:

Header::RIS dataRIS data

Image dataImage data

from PACSfrom PACS

Report TemplatesReport TemplatesFrom DICOM From DICOM standard:standard:

Coding SchemesCoding Schemesbehind pop-up menusbehind pop-up menus

ThoraxThorax……....……....……....

MassMass……....……....

Daim.Daim.Infiltr.Infiltr.

……....……....

(Pointer)

select select

Report Creator Report Creator

applicationapplication

(DIC

OM

) S

R O

bjec

t(D

ICO

M)

SR

Obj

ect

January 12, 2002 17

4. Orders and Results Management

• Great opportunities for IHE.

• Important roles for HL7 Clinical Document Architecture and DICOM Structured Reporting

• One should not consider DICOM SR as the only possibility to integrate multi-speciality information. Especially XML-based implementations should be considered.

January 12, 2002 18

5. Security

At Modality

Web Viewer

PACS ViewingStation

Webserver

Security

January 12, 2002 19

5. Security

• NEMA and COCIR address some major issues as a result of HIPAA, e.g. remote service.

• Security remains a challenge with connected systems, and is of course dependent on hospitals ensuring policies and procedures

• Use of Audit trial standards in a multi-vendor environment needs further detailing

January 12, 2002 20

6. Freedom of Application Workspot

At ModalityPACS Viewing

Station

Web Viewer

Webserver

January 12, 2002 21

Standards in Imaging-IT

1. Horizontal Integration DICOM

2. Vertical Integration IHE, DICOM, HL7

3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML

4. Orders and Results IHE, DICOM, HL7

Management

5. SecurityIHE,IETF,DICOM,HL7,ASTM

6. Freedom of Application ISO/CEN, CCOW, IETF,

Workspot DICOM, XML

January 12, 2002 22

The (multi-vendor) Integrated The (multi-vendor) Integrated Imaging Imaging SolutionSolution

ImageImageServeServe

rr

CDCDExchangeExchange

DepartmenDepartmentt

Info ServerInfo Server

Diagnostic Diagnostic WorkstatiWorkstati

onon

Image Image ArchivArchiv

ee

Connection Connection to other to other NetworkNetworkand/or and/or

TeleCardioloTeleCardiologygy

secure transportdigital signature

HangingProtocols

Email attachmentDICOM URL

General PurposeWorklist

Structured Documents (XML)Numeric reportQCA, LVA

January 12, 2002 23

The distribution problem

Electronic Patient Record

Radiology

PACS

Cardiology

PACS

VL, US, NM

PACS

HIS

RIS

OtherClinicalSystem

Web Viewers

Webserver

Report Type:Findings:

Conclusions: Ima

g

e

R

e

f

s

.

:

Header::ThoraxThorax……....……....……....MassMass……....…….... Daim.Daim.Infiltr.Infiltr.

……....……....(Poi

n

t

e

r

)

URL/URI?