DICOM Structured Reporting Workshop - March 2000
Structured Reporting and the IHE Year 2 Technical Framework
Simon Wail, PhD
Marconi Medical Systems
DICOM Structured Reporting Workshop - March 2000
What is IHE?
IHE is “Integrating the Healthcare Environment” by: Continuity & Integrity of Patient Information Clinical Workflow Optimization Foster Communication Among Diverse Healthcare
Information Systems Avoid Repeating Tasks Eliminate Data Redundancy Eliminate Rigid & Costly Proprietary Solutions Show Evolving Capabilities of Standards Promote Emerging Standards
DICOM Structured Reporting Workshop - March 2000
What is IHE? (cont.)
Sponsored by RSNA (Radiological Society of North America) and HIMSS (Healthcare Information and Management Systems Society)
5 year program of Incremental Capability & Demonstration Growth
Demonstrations at each RSNA and HIMSS Annual Meetings
IHE Technical Framework: Flexible solutions Defines information model Defines vendor and product neutral architecture based on
actor definitions and transactions Promotes the use of industry standards: DICOM and HL7 Is NOT a standard
DICOM Structured Reporting Workshop - March 2000
IHE Year 1
DepartmentSystem Scheduler
/ Order Filler
ADT PatientRegistration
OrderPlacer
AcquisitionModality
ImageArchive
DepartmentSystem DataBase
ImageStorage
12aStorageCommitment
12b
Modality WorklistProvided
8b
OrderCancelled
3
New Order3
ImageManager
Required for IHE Year 1
Either 12b or 9/11 requiredon modalities for IHE Year 1
RSNA 99/ HIMSS 2000Demonstration:
5
New Requested Proc.Scheduled
Cancelled
Patientregistration
1
Internal orExternal Image
Users
Query/Retr.Storage13
b
ProcedureStep Started/Completed
9 11ProcedureStep Started/Completed
9 11
PerformedProcedure Step
Manager
Integration of IS and Image equipment
Demonstrated at RSNA ‘99 and HIMSS ‘00 (23 vendors)
DICOM Structured Reporting Workshop - March 2000
External ReportRepository Access
Required for IHE Year 2
IHE Technical Framework Year 2 :
DepartmentSystem Scheduler
/ Order Filler
ADT PatientRegistration
OrderPlacer
DepartmentSystem Database
Image Creator
OrderUpdate/Cancel
3
New Order2
ImageManager
4
ProcedureScheduled
ProcedureUpdate 13
Patientregistration
1
ImageAvailability Query
11
PerformedProcedure Step
ManagerCommitment
Mod. Storage10
ReportCreator
ReportManager
ReportReader
ReportRepository
Query Report26
ReportIssuing
25
PrintServer
Print Request withPresentation LUT
23
PrintComposer
Modality
PresentationState Stored
9
AcquisitionModality
Optional for IHE Year 2(See Section 3 and Section 6)
ReportSubmission
24
PatientUpdate 12
Mod. ProcedureStep In-Progress
/Completed6 7Modality Worklist
Provided5
Modality Images Stored
8
Retrieve Images
16
Creat. Storage
Commitment
22
Creator Images Stored
18
CreatorPresentationState Stored
19
Creator Procedure
Step In-Progress/Completed
20 21
Retrieve Report27
Image Display
Query Present. State
15
Retrieve Present. State
17
Query Images
14
ImageArchive
PatientUpdate 12
Modality/Creator.
Procedure StepIn-Progress
/Completed.
6
20
7
21
Modality/Creator.
Procedure StepIn-Progress
/Completed.
6
20
7
21
IHE Year 2
Report Creation and Access
Images Available
Information Query
Softcopy/Hardcopy Consistency
Unidentified Patient Management
DICOM Structured Reporting Workshop - March 2000
Structured Reporting Transaction Chart
External ReportRepository Access
ReportCreator
ReportManager
ReportReader
ReportRepository
Query Report26
ReportIssuing
25 ReportSubmission
24Retrieve Report27
DICOM Structured Reporting Workshop - March 2000
Structured Reporting Actors and Transactions
Report Creator Report Submission (C-STORE SCU)
Report Repositoryand External Report Repository Access
Report Manager
Report Reader
Report Submission (C-STORE SCP) Report Issuing (C-STORE SCU)
Report Issuing (C-STORE SCP) Query Report (C-FIND SCP) Retrieve Report (C-MOVE SCP and
C-STORE SCU)
Query Report (C-FIND SCU) Retrieve Report (C-MOVE SCU and
C-STORE SCP)
DICOM Structured Reporting Workshop - March 2000
Report Actor Grouping
Any actors may be grouped together depending on implementation specification
Must still support all external transactions and individual actor requirements according to the IHE Technical Framework
For example - group Report Creator and Report Manager Must support Report Submission as SCU AND SCP Must support Report Issuing as SCU Must support creating new reports (Report Creator) and
managing/modifying existing reports (Report Manager)
DICOM Structured Reporting Workshop - March 2000
Report Creator
Provides user interface to create new reports including setting status flags - “Completion Flag” and “Verification Flag”
Configurable coded entries Must support evidence sequences to specify referenced objects Must support “Identical Documents Sequence” if necessary Creates Basic Text SR object OR Creates Enhanced SR object Stores report in Report Manager using:
Basic Text SR Storage SOP class; OR Enhanced SR Storage SOP class; OR both
DICOM Structured Reporting Workshop - March 2000
Report Manager
Receives reports from Report Creator Supports Basic Text SR objects Supports Enhanced SR objects (optional) May forward reports to Report Repository at any time Must allow users to set status flags - “Completion Flag” and
“Verification Flag” Other modifications and report manipulation is possible
Amending reports Merging reports Additional content etc.
All changes require new SOP Instance UID Must send final reports to Report Repository
DICOM Structured Reporting Workshop - March 2000
Identical Documents Sequence
OriginalDocument 1
IdenticalDocumentsSequence
IdenticalDocumentsSequence
PredecessorDocumentsSequence
OriginalDocument 2
OriginalDocument 3
ModifiedDocument 1
ModifiedDocument 2
ModifiedDocument 3
Ask user if modify all documents
If all, then must set “Predecessor Documents Sequence” and “Identical Documents Sequence” appropriately
DICOM Structured Reporting Workshop - March 2000
Report Repository
Receives reports from Report Manager Supports Basic Text SR objects Supports Enhanced SR objects Responds to Query and Retrieve requests from Report Reader Sends reports to Report Reader
DICOM Structured Reporting Workshop - March 2000
Report Query KeysQuery Keys Matching Query Keys ReturnAttribute Name Tag
SCU SCP SCU SCP
Completion Flag (0040,A491) R+ R+ R+ R+
Verification Flag (0040,A493) R+ R+ R+ R+
Content Date (0008,0023) O O O R+
Content Time (0008,0033) O O O R+
Observation DateTime (0040,A032) O O O R+
Verifying Observer Sequence (0040,A073) R+ R+ R+ R+
>Verifying Organization (0040,A027) O O R+ R+
>Verification DateTime (0040,A030) R+ R+ R+ R+
>Verifying Observer Name (0040,A075) R+ R+ R+ R+
>Verifying ObserverIdentification Code Sequence
(0040,A088) O O R+ R+
Referenced Request Sequence (0040,A370) O O R+ R+
>Study Instance UID (0020,000D) O O R+* R+
>Accession Number (0008,0050) O O R+ R+
>Requested Procedure ID (0040,1000) O O R+ R+
>Requested Procedure CodeSequence
(0032,1064) O O O R+
>>Code Value (0008,0100) O O O R+
>>Coding Scheme Designator (0008,0102) O O O R+
>>Coding Scheme Version (0008,0103) O O O R+
>>Code Meaning (0008,0104) O O O R+
Concept Name Code Sequence (0040,A043) R+ R+ R+ R+
>Code Value (0008,0100) R+ R+ R+ R+
>Coding Scheme Designator (0008,0102) R+ R+ R+ R+
>Coding Scheme Version (0008,0103) O O O R+
>Code Meaning (0008,0104) O O R+ R+
DICOM Structured Reporting Workshop - March 2000
External Report Repository Access
Allows access to reports from outside radiology department, for example, Laboratory
Converts external report to DICOM SR objects Supports Basic Text SR objects Supports Enhanced SR objects (optional) Must provide consist Patient ID with radiology May create Study, Series, and Instance UIDs and must conform to
DICOM UID rules Must provide consist UIDs - if same report is queried and retrieved
several times, then the same UIDs shall be used Must support same Instance level query keys as Report Repository
but reduced set of keys for Patient, Study, and Series levels
DICOM Structured Reporting Workshop - March 2000
Report Reader
Provides user interface to view reports Allows user to select report from either Report Repository or
External Report Repository Access via DICOM Query/Retrieve mechanisms
Must support SCU query keys in previous table - allows user to filter for particular reports
Supports Basic Text SR objects Supports Enhanced SR objects (optional) Must show any object references May retrieve and display image objects if grouped with Image
Display
DICOM Structured Reporting Workshop - March 2000
Report Pattern - Key Image Note
Document Title(CONTAINER)
1 1-n
CONTAINS
HAS OBS CONTEXT
1-n
Image Reference(IMAGE)
Observation Context
Key Image Description(TEXT)
Required for Report Creator, Report Manager and Report Reader Optional for External Report Repository Access
DICOM Structured Reporting Workshop - March 2000
Report Pattern - Simple Image Report
0-n
CONTAINS
HAS OBS CONTEXT
1-n
CONTAINS
1-n
0-n
INFERRED FROM
Report Text(TEXT)
Image Reference(IMAGE)
Observation Context
1-n
Section Heading(CONTAINER)
Document Title(CONTAINER)
Image Reference(IMAGE)
Required for Report Manager, Report Reader and External Report Repository Access
Optional for Report Creator
DICOM Structured Reporting Workshop - March 2000
Report Pattern - Simple Image and Numeric Report
0-n
CONTAINS
HAS OBS CONTEXT
1-n
CONTAINS
1-n
0-n
INFERRED FROM
0-n
0-n
1-n
Document Title(CONTAINER)
Section Heading(CONTAINER)
Observation Context
Measurement(NUM)
Image Reference(IMAGE)
Report Text(TEXT)
Image Reference(IMAGE)
Measurement(NUM)
Required if actor supports Enhanced SR object
DICOM Structured Reporting Workshop - March 2000
Report Pattern - Observation Context
1 1
0-n
0-1
0-1 0-1
1
0-1*
0-1*
* - “Patient-Data-Acquisition Subject” and “Mother offetus” are mutually exclusive based on the value of“Observation Subject Class” and one and only one itemshall appear
Observation ContextMode
(CODE = “DIRECT”)
RecordingObserver’s Name
(PNAME)
Recording Observer’sOrganization Name
(TEXT)
Study Instance UIDof Evidence Directly
Examined by RO(UIDREF)
HL7 Placer Numberof Evidence-Source
Procedure(TEXT)
HL7 Filler Numberof Evidence-Source
Procedure(TEXT)
Observation SubjectClass
(CODE = “Patient” or“Fetus”)
Patient-Data-Acquisition Subject
(PNAME)
Mother of fetus(PNAME)
HAS OBS CONTEXT
Document Title(CONTAINER)
Required for: Report
Creator Report
Manager External
Report Repository Access
Report Reader
DICOM Structured Reporting Workshop - March 2000
Participation Timeline
April 26-27 Vendor Workshop (Chicago) June 1 Applications due July 10-11 Vendor participant’s Workshop (Chicago) September 20 Test and simulation logs due October 2-6 Connect-a-thon (Chicago) October 9 Final commitment and payment due Nov 26-Dec 1 RSNA 2000 (Chicago) February 10-15 HIMSS 2001 (New Orleans)
DICOM Structured Reporting Workshop - March 2000
Questions?
IHE Technical Framework V4.0 available from:
http://www.rsna.org/IHE