THE DICOM 2014 INTERNATIONALCONFERENCE & SEMINARMarch 14-16 Bangalore, India
THE DICOM 2014 Chengdu Workshop
August 25 Chengdu, China
Reporting:Presentation & Interpretation
Nikolaus Wirsz, PhDSIEMENS AG – Healthcare SectorProgram Manager Standards & InteroperabilityErlangen, Germany
Thomas FreierSoftgate GmbHErlangen, Germany
Reporting:Presentation & Interpretation
• Introduction
• Standards Elements for BuildingTools for Reading & Interpretation
• IHE Profiles for Interpretation & Reporting
• Conclusions
Reporting: Presentation & Interpretation 2August 2014 DICOM International Conference & Seminar
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
Access to Images andImage Related Information
• Retrieval of Images upon Availability► Newly Acquired Images► Prior Images for Comparison► Evidence Documents
• Interpretation Worklists for Radiology Staffsorted 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
ImageManagement
(PACS)Interpretation
ReviewingWorkstation
Q/R: C-FIND / C-MOVE
C-FIND/ C-MOVE
New Images
Prior Images / Evidences
ImageAcquisition
Modality
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Description Tag TypePatient’s Name (0010,0010) RPatient ID (0010,0020) U
Study Date (0008,0020) RStudy Time (0008,0030) RAccession Number (0008,0050) RStudy ID (0020,0010) R
Name of Physician(s) Reading Study (0008,1060) O
Modality (0008,0060) R
August 2014 DICOM International Conference & Seminar
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 andappearance of images between displays of different luminance
August 2014 DICOM International Conference & Seminar
Image Display Consistency -Ensuring Quality for Reviewing & Interpretation
Reporting: Presentation & Interpretation 6
• Issue #2: Image Display Set-Ups, Transformations and Annotations get Lostwhen Viewed on Different Displays
Reporting Radiologist
Original Image
Window Level
Flip
Area Of
Interest
ConsistentImage Presentation
Using GSDF
Apply Grayscale Softcopy Presentation State (GSPS)
Zoom
Area Of
Interest
Annotate
InconsistentImage Presentation
Reporting Radiologist /Referring Physician
August 2014 DICOM International Conference & Seminar
InconsistentImage Presentation
Using GSDF
Apply Grayscale Softcopy Presentation State (GSPS)
Grayscale Softcopy Presentation State (GSPS)
► GSPS objects contain only presentationparameters 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 DisplayCharacteristics or Transformations
► Communication of Display Parameters usingregular 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 Lostwhen Viewed on Different Displays
Reporting Radiologist
Original Image
Window Level
Flip
Zoom
Area Of
Interest
ConsistentImage Presentation
Reporting Radiologist /Referring Physician
Area Of
Interest
Annotate
August 2014 DICOM International Conference & Seminar
InconsistentImage 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 Lostwhen Viewed on Different Displays
Reporting Radiologist
Original Image
Window Level
Flip
Zoom
Area Of
Interest
Annotate
Area Of
Interest
ConsistentImage Presentation
Reporting Radiologist /Referring Physician
August 2014 DICOM International Conference & Seminar
Simple Image and Numeric Report Pattern (from IHE Technical Framework)
Standard DICOM HeaderPatientStudySeriesDocument
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 wellStructured & Contain Coded Entries► Relationships► Meanings / Semantics► References to Images or
other Relevant Information
August 2014 DICOM International Conference & Seminar
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 forSpecific 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 ImagesKey Image Note (KIN) Pattern (from IHE Technical Framework)
August 2014 DICOM International Conference & Seminar
Report Generation
Reporting: Presentation & Interpretation 11
Assembling DICOM Evidences for Clinical Use
ImageManagement
(PACS)Interpretation
ReviewingWorkstation
C-FIND/ C-MOVE
C-STORE
Images - Presentation StatesKey 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
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
TranscriptionDiagnostic
Imaging Report(DIR)
Evidence Document
KOS
Interpretation
Clinical Report
HL7 CDA
DICOM SR HL7 CDA
Inclusion of resultsInclusion 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
Integrating the Healthcare Enterprise
• IHE:Standards Profiling Organization for Advancing Integration in Clinical Practice
• Interoperability Frameworks for Implementing and DeployingStandards-Based (HL7 & DICOM) Integrated Solutions
• IHE Integration Profiles - Address Specific Integration IssuesFor 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
13August 2014 DICOM International Conference & Seminar Reporting: Presentation & Interpretation
Content & PresentationPertinent to Presentation & Interpretation• ARI Access to Radiology Information
► Access & share images, evidences & related datawithin 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
Workflow ProfilesPertinent 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 reportsfacilitate automated reporting
► Using DICOM SR, store, Q/R and FTP► Reporting required in parts of U.S. and
Europe
Reporting: Presentation & Interpretation 15August 2014 DICOM International Conference & Seminar
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National Registry
ArchiveDose Information
Consumer / Reporter
Outlier: #Performing Phys.Over Target: 12.2%
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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
Workflow ProfilesPertinent to Presentation & Interpretation
• PAWF Post-Acquisition Workflow (in Trial Implementation)
► Managing, organizing and schedulingpost-processing tasks in preparation ofimage interpretation & reporting
► Monitoring progress and completion oftasks performed during interpretation
► Worklist Management & Status Report
+ Launching of appropriate applications
• Reporting Workflow► in preparation …
Reporting: Presentation & Interpretation 16August 2014 DICOM International Conference & Seminar
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
ImageManagement
(PACS)Interpretation
ReviewingWorkstation
C-FIND/ C-MOVE
C-STORE
Images - Presentation StatesKey Objects – Evidences - SR
Images PS
KIN
Annotations
Measurements
Radiology Results
August 2014 DICOM International Conference & Seminar
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
Author Contact
Reporting: Presentation & Interpretation 19
Nikolaus Wirsz, PhDSIEMENS AG - Healthcare SectorImaging & Therapy DivisionHartmannstr. 1691052 Erlangen, [email protected]
Thank you for your attention !
August 2014 DICOM International Conference & Seminar
Presenter Contact
Reporting: Presentation & Interpretation 20
Thomas Freiersoftgate GmbHNägelsbachstr. 2691052 Erlangen, [email protected]
Thank you for your attention !
August 2014 DICOM International Conference & Seminar