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

Structured Reporting and the IHE Year 2 Technical Framework

Simon Wail, PhD

Marconi Medical Systems


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


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


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)


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


Structured Reporting Transaction Chart

External ReportRepository Access

ReportCreator

ReportManager

ReportReader

ReportRepository

Query Report26

ReportIssuing

25 ReportSubmission

24Retrieve Report27


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)


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)


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


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


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


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


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+


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


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


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


Report Pattern - Simple Image Report

0-n

CONTAINS

HAS OBS CONTEXT

1-n

CONTAINS

1-n

0-n

INFERRED FROM

Report Text(TEXT)


Observation Context

1-n

Section Heading(CONTAINER)



Required for Report Manager, Report Reader and External Report Repository Access

Optional for Report Creator


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


Section Heading(CONTAINER)

Observation Context

Measurement(NUM)


Report Text(TEXT)


Measurement(NUM)

Required if actor supports Enhanced SR object


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


Required for: Report

Creator Report

Manager External

Report Repository Access

Report Reader


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)


Questions?

IHE Technical Framework V4.0 available from:

http://www.rsna.org/IHE

DICOM Structured Reporting Workshop - March 2000 Structured Reporting and the IHE Year 2 Technical Framework Simon Wail, PhD Marconi Medical Systems.

Documents

scp report

report actor

report repository slide

report manipulation

report creation

report reader slide

scu report repository

report query keys