DICOM Working Group 10 Munich, Germany, 2 September 2004

Integrating Imaging and Integrating Imaging and Reporting using DICOM SR Reporting using DICOM SR

and HL7 CDAand HL7 CDAFred M. Behlen, Ph.D.

Co-Chair, DICOM WG20 / HL7 IISIGCo-Editor, HL7 CDA Release 2

ACR Representative to HL7

LAItek

Loosely Integrated Reporting

• Image viewing and reporting done in different appli-cations, on same or different (adjacent) platforms

• Reports may reference images (individual or groups)– Linkage is no finer-grained than the report level

• References may include overlays of graphical or text annotation

******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96

FINDINGS: As above. IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumorgrowth.

Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3

******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96

FINDINGS: As above. IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumorgrowth.

Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

This updates and extends a written report to WG10 in April 2004. Further detail is in the WG20/IISIG minutes, 2004.

Imageselection

Annotation

Loosely Integrated Reporting

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

Image Archive Reporting System

Dictatedreport

KO“For Report”

GSPSReport(SR or CDA)

Pointers to KO “For Report” objects

Imageselection

Annotation********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

********************************************************************************

UNIVERSITY OF CHICAGO HOSPITALS

RADIOLOGY CONSULTATION

342 02/05/96

BHIS #: 1234567 INPATIENT 201-23-90

Hematology / Oncology CHANDLER, CAROLYN

Mitchell-6NE 49 FEMALE

Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA

Clinical data: Biliary tube check.

Carl M. Gompers, MD

Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96

COMPARISON: 07/23/95 and 06/27/95

FINDINGS: After the procedure was explained to the patient and informed

& Int -- Exam #47 on 02/05/96

FINDINGS: As above.

IMPRESSION:

Successful biliary tube change, and findings consistent with interval tumor

growth.

Simon A. Templar, MD / Richard Nixon, MD (R19)

Signed 02/9/96 at 8:48 AM

3

Image Viewing Application

Reporting Application

Image Archive

Reporting SystemValidation Functions

Dictatedreport

KO“For Report”

GSPS

Transcribednarrative

DICOM Query/Retrieve for all KO objects matching Accession Number

WADOServer

Reporting Integration Functions

CDAReport

SRReport

DICOM references to Images & GSPSs

WADO URI references to Images & GSPSs

Verification

Transformation

Verification ProcessThe verifying radiologist will either:

• Send the report back to Transcription for correction, or

• Complete and verify the report.– Make corrections as necessary

– Sign it

Verification ProcessThe verifying radiologist will either:

• Send the report back to Transcription for correction, or

• Complete and verify the report.– Make corrections as necessary

– Confirm image references (using check boxes)

– Sign it

Deliverables• CP451: Add “For Report” code to KO

• Supplement 1xx: HL7 Structured Document Object References– Report template to Part 16– CDA Reference from within DICOM

Documents– Informative Annex describing translation to

CDA for this SR object• Release 1• Release 2

Schedule• CP451: Done.

• Supplement 1xx: – WG6 first read Sept. 2004– WG20 review, prepare PC Draft Sept. 2004– WG6 review Nov. 2004– Public Comment Nov.-Dec. 2004– WG20 Review Jan. 2005– WG6 review for LB Mar. 2005– Letter Ballot Apr-May 2005– Wg20 Review May 2005– WG6 Final Text June 2005

Could be a candidate for IHE at RSNA 2005, but with no room for schedule slippage.