Applications of DICOM SR

1. Applications of DICOM SR Andrei Leontiev Dynamic Imaging Solutions, GE Healthcare Add logo if desired

2. Structured Reporting • DICOM Structured Reporting (SR) is an encoding for non-imaging content: • evidence information generated in a course of medical imaging acquisition, • diagnostic reports, • other types of documentation

3. DICOM SR Document • Each SR object represents a document; the content of a document is a tree of Content Items connected via different types of relationships • As other DICOM objects, SR Document is composite object fitting Patient-Study-Series hierarchical model

4. Content Items and Relationships • The Content Item is a node of the SR Document • Provides a name-value pair, i.e., a Concept Name, and a Concept Value. • The Concept Name is a code identifying the concept the Content Item represents • The Concept Value may be of different Value Type, including text, personal name, numeric, and coded concept values.

5. Data Types • Content Items may represent: • Text (words, sentences or paragraphs) • NUMERIC (measurements) • Dates, times • Person Names • References to images and other objects • Spatial and time coordinates • Codes • Containers (groups of other items)

6. Coded Entries • Coded values for Content Items provide for ability to use vocabularies to convey content • Vocabularies used: • DICOM Content Mapping Resource • SNOMED • Subject-specific coded schemes

7. SR Tree

8. Sample Report • Chest X-Ray • has concept modifier Views=PA and Lateral • Recording Observer=Smith^John^^Dr^ • Study Instance UID …=1.2.3.4.5.6.7.100 • Patient-Data-Acquisition-Subject=Homer^Jane^^^ • Finding=Mass • has properties diameter=1.3 cm • has properties margination=infiltrative (1.4.2) • Baseline Image • Conclusions • conclusion=probable malignancy • inferred from 1.4.2 • inferred from 1.7.1 • Specific Image Findings • best illustration of findings(1.7.1) • . Slide by D. Clunie

9. “Chest X-Ray” CONTAINER Context “Recording Observer”=“Smith^John^^Dr^” PNAME 1.1 Context “Study Instance UID ...”=“1.2.3.4.5.6.7.100” UIDREF 1.2 Context “… Acquisition Subject”=“Homer^Jane^^^” PNAME 1.3 Contains CODE “Finding”=“Mass” 1.4 Properties “diameter”=“1.3” “cm” NUM 1.4.1 1.6.1.1 Properties Infd From CODE “margination”=“infiltrative” 1.4.2 Contains IMAGE “Baseline”= 1.5 Contains “Conclusions” CONTAINER 1.6 Contains “conclusion”=“probable malignancy” CODE 1.6.1 Contains “Specific Image Findings” CONTAINER 1.7 Contains SCOORD “best illustration of findings”= 1.7.1 Infd From Seld From IMAGE 1.7.1.1 1.6.1.2 Modifier CODE “Views”=“PA and Lateral” 1.8 Slide by D. Clunie

10. Relationships • Relationships between nodes convey meanings of: • Containment • Observation Context • Modification/clarification of the Concept Code • Derivation of content of one Item from other item(s)

11. Observation Context • The content of an SR document exists in Observation Context • Initially provided by Patient/Study/Series/Instance level attributes • Inherited by all nodes in tree hierarchy • Can be overridden for each node

12. Templates • To define appropriate structure for specialized applications, DICOM defines templates. • Templates may be applied to: • Generic SOP Classes (Basic Text, Enhanced, Comprehensive) • Specialized SOP Classes (Mammo CAD, Chest CAD • Templates may be extensible and non-extensible

13. Typical Top Level Template Structure Template specified title OB-GYN, Adult Echo, IVUS Ultrasound Vascular, Cath/Hemo … CONTAINER Document Title … CONTAINER … CONTAINER Patient Characteristics CONTAINER Summary CONTAINER Findings Heading CONTAINER Finding Heading CONTAINER Finding Heading TID 1002ObservationContext … … … … SummaryFindings Findings Other Context e.g. procedure Slide by D. Sluis

14. Key Object Selection Documents • Initiated by the desire to have simple Key Image Note • Developed as generic “manifest” – collection of pointers to images (or even specific frames) • Specifies intent of selection, simple textual note • Non-extensible template

15. Key Image Notes • One use of KOSD is to attach « electronic post-it™ » to images to communicate: • specific examination events • image quality issues • consultancy • KOSD can be stored in the archive and later retrieved

16. Evidence Documents • Measurements and coded data • DICOM SR document • Created by either Acquisition Modality or Workstation • Produced during acquisition or post-processing workflows • Interpreted along with the images

17. Evidence Documents Examples • Mammography CAD • Chest CAD • OB-Gyn Ultrasound Measurements • Vascular Ultrasound Measurements • Vascular Intervention Results • Echocardiography Measurements

18. Diagnostic Reports • SR infrastructure supports creation and interchange diagnostic report documents: • Simple structure of section headings and paragraphs • More coded entries on different levels to support data mining and statistical analysis • Measurements, image references, etc.

19. Simple Dx Report • Minimal Structure : Coded Title and Headings • Full image links from specific sections of report • Observation Context (who, what, when) may be section specific

20. Added Measurements Adds Measurements to Simple Image Reports

21. Interpretation Header: Report Type: OB / Gyn Radiology Report Header: ….. BPD BPD Report Type: OB / Gyn Findings: ... ... ….. ….. ….. Findings: Gestational Impressions: Age ... Image Refs.: Image Refs.: Workflow of SR objects Evidence Documents Key Image Notes Dx Report

22. Link into IT world • DICOM SR structure can be transcoded into HL7 CDA XML-based document structure • Allows for creation of DICOM SR documents with subsequent emnterprise distribution as CDA documents • Both structures allow cross-referencing of documents (images, reports, etc.) in other encoding.