Success of DICOM standard

1. Success of DICOM standard Cor Loef Industry Co-Chair DICOM Strategic Advisory Committee

2. Success of DICOM standard • Mission and goal of the DICOM standard • Some recent new developments • View on the future of DICOM • Summary Workshop on Standardization in E-health

3. Mission and goal of DICOM • Mission of DICOM • Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information • Goals of DICOM • Achieve interoperability and improve workflow efficiency between imaging systems and other information systems Workshop on Standardization in E-health

4. Some recent new developments • 16 parts of official DICOM 2003 edition available at: http://medical.nema.org • Security • De-identification, Clinical Trials • Applications of structured reporting (DICOM SR) – Evidence documents: • Chest CAD • Cath Lab Reporting • OB-GYN, Vascular US, Echocardiography Workshop on Standardization in E-health

5. Some recent new developments • New Media • DVD-R, E-mail attachments, large capacity MODs • New Objects • Multi-frame MR • New CT, XA, VL • JPEG 2000 • Configuration Management Workshop on Standardization in E-health

6. Multi-frame MR • New object definition supporting latest advancements in MR technology • Support for very large data sets, split of an acquisition between several multi-frame objects • New concepts – functional groups Workshop on Standardization in E-health

7. Ultrasound Procedure Reporting • A number of supplements covering different areas of US procedure reporting: • OB-GYN • Vascular • Echocardiography • Further advances the concept of Evidence Documents – objects generated by machine, that are not images but are carrying the supplemental coded information for the procedure to aid in diagnosis Workshop on Standardization in E-health

8. DICOM Object Access via Net • In addition to the e-mail distribution of DICOM objects, DICOM recently spearheaded a joint Work Item with ISO TC215 – WADOWeb Access to DICOM Persistent Objects • In currently prototype phase • Will allow for web-access to images in different formats utilizing standardized URL (HTTP-GET) • In conjunction with standardized MIME type allows for access using a Web Browser Workshop on Standardization in E-health

9. Charter of Strategic Advisory Committee • To develop and maintain the long-term strategic plan of the DICOM Standards Committee; • To review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics; • To consider issues and opportunities related to the strategic evolution of DICOM; • To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN. Workshop on Standardization in E-health

10. Quality of care improved by information and IT All relevant information the care giver and patient need, anywhere and anytime, for the best clinical decisions,through one common and simple user interface, adapted for the task. Workshop on Standardization in E-health

11. All relevant info accessible Workshop on Standardization in E-health

12. HIS Other Clinical System RIS Cardiology PACS VL, US, NM PACS Radiology PACS Web distribution At the desktop Trends in Imaging-IT • Horizontal Integration • Vertical Integration • Active workflow • Data explosion • Web based PACS Workshop on Standardization in E-health

13. HIS HIS IMAGING: IMAGING: ADT Patient Registration • • PACS / Archives PACS / Archives Patient Registration • • Workstations Workstations Image Creator • • Modalities Modalities Order Placer Image Display New Order The Healthcare Enterprise Q /R Images Department System Scheduler – Order Filler – Image Archive Procedure Scheduled Image Manager Images Stored Storage Commit PPS In-Progress / Completed Acquisition Modality RIS RIS Modality Worklist Vertical Integration Workshop on Standardization in E-health

14. Active Workflow Workshop on Standardization in E-health

15. Registration Preparation Examination Post Examination ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... Archiving ..010011... ..010011... ..010011... Referral Reviewing Image Distribution Demonstration Transcription Reporting Workflow in Radiology Digital Radiology Workshop on Standardization in E-health

16. User’s default display protocol Workshop on Standardization in E-health

17. Paradigm shift in PACS:Clinical Applications to PACS Workshop on Standardization in E-health

18. Multi-slice CT: 1000+ images Workshop on Standardization in E-health

19. Post-processing everywhere • Viewing and Advanced Image Processing: • clinical SW packages • move towards modalities, PACS and web 3D Spine Cardiac MR Endo3D Workshop on Standardization in E-health

20. Post-processing everywhere • Analysis tools to enhance clinical decisions: • Echo measurements & calculations • Left Ventricular Analysis • Quantitative Coronary Analysis • Vascular X-Ray Analysis • Vascular X-Ray Post-Processing Workshop on Standardization in E-health

21. Horizontal Integration Hospital Information System, Master Person Index Radiology workflow Cardiology workflow Ultrasound workflow Pathology workflow Radiology PACS Cardiology PACS Ultrasound PACS Visible Light PACS One Image Management Infrastructure Workshop on Standardization in E-health

22. Horizontal Integration • Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports Workshop on Standardization in E-health

23. RIS data Thorax ….. ….. ….. Report Creator application Mass (DICOM) SR Object ….. ….. Diam. Infiltr. ….. ….. DICOM SR Creation - Example -Radiology Header: Report Type: Findings: Image data from PACS Conclusions: Image Refs.: (Pointer) select Coding Schemesbehind pop-up menus Report Templates Workshop on Standardization in E-health

24. Web Viewer Webserver PACS Viewing Station At Modality Web based PACS Workshop on Standardization in E-health

25. Web Viewer Webserver Security PACS Viewing Station At Modality Web and Security Workshop on Standardization in E-health

26. “Electronic Health Record” • Image Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve) • EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health information • Need for coded vocabularies to represent medical knowledge and the patient’s health condition Workshop on Standardization in E-health

27. “Electronic Health Record” • Web front-end: • viewing not only of images but also waveforms, measurements, reports, lab results, etc • need the capability to access the original medical images • Support for (DICOM) Structured Reporting • XML and XML Schema for the exchange of clinical documents Workshop on Standardization in E-health

28. EHR: Visual Integation Efficiency Back-Office Clinical Information System Clinical Information System messages Integrated Clinical Viewing at the desktop Improve Clinical Decisions Front Office Workshop on Standardization in E-health

29. Summary • DICOM is well positioned to continue to serve integration needs of medical imaging, including workflow, evidence information recording, effective access to imaging results in the enterprise • Active cooperation with other standards assures DICOM objects integration into future EHR – whether by reference, or through well-defined trans-coding mechanisms. Workshop on Standardization in E-health