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Application of DICOM Structured Report

Application of DICOM Structured Report. Andrei Leontiev Dynamic Imaging. DICOM Structured Report. Encoding for structured observations Universal mechanism Generic Applications Basic Text, Enhanced, Comprehensive Specialty Applications Key Object Selection CAD, US measurements, …

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Application of DICOM Structured Report

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  1. Application of DICOM Structured Report Andrei Leontiev Dynamic Imaging

  2. DICOM Structured Report • Encoding for structured observations • Universal mechanism • Generic Applications • Basic Text, Enhanced, Comprehensive • Specialty Applications • Key Object Selection • CAD, US measurements, … • Patient Relevant Information Query DICOM Seminar – Singapore 2005

  3. Encoding of Structured Reports

  4. SR Intent • Support measurements by imaging devices • Enable collaborative reporting by any number of persons or devices • Enable links to key images • Enable links to regions of interest within images and waveforms • Template-driven content and structure DICOM Seminar – Singapore 2005

  5. Simple Example of SR • Shows example of simple diagnostic report • Multi-level structure • Text, codes, pointers to images DICOM Seminar – Singapore 2005

  6. DICOM Seminar – Singapore 2005

  7. Report of Chest X-Ray (PA and LateralViews) • Patient Jane Homer • Study # 123456 • Recorded by Dr. John Smith • The finding is a mass measuring 1.3cm in diameter with an infiltrativemargination. • The baseline image is shown at • Conclusions • The conclusion is a probable malignancy, inferred from the infiltrativemargination of the mass and the appearance shown by the best illustration of findings. • Specific Image Findings • The best illustration of findings is (Click to view) (Click to view) Slide by D. Clunie DICOM Seminar – Singapore 2005

  8. 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 DICOM Seminar – Singapore 2005

  9. “contains” relationship not shown • Chest X-Ray • has concept modifierViews=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 DICOM Seminar – Singapore 2005

  10. Concept Name /Value pairs used • Chest X-Ray • has concept modifierViews=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 DICOM Seminar – Singapore 2005

  11. Concept Name without a value used as a heading (container) • Chest X-Ray • has concept modifierViews=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 DICOM Seminar – Singapore 2005

  12. Concept Name without a value used as Purpose of Reference for IMAGE, SCOORD • Chest X-Ray • has concept modifierViews=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 DICOM Seminar – Singapore 2005

  13. “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 DICOM Seminar – Singapore 2005

  14. “Chest X-Ray” CONTAINER Contains CODE “Finding”=“Mass” 1.4 1.4.1 1.6.1.1 Properties Infd From CODE “margination”=“infiltrative” 1.4.2 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 1.6.1.2 Slide by D. Clunie DICOM Seminar – Singapore 2005

  15. The numbering of items is implicit ! “Chest X-Ray” 1 “Recording Observer”=“Smith^John^^Dr^” 1.1 “Study Instance UID ...”=“1.2.3.4.5.6.7.100” 1.2 “… Acquisition Subject”=“Homer^Jane^^^” 1.3 “Finding”=“Mass” 1.4 “diameter”=“1.3” “cm” 1.4.1 “margination”=“infiltrative” 1.4.2 “Baseline”= 1.5 “Conclusions” 1.6 “conclusion”=“probable malignancy” 1.6.1 “Specific Image Findings” 1.7 “best illustration of findings”= 1.7.1 1.7.1.1 “Views”=“PA and Lateral” 1.8 Slide by D. Clunie DICOM Seminar – Singapore 2005

  16. Inheritance of Context • Observation Context • includes top-level attributes of Composite IOD • may be attached to root node CONTAINER • is inherited along by-value relationships • is not inherited along by-reference relationships • may be extended (but not replaced) in children • may be attached to any content item, not just CONTAINER Slide by D. Clunie DICOM Seminar – Singapore 2005

  17. “Chest X-Ray” Context “Recording Observer”=“Smith^John^^Dr^” Context “Study Instance UID ...”=“1.2.3.4.5.6.7.100” Context “… Acquisition Subject”=“Homer^Jane^^^” Contains “Finding”=“Mass” General Patient Module: “Patient Name”=“Homer^Jane^^^” “Patient ID”=“234567” “Patient Sex”=“F” “Patient DOB”=“19991109” SR Comprehensive SOP Instance General Study Module: “Accession Number”=“123456” “Study ID”=“345678” DICOM Seminar – Singapore 2005 Slide by D. Clunie

  18. “Chest X-Ray” Context “Recording Observer”=“Smith^John^^Dr^” Context “Study Instance UID ...”=“1.2.3.4.5.6.7.100” Context “… Acquisition Subject”=“Homer^Jane^^^” Contains “Finding”=“Mass” Properties “diameter”=“1.3” “cm” Properties Infd From “margination”=“infiltrative” Contains “Baseline”= Contains “Conclusions” Contains “conclusion”=“probable malignancy” Contains “Specific Image Findings” Contains “best illustration of findings”= Infd From Seld From Modifier “Views”=“PA and Lateral” Slide by D. Clunie DICOM Seminar – Singapore 2005

  19. “Obstetric Ultrasound” Obsn Context “Mother of Fetus”=“Homer^Jane^^^” Contains “Findings for Fetus” Obsn Context “Fetus Identifier”=“Fetus A” Properties “Gestational Age”=“16” “weeks” Infd From “BPD”=“27” “mm” Contains “Findings for Fetus” Obsn Context “Fetus Identifier”=“Fetus B” Properties “Gestational Age”=“16” “weeks” Slide by D. Clunie Infd From “BPD”=“28” “mm” DICOM Seminar – Singapore 2005

  20. “Obstetric Ultrasound” Obsn Context “Mother of Fetus”=“Homer^Jane^^^” Contains “Findings for Fetus” Obsn Context “Fetus Identifier”=“Fetus A” Properties “Gestational Age”=“16” “weeks” Infd From “BPD”=“27” “mm” “Inferred from” relationships may be by-value as well as by-reference, and are often more appropriate then “has properties” or “contains.” Slide by D. Clunie DICOM Seminar – Singapore 2005

  21. Post-Coordination:HAS CONCEPT MOD • Elaborates on meaning of Concept Name in • CONTAINER (headings) • CODE, TEXT, NUM … • May: • qualify meaning further • describe meaning • provide translations Slide by D. Clunie DICOM Seminar – Singapore 2005

  22. “Chest X-Ray” CONTAINER Modifier CODE “Views”=“PA and Lateral” Modifier TEXT “Full Description”=“This is a reporton a two-view (PA and lateral) ChestX-Ray examination.” Modifier “Equivalent Meaning in Italian”=“Radiografia del ...” TEXT Slide by D. Clunie DICOM Seminar – Singapore 2005

  23. Post-coordinated ... CODE “Finding”=“Mass” Properties “diameter”=“1.3” “cm” NUM Modifier CODE “method”=“Smith” Modifier “threshold”=“75” “HU” NUM Pre-coordinated ... CODE “Finding”=“Mass” Properties “diameter by Smith method @ 75HU threshold” = “1.3” “cm” NUM Slide by D. Clunie DICOM Seminar – Singapore 2005

  24. SR Applications

  25. Three Base SR Classes • Three base SR classes are defined to allow encode any type of structured information: • Basic Text SR • Enhanced SR • Comprehensive SR • Distinguished by Value Types and Relationships supported DICOM Seminar – Singapore 2005

  26. SR 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 DICOM Seminar – Singapore 2005

  27. Header: Report Type: OB / Gyn ….. BPD Findings: ... ….. Query / Retrieve Image Refs.: Storage Storage Commitment Evidence Documents DICOM Seminar – Singapore 2005

  28. 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 DICOM Seminar – Singapore 2005

  29. Evidence Documents Examples • Mammography CAD • Chest CAD • OB-Gyn Ultrasound Measurements • Vascular Ultrasound Measurements • Vascular Intervention Results • Echocardiography Measurements DICOM Seminar – Singapore 2005

  30. Typical Ultrasound SR • Based on one of generic SR SOP Classes • Intended to precisely convey measurements and findings, relationships between them • Each specialized “report” uses its own template DICOM Seminar – Singapore 2005

  31. Legend for templates Value Types CONTAINER, NUM, CODE, IMAGE … Value Type Concept Name = Value relationship relationship Value Type Concept Name = Value Value Type Concept Name = Value • Concept Names and Values of type CODE are triplets • Code Value • Coding Scheme Designator • Code Meaning (actually, just some text to evoke meaning to user) Slide by D. Sluis DICOM Seminar – Singapore 2005

  32. 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 DICOM Seminar – Singapore 2005

  33. has concept modifier “Laterality” = “Left” “Finding Site” = “Cerebral Vessels” CODE Concept Modifier Document Headings CONTAINER Document Title The heading may have semanticsshared by children findings contains CONTAINER Heading Specific: “Exercise Challenge” Generic: “Findings” … Findings Slide by D. Sluis DICOM Seminar – Singapore 2005

  34. Discrete Numeric Findings Distributed semantics CONTAINER Group has concept modifier CODE Modifier Concept contains Diameter, Area, Volume, Blood Velocity, Indices, Ratios, Time Interval … NUM Measurement or pre-coordinated concept: BPD, FL … has concept modifier Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase … CODE Modifier Concept Slide by D. Sluis DICOM Seminar – Singapore 2005

  35. Vascular Content Hierarchy CONTAINER Vascular Report Document Title contains has concept modifier CONTAINER Findings Section Heading CODE Laterality contains has concept modifier CONTAINER Anatomy Group CODE Topographical Modifier Minimum Concepts contains NUM Measurement Discrete Finding property Slide by D. Sluis DICOM Seminar – Singapore 2005

  36. Vascular Templates has concept modifier Content Item Value Set CONTAINER Findings CODE Laterality Right, Left, or Unilateral TID 5103 Slide by D. Sluis DICOM Seminar – Singapore 2005

  37. Vascular Templates has concept modifier Content Item Value Set CONTAINER Findings CODE Laterality TID 5104 contains CONTAINER Anatomy Slide by D. Sluis DICOM Seminar – Singapore 2005

  38. Vascular Templates has concept modifier Content Item Value Set CONTAINER Findings CODE Laterality TID 5104 contains has concept modifier CONTAINER Anatomy CODELongitudinal Modifier Optional specificity Slide by D. Sluis DICOM Seminar – Singapore 2005

  39. Vascular Templates has concept modifier Content Item Value Set CONTAINER Findings CODE Laterality TID 5104 contains has concept modifier CONTAINER Anatomy CODE Topographical Modifier contains NUM Measurement DICOM Seminar – Singapore 2005 Slide by D. Sluis

  40. Findings Origin and Context TID 300 Measurements NUM Measurement SCOORD Coordinates Inferred from IMAGE Image Inferred from NUM Numeric dependency Inferred from CODE Equation or Table Inferred from Image Mode Image View CODE has acquisition context Normality, Significance Normal Range, … CODE, TEXT has properties Slide by D. Sluis DICOM Seminar – Singapore 2005

  41. Dx Reports • Based on DICOM SR • Allows to include without transcription:- measurements- image links- structured content • Integrated with the imaging workflow • Friendly to XML implementations • Easy to export to the EPR (HL7) DICOM Seminar – Singapore 2005

  42. Simple Structure • Minimal Structure : Coded Title and Headings • Full image links from specific sections of report • Observation Context (who, what, when) may be section specific DICOM Seminar – Singapore 2005

  43. Added Measurements Simply adds Measurements to Simple Image Reports DICOM Seminar – Singapore 2005

  44. 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 DICOM Seminar – Singapore 2005

  45. for referring physician Here you can see the renal osteopathy. For teaching Fibroosteoclasia DICOM Seminar – Singapore 2005

  46. Note3 Note1 Note2 for referring physician Here you can see the renal rupture. for referring physician This is the hematoma. for referring physician Hematoma everywhere Note1 Note2 for refering physician This is the hematoma. for refering physician Here you can see the renal rupture. Note3 Note3 Note3 Note3 for refering physician Hematoma everywhere for refering physician Hematoma everywhere for refering physician Hematoma everywhere for refering physician Hematoma everywhere Different notes on different images Same note on different images DICOM Seminar – Singapore 2005

  47. Codes Of Interest Rejected for Quality Reasons For Referring Provider For Surgery For Teaching For Conference For Therapy For Patient For Peer Review For Research Quality Issue Reporting Title of KOSD is a Code The note title defines the semantics of the reason of significance. Key Image Notes can be queried by code. The user comments are meant to be informal. DICOM Seminar – Singapore 2005

  48. 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 DICOM Seminar – Singapore 2005

  49. 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 DICOM Seminar – Singapore 2005

  50. Patient Information Query • A simple query that allows retrieve ANY patient information, provided SCP can format it using specified template • Useful for retrieval of relevant information about patient, e.g., from HIS • Intended for use on Modalities and other equipment that is already DICOM enabled DICOM Seminar – Singapore 2005

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