DICOM Strategic Direction for Image Distribution Cor Loef co-chair DICOM Strategic Advisory Committee

Contents Scope of DICOM Standards Committee Trends in Imaging-IT Standards in Imaging-IT Objects, Information, EPR, Web-distribution, Desktop January 12, 2002

Scope of DICOM Standards Committee Mission of DICOM Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information Goals of DICOM Achieve compatibility and improve workflow efficiency between imaging systems and other information systems The DICOM Standards Committee exists to create and maintain international standards for communication of bio-medical diagnostic and therapeutic information in disciplines that use digital images and associated data. The goals of DICOM are to achieve compatibility and to improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide. January 12, 2002

New: published in DICOM 2000 Sup 23: Structured Reporting (Pre-reports, image measurements, analysis results, diagnostics reports with qualified image links) Sup 30: Waveform (sound, ECG, Electr. Physio.) synchronized with images Sup 31: Network Security (node authentication and transport encryption) Sup 33: Softcopy Presentation State 42 Correction Items, Including: JPEG-LS, Thai & Korean, Time zones, Case Insensitive Name Queries January 12, 2002

Supplements approved in 2001 Sup 40 DVD RAM Application Profiles Sup 50 Mammography Comp. Aided Detect. Reports Sup 52 General Purpose Worklist Reporting workflow management, image postprocessing, computer aided detection, filming, quality control, etc. Sup 53 Content Mapping Resource codes and templates for Structured Reporting Sup 54 MIME Content Type for e-mailing DICOM persistent objects (images reports, presentation states, key object selection, etc. Sup 59 Key Object Selection January 12, 2002

New Work Items New generations of image objects: Revised Secondary Capture Images (specific applications) Multiframe MR and CT (large number of dynamic dimensions) Sup 41 Digital Signature secure transformation of images and reports Security on Storage Media (confidentiality) Attribute Level Confidentiality (de-identification) January 12, 2002

Current Direction Present focus is to meet new end-user needs, adopt complementary and proven standards. Key areas are: Security, New imaging technology, and Image Distribution in the enterprise. January 12, 2002

Liaison with TC 215 Good liaison since April 99. Cross-representation may be the effective next step beyond TC 215 DICOM Task Force. Procedure TC 215 has agreed to rely on DICOM for Medical Imaging Standardization DICOM offers expertise in medical imaging, with world-wide users and vendors representation. Need to ensure coherence with other ISO standards group on imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000) DICOM is ready to further develop its relationship with TC 215. January 12, 2002

Trends in Imaging-IT: Cardiology PACS VL, US, NM 1. Horizontal Integration HIS RIS 2. Vertical Integration Other Clinical System 3. Elect. Patient Record Radiology PACS Electronic Patient Record At the desktop January 12, 2002

1. Horizontal Integration Image management system supports archiving/retrieving of all types of images (incl. visible light) and Structured Reports January 12, 2002

2. Vertical Integration HIS IMAGING: RIS • PACS / Archives Workstations Modalities ADT Patient Registration Patient Registration Image Creator Image Display Order Placer New Order Q /R Images RIS The Healthcare Enterprise Department System Scheduler – Order Filler – Image Archive Image Manager Procedure Scheduled Modality Worklist PPS In-Progress / Completed Images Stored Storage Commit Acquisition Modality January 12, 2002

Integration: not only back-office! Efficiency messages Clinical Information System Back-Office Integrated Clinical Viewing at the desktop Front Office Improve Clinical Decisions January 12, 2002

3. Electronic Patient Record Image Management system and Departmental Information System must be EPR-prepared (Queries) EPR: emphasis today on desktop integration, should become the integrated, secure, patient centric, source of health information Web front-end: viewing not only of images but also waveforms, measurements, reports, etc always need the capability to access the original medical images support for DICOM Structured Reporting January 12, 2002

Ultimate goal: All the information the user needs through one common and simple user interface January 12, 2002

4. Order and Results Management PACS RIS Other Clinical Information Systems Multi-Media Report with references Clinical Question January 12, 2002

DICOM SR Creation - Example -Radiology RIS data Report Type: Findings: Conclusions: Image Refs.: Header: (DICOM) SR Object Report Templates From DICOM standard: Thorax ….. Mass ….. Report Creator application Daim. Infiltr. ….. Image data (Pointer) from PACS select Coding Schemes behind pop-up menus January 12, 2002

4. Orders and Results Management Great opportunities for IHE. Important roles for HL7 Clinical Document Architecture and DICOM Structured Reporting One should not consider DICOM SR as the only possibility to integrate multi-speciality information. Especially XML-based implementations should be considered. January 12, 2002

5. Security Web Viewer Webserver Security PACS Viewing Station At Modality January 12, 2002

5. Security NEMA and COCIR address some major issues as a result of HIPAA, e.g. remote service. Security remains a challenge with connected systems, and is of course dependent on hospitals ensuring policies and procedures Use of Audit trial standards in a multi-vendor environment needs further detailing January 12, 2002

6. Freedom of Application Workspot Web Viewer Webserver PACS Viewing Station At Modality January 12, 2002

Standards in Imaging-IT 1. Horizontal Integration DICOM 2. Vertical Integration IHE, DICOM, HL7 3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML 4. Orders and Results IHE, DICOM, HL7 Management 5. Security IHE,IETF,DICOM,HL7,ASTM 6. Freedom of Application ISO/CEN, CCOW, IETF, Workspot DICOM, XML January 12, 2002

The (multi-vendor) Integrated Imaging Solution secure transport digital signature Connection to other Network and/or TeleCardiology Email attachment DICOM URL Image Archive Image Server Department Info Server General Purpose Worklist CD Exchange Diagnostic Workstation Hanging Protocols Structured Documents (XML) Numeric report QCA, LVA January 12, 2002

The distribution problem HIS Other Clinical System RIS Cardiology PACS Radiology PACS VL, US, NM PACS Report Type: Findings: Conclusions: Image Refs.: Header: Thorax ….. Mass Daim. Infiltr. (Pointer) Electronic Patient Record URL/URI? Webserver Web Viewers January 12, 2002