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

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

January 12, 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

January 12, 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, 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 ing DICOM persistent objects (images reports, presentation states, key object selection, etc. Sup 59 Key Object Selection

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

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

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

January 12, Integration: not only back-office!messages ClinicalInformationSystemClinicalInformationSystem Back-Office Integrated Clinical Viewing at the desktop at the desktop Front Office Efficiency ImproveClinicalDecisions

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

January 12, ClinicalQuestion Multi-Media Report with references 4. Order and Results Management PACS RIS Other Clinical InformationSystems

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

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

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

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

January 12, The distribution problem Electronic Patient Record Radiology PACS Cardiology PACS VL, US, NM PACS HIS RIS Other Clinical System Web Viewers Webserver Report Type: Findings: Conclusions: Ima g e R e f s. : : Header: Thorax ….. ….. ….. Mass ….. ….. Daim. Infiltr. ….. ….. (Poi n t e r ) URL/URI?