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DICOM SR Requirements Applications Benefits
W. Dean Bidgood, Jr., M.D., M.S. SR Data Solutions, Inc. (919)
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No report is unstructured.
But not all reports are effective ….. “A picture is worth a thousand words” Knowledge is valuable Don’t waste it. It’s time for DICOM SR
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With SR, Useful Structure is Available
User decides how much “structure” to use and precisely controls (with templates) not only the type of content … But also the degree of OPTIONALITY And the MODE OF EXPRESSION … where required
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SR Distinctives DICOM base Simple entry point
Supports high-end applications Practical approach to codes and terminology Availability (trading partners) The model is the message
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Simple Entry Point Title and text Links to images
…. But also supports advanced applications
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DICOM Environment Unique object identifiers Persistent objects
Workflow context Binary data types Print management Consistent soft-copy display
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SR Highlights Integrate fully into the DICOM environment
Achieved in DICOM SR Support measurements by imaging devices Achieved in DICOM SR Enable collaborative reporting by any number of persons or devices Achieved in DICOM SR
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SR Highlights Enable links to key images of any case
Achieved in DICOM SR Enable links to regions of interest within images and waveforms Achieved in DICOM SR Template-driven content and structure Achieved in DICOM SR
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SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS
Customization Permitted For Presentation User interface Database implementation SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS
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Structured Documentation
Forty years of progress …. … , Lindberg, Hall, Pendergrass, Barnett, Greenes, Wheeler, Simborg, Gitlin, Clayton, McDonald, Weed, Shortliffe, Hammond, Stead, Cote, Sowa, Bernauer, McCray, Johnson, Rector, Kuhn, Cimino, Huff, Campbell, Bell, Kahn, Poon, Friedman, ….. 1960’s Lab, Radiology (1969), Early SQL … 1970’s Hopkins (76), ACR-NEMA, Early SNOMED 1980’s OBUS (82), SGML (86), HL7, UMLS, … 1990’s UltraSTAR, DICOM (93), WWW, CMT, DRML NEMA SR Workshop: rollout of DICOM SR
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SR Applications
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Ultrasound Measurements
Immediate Need Generate with image LOINC codes Spatial Coordinates
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CAD Device Emerging application Generate from image BIRADS codes
Spatial coordinates
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Device Output Predictable content and meaning
Measurements, codes, text Coordinates Inferences
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Numeric Measurement Unambiguous description
LOINC code -- measurement name SNOMED code -- units Concept Name ( LOINC ) Units ( SNOMED ) Numeric Value NUM Content Item
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Inference Tree Inferred From
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Structured Reporting for the Cath Lab
HIS/CIS Patient Demographics XA IVUS Hemo Monitoring Images Reports Measurements Audio Waveforms Procedure Log Lab Reports Hx/Px Information Structured Reporting for the Cath Lab Integrated Structured Report Author: Thomas Kennedy
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Content Integration Author: Harry Solomon
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Miscellaneous Documents
Intradepartmental messages Teaching files Quality control (e.g. densitometry, floods, ….)
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Interpretation
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Link Features to Description
New nodule superimposed with right fourth rib 10% PTX Cavitation Free air
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Who’s talking? Who said what Persons and/or devices OBSERVER CONTEXT
DIRECT or QUOTED OBSERVER CONTEXT
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How good is the evidence?
Source (Study Instance UID) CURRENT or OTHER Audit trail PROCEDURE CONTEXT
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What are they talking about?
Patient? Data? Procedure? Mother? Twin A? Twin B? Slide: block , cut , stain , re-stain OBSERVATION SUBJECT
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What is being said? Document title Heading for type of content
Concept name (coded label) OBSERVATION CATEGORY
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Anywhere in the document
WE KNOW Who’s talking Source of evidence Subject and scope talked about Category of information OBSERVATION CONTEXT
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Accountability Referring physician and request
Status (COMPLETE, VERIFIED) Verifying Observer, organization Evidence checklist: CURRENT, OTHER ADMINISTRATIVE CONTEXT
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Delivery to Point of Care
DICOM SR Documents in database DICOM to PACS workstations Web to enterprise
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Analysis Scientific research Education and training Clinical trials
Performance evaluation
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Databaseable Reporting*
Chuck Thomas coined this term Share knowledge Enhance understanding in consultation Increase effectiveness Say it once! Re-use clinical findings for training Increase efficiency Evaluate Improve outcomes
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