1. DICOM SR Requirements Applications Benefits W. Dean Bidgood, Jr., M.D., M.S. SR Data Solutions, Inc. www.srdata.com (919) 806-2220

2. 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

3. With SR, Useful Structure is Available User decides how much “structure” to use … where required But also the degree of OPTIONALITY And the MODE OF EXPRESSION and precisely controls (with templates) not only the type of content …

4. SR Distinctives DICOM base Availability (trading partners) The model is the message Simple entry point Practical approach to codes and terminology Supports high-end applications

5. Simple Entry Point Title and text Links to images …. But also supports advanced applications

6. DICOM Environment Unique object identifiers Persistent objects Workflow context Binary data types Consistent soft-copy display Print management

7. SR Highlights Support measurements by imaging devices Achieved in DICOM SR Integrate fully into the DICOM environment Achieved in DICOM SR Enable collaborative reporting by any number of persons or devices Achieved in DICOM SR

8. SR Highlights Enable links to regions of interest within images and waveforms Achieved in DICOM SR Enable links to key images of any case Achieved in DICOM SR Template-driven content and structure Achieved in DICOM SR

9. Customization Permitted For User interface Presentation Database implementation SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY STANDARDS IN THESE AREAS

10. 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 2000 NEMA SR Workshop: rollout of DICOM SR

11. SR Applications

12. Ultrasound Measurements Immediate Need Generate with image LOINC codes Spatial Coordinates

13. CAD Device Emerging application Generate from image BIRADS codes Spatial coordinates

14. Device Output Predictable content and meaning Measurements, codes, text Coordinates Inferences

15. Numeric Measurement Unambiguous description LOINC code -- measurement name SNOMED code -- units Concept Name ( LOINC ) Numeric Value Units ( SNOMED ) NUM Content Item

16. Inference Tree Inferred From

17. HIS/CIS Patient Demographics XA IVUS Hemo Monitoring Images Reports Measurements Images Reports Audio Measurements Waveforms Reports Measurements Procedure Log Lab Reports Hx/Px Information Structured Reporting for the Cath Lab Integrated Structured Report Author: Thomas Kennedy

18. Content Integration Author: Harry Solomon

19. Miscellaneous Documents Teaching files Intradepartmental messages Quality control (e.g. densitometry, floods, ….)

20. Interpretation

21. Link Features to Description New nodule superimposed with right fourth rib Free air 10% PTX Cavitation

22. Who’s talking? Who said what Persons and/or devices DIRECT or QUOTED OBSERVER CONTEXT

23. How good is the evidence? Source (Study Instance UID) CURRENT or OTHER Audit trail PROCEDURE CONTEXT

24. What are they talking about? Patient? Data? Procedure? Mother? Twin A? Twin B? Slide: block OBSERVATION SUBJECT, cut, stain, re-stain

25. What is being said? Document title Heading for type of content Concept name (coded label) OBSERVATION CATEGORY

26. Anywhere in the document Who’s talking Source of evidence Subject and scope talked about Category of information OBSERVATION CONTEXT WE KNOW

27. Accountability Referring physician and request Evidence checklist: CURRENT, OTHER Status ( COMPLETE, VERIFIED ) Verifying Observer, organization ADMINISTRATIVE CONTEXT

28. Delivery to Point of Care DICOM SR Documents in database DICOM to PACS workstations Web to enterprise

29. Analysis Scientific research Clinical trials Performance evaluation Education and training

30. Databaseable Reporting * Share knowledge Evaluate Enhance understanding in consultation Say it once! Increase effectiveness Increase efficiency Improve outcomes Chuck Thomas coined this term Re-use clinical findings for training