1. Aspects of DICOM for Patient Safety
Helmut Koenig, Siemens Healthcare
Harry Solomon, GE Healthcare
Co-chairs, HL7/DICOM Imaging Integration WG

2. Topics Brief Intro to DICOM Radiation Dose Reporting
Substance Administration
Adverse Event Reporting

3. Digital Imaging and Communications in Medicine (DICOM) is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department
Published as NEMA PS3 and as ISO 12052

4. Relationships Memorandum of Understanding with HL7
Joint Working Group (Imaging Integration / WG-20)
Type B Liaison with ISO TC215 Health Informatics
DICOM is an ISO Standard “by reference”
SDO Member of Integration the Healthcare Enterprise
Liaison with International Health Terminology SDO
SNOMED license as primary external vocabulary

5. Key features of DICOM Focus on practical needs of biomedical imaging
Object-oriented, persistent information objects
Tagged data elements, binary encoding
Client-server network services, service negotiation
Image compression by encapsulation
Conformance Statements

6. DICOM Network Services
Information object exchange
Reliable object storage (commitment)
Object repository (PACS) query / retrieve
Modality worklist query
Performed procedure step status notification
Image print
Others
Network Services are denoted
“Service-Object Pair (SOP) Classes”

7. The DICOM Change Process
Continuous process for evolution of the standard
It’s just “DICOM”, not DICOM 3.0, 3.1, etc.
Conformance is to SOP Classes, not to a ‘version’ of the Standard
Change Proposals for minor corrections
About 100 / year
Supplements for major changes – new object types, services, compression schemes
About 10 / year
Require Work Item approved by DICOM Standards Committee
Consolidated edition published ~ every 18 months
Most recently, July 2011
Available free at DICOM web site

8. Radiation Dose Structured Report and Radiology Report Dose Summary

9. Dose SR
Radiation Dose Structured Report is a SOP Class (unit of conformance)
Standard templates
TID Projection X-Ray (including Mammo)
TID CT
Typically produced for each Study or for each Performed Procedure Step
Each exposure event has a unique ID
Associated workflow profiled in IHE Radiation Exposure Management (REM) Profile

10. Templates Developed in conjunction with IEC and AAPM
~ 80 discrete data elements
Aligned with NEMA XR-25 CT Dose Check Standard
Check parameters and authorizations captured

11. Status Identified in ACR White Paper on Radiation Dose
On FDA “radar” – identified in Radiation Dose Reduction White Paper
Commitments from NEMA members to implement
Interoperability testing at IHE Connectathons

12. Dose Summary Standard sub-template for radiology reports
Specified as DICOM template
Standard transcoding to CDA
Conveys summary of radiation dose data
Conforms to German, French, other national regulations on dose reporting, ACR best practice

13. Substance Administration (Imaging Contrast)

14. Substance Administration
Patient safety issue – “five rights” checking for imaging contrast agents
Point of use verification for substances often “out of the loop” of hospital pharmacy systems
Intended as DICOM interface to EHR / CDS functionality
Typically via gateway
Three DICOM SOP Classes

15. SOP Classes Query: Look up product characteristics
Given a barcode ID (from contrast agent bottle), get name, active ingredient, concentration, etc.
Contrast attributes may be included in DICOM image metadata
Query: Check for substance contra-indications
Given agent, patient, route of administration; get approval or warnings based on label and on patient record
Report contrast used to Medication Administration Record

16. Status
Limited HL7 standards for these functions to which DICOM services may be mapped
Currently each implementation needs custom development
Possible standard query definition using pharmacy segments
RAS^O17 for MAR submission
Not included in any IHE Profiles
No known product implementations

17. Adverse Event Reporting

18. Adverse Events
No specific DICOM services related to adverse event reports
Generally not considered within competency or scope of radiology technologists / exams
Performed Procedure Step discontinuation codes
Insufficient data to report nature of adverse event
Optional