Dicom strategic direction for image distribution
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DICOM Strategic Direction for Image Distribution. Cor Loef co-chair DICOM Strategic Advisory Committee. Scope of DICOM Standards Committee Trends in Imaging-IT Standards in Imaging-IT Objects , Information, EPR, Web-distribution, Desktop. Contents. Mission of DICOM

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Dicom strategic direction for image distribution

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

Contents


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

Scope of DICOM Standards Committee


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

New:published in DICOM 2000


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

Supplements approvedin 2001


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)

New Work Items


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.

Current Direction


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.

Liaison with TC 215


Trends in imaging it

1. Horizontal Integration

HIS

2. Vertical Integration

RIS

Cardiology

PACS

VL, US, NM

PACS

Radiology

PACS

Trends in Imaging-IT:

Other

Clinical

System

3. Elect. Patient Record

Electronic Patient Record

At the desktop


1 horizontal integration

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

1. Horizontal Integration


2 vertical integration

HIS

HIS

IMAGING:

IMAGING:

ADT

Patient Registration

PACS / Archives

PACS / Archives

Patient Registration

Workstations

Workstations

Image Creator

Modalities

Modalities

Order Placer

Image Display

New Order

Q /R

Images

Department

System Scheduler

– Order Filler –

Image Archive

Procedure Scheduled

Image Manager

Images

Stored

Storage

Commit

PPS

In-Progress

/ Completed

Acquisition

Modality

RIS

RIS

Modality Worklist

2. Vertical Integration

The Healthcare Enterprise


Integration not only back office

Back-Office

Clinical

Information

System

Clinical

Information

System

messages

Integrated

Clinical Viewing

at the desktop

Front Office

Integration: not only back-office!

Efficiency

Improve

Clinical

Decisions


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

3. Electronic Patient Record


Dicom strategic direction for image distribution

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


Dicom strategic direction for image distribution

Other Clinical

Information

Systems

Multi-Media

Report with

references

Clinical

Question

RIS

PACS

4. Order and Results Management


Dicom sr creation example radiology

RIS data

Header:

Thorax

Report Type:

…..

…..

…..

Report Creator application

Findings:

Mass

(DICOM) SR Object

…..

…..

Daim.

Conclusions:

Infiltr.

…..

…..

Image Refs.:

From DICOM standard:

Report Templates

DICOM SR Creation - Example -Radiology

Image data

(Pointer)

from PACS

select

Coding Schemesbehind pop-up menus


4 orders and results management

Great opportunities for IHE.

Important roles for HL7 Clinical Document Architectureand 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.

4. Orders and Results Management


5 security

5. Security

Web Viewer

Webserver

Security

PACS Viewing

Station

At Modality


5 security1

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

5. Security


6 freedom of application workspot

PACS Viewing

Station

At Modality

6. Freedom of Application Workspot

Web Viewer

Webserver


Standards in imaging it

1.Horizontal IntegrationDICOM

2.Vertical IntegrationIHE, DICOM, HL7

3.Electronic Patient RecordISO/CEN,DICOM,HL7,XML

4.Orders and Results IHE, DICOM, HL7Management

5.SecurityIHE,IETF,DICOM,HL7,ASTM

6.Freedom of Application ISO/CEN, CCOW, IETF, WorkspotDICOM, XML

Standards in Imaging-IT


Dicom strategic direction for image distribution

The (multi-vendor) Integrated Imaging Solution

Structured

Documents (XML)

Numeric report

QCA, LVA

General

Purpose

Worklist

Hanging

Protocols

secure transport

digital signature

Email attachment

DICOM URL

Connection to other Network

and/or TeleCardiology

Image Archive

Image

Server

Department

Info Server

CD

Exchange

Diagnostic Workstation


The distribution problem

Header:

Thorax

Report Type:

…..

…..

…..

Findings:

Mass

…..

…..

Radiology

PACS

Daim.

Conclusions:

Infiltr.

…..

…..

(Pointer)

Image Refs.:

The distribution problem

HIS

Other

Clinical

System

RIS

Cardiology

PACS

VL, US, NM

PACS

Electronic Patient Record

URL/URI?

Webserver

Web Viewers


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