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Aspects of DICOM for Patient Safety

Aspects of DICOM for Patient Safety. Helmut Koenig, Siemens Healthcare Harry Solomon, GE Healthcare Co-chairs, HL7/DICOM Imaging Integration WG. Topics. Brief Intro to DICOM Radiation Dose Reporting Substance Administration Adverse Event Reporting.

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Aspects of DICOM for Patient Safety

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  1. Aspects of DICOMfor 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 Reportand Radiology Report Dose Summary

  9. Dose SR • Radiation Dose Structured Report is a SOP Class (unit of conformance) • Standard templates • TID 10001 Projection X-Ray (including Mammo) • TID 10011 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

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