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DICOM Strategy. Cor Loef co-chair DICOM WG10:Strategic Advisory Committee Philips Medical Systems. Scope of DICOM Charter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning process Collaboration with other SDOs. Contents. Mission of DICOM

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dicom strategy

DICOM Strategy

Cor Loef

co-chair DICOM WG10:Strategic Advisory Committee

Philips Medical Systems

contents
Scope of DICOM

Charter WG10: Strategic Advisory Cmt

Trends in Imaging-IT

Strategy Planning process

Collaboration with other SDOs

Contents

IHE @ RSNA 2002

scope of dicom
Mission of DICOM

Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information

Goals of DICOM

Achieve interoperability and improve workflow efficiency between imaging systems and other information systems

Scope of DICOM

IHE @ RSNA 2002

charter of wg10
To develop and maintain the long-term strategic plan of the DICOM Standards Committee. URL: http://medical.nema.org/dicom/geninfo/dicom_strategy

To review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics;

To consider issues and opportunities related to the strategic evolution of DICOM;

To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN

Charter of WG10

IHE @ RSNA 2002

overview
Scope of DICOM

Charter WG10: Strategic Advisory Cmt

Trends in Imaging-IT

Strategy Planning process

Collaboration with other SDOs

Overview

IHE @ RSNA 2002

slide6

Quality of care improved by information and IT:

All relevant information the care giver and patient need, anywhere and anytime, for the best clinical decisions through one common and simple user interface, adapted for the task.

IHE @ RSNA 2002

trends in imaging it

Horizontal Integration

Vertical Integration

HIS

Other

Clinical

System

RIS

Web based PACS

Cardiology

PACS

VL, US, NM

PACS

Radiology

PACS

Web distribution

At the desktop

Trends in Imaging-IT:

Active workflow

Paradigm shift

IHE @ RSNA 2002

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

Vertical Integration

The Healthcare Enterprise

IHE @ RSNA 2002

slide10

Active Workflow

IHE @ RSNA 2002

slide11

Registration

Preparation

Examination

Post Examination

..010011...

..010011...

..010011...

..010011...

..010011...

..010011...

..010011...

..010011...

Archiving

..010011...

..010011...

..010011...

Referral

Reviewing

Image Distribution

Demonstration

Transcription

Reporting

Workflow in Radiology

Digital

Radiology

IHE @ RSNA 2002

active workflow
Active Workflow

Personalized

Work list

For each user

IHE @ RSNA 2002

post processing everywhere
Viewing & Advanced Image Processing:

clinical SW packages

move towards modalities, PACS and web

Post-Processing everywhere

3D

Spine

Cardiac MR

Endo3D

IHE @ RSNA 2002

slide17
Analysis tools to enhance clinical decisions:

Echo measurements & calculations

Left Ventricular Analysis

Quantitative Coronary Analysis

Vascular X-Ray Analysis

Vascular X-Ray Post-Processing

IHE @ RSNA 2002

slide18

Horizontal Integration

Hospital Information System, Master Person Index

Radiology

workflow

Cardiology

workflow

Ultrasound

workflow

Pathology

workflow

Radiology

PACS

Cardiology

PACS

Ultrasound

PACS

Visible Light

PACS

One Image Management Infrastructure

IHE @ RSNA 2002

horizontal integration
Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured ReportsHorizontal Integration

IHE @ RSNA 2002

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

IHE @ RSNA 2002

web based pacs

Web Viewer

Webserver

PACS Viewing

Station

At Modality

Web based PACS

IHE @ RSNA 2002

web and security
Web and Security

Web Viewer

Webserver

Security

PACS Viewing

Station

At Modality

IHE @ RSNA 2002

electronic health record
Image Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve)

EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health information

Need for coded vocabularies to represent medical knowledge and the patient’s health condition

Web front-end:

viewing not only of images but also waveforms, measurements, reports, lab results, etc

need the capability to access the original medical images

support for (DICOM) Structured Reporting

XML and XML Schema for the exchange of clinical documents

“Electronic Health Record”

IHE @ RSNA 2002

ehr visual integation

Back-Office

Clinical

Information

System

Clinical

Information

System

messages

Integrated

Clinical Viewing

at the desktop

Front Office

EHR: Visual Integation

Efficiency

Improve

Clinical

Decisions

IHE @ RSNA 2002

overview1
Scope of DICOM

Charter WG10: Strategic Advisory Cmt

Trends in Imaging-IT

Strategy Planning process

Collaboration with other SDOs

Overview

IHE @ RSNA 2002

strategic planning process
In recent meetings WG10 has identified quite a number of strategic topics in the following domains:

data acquisition, imaging technology

post-processing and presentation

object management and archiving

data and result distribution

treatment planning

workflow management

Strategic planning process

IHE @ RSNA 2002

slide27

The (multi-vendor) Integrated Imaging Solution

Connection to other Network

and/or TeleCardiology

Image Archive

Image

Server

Department

Info Server

CD

Exchange

Diagnostic Workstation

IHE @ RSNA 2002

slide28

Quality of Patient Care

Effective treatment plan

Fast and accurate diagnosis

Images

Waveforms

Measurements

Order

Report

Treatment

plan

Diagnose

Collect and present

Reduce Errors

Codes and

vocabularies

Codes and

vocabularies

Persistent

Object Ref

Structured

Presentation

IHE @ RSNA 2002

slide29
Topics in Acquisition domain:

Workflow outside the Radiology domain: RT, VL, Cardio. Requires specialized workflow. Refreshing the worklist, event based.

Amount of data generated, kind of data generated.

More, 3D, real-time, grayscale, color, time-sequence, text

Text really broadens the scope: evidence documents, key image note, codes, vocabularies, templates. Need for simple, small documents, e.g. just a few measurements

Amount of data will impact performance

Need to manage separate objects that do belong together, SOP Class future. modeling instead of SOP ( HL7 way), separate info model from communication

IHE @ RSNA 2002

slide30
Topics in Acquisition/Post-processing domain:

Integration, data from multiple modalities needed together, fused, merge recipe. Requires synchronization in time and/or space.

US + CathLab

PET + CT

MR + NM

Communication technology

Media for exchange, profiles

Wireless (TCP/IP is on top of this, should be no issue)

IHE @ RSNA 2002

slide31
Topics in Archive domain:

Delete service. All images come together in central archive with satellites. Co-operation in a loosely connected environment.

Co-operation between multiple loosely connected workflow managers.

IHE @ RSNA 2002

slide32
Topics in Diagnostic Review domain:

Presentation, have only grayscale presentation currently.

color, 3D, waveform, Cine, MR-multiframe

hanging protocols

multi-modality presentation

SR presentation

Interactive collaboration, tele-radiology

Data mining, statistics, need for uniform definition.

Should we organize a workshop on this topic?

IHE @ RSNA 2002

slide33
Topics in Reporting domain:

Harmonization with CDA L3, XML encoding

Next versions of TID 2000, templates

Codes, Vocabulary, Procedure Codes, Diagnostic Codes, HIPAA induced codes

IHE @ RSNA 2002

slide34
Topics in Result Distribution domain:

DICOM’s document paradigm: Persistent Object Reference

Exchange information outside the DICOM domain

HIPAA, Privacy, Security, Authentication, VPN

CD/DVD for exchange

IHE @ RSNA 2002

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

IHE @ RSNA 2002

slide36
Topics in Treatment/Treatment planning domain:

CAD tools, HPGL standard, templates for implants

3D, image guided surgery, contours, locate images in 3D space

multi modality aspect

Image fusion

IHE @ RSNA 2002

strategic planning process1
Summary of the statements made:

We started with the ultimate goal in mind: Quality of Patient Care, Continuity of Care, and the two contributing factors: fast and accurate diagnosis, and most effective treatment plan

The key persons to support with information are the technologist, radiologist/cardiologist, and the referring clinician.

Images, waveforms, measurement reports are generated and need an integrated presention to the key decision makers.

We see this integration and presentation to the diagnostic decision maker as the top priority.

Strategic planning process

IHE @ RSNA 2002

strategic planning process2
Statements (continued):

We have the feeling that much is available in DICOM which is not deployed in practice to solve integration and presentation problems==> Education and promotion task

There will be gaps as well.==> Identify the gaps in the Radiology, Cardiology, NM and US domain

Imaging (related) information from other domains (-ologies) needs to be integrated as well==> Convince other -ologies to use the DICOM paradigm for their persistent objects.

Strategic planning process

IHE @ RSNA 2002

slide39

Strategic priorities

4

1

2

3

3

Integration from acquisition via

presentation to interpretation and

reporting

Radiology

Acquisition

Interpretation

Reporting

Cardiology

Other -ologies

Archiving plus Object management

Acquisition

Interpretation

Reporting

Ultrasound

NM

IHE @ RSNA 2002

overview2
Scope of DICOM

Charter WG10: Strategic Advisory Cmt

Trends in Imaging-IT

Strategy Planning process

Collaboration with other SDOs

Overview

IHE @ RSNA 2002

standards in imaging it
1. Horizontal Integration DICOM

2. Vertical Integration IHE, DICOM, HL7

3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML

4. Orders and Results IHE, DICOM, HL7Management

5. Security IHE,IETF,DICOM,HL7,ASTM

6. Freedom of Application ISO/CEN, CCOW, IETF, Workspot DICOM

When new technology is required, the strategy is to adopt proven

international, industry or de facto standards.

Standards in Imaging-IT

IHE @ RSNA 2002

ihe integrating the healthcare enterprise reducing the barriers to optimized patient care
Fostering communication between vendors and users of medical information technology

Gaining knowledge of the data required for optimal patient care decisions, i.e. understanding each others problems

Driving the deployment and evolution of existing standards

Eliminating the gaps and redundancies in data access.

IHE - Integrating the Healthcare EnterpriseReducing the Barriers to Optimized Patient Care

IHE @ RSNA 2002

liaison with tc 215
Good Type A liaison since April 99.

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)

New workitem: Web Access to DICOM’s Persistent Objects, co-operation of ISO TC 215/WG2 and DICOM

in DICOM a WG6 ad-hoc group is established to work on the supplement, together with a group of ISO nominated experts

Liaison with TC 215

IHE @ RSNA 2002

collaboration with hl7
WG20: Integration of Imaging and Information Systems, common DICOM-HL7 working group.

Works on the harmonization of the information models, HL7 RIM and DICOM Real-World model.

Works on the harmonization of DICOM SR and the HL7 CDA (Clinical Document Architecture) level 1,2,3

An informative annex to the DICOM standard will be created with the mapping of DICOM header data element to CDA level 1.

CDA level 2 and 3 are progressing.

Collaboration with HL7

IHE @ RSNA 2002