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Simple Image and Numeric Reports

Simple Image and Numeric Reports. 簡単な画像と数値を含むレポート. ベンダーワークショップ２００３資料 ２００３．９．１２ IHE-J 技術検討委員会. 日立メディコ　井桁. Scheduled Workflow. Post- Processing Workflow. Patient Information Reconciliation. Charge Posting. Admit, order, schedule, acquire images, notify of completed steps.

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Simple Image and Numeric Reports

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  1. Simple Image and Numeric Reports 簡単な画像と数値を含むレポート ベンダーワークショップ２００３資料 ２００３．９．１２ IHE-J 技術検討委員会 日立メディコ　井桁

  2. Scheduled Workflow Post- Processing Workflow Patient Information Reconciliation ChargePosting Admit, order, schedule, acquire images, notify of completed steps Schedule, perform, & notify image processing & CAD steps Collection of billable procedure details Unknown patients and unscheduled orders Consistent Presentation of Images Key ImageNotes Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements 画像および数値を 含むレポート Hardcopy and softcopy grayscale presentation state Flag significant images Presentation of Grouped Procedures Subset a single acquisition Access to Radiology Information Easy access to pertinent images and reports Basic Security Audit Trail Consolidation & Node Authentication JIRA/JAHIS

  3. Overview • Report Definition • Reporting Transactions • Reporting Actor Requirements • Report Content Structure JIRA/JAHIS

  4. What is a DICOM Structured Report Object ? A “Persistent Document” which:ずっと使える！ : • Provides “semantic” documentation of diagnosis 　 • Provides context such as 意味のあるドキュメント！:scheduled procedure, observer, current and previous images • Link text and codes with images, and measurements • Coded entries using standardized or private lexicons • Flexible enough to address: • Minimally structured radiology reports (IHE Simple Image and Numeric) • More advanced and specialized reports ( obgyn, mammography, etc.) • Beyond radiology imaging (cardiac cath logs, etc.) Facilitates computer outcomes analysis JIRA/JAHIS

  5. Simple Image& NumericReports • Based on DICOM SR • Allows to include without transcription:- measurements- image links- structured content • Integrated with the imaging workflow • Friendly to XML implementations • Easy to export to the EPR (HL7) JIRA/JAHIS

  6. MALIGNANCY Based on: MASS Size: 7mm Shape: irregular Margin: spiculated Associated with: CALCIFICATION Type: Heterogeneous Type: Branching Distribution: Grouped What Isn’t DICOM SR? . . . it isn’t a document presentation standard! JIRA/JAHIS

  7. IHE Simple Image & Numeric Report Imaging Department Measurements, Image Analysis, etc. Acq. Modality Electronic Patient Record Images Image Manager EnterpriseReport Repository Evidence Docs (DICOM SR) EvidenceCreator ReportCreator HL7 TextReports Workstations ReportMgr RIS/PACS FormalReports(DICOM SR) Formal Reports (DICOM SR) Other DepartmentsRepositories Report Reposit. ExternalReport Repository Access Report Reader Workstations JIRA/JAHIS

  8. 患者治療のための レポートと画像参照 SINR　Actors レポート作成 レポートチェック Report Creator チェックされたレポート 最初のレポート レポートを読む 診断のために提示された 画像と検査データ レポートと画像の検索 ネットワークアクセスのできる レポート保管 画像検索 Report Manager Report Repository Report Reader 画像保管・管理 レポート管理と保存 JIRA/JAHIS

  9. 読影レポートのアクター分割 ＲｅｐｏｒｔＣｒｅａｔｏｒ ｛レポート作成｝ ↓[24] Report Submission ↓[28] Structured Report Export Ｒｅｐｏｒｔ　Ｍａｎａｇｅｒ ｛電子カルテへ｝ Enterprise Report Repository ｛レポート管理｝ ↓[25] Report Issuing <<DICOM SR//HL7>> External Report Repository Access Ｒｅｐｏｒｔ　Ｒｅｐｏｓｉｔｏｒｙ　 ｛レポート閲覧｝ ｛レポート保存｝ ↓[26] Query Report ↓[26] Query Report ↓[27] Retrieve Report ↓[27] Retrieve Report Ｒｅｐｏｒｔ　Ｒｅａｄｅｒ ｛レポート閲覧｝ Simple Image and Numeric Report Diagram JIRA/JAHIS

  10. SR Is Managed Like Any Other DICOM Object Patient Information Patient ID Study Information Study Inst. UID Series Information Series Information Series Information Series Information Series Inst. UID Image Presentation State OtherComposite IODs SR Document Information SOP Inst. UID Images, SR Documents, Presentation States, Stored Print, etc. can exist in same Study JIRA/JAHIS

  11. Report Creator • Provides user interface to create new reports including setting status flags - “Completion Flag” and “Verification Flag” （完成、承認のフラグ） • Configurable coded entries (Title, Headings, etc.) • May reference images in report content • Must support “Identical Documents Sequence” if necessary • Creates Basic Text SR with TID 2000 object OR • Creates Enhanced SR with TID 2000object (when including measurements) • Stores report in Report Manager using: • Basic Text SR Storage SOP class; OR • Enhanced SR Storage SOP class; OR both JIRA/JAHIS

  12. Report Manager • Receives reports from Report Creator • Supports Basic Text SR with TID 2000 objects • Supports Enhanced SR with TID 2000 objects (optional) • May forward reports to Report Repository at any time • Must allow users to set status flags - “Completion Flag” and “Verification Flag” • Other modifications and report manipulation is possible • Amending reports • Merging reports • Additional content 修正・マージ・追加が • etc. • All changes require new SOP Instance UID • Must send final(verified) reports to Report Repository JIRA/JAHIS

  13. Report Repository • Receives reports from Report Manager • Supports Basic Text SRandEnhanced SR objects • Responds to Query and Retrieve requests from Report Reader to sends reports to Report Reader JIRA/JAHIS

  14. Report Reader • Provides user interface to view reports • Allows user to select report from either Report Repository or External Report Repository Access via DICOM Query/Retrieve mechanisms • Must support SCU query keys in following table - allows user to filter for particular reports • Supports Basic Text SR objects • Supports Enhanced SR objects (optional) • Must show any object references • May retrieve and display image objects if grouped with Image Display JIRA/JAHIS

  15. Report QueryKeys JIRA/JAHIS

  16. External Report Repository Access • Allows radiology to access reports generated outside radiology, for example Laboratory • Converts external report to DICOM SR objects • Supports Basic Text SR objects • Supports Enhanced SR objects (optional) • Assumes consistent Patient ID with radiology • May create Study, Series, and Instance UIDs and must conform to DICOM UID rules • Must provide consistent UIDs - if same report is queried and retrieved several times, then the same UIDs shall be used • Must support same Instance level query keys as Report Repository but reduced set of keys for Patient, Study, and Series levels JIRA/JAHIS

  17. Enterprise Report Repository • Receives final reports (verified/signed) from Report Manager. • Actor may be implemented by a Clinical Patient Record, or any other systems. • Report Manager converts/presentsSimple Image and Numeric Reports (DICOM SR objects) as an HL7 ORU Message (OBX Segments). • IHE does not define the mapping of the structured content of DICOM SR in non structured ASCII Text in OBX segments. This presentation is created by the Report Manager. • Assumes consistent Patient ID/Order Numbersmanaged by the same ADT and Order Placer. • In addition to ASCII Text, receives the « links » to native DICOM objects so that Enterprise Report Repository may retrive native images and structured report. JIRA/JAHIS

  18. Root Content Item Content Item Content Item Content Item Content Item SR Document Tree • Single RootContent Item • Followed bynested Content Items JIRA/JAHIS

  19. SINR with Basic SR • Minimal Structure : Coded Title and Headings • Full image links from specific sections of report • Observation Context (who, what, when) may be section specific JIRA/JAHIS

  20. SINR with Advanced SR Simply adds Measurements to Simple Image Reports JIRA/JAHIS

  21. Report Pattern - Observation Context • An Example : • Who :Observer • What :Observed Evidence • Subject :Patient/Fœtus/Specimen Required only when the Observation Context is different from the default. Fully defined in TID 1001 and related Templates in Supplement 53. JIRA/JAHIS

  22. An Illustration Chest, PA & Lateral (GCS,T78) Dr Andrew Smith……. George Jones…... Procedure PA and Lateral radiographs were ……. Findings The PA demonstrates ... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Conclusions Possible Mass (ICD,XXX) JIRA/JAHIS

  23. Recording Observer Name‘Smith^Andrew^^Dr’ Has Obs. Context Observation Subject‘Jones^George’ Document Heading‘Procedures’ (GCS,H12) Contains Text‘procedure (GCS,H12) = PA and Lateral radiographs were …….’ Contains Contains Document Heading‘Findings’ (GCS,H34) Text‘findings (GCS,H34) = The PA demonstrates… A small opacityis visible in the base of lung in lateral view. CT recommended.’ Contains Contains Image ReferenceInstance UID=3.56.18.9 Inferred From Document Heading‘Conclusions’ (GCS,H56) Code‘conclusions (GCS H56) = Possible Mass’ (ICD,XXX)’ Contains Document Title‘Chest PA & LAT’ (GCS,T78) Content Items and Relationship Has Obs. Context

  24. Document Title‘Chest PA & LAT’ (GCS,T78) JIRA/JAHIS

  25. Diagnostic Report Titles Defined by DICOM Part 16 May be extended JIRA/JAHIS

  26. Diagnostic Report Headings Defined by DICOM Part 16 May be extended JIRA/JAHIS

  27. Status and Verifying Attributes • Completion Flag - PARTIAL or COMPLETE • how to set the flag is open to implementation • Completion Flag Description - free form text • Verification Flag - UNVERIFIED or VERIFIED • Verifying Observer Sequence • identifies person(s) verifying the document and organization(s); required if flag = VERIFIED Prevailing final version = most recentVerification DateTime, VERIFIED, COMPLETE JIRA/JAHIS

  28. SR IODs • Basic Text SR IOD • Minimal usage of coded entries • Reference to SOP Instances restricted to leaves from text tree • No by-reference Content Items (i.e. by-value only) • Enhanced SR IOD • superset of Basic Text but extended to include measurements, spatial and temporal regions of interest • Comprehensive SR IOD • superset of Basic Text and Enhanced, references to leaves not restricted and includes by-reference Content Items JIRA/JAHIS

  29. Simple Image and Numeric Report • Report content is more than words….. • With IHE, it is possible to add value to reporting with input from modalities and image processing applications (e.g. Measurements). • This IHE Integration Profile is the cost effective solution for sharing reports and inclusion of image enabled reports into the Electronic Patient Record. JIRA/JAHIS

  30. SINRの利点 • Reporting　Actorを定義し、トランザクションを明確化することで、必要なActorをシステムに付加できる。 • ユーザはSINRをレポート間の交換ファイルとして利用できる。施設間のレポートやり取りが可能になる。 • SRは発展途上。より詳細なレポートへ発展－ユーザにとって使いやすいレポートへ。 JIRA/JAHIS

  31. JIRA/JAHIS

  32. Questions? Documents Available On the Web at: www.rsna.org/IHE or www.himss.org IHE Technical Framework　Ｖｅｒ．５．５ Vol. I p86 – p92 Vol. II p150-p176 JIRA/JAHIS

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