dicom international conference & seminar april 8-10, 2008 chengdu, china use and transformation...

DICOM INTERNATIONALCONFERENCE & SEMINARApril 8-10, 2008 Chengdu, China

Use and Transformation of DICOM SR and

CDA Release 2 Diagnostic Imaging Reports Helmut Koenig, MDSiemens HealthcareCo-Chairman DICOM WG20 and HL7 Imaging Integration WG

April 8-10, 2008 DICOM International Conference & Seminar 2

Overview on Presentation

• Introduction– Comparison of Structured Document Standards:

DICOM SR vs. HL7 CDA Rel.2– DICOM Reporting Strategy

• Facilitation of Document Exchange between Imaging and Information Systems– Use Cases / Scenarios– Scope of SR Transformation Guide / CDA

Implementation Guide

• Conclusions– Strategies for Document Exchange


Acknowledgments

• Contributions to Documents and Sample Materials:– D. Donker, PhD: CDA Sample Document + XSL Stylesheet– David S. Channin, MD: Basis for SR Sample Document, Sample

Images– F. Behlen, PhD, L. Alschuler, R. Geimer : CDA Implementation

Guide– B. Dolin, MD and Members of HL7 Structured Documents WG:

Guidance on CDA Standard


Introduction

• Goal: Leverage Communication of Document-Based Imaging Results for Coordination of Clinical Tasks– Multiple Specialties in Intra- and Cross-Institutional Settings– Provision of Relevant Images, Image-Based Quantitative

Measurements and Interpretation Results for Planning Diagnostic and Therapeutic Activities

• DICOM WG20 is Working on a Pair of Aligned Diagnostic Imaging Report (DIR) Implementation Guides to Harmonize Structured Document Standards– DICOM SR / HL7 CDA R2 Transformation Guide– CDA Implementation Guide


Comparison DICOM SR / HL7 CDA R2

• Structure of DICOM SR and HL7 CDA R2:

– Analysis of SR Basic Diagnostic Imaging Report (Template 2000):• Essential SR Imaging Service Data + Context can be represented

and mapped to CDA R2. Not only as narrative text, but as structured document content.

• Minimal Context Information on Subject (Patient/Fetus), Observer (Person/Device) and Procedure has been identified

Header

Content Tree

Section incl.Narrative Text

Header

Content Tree

Root Content Itemincl. Report Title

DICOM SR HL7 CDA R2


Comparison DICOM SR / HL7 CDA R2

DICOM SR HL7 CDA R2

Scope Imaging Clinical

-> Common Data Identified

Text Representation Text Content Item Section Narrative Text (Attested Content) + Structured Entries

-> TEXT Content Items Map to CDA Entries (Structured Part) Referenced within Narrative Text

DICOM Object References

Image / Composite Content Items (“Native” DICOM References)

Use of WADO References (Web Access to DICOM Persistent Objects)

-> DICOM Composite Object Reference CMET Patterns, HL7 V3 Normative Edition 2007/2008

Encoding Binary XML


Terms & Definitions

• Evidence Document– Uninterpreted Information (Primarily Managed and Used Inside

the Imaging Department)– Non-Image Information such as Measurements, CAD Results– Used in the Process of Creating a Radiological Diagnostic Report

• Radiological Diagnostic Report– Interpreted Information, Primary Output of the Radiology

Department– “Evidence Documents may be used either as additional evidence

for the reporting physician or in some cases for selected items in the Evidence Document to be included in the diagnostic report.”

• Clinical Document– May contain Results and Diagnoses from various Clinical

Specialties– Radiological Diagnostic Report may be included in the Clinical

Document


DICOM Reporting Strategy

• …

– ...• …

ClinicalDocument

OrderSpecializedDiagnostics/Interventions

HL7 CDA

DICOM SR

Image DataPost-Processing

ImageData

DerivedImageData

Obser-vations

EvidenceDocument

ImagingReport

Interpretation

ObservationsConclusionsDiagnoses

ClinicalDocument

Patient MedicalHistory / RelevantPrior Documents

On one or moreImaging procedures

SR -> CDA Rel.2Transcoding

Evidence Doc Import

Imaging Report Export

Evidence Doc Export

Clinical SummaryReport

Inclusion into

CCOW Access

HL7 Message

* Convey relevant informationof clinical document

* *

*

Format: DICOM SR, HL7 CDA,Text, PDF


Use Cases / Scenarios

PostProcessing

Selection/Annotation of RelevantImages

Measurements, e.g.based on Pattern/Object

Recognition

Dictation

TranscriptionDiagnostic

Imaging Report(DIR)

TransformationEvidenceDocument

KOS

Interpretation

Clinical Report

DICOM SRor HL7 CDA

Inclusion

DICOM SR

HL7 CDA

Inclusion (DIR inSR Format)

DIR inCDA Format

DIR inSR Format

Inclusion(DIR in CDA

Format)

• Inclusion / Transformation: Complete or Partial Document (Minimal Context Information has been specified)• DICOM Template Hierarchy Allows for Reuse of Mapped Content for Various Document Types, such as Evidence Documents

CDA = Clinical Document ArchitectureDIR = Diagnostic Imaging ReportKOS = Key Object SelectionSR = Structured Reporting


Materials to Support the Reporting Processes

• Guidance on the Use and Exchange of SR and CDA DIR Documents– Diagnostic Imaging Report (DIR) Transformation

Guide– CDA DIR Implementation Guide– CDA DIR Refined Message Information Model

(RMIM)– DIR SR and CDA Sample Documents + CDA

Stylesheet


Original CDA R2 RMIM

Document Header- Related Acts: Encounter, Order, Parent Document…- Participations: PatientRole, Author…

Document Body- Section with Narrative Text- Structured Section Entries

Section


Constrained DIR RMIM

• Clinical Document– Participations mapped except “informant” – Related acts mapped except “Consent” and

“EncompassingEncounter” (only related Attender Participation)

• Structured Body– NonXMLBody and Section recursive actRelationship

(Nested Sections) not used, “informant” not mapped– Relevant Clinical Statement Entries: “Observation”

(Text and Code), “Procedure” and “Act”– entryRelationship Types used: “component”, “reason”,

“subject”, “support”– Not used: Entry Participations and External

References


Overview on Mapping of Document Context & Structure

DICOM SR HL7 CDA R2

Document Context Information

Transformed SR Document

ClinicalDocument

Original SR Document ParentDocument

Preservation of Structural Information

Section Level Container Content Item

Section

Content Items and Relationships

CDA Entries and Entry Relationships

Participants Author/Person Observer Author

Attestor Authenticator

Verifying Observer Legal Authenticator

… …


Overview on Mapping of Observation Context

DICOM SR HL7 CDA R2

Subject Context Patient recordTarget/Patient

Fetus relatedSubject/SubjectPerson

Procedure (Diagnostic / Image-Guided Interventions)

Procedure ServiceEvent (Document Level), Act/Procedure (Section Entry Level)

Order, Requested Procedure

Order

Observer Person Observer author/assignedAuthor/Person

Device Observer author/assignedAuthor/AuthoringDevice


Numeric Measurements and Image References

• CDA R2 Structured RepresentationQuantityMeasurementclassCode*: <= OBSmoodCode*: <= EVNcode*: CD CWE [1..1] <= ExternallyDefinedActCodes (Concept NameCode Sequence)effectiveTime: TS [0..1] (Observation Date Time (0040,A032)languageCode: CE CWE [0..1] <= HumanLanguagevalue*: PQ [1..1] (DICOM Decimal String Data Type)

SopInstanceclassCode*: <= DGIMGmoodCode*: <= EVNid*: II [1..1] (SOP Instance UID (0008,0018)code*: CE CWE [1..1] <= ExternallyDefinedActCodes (SOP Class UID Code (0008,0016)title*: ST [0..1] (SOP Class UID derived name)text: ED [0..1] (WADO Reference)effectiveTime: TS [0..1] (Content Date (0008,0023) and Content Time (0008,0033)targetSiteCode: SET<CD> CWE [0..*] <= ActSitesubjectOrientationCode: CE CWE [0..1] <= ImagingSubjectOrientation

PurposeOfReferenceclassCode*: <= OBSmoodCode*: <= EVNcode*: CE CWE [1..1] <= ExternallyDefinedActCodes (PurposeOfReference Code: external DICOM codes CID3407, 7002, 7003, 7005 defined in DICOM Part 16)

ReferencedFramesclassCode*: <= ROIBNDmoodCode*: <= EVNcode*: CV CNE [1..1] <= ExternallyDefinedActCodes (Multi-Frame)

0..1 purposeOfReference

typeCode*: <= RSONcontextControlCode*: CS CNE [1..1] <= ContextControl "AP"contextConductionInd*: BL [1..1] "true"

reason

0..1 referencedFrames

typeCode*: <= COMPcontextControlCode*: CS CNE [1..1] <= ContextControl "AP"contextConductionInd*: BL [1..1] "true"

component

BoundaryclassCode*: <= OBSmoodCode*: <= EVNcode*: CE CNE [1..1] <= ExternallyDefinedActCodes (Spatial Boundary)value*: LIST<INT> [1..*] (Referenced Frame Number (0008,1160)

1..1 boundarytypeCode*: <= COMP

component

0..* sopInstance

typeCode*: <= SUBJcontextControlCode: CS CNE [0..1] <= ContextControl "AP"contextConductionInd*: BL [1..1] "true"

subject

Note:INFERRED FROM, R-INFERRED FROMDICOM Relationship TypesConstraint on SOP Classes

Note:DICOM Value Type NUMDICOM Data Type Decimal String mapped to value: PQ (Physical Quantity) Data Type

subject

0..* sopInstance

typeCode*: <= SUBJcontextControlCode*: CS CNE [1..1] <= ContextControl "AP"contextConductionInd*: BL [1..1] "true"

DICOM Code 113036 ”Group of Frames for Display” ->


Conclusions

• Represention of Essential SR Imaging Service Data and Context Information in CDA R2 is Possible– Document and Observation Context– Preservation of Structural Information, i.e. for Measurements

based on Image Data and their Interpretation• Reuse of Identified Patterns for Other Document

Types• Mapping Supports Communication of Structured

Imaging Results and Diagnoses to HL7 Speaking Information Systems

• Potential Next Steps: – Work on Representation and Mapping of Evidence Document

Contents– Specification of IHE Profile to Define Actors and Transactions


References

http://medical.nema.org/

http://www.HL7.org/

http://www.IHE.org/

Thank you for your attention !


Glossary

Terms & Definitions:• Evidence Document

– Uninterpreted Information (Primarily Managed and Used Inside the Imaging Department)– Non-Image Information such as Measurements, CAD Results– Used in the Process of Creating a Radiological Diagnostic Report

• Radiological Diagnostic Report– Interpreted Information, Primary Output of the Radiology Department– “Evidence Documents may be used either as additional evidence for the reporting physician

or in some cases for selected items in the Evidence Document to be included in the diagnostic report.”

• Clinical Document– May contain results and diagnoses from various clinical specialties– Radiological Diagnostic Report may be included in the Clinical Document

Acronyms:CDA = Clinical Document ArchitectureDIR = Diagnostic Imaging ReportGSPS = Grayscale Softcopy Presentation StateKOS = Key Object SelectionRMIM = Refined Message Information Model (HL7 Version 3)SOP = Service Object PairSR = Structured ReportingWADO = Web Access to DICOM Persistent Object (DICOM Part 18)


DICOM Supplement 101

• Includes TID 2005 and Use Cases– Text-based Transcribed Diagnostic Imaging Report– Includes References to Relevant Images (Conveyed

by KOS “For Report Attachment”) in a separate “Key Images” Section

– DICOM Image References– Optional GSPS References for GSPS applied to

Images– TID 2005 can be transformed to CDA R2 (Subset of

TID 2000)

dicom international conference & seminar april 8-10, 2008 chengdu, china use and transformation...

Documents

transformation of dicom

dicom srhl7 cda r2 slide

cda release

sr sample document

cda entries structured

cda standard slide

structured document

document exchange slide