Use and Transformation of DICOM SR and CDA Release 2 Diagnostic Imaging Reports

1
Use and Transformation of DICOM SR and CDA
Release 2 Diagnostic Imaging Reports

• Helmut Koenig, MD
• Siemens HealthcareCo-Chairman DICOM WG20 and HL7
  Imaging Integration WG

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

3
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

4
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

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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

DICOM SR
HL7 CDA R2
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Comparison DICOM SR / HL7 CDA R2
DICOM SR HL7 CDA R2
Scope Imaging Clinical
Scope -gt Common Data Identified -gt Common Data Identified
Text Representation Text Content Item Section Narrative Text (Attested Content) Structured Entries
Text Representation -gt TEXT Content Items Map to CDA Entries (Structured Part) Referenced within Narrative Text -gt 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 Object References -gt DICOM Composite Object Reference CMET Patterns, HL7 V3 Normative Edition 2007/2008 -gt DICOM Composite Object Reference CMET Patterns, HL7 V3 Normative Edition 2007/2008
Encoding Binary XML
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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

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DICOM Reporting Strategy

• ...

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Use Cases / Scenarios

• 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 Architecture DIR
Diagnostic Imaging Report KOS Key Object
Selection SR Structured Reporting
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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

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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
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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

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Overview on Mapping of Document Context
Structure
DICOM SR HL7 CDA R2
Document Context Information Transformed SR Document ClinicalDocument
Document Context Information Original SR Document ParentDocument
Preservation of Structural Information Section Level Container Content Item Section
Preservation of Structural Information Content Items and Relationships CDA Entries and Entry Relationships
Participants Author/Person Observer Author
Participants Attestor Authenticator
Participants Verifying Observer Legal Authenticator
Participants
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Overview on Mapping of Observation Context
DICOM SR HL7 CDA R2
Subject Context Patient recordTarget/Patient
Subject Context Fetus relatedSubject/SubjectPerson
Procedure (Diagnostic / Image-Guided Interventions) Procedure ServiceEvent (Document Level), Act/Procedure (Section Entry Level)
Procedure (Diagnostic / Image-Guided Interventions) Order, Requested Procedure Order
Observer Person Observer author/assignedAuthor/Person
Observer Device Observer author/assignedAuthor/AuthoringDevice
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Numeric Measurements and Image References

• CDA R2 Structured Representation

DICOM Code 113036 Group of Frames for Display
-gt
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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

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References

• http//medical.nema.org/

http//www.HL7.org/
http//www.IHE.org/
Thank you for your attention !
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Glossary

• Acronyms
• CDA Clinical Document Architecture
• DIR Diagnostic Imaging Report
• GSPS Grayscale Softcopy Presentation State
• KOS Key Object Selection
• RMIM Refined Message Information Model (HL7
  Version 3)
• SOP Service Object Pair
• SR Structured Reporting
• WADO Web Access to DICOM Persistent Object
  (DICOM Part 18)

• 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

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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)