Title: DICOM Working Group 10 London, 23 June 2003 Integrating Imaging and Reporting using DICOM SR and HL7
1DICOM Working Group 10London, 23 June
2003Integrating Imaging and Reporting using
DICOM SR and HL7 CDA
- Fred M. Behlen, Ph.D.
- Co-Chair, DICOM WG20 / HL7 IISIGMember, HL7
Structured Document TC
LAItechnology
Longitudinal Application Integration Solutions
for Health Records
2Use Cases for CDA inDICOM Application Domains
- Report created in DICOM SR, transformed to CDA
for export - Report created in CDA, including image references
and annotation - DICOM evidence production requires input from
external CDA documents - Imaging application needs to present rendered CDA
content
31. Report created in SR, trans-formed to CDA for
export
- SR Reporting application tightly integrated with
image viewing and annotation application - CDA document references SR source document
- Need
- SR-to-CDA standards and tools
- Constraints on SR for reliable transformation
- Trial transformations of existing SR Templates
- Rules defining boundaries for new templates
- Robust CDA reference pointers to DICOM objects
(WADO DIMSE access)
42. Report created in CDA
- Image viewing and CDA reporting may be different
applications, on the same or different platforms - Reporting including image references and
annotation is done in CDA document - Reporting application may require access to DICOM
SR evidence documents - Potential encapsulation of CDA in DICOM for
management with other DICOM objects? - Need
- Messaging between image viewing and CDA reporting
application - Robust CDA reference pointers to DICOM objects
(WADO DIMSE access)
53. Import CDA data for DICOM evidence production
- CDA Structured content needs to be imported into
DICOM application - Requires a query and retrieve mechanism from
DICOM appli-cation to CDA repository (crosses
DICOM/HL7 boundary) - May overlap with Relevant Patient Information
Query - CDA content may include image references
- Need
- May not require additional standards work if RPIQ
is used - If RPIQ is not used, then need to define Q/R
mechanism and possible encapsulation in DICOM
environment - Even if RPIQ is used, Query/display may be
required - Need to define templates for specific content
extracts from CDA
64. Display rendered CDA
- CDA content not required in DICOM application
- Requires a query/display mechanism from DICOM
application to CDA repository - CDA content may include image references
- Need
- Query facilities already planned as IHE CDA
Query/Display - Display may need to extract DICOM image reference
and annotation from CDA document for rendering in
diagnostic quality display
7Use Cases for CDA
- Report created in DICOM SR, transformed to CDA
for export? Subspecialty domains only - Report created in CDA, including image references
and annotation - DICOM evidence production requires input from
external CDA documents? May be served by RPIQ - Imaging application needs to present rendered CDA
content ? No additional standards work required
8CDA Reporting Integration
- Create authenticated reports directly in target
format - CDA Release 2 (first committee ballot August
2003) has equivalent of DICOM SCOORD and image
referencing - Image viewing and reporting done in different
appli-cations, on same or different (adjacent)
platforms - Network communications model serves both cases
9CDA Reporting Integration
Communications over TCP/IP(to server if
Web-based)
Image Viewing Application
Reporting Application
Measurements, Annotation
Display control optional (User, Patient and
Exam context)
10CDA Reporting Integration
Communications over TCP/IP(to server if
Web-based)
Image Viewing Application
Reporting Application
Measurements, Annotation
Display control optional (User, Patient and
Exam context)
- Display control.
- Use CCOW?
- DICOM Normalized Services?
- OLE automation?
- Special-purpose XML messaging?
- Measurements and Annotation
- DICOM Application Event Notification Service
(Supp. 66)? - HL7 V.3 Messaging?
- Special-purpose XML messages?
11Display control optional
- CCOW
- Expensive
- High entry level
- DICOM Normalized Services
- New standards development
- Costly implementation
- Requires reporting vendor to adopt and support
DICOM protocol stack and tools - OLE Automation
- Microsoft Windows only
- May not work / security problems over network
- Special-purpose XML messaging?
- New to DICOM, but IHE audit trail uses similar
approach - Uses same connection as XML measurement/annotation
12Measurements Annotation
- DICOM Application Event Notification Service
(Supp. 66)? - Annotation in SR document fragments
- Costly implementation on reporting system end
- Requires reporting vendor to adopt and support
DICOM protocol stack and tools - HL7 V.3 Messages?
- Standards development required, not really HL7
application domain - Special-purpose XML messaging?
- Annotation in CDA document fragments
- New to DICOM, but IHE audit trail uses similar
approach - Uses same connection as XML measurement/annotation
13Special-purpose XMLmessaging?
- Point-to-point TCP/IP socket connection
- Could be secured using TLS Record Layer Protocol
if desired - W3C XML Schema validation of messages
- Single Schema for messages in each direction
- Event notification function only, minimal
protocol overhead - Instance UID allows receiver to ignore duplicate
sends, but otherwise no flow control
14Conclusion Viable Protocols
- DICOM Normalized services
- Standards exist (Supp. 66) for event logging
- Standards development
- SR root templates for annotation measurements
- SR-to-CDA mapping for annotation measurements
- CDA Diagnostic Imaging Report document
specification - Special-purpose XML protocol
- Standards development
- XML message schemas for annotation measurements
- Socket transport specification
- CDA Diagnostic Imaging Report document
specification - ? More work for standards developers, less work
for implementers
15Open Issues
- If XML protocol, where would it go in the
Standard? - A new Part?
- An Annex?
- Where would the CDA Imaging Report document
profile go? - The IHE Technical Framework?
- An HL7 Informative Document?
- To become a balloted Template when (someday) HL7
Templates are available? - A DICOM standard?
16A Possible Schedule
17Accelerated Schedule