DICOM Strategy

1
DICOM Strategy

• Cor Loef
• co-chair DICOM WG10Strategic Advisory Committee
• Philips Medical Systems

2
Contents

• Scope of DICOM
• Charter WG10 Strategic Advisory Cmt
• Trends in Imaging-IT
• Strategy Planning process
• Collaboration with other SDOs

3
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

4
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_strate
  gy
• 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

5
Overview

• Scope of DICOM
• Charter WG10 Strategic Advisory Cmt
• Trends in Imaging-IT
• Strategy Planning process
• Collaboration with other SDOs

6
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.
7
(No Transcript)
8
Trends in Imaging-IT
Active workflow
Paradigm shift
9
Vertical Integration
The Healthcare Enterprise
10
Active Workflow
11
Workflow in Radiology
Digital Radiology
12
Active Workflow
Personalized Work list For each user
13
Users default display protocol
14
Paradigm shift in PACSClinical Applications to
PACS

• Yesterday

15
Multi-slice CT 1000 images
16
Post-Processing everywhere

• Viewing Advanced Image Processing
• clinical SW packages
• move towards modalities, PACS and web

3D
Spine
Cardiac MR
Endo3D
17

• Analysis tools to enhance clinical decisions
• Echo measurements calculations
• Left Ventricular Analysis
• Quantitative Coronary Analysis
• Vascular X-Ray Analysis
• Vascular X-Ray Post-Processing

18
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
19
Horizontal Integration

• Image (information) management system supports
  archiving/retrieving of all types of clinical
  objects (incl. visible light) and Structured
  Reports

20
DICOM SR Creation - Example -Radiology
Image data
(Pointer)
from PACS
select
Coding Schemesbehind pop-up menus
21
Web based PACS
22
Web and Security
Web Viewer
Webserver
Security
PACS Viewing Station
At Modality
23
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 patients 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

24
EHR Visual Integation
Efficiency
Improve Clinical Decisions
25
Overview

• Scope of DICOM
• Charter WG10 Strategic Advisory Cmt
• Trends in Imaging-IT
• Strategy Planning process
• Collaboration with other SDOs

26
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

27
The (multi-vendor) Integrated Imaging Solution
Connection to other Network and/or TeleCardiology
Image Server
Department Info Server
Image Archive
CD Exchange
Diagnostic Workstation
28
Reduce Errors
Codes and vocabularies
Codes and vocabularies
Persistent Object Ref
Structured Presentation
29

• 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

30

• 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)

31

• 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.

32

• 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?

33

• 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

34

• Topics in Result Distribution domain
• DICOMs document paradigm Persistent Object
  Reference
• Exchange information outside the DICOM domain
• HIPAA, Privacy, Security, Authentication, VPN
• CD/DVD for exchange

35
The distribution problem
HIS
Other Clinical System
RIS
Cardiology PACS
VL, US, NM PACS
Electronic Patient Record
URL/URI?
Webserver
Web Viewers
36

• 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

37
Strategic planning process

• 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.

38
Strategic planning process

• 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.

39
Strategic priorities
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
40
Overview

• Scope of DICOM
• Charter WG10 Strategic Advisory Cmt
• Trends in Imaging-IT
• Strategy Planning process
• Collaboration with other SDOs

41
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.

42
IHE - Integrating the Healthcare
EnterpriseReducing 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.

43
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 DICOMs 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

44
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.