DICOM SR

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DICOM SR

• Requirements
• Applications
• Benefits

W. Dean Bidgood, Jr., M.D., M.S.
SR Data Solutions, Inc. www.srdata.com (919)
806-2220
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No report is unstructured.
But not all reports are effective ..
A picture is worth a thousand words Knowledge
is valuable Dont waste it.
Its time for DICOM SR
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With SR, Useful Structure is Available

• User decides how much structure to use

and precisely controls (with templates) not only
the type of content

• But also the degree of OPTIONALITY

• And the MODE OF EXPRESSION

where required
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SR Distinctives

• DICOM base

• Simple entry point

• Supports high-end applications

• Practical approach to codes and terminology

• Availability (trading partners)

• The model is the message

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Simple Entry Point
Title and text Links to images . But also
supports advanced applications
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DICOM Environment

• Unique object identifiers

• Persistent objects

• Workflow context

• Binary data types

• Print management

• Consistent soft-copy display

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SR Highlights

• Integrate fully into the DICOM environment

• Achieved in DICOM SR

• Support measurements by imaging devices

• Achieved in DICOM SR

• Enable collaborative reporting by any number of
  persons or devices

• Achieved in DICOM SR

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SR Highlights

• Enable links to key images of any case

• Achieved in DICOM SR

• Enable links to regions of interest within images
  and waveforms

• Achieved in DICOM SR

• Template-driven content and structure

• Achieved in DICOM SR

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Customization Permitted For

• Presentation

• User interface

• Database implementation

SR PROMOTES INNOVATION AND DEFERS TO INDUSTRY
STANDARDS IN THESE AREAS
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Structured Documentation

• Forty years of progress .

, Lindberg, Hall, Pendergrass, Barnett,
Greenes, Wheeler, Simborg, Gitlin, Clayton,
McDonald, Weed, Shortliffe, Hammond, Stead, Cote,
Sowa, Bernauer, McCray, Johnson, Rector, Kuhn,
Cimino, Huff, Campbell, Bell, Kahn, Poon,
Friedman, ..

• 1960s Lab, Radiology (1969), Early SQL

• 1970s Hopkins (76), ACR-NEMA, Early SNOMED

• 1980s OBUS (82), SGML (86), HL7, UMLS,

• 1990s UltraSTAR, DICOM (93), WWW, CMT, DRML

• 2000 NEMA SR Workshop rollout of DICOM SR

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SR Applications
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Ultrasound Measurements
Immediate Need
Generate with image
LOINC codes
Spatial Coordinates
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CAD Device
Emerging application
Generate from image
BIRADS codes
Spatial coordinates
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Device Output

• Predictable content and meaning

• Measurements, codes, text

• Coordinates

• Inferences

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Numeric Measurement

• Unambiguous description

• LOINC code -- measurement name

• SNOMED code -- units

Concept Name ( LOINC )
Units ( SNOMED )
Numeric Value
NUM Content Item
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Inference Tree
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Author Thomas Kennedy
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Content Integration
Author Harry Solomon
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Miscellaneous Documents

• Intradepartmental messages

• Teaching files

• Quality control (e.g. densitometry, floods, .)

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Interpretation
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Link Features to Description
New nodule superimposed with right fourth rib
10 PTX
Cavitation
Free air
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Whos talking?
Who said what
Persons and/or devices
DIRECT or QUOTED
OBSERVER CONTEXT
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How good is the evidence?
Source (Study Instance UID)
CURRENT or OTHER
Audit trail
PROCEDURE CONTEXT
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What are they talking about?
Patient? Data? Procedure?
Mother? Twin A? Twin B?
Slide block
, cut
, stain
, re-stain
OBSERVATION SUBJECT
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What is being said?
Document title
Heading for type of content
Concept name (coded label)
OBSERVATION CATEGORY
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Anywhere in the document
WE KNOW
Whos talking
Source of evidence
Subject and scope talked about
Category of information
OBSERVATION CONTEXT
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Accountability
Referring physician and request
Status (COMPLETE, VERIFIED)
Verifying Observer, organization
Evidence checklist CURRENT, OTHER
ADMINISTRATIVE CONTEXT
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Delivery to Point of Care

• DICOM SR Documents in database
• DICOM to PACS workstations
• Web to enterprise

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Analysis
Scientific research
Education and training
Clinical trials
Performance evaluation
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Databaseable Reporting
Chuck Thomas coined this term

• Share knowledge

Enhance understanding in consultation
Increase effectiveness
Say it once!
Re-use clinical findings for training
Increase efficiency

• Evaluate

Improve outcomes