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DICOM Strategy

Cor Loef
co-chair DICOM WG10:Strategic Advisory Committee
Philips Medical Systems

Contents

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

December5,

IHE @ RSNA 2002

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
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IHE @ RSNA 2002

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_strategy
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
December5,

IHE @ RSNA 2002

Overview

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

December5,

IHE @ RSNA 2002

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.

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IHE @ RSNA 2002

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Trends in Imaging-IT:
Other
Clinical
System

HIS

Horizontal Integration
Vertical Integration
Active workflow

RIS

Paradigm shift
Web based PACS

Cardiology
PACS

Radiology
PACS

VL, US, NM
PACS

Web distribution
At the desktop
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IHE @ RSNA 2002

Vertical Integration
HIS

ADT
Patient Registration

IMAGING:
PACS / Archives
Workstations
Modalities

Patient Registration

Order Placer

Image Creator

New Order

Image Display
TheHealthcareEnterprise

Department
System Scheduler
Order Filler

Proced
ure

Schedu
le

Q /R
Images

Image Archive

Image Manager

PPS
In-Progress
/ Completed

RIS

Storage
Commit

Images
Stored

Acquisition
Modality

Modality Worklist

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Active Workflow

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Workflow in Radiology
Registration

Preparation

..010011...

Post Examination

..010011...

Referral

Archiving

..010011...

..010011...

Image Distribution

December5,

..010011...

Demonstration

..010011...

..010011...

Digital
Radiology

Reviewing

..010011...

..010011...

..010011...

Examination

..010011...

Transcription

IHE @ RSNA 2002

Reporting

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Active Workflow
Personalized
Work list
For each user

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Users default display protocol

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Paradigm shift in PACS:


Clinical Applications to PACS
Yesterday

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Multi-slice CT: 1000+ images

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Post-Processing everywhere
Viewing & Advanced Image Processing:
clinical SW packages
move towards modalities, PACS and web
3D

Spine
Endo3D
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Cardiac MR
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Analysis tools to enhance clinical


decisions:

Echo measurements & calculations


Left Ventricular Analysis
Quantitative Coronary Analysis
Vascular X-Ray Analysis
Vascular X-Ray Post-Processing

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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

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

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DICOM SR Creation - Example -Radiology


RIS data

Header:
Thorax

Report Creator
application

Findings:

(DICOM) SR Object

Report Type:..
..
..

Mass
..
..

Conclusions:

Image data

Daim.
Infiltr.
..
..

Image Refs.:(Pointer)

from PACS
select

From DICOM
standard:

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Report Templates

Coding Schemes
behind pop-up menus

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Web based PACS


Web Viewer

Webserver

PACS Viewing
Station

At Modality
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Web and Security


Web Viewer

Webserver
Security

PACS Viewing
Station

At Modality
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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

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EHR: Visual Integation


Efficiency

Back-Office
Clinical
Information
System

messages

Clinical
Information
System

Integrated
Clinical Viewing
at the desktop
Front Office
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Improve
Clinical
Decisions
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Overview

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

December5,

IHE @ RSNA 2002

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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

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The (multi-vendor) Integrated Imaging


Solution

Image
Archiv
e

Image
Serve
r

Departmen
t
Info Server

CD
Exchange

Diagnostic
Workstati
on

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Connection
to other
Network
and/or
TeleCardiolo
gy

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Quality of Patient Care

Fast and accurate diagnosis


Effective treatment plan
Reduce Errors
Order

Codes and
vocabularies

Waveforms
Images
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Collect and present

Measurements

Codes and
vocabularies
Diagnose

Structured
Presentation
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Report

Treatment
plan
Persistent
Object Ref
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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
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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)

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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.

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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?

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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

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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

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The distribution problem


HIS

Other
Clinical
System

RIS

Cardiology
PACS

Radiology
PACS

Electronic Patient Record


URL/URI?
Webserver

VL, US, NM
PACS
Header::
Thorax
Report
Type:

..

..
..
Findings:
Mass
..
..

Daim.
Conclusions:
Infiltr.
..
Ima (Poi ..
g n
e t
e
R r
e )
f
s
.
:

Web Viewers
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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

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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.
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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.
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Strategic priorities
Radiology
Acquisition

Interpretation
Reporting

Cardiology
Acquisition

Interpretation
Reporting

Ultrasound

NM

December5,

Integration from acquisition via


presentation to interpretation and
reporting

4
Other -ologies
Archiving plus
Object management

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Overview

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

December5,

IHE @ RSNA 2002

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Standards in Imaging-IT
1. Horizontal Integration
2. Vertical Integration
3. Electronic Patient Record
4. Orders and Results
Management
5. Security
6. Freedom of Application
Workspot

DICOM
IHE, DICOM, HL7
ISO/CEN,DICOM,HL7,XML
IHE, DICOM, HL7
IHE,IETF,DICOM,HL7,ASTM
ISO/CEN, CCOW, IETF,
DICOM

When new technology is required, the strategy is to adopt proven


international, industry or de facto standards.
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IHE - Integrating the Healthcare Enterprise


Reducing 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.
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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
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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.

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