International Telecommunication Union
Success of DICOM
standard
Cor Loef
Industry Co-Chair
DICOM Strategic Advisory Committee
Workshop on Standardization in E-health
Geneva, 23-25 May 2003
Success of DICOM standard
ITU-T
o
o
o
o
23-25 May 2003
Mission and goal of the DICOM
standard
Some recent new developments
View on the future of DICOM
Summary
Workshop on Standardization in E-health
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Mission and goal of DICOM
ITU-T
o Mission of DICOM
• Create and maintain international
standards for communication of
bio-medical diagnostic and therapeutic
information
o Goals of DICOM
• Achieve interoperability and improve
workflow efficiency between imaging
systems and other information systems
23-25 May 2003
Workshop on Standardization in E-health
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Some recent new developments
ITU-T
o 16 parts of official DICOM 2003 edition
available at: http://medical.nema.org
o Security
• De-identification, Clinical Trials
o Applications of structured reporting
(DICOM SR) – Evidence documents:
• Chest CAD
• Cath Lab Reporting
• OB-GYN, Vascular US, Echocardiography
23-25 May 2003
Workshop on Standardization in E-health
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Some recent new developments
ITU-T
23-25 May 2003
o New Media
• DVD-R, E-mail attachments, large
capacity MODs
o New Objects
• Multi-frame MR
• New CT, XA, VL
o JPEG 2000
o Configuration Management
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Multi-frame MR
ITU-T
o New object definition supporting latest
advancements in MR technology
o Support for very large data sets, split of
an acquisition between several multiframe objects
o New concepts – functional groups
23-25 May 2003
Workshop on Standardization in E-health
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ITU-T
Ultrasound Procedure
Reporting
o A number of supplements covering
different areas of US procedure reporting:
• OB-GYN
• Vascular
• Echocardiography
o Further advances the concept of
Evidence Documents –
objects generated by machine, that are not
images but are carrying the supplemental
coded information for the procedure to aid in
diagnosis
23-25 May 2003
Workshop on Standardization in E-health
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DICOM Object Access via Net
ITU-T
o In addition to the e-mail distribution of DICOM
objects, DICOM recently spearheaded a joint
Work Item with ISO TC215 – WADO
Web Access to DICOM Persistent Objects
• In currently prototype phase
• Will allow for web-access to images in different
formats utilizing standardized URL (HTTP-GET)
• In conjunction with standardized MIME type
allows for access using a Web Browser
23-25 May 2003
Workshop on Standardization in E-health
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ITU-T
Charter of Strategic Advisory
Committee
o To develop and maintain the long-term
strategic plan of the DICOM Standards
Committee;
o To review standards and technology trends in
healthcare, biomedical imaging, commerce,
telecommunications, and informatics;
o To consider issues and opportunities related to
the strategic evolution of DICOM;
o To provide liaison to other standards
developing organizations: ISO, HL7, JIRA, CEN.
23-25 May 2003
Workshop on Standardization in E-health
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ITU-T
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.
23-25 May 2003
Workshop on Standardization in E-health
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All relevant info accessible
ITU-T
23-25 May 2003
Workshop on Standardization in E-health
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Trends in Imaging-IT
o Horizontal
ITU-T
HIS
Other
Clinical
System
RIS
Cardiology
PACS
Radiology
PACS
o
o
o
o
Integration
Vertical Integration
Active workflow
Data explosion
Web based PACS
VL, US, NM
PACS
Web distribution
At the desktop
23-25 May 2003
Workshop on Standardization in E-health
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Vertical Integration
ITU-T
HIS
ADT
Patient Registration
Patient Registration
IMAGING:
• PACS / Archives
• Workstations
Order Placer
Image Creator
• Modalities
New Order
Image Display
The Healthcare Enterprise
Q /R
Images
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
PPS
In-Progress
/ Completed
RIS
23-25 May 2003
Storage
Commit
Images
Stored
Acquisition
Modality
Modality Worklist
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Active Workflow
ITU-T
23-25 May 2003
Workshop on Standardization in E-health
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Workflow in Radiology
ITU-T
Registration
Preparation
..010011...
..010011...
Image Distribution
..010011...
..010011...
Demonstration
..010011...
..010011...
Digital
Radiology
Reviewing
Referral
..010011...
Archiving
..010011...
23-25 May 2003
Post Examination
..010011...
..010011...
..010011...
Examination
Transcription
Workshop on Standardization in E-health
Reporting
15
User’s default display protocol
ITU-T
23-25 May 2003
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ITU-T
23-25 May 2003
Paradigm shift in PACS:
Clinical Applications to PACS
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Multi-slice CT: 1000+ images
ITU-T
23-25 May 2003
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Post-processing everywhere
ITU-T
o Viewing and Advanced Image Processing:
• clinical SW packages
• move towards modalities, PACS and web
3D
Spine
Endo3D
23-25 May 2003
Cardiac MR
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Post-processing everywhere
ITU-T
o Analysis tools to enhance clinical
decisions:
•
•
•
•
•
23-25 May 2003
Echo measurements & calculations
Left Ventricular Analysis
Quantitative Coronary Analysis
Vascular X-Ray Analysis
Vascular X-Ray Post-Processing
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Horizontal Integration
ITU-T
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
23-25 May 2003
Workshop on Standardization in E-health
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Horizontal Integration
ITU-T
o Image (information) management system
supports archiving/retrieving of all types of
clinical objects (incl. visible light) and
Structured Reports
23-25 May 2003
Workshop on Standardization in E-health
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DICOM SR Creation - Example Radiology
ITU-T
RIS data
Header:
Report Creator
application
Image data from PACS
Findings:
…..
…..
Mass
…..
…..
Conclusions:
Image Refs.: (Pointer)
Diam.
Infiltr.
…..
…..
(DICOM) SR Object
Thorax
Report Type: …..
select
Coding Schemes
Report Templates behind pop-up menus
23-25 May 2003
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Web based PACS
ITU-T
Web Viewer
Webserver
PACS Viewing
Station
At Modality
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Web and Security
ITU-T
Web Viewer
Webserver
Security
PACS Viewing
Station
At Modality
23-25 May 2003
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“Electronic Health Record”
ITU-T
o Image Management system and Departmental
Information Systems must be EHR-prepared
(Query/Retrieve)
o EHR: emphasis today on visual integration on
the desktop, will become the integrated,
secure, patient centric, source of health
information
o Need for coded vocabularies to represent
medical knowledge and the patient’s health
condition
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“Electronic Health Record”
ITU-T
23-25 May 2003
o 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
ITU-T
Efficiency
Back-Office
Clinical
Information
System
messages
Clinical
Information
System
Integrated
Clinical Viewing
at the desktop
Front Office
23-25 May 2003
Workshop on Standardization in E-health
Improve
Clinical
Decisions
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Summary
ITU-T
o DICOM is well positioned to continue to
serve integration needs of medical
imaging, including workflow, evidence
information recording, effective access
to imaging results in the enterprise
o Active cooperation with other standards
assures DICOM objects integration into
future EHR – whether by reference, or
through well-defined trans-coding
mechanisms.
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