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MINUTES
DICOM WORKING GROUP TWENTY
(Integration of Imaging and Information Systems)
and
HL7 IMAGING INTEGRATION WORK GROUP
Jan. 18-19, 2012
San Antonio, Texas
Members Present
Represented by
ACR
GE Healthcare
Philips Healthcare
Siemens Healthcare
Kahn, Charles
Solomon, Harry
Loef, Cor
Koenig, Helmut
Members Absent
Voting Representative
Merge Healthcare
Cowan, Ron *
Others Present
Affiliated with
Garriott, Teresa
Martin, Michael
Vastagh, Stephen
Medical Network Integrators
Clemson University
MITA
Presiding Officers:
Helmut Koenig, Co-Chair
Harry Solomon, Co-Chair
* Not counted toward quorum
Preliminary Events
The Members identified themselves and their employers.
The Agenda was approved; the Secretary reviewed the antitrust rules.
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1. Joint Meeting with Orders and Observations (O&O) Work Group
WG-20/IIWG joined the HL7 Orders and Observations Work Group and the HL7 Anatomic
Pathology Work Group for a joint meeting, which was called to order at 9 am on January 18.
The joint meeting was hosted by O&O WG, and therefore its minutes are official.
Unique Specimen Identifier
APWG is sponsoring this project, cosponsors are OOWG and IIWG. A universally unique
identifier is proposed to identify every anatomic pathology specimen for managing workflow,
including use outside of the laboratory where it was originally labeled.
Other interested parties include CLSI, GS1, DICOM WG-26, and IHE.
A Project Scope Statement prepared by APWG was discussed, and revised into separate projects
for both an informative Domain Analysis Model, and a normative track Standard. OOWG voted
to cosponsor the informative DAM project. APWG will continue to develop the normative track
Project Scope Statement, which will be presented at a later time.
Radiology/Surgery/Pathology Workflow Integration Project
This project is going to create a guide/white paper on integrating pathology and imaging
workflow, such as receipt of order for biopsy, collection of specimen and associated imaging
procedures. The groups decided to start a series of joint conference calls after the HL7 WGM
meeting to discuss those topics.
H. Solomon reported on an informal meeting on January 16 of an ad hoc group looking at
clinical flow cytometry standards. They are looking at work that needs to be done across many
standards bodies, including DICOM, HL7, ISAC, LOINC, and IHE. More information is
available through their Google Group http://groups.google.com/group/clinicalflowstandards.
2. IIWG/DICOM WG-20
2.1
The Roster of WG-20 was reviewed. No changes were proposed.
2.2
Helmut reported that Imaging Integration was moved from the Domain Experts
Steering Committee to the Structure and Semantic Design Steering Division in order to
accommodate Clinical Genomics in the Domain Experts Steering Committee.
2.3
H. Solomon reported further on the clinical flow cytometry (FC) meeting of
January 16. FC professionals are increasingly interested in standards implementation.
The consensus at the January 18 meeting was for FC files to be able to be encapsulated in
DICOM to take advantage of the DICOM infrastructure capabilities (persistent object
storage, query/retrieve, interchange). New SOP Classes are needed for the DICOM
wrapper. The subject FC files are stable; they have been in use since the 1990’s. This
implementation would allow a common infrastructure to serve the radiology and
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pathology departments. One FC evidence document is generally produced as PDF, and
DICOM has an SOP Class for wrapping PDF. New modality code needs to be assigned
for flow cytometry.
Conclusion:
A DICOM Work Item should be put forth by WG-26 for encapsulating FC
documents.
It was further stated that IHE Lab profiling of HL7 v.2, which would be used for FC lab
device workflow, should be assured to be a sufficient alternative to Modality Work List
and MPPS. LOINC Codes for flow cytometry need to be reviewed for use in workflow
management.
2.4
Strategy Document
II/WG-20 Strategy Document was updated to read:
Scope:
Development of DICOM and HL7 standards for image-related information for areas where the consistent use of
HL7 and DICOM is of prime concern, and for the coordination and mutual education and understanding between the
HL7 and DICOM organizations and their technical committees/working groups.
Roadmap:
 Contribute to HL7 Reference Information Model (RIM) any additional classes or attributes needed for
representing DICOM information model.
 Work with the Structured Document Technical Committee to develop document description for SR, resulting in
the mapping of DICOM SR objects into CDA Level 3 documents.
 Develop messages supporting Imaging Integration
Short-Term Objectives:
 Modeling DICOM concepts in the HL7 Reference Information Model.
 Participation in HL7 Version 3 development to maximize compatibility between HL7 and DICOM.
Current Status:
 DICOM Supplement 150: “Radiation Dose Summary Information in Radiology Reports” was approved final
text in August 2011
 DICOM Supplement 135: “SR Diagnostic Imaging Report Transformation Guide” was approved final text in
August 2010
 HL7 CDA R2 Procedure Note Implementation Guide has been released by HL7 as DSTU in July 2010
 HL7 CDA R2 Diagnostic Imaging Report Implementation Guide has been released by HL7 in March 2009
 HL7 V3 Normative Edition 2008: Common Message Element Types COCT_RM830110UV
(A_DicomSequence minimal) and COCT_RM830120UV (A_DicomCompositeObjectReference minimal) have
been approved by ANSI. The patterns can be used to reference DICOM composite objects from HL7 V3
messages and CDA release 2 documents.
 DICOM Supplement 101: “Structured Document Object References” has been approved final text on June 15,
2005.
 CDA Release2: Received approval from the American National Standards Institute (ANSI) in May 2005.
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
HL7 V2.5: Imaging Order (OMI) and Response Message (ORI) were approved as an ANSI Standard in 2003.
Current Work Items:
 HL7 activities:
o Radiology/Surgery/Pathology Orders Workflow Project (Develop an implementation guide for
anatomic pathology orders that better captures data from the surgical or interventional radiology
procedure that produced the specimen.)
o Co-sponsor of CDA Implementation Guide Consolidation Project that is initiated by the HL7
Structured Documents WG
o Work with the Orders/Observations TC on HL7 V3 Imaging Order and Results Messages and
Workflow Model for Cross-Departmental Communication of Task Information
o Update DICOM object reference CMET A_DicomCompositeObjectReference minimal
(COCT_RM830120UV05 Release 2) to harmonize it with the HL7 V3 assertion pattern after release of
HL7 V3 Data Types R2
2. DICOM activities:
o Work with DICOM WG8 on DICOM Supplement 155 “Templates for Imaging Procedure Reports
encoded in CDA”
Risks:
Linking goals to related efforts in HL7 exposes us to delays over which we may have limited control.
3.
Joint Mtg with Structured Documents WG (SD)
WG-20/IIWG joined the HL7 Structured Documents Work Group for a joint meeting. Formally,
the joint meeting was hosted by SDWG, and therefore its minutes are official; a summary of the
discussion is provided here.
H. Solomon reported on the Project for Radiology Reports – CDA: there are now 141 Clinical
Templates developed by an RSNA Task Force on Clinical Initiatives. They are now to be
transformed into CDAs.
C. Kahn, Vice Chair of the RSNA Task Force explained the radiology report templates, which
describe clinical content. The purpose of RSNA is to move radiologists toward structured
reporting. This is not yet implemented.
Members of SD asked how RSNA Radiology Report Templates fit in CDA. H. Solomon
projected Sup. 155 Fig. 1 to illustrate the linkage. The focus is on meta structures for radiology
report templates that can be mapped to CDA.
CDA Consolidation:
H. Solomon congratulated the Structured Documents Work Group for accomplishing CDA
consolidation (the guide is about 500 pages.) The next work is on meta structures for radiology
reports that can be mapped to CDA.
4. IIWG/DICOM WG-20-Continued
4.1
The Group discussed at length the Radiology-Pathology Workflow including the
CAPRIT project (a federally funded project on improving work and information flow
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between radiology and pathology for cancer reporting). A flowchart of a biopsy was
discussed. It was noted that currently no data are collected on thyroid lumps or on
prostate biopsies.
4.2
The Group next discussed at length the Contrast Agent administration work flow
recognizing that a DICOM Ad-Hoc Group of WG-06 started to work on a Supplement to
the DICOM Standard. WG-20 analyzed contrast information communication between
imaging and clinical information systems.
Since HL7 and DICOM standards as well as IHE profiles are involved, there is a need to
clearly define the scope of WG20 activities in that field in order to avoid duplicate
efforts..
H. Solomon noted that a set of DICOM services (queries for contrast agent information,
request for approval, and notification of administration) was defined about 5 years ago
but there was no implementation.
4.3
“Goldminer” – ARRS (American Roentgen Ray Society) – Research Service
http://goldminer.arrs.org/home.php
C. Kahn demonstrated and explained the ARRS service. He illustrated the capabilities of
this search and reference feature that is a most powerful clinical search feature for
medical images and allows time-saving access to several journals’ full text articles.
4.4
Reference was made to the HL7 Chapter in “Informatics in Medical Imaging” .
The chapter was contributed by the Co-Chair of WG-20, Helmut Koenig.
http://www.crcpress.com/product/isbn/9781439831243;jsessionid=7Li4WZFep9UGDBp
Ngvx1cg**
5. New Business
No new business was discussed during this meeting.
6. Future Meetings
The next meeting will be held in Vancouver, B.C. Canada, on May 16-17, 2012.
The following meeting will be held in Baltimore, MD the week of September 10, 2012
7. Adjournment
The meeting was adjourned at 12:30 p.m. on Thursday, Jan. 19, 2012.
Reported by:
Stephen Vastagh, Secretary
2012-02-03
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Reviewed by Counsel:
CRS 2012-02-03
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