Meeting Minutes
for the
DICOM WG-09 Meeting
Friday, 10/15/10
Hyatt McCormick Place Hotel
Chicago, IL
Attendees:
Noam Allon
Lloyd Hildebrand
Yijun Huang
Daniel Ache
Rich Amador
Italo Assudillo
Anthony Vipas Das
Michael Boland
Rick Butler
Cheng-Ning Cheng
Michael Chiang
Edmund Cope
Bryan Farrell
Tom Gettelfinger
Cameron Gibson
Gidi Goren
Rajiev Grover
Shagun Grover
Mark Horton
Chris Johnson
Artur Kowalski
Tobias Kurzke
Paul Latkany
Matthias Monhart
Michael Neider
Rik Neigebauer
Rob Orsino
Ben Pasantino
Najhi Rahman
Michael Reutter
Jim Riggi
Alzanmbi Saed
Vendor Co-Chair of WG9, Ophthalmic Imaging Systems
Clinical Co-Chair of WG9
University of Wisconsin, Madison Reading Center
Oculus Optigerate, GmBH
Canon Medical Systems
LV Prasad Eye Institute, Hyderabad, India
Johns Hopkins University Wilmer Ophthalmology Institute
Medflow
Accutome, Inc.
Columbia University
Optos Inc.
Memphis Eye and Cataract
Canon Medical Systems
Lumenis
University of Florida
TSG Integrations
Indian Health Service
University of Iowa
Topcon Medical Systems
Carl Zeiss Meditec
Clinical academic informatics
Haag-Streit
University of Wisconsin Reading Center
Softouch
Topcon Medical Systems
ifa systems
Heidelberg Engineering
Medflow
1
Peter Scherer
Joe Warnicke
Linda Wedemeyer
Katrina Winter
Stephen Zhou
Integration AG
DARC Reading Center
Department of Veterans Affairs
Duke University Eye Center
Aarenine
.
Staff:
Flora Lum
American Academy of Ophthalmology
I. Welcome and Introductory Remarks; Introduction of Participants
Dr Lloyd Hildebrand welcomed the participants. Everyone introduced themselves and
described their interest in a special interest workgroup. Dr. Hildebrand noted that there
were more clinicians involved in this meeting than in previous meetings. The
Meaningful Use incentive program has enhanced interest in this area and this will
continue to accelerate.
II. Approval of Previous Meeting Minutes
The minutes of the October 2009 WG9 meeting in San Francisco were approved.
III. Biometry Subgroup
Dr. Wedemeyer reported that the Supplement on Axial Length Measurements was
approved for final text in June 2010. To benefit clinicians, this will not only provide the
axial measurement data but also the IOL calculations. Dr. Hildebrand noted that this will
have a significant impact, given the 2.9 million cataract procedures being performed in
the United States each year. Also, this will have great utility, because axial length
measurements are needed in multiple places, e.g., operating room, patient exam areas.
Dr. Chiang remarked that these Supplements provide the vehicle to collect the data which
is the first step to creating a data source that can be used for clinical decision support to
inform decisionmaking and improve patient outcomes.
VI.
Visual Field Subgroup
Dr. Boland reported that Supplement on Visual Fields (Static Perimetry) was approved
for final text in August 2010. This will provide useful data that previously was available
mostly as a printout that needed to be scanned into the electronic health record. Dr.
Hildebrand noted that this will also have a significant impact because of the high
frequency of visual field reporting.
VII.
Ophthalmic Mapping Subgroup
2
Yijun Huang reported that this group has focused on retinal thickness mapping: a set of
measures that are distributed topographically and are typically presented in pseudo-color
representation. This is expected to go out for public comment in a couple of weeks and
be available as final text by end of summer of 2011.
Yijun Huang also reported that the Ophthalmic Thickness Mapping (OPM) Information
Object Definition (IOD) is well complement with the OPT IOD in the real-world use
case. The OPT Information Object Definition (IOD) does provide a tremendous amount
of information about the OCT image, while the OPM together with the Structured Report
for Macular Grid Thickness and Volume, covers the quantitative analysis results for OCT
macular scans. It is also noted that the OCT analysis and reporting for glaucoma
applications are not well covered comparing to those for the retinal applications.
VIII.
Adoption in the Marketplace
The group discussed at length the barriers to adoption in the marketplace. There has been
progress over the past year. Yijun Huang reported that the University of Wisconsin
Reading Center has strived to become a DICOM-centric reading center and to embrace
the DICOM standard. It was suggested that the Wisconsin Reading Center submit a
clinical paper describing the standardization of clinical images to help foster
dissemination. Jim Riggi reported that Medflow had 10 practice sites with DICOM
implementation, and another 15 sites with planned DICOM implementation. Noam
Allon noted that eventually the marketplace would sort out and DICOM integration
would be the solution, given the current legacy equipment base. It was also pointed out
that hospital IT departments are increasingly requiring DICOM capability, understanding
the need for integration.
Members of the group reported that the biggest challenge is for physicians to understand
the value of DICOM integration enough to undertake the purchase of upgraded
equipment that has this capability. The installed base of equipment consists mainly of
legacy equipment that does not have the DICOM integration capability. One option is to
provide the encapsulated pdf, which is good enough for image viewing and can enhance
workflow efficiency. However, clinicians pointed out that this is only the first step, and
most clinicians would like to go further, having the data to be able to manipulate and to
help in clinical decision making. Also, a capture station may have multiple steps
involved in obtaining the encapsulated pdf versus a more streamlined approach to obtain
the native DICOM object. This raw data is also important for meaningful use because it
can be utilized for clinical decision support. This is important for device manufacturers
because with the meaningful use incentives, there is a need to provide data to the EHR
for clinical decision support.
IV.
Summary of IHE Eye Care
3
IHE Eye Care starts with DICOM modality worklist. Images and measurements are
stored automatically along with the metadata. All of the current DICOM modalities are
supported, including ophthalmic photography, ultrasound, ophthalmic tomography,
refractive measurements, and encapsulated pdf. This means that validated patient
demographics are received electronically, eliminating errors. The format is standardized
and vendor-independent for data migration and interoperability.
This year, there are 10 vendors who participated in the October Connectathon and
Showcase, which is more than last year. There are educational materials to provide
guidance to ophthalmologists on how to specify IHE compliance and DICOM
conformance in their RFPs. A user handbook is being worked on and can be circulated to
the vendors for comment.
VIII.
New Work Items and Action Steps
The group agreed to form two new workgroups. One workgroup is to explore reporting,
led by Michael Chiang, MD. Other interested members include Ben Pasantino, Linda
Wedemeyer, MD, Mark Horton, OD, MD, Paul Latkany, MD and an individual (TBD)
from Medflow. The first item of business will be to explore different formats of
reporting, including DICOM Structured Report (SR). The clinical requirements need to
be the driver of this process but this will be technology-enabled. It was thought that the
initial reports should focus on interpretations of specific imaging modalities, i.e., a
diabetic retinopathy report based on a fundus photograph. This would be separate from
an overall clinical impression or summary report which would synthesize the patient
history, clinical findings upon examination with all of the diagnostic testing results.
Specific subgroups may be needed to tackle the different types of reports, e.g., OPT, VF,
OP, Axial Length Measurements, etc. The group believed that summary reports and
progress reports would be more difficult to tackle because of the significant need for
structured terminology and the longer standard-setting process involved in HL7.
The other workgroup is to focus on open source software development to facilitate
DICOM implementation by different vendors. This group is being led by Yijun Huang,
and other interested members include Paul Latkany, MD, Gidi Goren, Edmund Cape,
Cheng-Ning Chang and Joe Warnicke. Another possible interested individual might be
Peter Kuzmak because of his work within the VA.
Another potential work item is for OCT in glaucoma-related applications. Another
important area is for corneal topography and wavefront technology. However, these
device manufacturers are not currently represented in the WG9. Lloyd Hildebrand, MD
and Flora Lum, MD will try to identify companies and solicit their participation for the
next WG9 meeting.
IX.
Next Meetings of the Working Group 9
A. ASCRS, March 2011, San Diego
B. Friday, October 24, Academy Annual Meeting, Orlando
4
Reported by:
Flora Lum, Secretary
November 2, 2010
Reviewed by counsel:
November 3, 2010
5