Current Status and Role in the Electronic Patient Record
Harry Solomon
Co-chair, DICOM WG1 - Cardiovascular Information
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 1

• A means of encoding structured information …
• hierarchical tree of content items, using DICOM object syntax
• For vendor-independent exchange between systems …
• leveraging the DICOM object management infrastructure
• Providing unambiguous documentation of meaning …
• text, categorical codes, numeric measurements, inter-item relationships
• For the image-intensive clinical environment
• careful attention to clinical observation context
• robust references to DICOM images, waveforms
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 2

• DICOM SR is not just “reports”
– any structured data exchanged between systems
– measurements, analyses, sonographer notes ...
• DICOM SR is not Structured Data Entry
– Hierarchical pull-down menus to support report creation is often denoted “structured reporting”
– DICOM does not standardize applications or data entry techniques
– Structured data entry is a valuable means of creating SR content in certain circumstances
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 3

• Clinical Reports (cath, echo, nuc, etc.)
– to go along with our pretty DICOM pictures
• Analyses of raw image and waveform data
– backing up the Clinical Report
• Documentation of the procedure
– provide context for the raw data and analyses
• Input to a clinical database
– for patient care over time, or outcomes analysis
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 4

Cath Lab Report
Patient
67 yr old male, history of …
Ref prior ECG report
Procedure
Ref Log
Narrative ...
Findings
Hemodynamic
Ref HD Report
Narrative ...
Angiographic
70% stenosis ...
Ref image
Intervention
Stent placed in LAD …
Ref image
Complications
Summary
12:21 Pt released to holding
12:24 HD Report
Hemo Report
Baseline
Ref waveform
Measurements …
Post-intervention
Ref waveform
Measurements …
Derived measurements
Ref waveform

Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 6

• Work began in 1994
– Championed by Dr. Dean Bidgood
• Supplement 23: Structured Reporting -
April 2000
– Defined general format for SR objects
• DICOM header, hierarchical tree of content items
• Concepts represented by coded terminology using external
(non-DICOM) lexicons [e.g., Reed codes, SNOMED anatomy,
ICD-9/10 diagnosis or procedure codes, SCP-ECG lead IDs]
– Defined general classes of clinical reports
– Extremely flexible
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 7

• A document creator can put in anything in any structure
• A document reader must handle every possible document
• Need to constrain the SR content to enable meaningful receiving applications
– Structure
– Content
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 8

• Supplement 53: Content Mapping Resource May
2001
– Defined general structure for templates : document patterns
– Mechanism for terminology context groups : constrained vocabulary subsets
– Fundamental templates for documenting clinical context and for basic reports
– DICOM lexicon for vocabulary not externally available
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 9

• DICOM Structured Reporting is ready to be implemented for cardiology!
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 10

• Uses not well covered by “clinical report” model
– Procedure logs, preliminary measurement reports
• Many ways to encode the same information
– Need consistent approach for interoperability
• Need tailored subset of SR for developers
– Reduce the learning curve
Need Cardiology-specific SR Templates and consensus Terminology
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 11

• Supplement 66: Cath Lab SR (WG1)
– Procedure Log
– Hemodynamics Report
– ECG Report
– Quantitative Analysis Report
– Cath Lab Report
• Supplement 26: Ultrasound SR (WG12)
– Echocardiography Report
• Both to be released for Public Comment this autumn
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 12

• Structure - flat
• Ordering - strictly time sequential
• Linkage of events - associative Procedure Step /
Action ID
• SOP Class - distinct from reports
• Remote entries - new Application Event Logging
Service Class
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 13

• SOP Class - Cath Lab Measurements (together with QCA, QVA, IVUS measurements, etc.)
– Distinction from report titles
• Structure - deep hierarchy
• Terminology - post-coordinated, context from hierarchy
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 14

Hemo Report
CONTAINER
Baseline Phase
CONTAINER
Patient State
CONTAINER
Post-Contrast Phase
CONTAINER
Patient State
CONTAINER
Post-Intervention Phase
CONTAINER
Arterial Measurements
CONTAINER
Anatomic
Location =
L Fem Art
Systolic Pres
Diastolic Pres
Mean Pres
Arterial Measurements
CONTAINER
Anatomic
Location =
Aorta
Systolic Pres
Ventricular Measurements
CONTAINER
Diastolic Pres
Mean Pres
Gradient Measurements
CONTAINER

• http://www.pixelmed.com/srbook.html
– David Clunie’s excellent introduction to DICOM SR
• ftp://medical.nema.org/medical/dicom/supps
– text of draft supplements
• http://www.dicomwg12.org/structured_reporting
– echocardiography SR
• subscribe to WG1 email list
– send request to how_clark@nema.org
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 16

Questions?
mailto://harry.solomon@med.ge.com
Solomon, DICOM SR European Society of Cardiology 2 September 2001 page 17