1、Application of DICOM Structured Report,Andrei LeontievDynamic Imaging,April 1, 2005,DICOM Seminar Singapore 2005,DICOM Structured Report,Encoding for structured observations Universal mechanism Generic Applications Basic Text, Enhanced, Comprehensive Specialty Applications Key Object Selection CAD,
2、US measurements, Patient Relevant Information Query,Encoding of Structured Reports,April 1, 2005,DICOM Seminar Singapore 2005,SR Intent,Support measurements by imaging devices Enable collaborative reporting by any number of persons or devices Enable links to key images Enable links to regions of int
3、erest within images and waveforms Template-driven content and structure,April 1, 2005,DICOM Seminar Singapore 2005,Simple Example of SR,Shows example of simple diagnostic report Multi-level structure Text, codes, pointers to images,April 1, 2005,DICOM Seminar Singapore 2005,April 1, 2005,DICOM Semin
4、ar Singapore 2005,Report of Chest X-Ray (PA and LateralViews)Patient Jane Homer Study # 123456 Recorded by Dr. John SmithThe finding is a mass measuring 1.3 cm in diameter with an infiltrative margination.The baseline image is shown atConclusions The conclusion is a probable malignancy, inferred fro
5、m the infiltrative margination of the mass and the appearance shown by the best illustration of findings.Specific Image Findings The best illustration of findings is,(Click to view),(Click to view),Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Chest X-Ray has concept modifier Views=P
6、A and Lateral Recording Observer=SmithJohnDr Study Instance UID =1.2.3.4.5.6.7.100 Patient-Data-Acquisition-Subject=HomerJane Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4.2) Baseline Image Conclusionsconclusion=probable malignancyinferred from 1.4.2inferre
7、d from 1.7.1 Specific Image Findingsbest illustration of findings(1.7.1).,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Chest X-Ray has concept modifier Views=PA and Lateral Recording Observer=SmithJohnDr Study Instance UID =1.2.3.4.5.6.7.100 Patient-Data-Acquisition-Subject=HomerJan
8、e Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4.2) Baseline Image Conclusionsconclusion=probable malignancyinferred from 1.4.2inferred from 1.7.1 Specific Image Findingsbest illustration of findings(1.7.1).,“contains” relationship not shown,Slide by D. Clun
9、ie,April 1, 2005,DICOM Seminar Singapore 2005,Chest X-Ray has concept modifier Views=PA and Lateral Recording Observer=SmithJohnDr Study Instance UID =1.2.3.4.5.6.7.100 Patient-Data-Acquisition-Subject=HomerJane Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4
10、.2) Baseline Image Conclusionsconclusion=probable malignancyinferred from 1.4.2inferred from 1.7.1 Specific Image Findingsbest illustration of findings(1.7.1).,Concept Name /Value pairs used,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Chest X-Ray has concept modifier Views=PA and L
11、ateral Recording Observer=SmithJohnDr Study Instance UID =1.2.3.4.5.6.7.100 Patient-Data-Acquisition-Subject=HomerJane Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4.2) Baseline Image Conclusionsconclusion=probable malignancyinferred from 1.4.2inferred from
12、1.7.1 Specific Image Findingsbest illustration of findings(1.7.1).,Concept Name without a value used as a heading (container),Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Chest X-Ray has concept modifier Views=PA and Lateral Recording Observer=SmithJohnDr Study Instance UID =1.2.3.4
13、.5.6.7.100 Patient-Data-Acquisition-Subject=HomerJane Finding=Mass has properties diameter=1.3 cm has properties margination=infiltrative (1.4.2) Baseline Image Conclusionsconclusion=probable malignancyinferred from 1.4.2inferred from 1.7.1 Specific Image Findingsbest illustration of findings(1.7.1)
14、.,Concept Name without a value used as Purpose of Reference for IMAGE, SCOORD,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,CODE,SCOORD,CODE,“Chest X-Ray”,“Recording Observer”=“SmithJohnDr”,“Study Instance UID .”=“1.2.3.4.5.6.7.100”,Context,“ Acquisition Subject”=“HomerJane”,“Finding
15、”=“Mass”,Contains,“Baseline”=,Contains,“Conclusions”,Contains,“Specific Image Findings”,Contains,“Views”=“PA and Lateral”,Modifier,Context,Context,“diameter”=“1.3” “cm”,Properties,“margination”=“infiltrative”,Properties,“conclusion”=“probable malignancy”,Contains,“best illustration of findings”=,Con
16、tains,Seld From,Infd From,Infd From,CONTAINER,CONTAINER,CONTAINER,PNAME,UIDREF,PNAME,CODE,NUM,IMAGE,IMAGE,CODE,1.1,1.2,1.3,1.4,1.5,1.6,1.7,1.8,1.4.1,1.4.2,1.6.1,1.7.1,1.7.1.1,1.6.1.1,1.6.1.2,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,CODE,SCOORD,CODE,“Chest X-Ray”,“Finding”=“Mass”
17、,Contains,“Conclusions”,Contains,“Specific Image Findings”,Contains,“margination”=“infiltrative”,Properties,“conclusion”=“probable malignancy”,Contains,“best illustration of findings”=,Contains,Infd From,Infd From,CONTAINER,CONTAINER,CONTAINER,CODE,1.4,1.6,1.7,1.4.1,1.4.2,1.6.1,1.7.1,1.6.1.1,1.6.1.2
18、,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,“Chest X-Ray”,“Recording Observer”=“SmithJohnDr”,“Study Instance UID .”=“1.2.3.4.5.6.7.100”,“ Acquisition Subject”=“HomerJane”,“Finding”=“Mass”,“Baseline”=,“Conclusions”,“Specific Image Findings”,“Views”=“PA and Lateral”,“diameter”=“1.3”
19、 “cm”,“margination”=“infiltrative”,“conclusion”=“probable malignancy”,“best illustration of findings”=,1.1,1.2,1.3,1.4,1.5,1.6,1.7,1.8,1.4.1,1.4.2,1.6.1,1.7.1,1.7.1.1,1,The numbering of items is implicit !,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Inheritance of Context,Observati
20、on Context includes top-level attributes of Composite IOD may be attached to root node CONTAINER is inherited along by-value relationships is not inherited along by-reference relationships may be extended (but not replaced) in children may be attached to any content item, not just CONTAINER,Slide by
21、 D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,General Patient Module:“Patient Name”=“HomerJane”“Patient ID”=“234567”“Patient Sex”=“F”“Patient DOB”=“19991109”,General Study Module:“Accession Number”=“123456”“Study ID”=“345678”,SR Comprehensive SOP Instance,Slide by D. Clunie,April 1, 2005,DIC
22、OM Seminar Singapore 2005,“Chest X-Ray”,“Recording Observer”=“SmithJohnDr”,“Study Instance UID .”=“1.2.3.4.5.6.7.100”,Context,“ Acquisition Subject”=“HomerJane”,“Finding”=“Mass”,Contains,“Baseline”=,Contains,“Conclusions”,Contains,“Specific Image Findings”,Contains,“Views”=“PA and Lateral”,Modifier,
23、Context,Context,“diameter”=“1.3” “cm”,Properties,“margination”=“infiltrative”,Properties,“conclusion”=“probable malignancy”,Contains,“best illustration of findings”=,Contains,Seld From,Infd From,Infd From,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,“Obstetric Ultrasound”,“Mother of
24、 Fetus”=“HomerJane”,“Fetus Identifier”=“Fetus A”,“BPD”=“27” “mm”,“Findings for Fetus”,Obsn Context,Contains,Obsn Context,“Gestational Age”=“16” “weeks”,Properties,Infd From,“Fetus Identifier”=“Fetus B”,“BPD”=“28” “mm”,“Findings for Fetus”,Contains,Obsn Context,“Gestational Age”=“16” “weeks”,Properti
25、es,Infd From,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,“Obstetric Ultrasound”,“Mother of Fetus”=“HomerJane”,“Fetus Identifier”=“Fetus A”,“BPD”=“27” “mm”,“Findings for Fetus”,Obsn Context,Contains,Obsn Context,“Gestational Age”=“16” “weeks”,Properties,Infd From,“Inferred from” rel
26、ationships may be by-value as well as by-reference, and are often more appropriate then “has properties” or “contains.”,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,Post-Coordination: HAS CONCEPT MOD,Elaborates on meaning of Concept Name in CONTAINER (headings) CODE, TEXT, NUM May:
27、qualify meaning further describe meaning provide translations,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,“Chest X-Ray”,“Views”=“PA and Lateral”,Modifier,CONTAINER,CODE,“Full Description”=“This is a report on a two-view (PA and lateral) Chest X-Ray examination.”,Modifier,TEXT,“Equi
28、valent Meaning in Italian”=“Radiografia del .”,Modifier,TEXT,Slide by D. Clunie,April 1, 2005,DICOM Seminar Singapore 2005,“Finding”=“Mass”,“diameter”=“1.3” “cm”,Properties,CODE,NUM,“method”=“Smith”,Modifier,CODE,Modifier,“threshold”=“75” “HU”,NUM,“Finding”=“Mass”,“diameter by Smith method 75HU thre
29、shold” = “1.3” “cm”,Properties,CODE,NUM,Post-coordinated .,Pre-coordinated .,Slide by D. Clunie,SR Applications,April 1, 2005,DICOM Seminar Singapore 2005,Three Base SR Classes,Three base SR classes are defined to allow encode any type of structured information: Basic Text SR Enhanced SR Comprehensi
30、ve SR Distinguished by Value Types and Relationships supported,April 1, 2005,DICOM Seminar Singapore 2005,SR Templates,To define appropriate structure for specialized applications, DICOM defines templates. Templates may be applied to: Generic SOP Classes (Basic Text, Enhanced, Comprehensive) Special
31、ized SOP Classes (Mammo CAD, Chest CAD Templates may be extensible and non-extensible,April 1, 2005,DICOM Seminar Singapore 2005,Evidence Documents,Storage,Storage Commitment,Query / Retrieve,April 1, 2005,DICOM Seminar Singapore 2005,Evidence Documents,Measurements and coded data DICOM SR document
32、Created by either Acquisition Modality or Workstation Produced during acquisition or post-processing workflows Interpreted along with the images,April 1, 2005,DICOM Seminar Singapore 2005,Evidence Documents Examples,Mammography CAD Chest CAD OB-Gyn Ultrasound Measurements Vascular Ultrasound Measure
33、ments Vascular Intervention Results Echocardiography Measurements,April 1, 2005,DICOM Seminar Singapore 2005,Typical Ultrasound SR,Based on one of generic SR SOP Classes Intended to precisely convey measurements and findings, relationships between them Each specialized “report” uses its own template
34、,April 1, 2005,DICOM Seminar Singapore 2005,Legend for templates,Value Type Concept Name = Value,relationship,Value Type Concept Name = Value,Value Types CONTAINER, NUM, CODE, IMAGE ,Concept Names and Values of type CODE are tripletsCode ValueCoding Scheme DesignatorCode Meaning (actually, just some
35、 text to evoke meaning to user),relationship,Value Type Concept Name = Value,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,CONTAINER Finding Heading,CONTAINER Finding Heading,Typical Top Level Template Structure,CONTAINER Document Title,CONTAINER Patient Characteristics,Template speci
36、fied title OB-GYN, Adult Echo, IVUS Ultrasound Vascular, Cath/Hemo ,TID 1002 Observation Context,CONTAINER Summary,Other Context e.g. procedure,CONTAINER ,Summary Findings,CONTAINER Findings Heading,Findings,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Document Headings,CONTAINER Hea
37、ding,Findings,CONTAINER Document Title,The heading may have semantics shared by children findings,Specific: “Exercise Challenge” Generic: “Findings”,contains,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Discrete Numeric Findings,CONTAINER Group,NUM Measurement,Diameter, Area, Volume,
38、 Blood Velocity, Indices, Ratios, Time Interval ,or pre-coordinated concept: BPD, FL ,CODE Modifier Concept,has concept modifier,CODE Modifier Concept,has concept modifier,Laterality, Finding Site, Anatomic Site Modifier, Cardiac Phase ,contains,Distributed semantics,Slide by D. Sluis,April 1, 2005,
39、DICOM Seminar Singapore 2005,Vascular Content Hierarchy,CONTAINER Anatomy,CONTAINER Findings,CODE Laterality,has concept modifier,has concept modifier,NUM Measurement,CODE Topographical Modifier,contains,contains,CONTAINER Vascular Report,Document Title,Section Heading,Group,Discrete Finding,Minimum
40、 Concepts,contains,property,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Vascular Templates,CONTAINER Findings,CODE Laterality,has concept modifier,TID 5103,Content Item Value Set,Right, Left, or Unilateral,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,TID 5104,Vascula
41、r Templates,CONTAINER Anatomy,CONTAINER Findings,CODE Laterality,has concept modifier,contains,Content Item Value Set,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,TID 5104,Vascular Templates,CONTAINER Anatomy,CONTAINER Findings,CODE Laterality,has concept modifier,CODE Longitudinal M
42、odifier,has concept modifier,contains,Optional specificity,Content Item Value Set,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,TID 5104,Vascular Templates,CONTAINER Anatomy,CONTAINER Findings,CODE Laterality,has concept modifier,CODE Branch Modifier,has concept modifier,contains,Cont
43、ent Item Value Set,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Vascular Templates,CONTAINER Anatomy,CONTAINER Findings,CODE Laterality,has concept modifier,has concept modifier,NUM Measurement,CODE Topographical Modifier,contains,contains,TID 5104,Content Item Value Set,Slide by D.
44、Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Findings Origin and Context,NUM Measurement,SCOORD,Inferred from,IMAGE,CODE,CODE,Inferred from,Equation or Table,Inferred from,has acquisition context,Image Mode Image View,CODE, TEXT,Normality, Significance Normal Range, ,has properties,Coordinates,I
45、mage,NUM,Inferred from,Numeric dependency,TID 300 Measurements,Slide by D. Sluis,April 1, 2005,DICOM Seminar Singapore 2005,Dx Reports,Based on DICOM SR Allows to include without transcription: - measurements - image links - structured content,Integrated with the imaging workflow Friendly to XML imp
46、lementations Easy to export to the EPR (HL7),April 1, 2005,DICOM Seminar Singapore 2005,Simple Structure,Minimal Structure : Coded Title and Headings Full image links from specific sections of report Observation Context (who, what, when) may be section specific,April 1, 2005,DICOM Seminar Singapore
47、2005,Added Measurements,Simply adds Measurements to Simple Image Reports,April 1, 2005,DICOM Seminar Singapore 2005,Key Object Selection Documents,Initiated by the desire to have simple Key Image Note Developed as generic “manifest” collection of pointers to images (or even specific frames) Specifie
48、s intent of selection, simple textual note Non-extensible template,April 1, 2005,DICOM Seminar Singapore 2005,for referring physician Here you can see the renal osteopathy.,For teaching Fibroosteoclasia,April 1, 2005,DICOM Seminar Singapore 2005,Different notes on different images,Same note on different images,April 1, 2005,DICOM Seminar Singapore 2005,Title of KOSD is a Code,The note title defines the semantics of the reason of significance.Key Image Notes can be queried by code.The user comments are meant to be informal.,
