Abstract
In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user’s ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption—when a user views a patient’s images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability—as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy—as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.
Highlights
Enterprise imaging is at an early crossroads
For enterprise imaging to grow in an organized manner, we believe that standard metadata elements populated with
Mature acquisition and storage systems may automatically apply the appropriate standards, but less mature devices and applications may rely on the end-user to assign metadata data elements to newly created data
Summary
Enterprise imaging is at an early crossroads. The ability to share medical images meaningfully between entities, or even internally within an entity, is dependent on a common language. In our nasopharyngeal carcinoma clinical use case, most imaging studies would be identified using the same Anatomic Region Sequence data element value of Head and Neck. An emergency medicine nurse may take this type of photograph to show how a single traumatic event, such as a gunshot, affected both structures In this case, there may be no appropriate single coded term to use in the Anatomic Region Sequence data element. The major challenge with this potential solution is the same as identified for the single photograph with multiple contiguous body parts scenario, namely, the need to use concepts drawn from a system with a robust ontology that defines the structural relationships between body parts In this vascular malformation use case, the most appropriate Anatomic Region Sequence data element for the study would be the “upper limb”. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
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