Structure Reports Research Articles

CAD–PACS integration tool kit based on DICOM secondary capture, structured report and IHE workflow profiles

Computer aided diagnosis/detection (CAD) goes beyond subjective visual assessment of clinical images providing quantitative computer analysis of the image content, and can greatly improve clinical diagnostic outcome. Many CAD applications, including commercial and research CAD, have been developed with no ability to integrate the CAD results with a clinical picture archiving and communication system (PACS). This has hindered the extensive use of CAD for maximum benefit within a clinical environment. In this paper, we present a CAD–PACS integration toolkit that integrates CAD results with a clinical PACS. The toolkit is a software package with two versions: DICOM (digital imaging and communications in medicine)-SC (secondary capture) and DICOM–IHE (Integrating the Healthcare Enterprise). The former uses the DICOM secondary capture object model to convert the screen shot of the CAD results to a DICOM image file for PACS workstations to display, while the latter converts the CAD results to a DICOM structured report (SR) based on IHE Workflow Profiles. The DICOM-SC method is simple and easy to be implemented without ability for further data mining of CAD results, while the DICOM–IHE can be used for data mining of CAD results in the future but more complicated to implement than the DICOM-SC method.

Generating XML schemas for DICOM structured reporting templates

In this paper, the authors describe a methodology to transform programmatically structured reporting (SR) templates defined by the Digital Imaging and Communications for Medicine (DICOM) standard into an XML schema representation. Such schemas can be used in the creation and validation of XML-encoded SR documents that use templates. Templates are a means to put additional constraints on an SR document to promote common formats for specific reporting applications or domains. As the use of templates becomes more widespread in the production of SR documents, it is important to ensure validity of such documents. The work described in this paper is an extension of the authors' previous work on XML schema representation for DICOM SR. Therefore, this paper inherits and partially modifies the structure defined in the earlier work.

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change.

The Interchange of Radiological Reports Using Clinical Document Architecture Standards

We developed a Clinical Document Architecture(CDA) Generator module based on CDA standard for the interchange of radiological reports. Methods: This paper describes CDA standard, the template of radiological report, CDA Generator module, and the Web-form report using an Extensible Stylesheet Language(XSL) style-sheet. And the CDA Generator module is integrated into a existing Picture Archiving Communication System(PACS) Viewer. Results: Radiological reports based on CDA standard are used to interchange between different health institutions, and also presented in an Extensible Markup Language (XML) compatible web browser. Conclusion: The proposed module and concept in this paper may be a utility in improving health care delivery and can also be used to integrate with other Digital Imaging and Communication in Medicine(DICOM) Structured Report (SR) compliant PACS systems.

Evidence and Diagnostic Reporting in the IHE Context 1

Capturing clinical observations and findings during the diagnostic imaging process is increasingly becoming a critical step in diagnostic reporting. Standards developers-notably HL7 and DICOM-are making significant progress toward standards that enable exchanging clinical observations and findings among the various information systems of the healthcare enterprise. DICOM-like the HL7 Clinical Document Architecture (CDA) -uses templates and constrained, coded vocabulary (SNOMED, LOINC, etc.). Such a representation facilitates automated software recognition of findings and observations, intrapatient comparison, correlation to norms, and outcomes research. The scope of DICOM Structured Reporting (SR) includes many findings that products routinely create in digital form (measurements, computed estimates, etc.). In the Integrating the Healthcare Enterprise (IHE) framework, two Integration Profiles are defined for clinical data capture and diagnostic reporting: Evidence Document, and Simple Image and Numeric Report. This report describes these two DICOM SR-based integration profiles in the diagnostic reporting process.

Evidence and diagnostic reporting in the IHE context

Capturing clinical observations and findings during the diagnostic imaging process is increasingly becoming a critical step in diagnostic reporting. Standards developers—notably HL7 and DICOM—are making significant progress toward standards that enable exchanging clinical observations and findings among the various information systems of the healthcare enterprise. DICOM—like the HL7 Clinical Document Architecture (CDA)—uses templates and constrained, coded vocabulary (SNOMED, LOINC, etc.). Such a representation facilitates automated software recognition of findings and observations, intrapatient comparison, correlation to norms and outcomes research. The scope of DICOM structured reporting (SR) includes many findings that products routinely create in digital form (measurements, computed estimates, etc.). In IHE, two integration profiles are defined for clinical data capture and diagnostic reporting: evidence document, and simple image and numeric report. This paper describes these two DICOM SR based integration profiles in the diagnostic reporting process.

DICOM structured reporting: Part 2. Problems and challenges in implementation for PACS workstations.

Structured reporting (SR) was recently added to the Digital Imaging and Communications in Medicine (DICOM) standard to provide an efficient mechanism for the generation, distribution, and management of clinical reports. The main advantage of SR is the ability to link clinical documents with the referenced images for simultaneous retrieval and display. A generic SR toolkit that covers the different clinical reports used in today's healthcare enterprises was developed for picture archiving and communication system (PACS) workstations. The modules of the SR toolkit collaborate to automatically construct the DICOM SR files from the free-text input presented in hypertext markup language (HTML) by using the associated SR trees. The DICOM toolkit is reused for SR encoding and DICOM services. A setup module was required for creating both the standard and private SR templates used in different healthcare specialties. The SR manager transparently converts between the different SR document presentations, that is, DICOM SR files and HTML documents, to provide the end users with an easy-to-use toolkit. To evaluate and demonstrate the effectiveness of the SR toolkit in a pragmatic setting, the toolkit was integrated into PACS workstations.

DICOM structured reporting: Part 1. Overview and characteristics.

Supplement 23 to Digital Imaging and Communications in Medicine (DICOM) is an introduction to the structured reporting (SR) classes, which are used for transmission and storage of clinical documents. The SR classes fully support both conventional free-text reports and structured information, thus enhancing the precision, clarity, and value of clinical documentation. In addition, the SR standard provides the capability to link text and other data to particular images or waveforms and to store the coordinates of findings. In other words, SR documents not only describe the specific features contained in images or waveforms but can also refer to any number of images or waveforms. Accordingly, SR bridges the traditional gap between imaging systems and information systems. Furthermore, SR plays an essential role in Integrating the Healthcare Enterprise by providing healthcare practitioners with an effective tool that encompasses a variety of clinical contexts. Harmonization of DICOM SR and the Health Level Seven clinical document architecture standard is under way.

A flexible, multimodality structured reporting system based on medical and networking standards

A structured reporting (SR) system has been developed based on current medical and networking standards to provide structured reporting for multiple hospital departments and specialties. Use of existing standards such as Digital Imaging and Communications in Medicine (DICOM), Health Level 7 (HL7), Extensible Markup Language (XML), and Internet protocols allow it to easily integrate and be used with existing hospital information and Picture Archiving and Communications Systems (PACS). The structured reports are based on templates. The templates define the tree structure of the content of each type of report and also the relationship between elements within a report. The templates can be extended and customized to support the individual needs of each institution. Each element in the template and report is tagged with a code to provide a means for data mining and outcomes analysis applications. Standard lexicons such as LOINC (Logical Observation Identifiers Names and Codes) can be used to provide data level compatibility between institutions for similar reports. XML is used to store the templates and preliminary reports, and stylesheets written in the Extensible Stylesheet Language (XSL) are used to generate the human-readable output for each report. The stylesheets can also be extended and customized by report type. For archival purposes, the final reports are converted to a DICOM structured report object and transferred to a DICOM PACS. A web browser can be used to view and edit reports through the use of a simple Universal Resource Locator (URL) mechanism, allowing the reporting system client to be integrated with a variety of workstations.

XML Schema Representation of DICOM Structured Reporting.

The Digital Imaging and Communications in Medicine (DICOM) Structured Reporting (SR) standard improves the expressiveness, precision, and comparability of documentation about diagnostic images and waveforms. It supports the interchange of clinical reports in which critical features shown by images and waveforms can be denoted unambiguously by the observer, indexed, and retrieved selectively by subsequent reviewers. It is essential to provide access to clinical reports across the health care enterprise by using technologies that facilitate information exchange and processing by computers as well as provide support for robust and semantically rich standards, such as DICOM. This is supported by the current trend in the healthcare industry towards the use of Extensible Markup Language (XML) technologies for storage and exchange of medical information. The objective of the work reported here is to develop XML Schema for representing DICOM SR as XML documents. We briefly describe the document type definition (DTD) for XML and its limitations, followed by XML Schema (the intended replacement for DTD) and its features. A framework for generating XML Schema for representing DICOM SR in XML is presented next. None applicable. A schema instance based on an SR example in the DICOM specification was created and validated against the schema. The schema is being used extensively in producing reports on Philips Medical Systems ultrasound equipment. With the framework described it is feasible to generate XML Schema using the existing DICOM SR specification. It can also be applied to generate XML Schemas for other DICOM information objects.

Structured reporting in neuroradiology.

We have developed a system to structure free-text neuroradiology reports using a natural language processing program and formatted the output into the digital image and communication in medicine (DICOM) standard for structured reporting (SR). DICOM SR formats the correspondence of pertinent diagnostic images to the radiologist's dictated report of clinical findings. In addition, DICOM SR allows the information to be organized into a tree structure. Individual nodes of the tree can contain individual items or lists. Structuring the content of free-text information allows the creation of hierarchies with defined relationships between the concepts contained within the report.

Integrating Digital Imaging and Communications in Medicine (DICOM)-structured reporting into the hospital environment.

The Digital Imaging and Communications in Medicine (DICOM) Standards Committee has balloted and accepted a new class of objects dealing with the generation, distribution, and management of reports. The structured reporting (SR) objects bridge the traditional separation between imaging and information systems. The DICOM SR objects offer a higher level of integration of the medical enterprise, providing practitioners with an effective tool to cover all aspects of the medical process from admission to discharge. This report presents the technical challenges posed by integrating the concepts introduced by SR with a complete hospital information system (HIS).

DICOM Structured Reporting—a prototype implementation

About 1 year ago, Digital Imaging and Communications in Medicine (DICOM) Structured Reporting (SR) has been released as an official extension of the DICOM standard. Structured Reporting introduces a new concept for structuring and encoding medical reports in a standardised manner. Since this approach is quite different from any other extension that has been added to the DICOM standard in the past, it is not surprising that there is no “real” application available up to now. However, we have developed a DICOM SR editor and viewer, and demonstrated this prototype at RSNA infoRAD 2000 and ECR 2001 together with two of DICOM's new security extensions: secure network transmission and digital signatures.

Clinical importance of the DICOM structured reporting standard.

The purpose of the DICOM Structured Reporting (SR) specification is to improve the documentation of diagnostic images and waveforms. The specification supports the interchange of expressive compound reports in which the critical features shown by images and waveforms can be denoted unambiguously by the observer, indexed, and retrieved selectively by subsequent reviewers. Findings may be expressed by the observer as: 1) text, codes, numeric measurements: 2) computer-generated coordinates of specific regions of interest within images or waveforms; or 3) reference to comparison images, sound, waveforms, curves, and previous report information. The observational and historical findings recorded by the observer may include any evidence referenced as part of an interpretation procedure. Thus, DICOM SR supports not only the reporting of diagnostic observations, but the capability to document fully the evidence that evoked the observations. This capability provides significant new opportunities for large-scale collection of structured data for clinical research, training, and outcomes assessment as a routine by-product of diagnostic image and waveform interpretation and facilitates the pooling of structured data for multi-center clinical trials and evaluations.