Transcript strategic_direction - Dicom

DICOM Strategic Direction
for
Image Distribution
Cor Loef
co-chair DICOM Strategic Advisory
Committee
Contents
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•
•
•
Scope of DICOM Standards Committee
Trends in Imaging-IT
Standards in Imaging-IT
Objects, Information, EPR,
Web-distribution, Desktop
January 12, 2002
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Scope of DICOM
Standards Committee
• Mission of DICOM
– Create and maintain international standards for
communication of bio-medical diagnostic and
therapeutic information
• Goals of DICOM
– Achieve compatibility and improve workflow
efficiency between imaging systems and other
information systems
January 12, 2002
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New: published in
DICOM 2000
• Sup 23: Structured Reporting (Pre-reports, image
measurements, analysis results, diagnostics reports
with qualified image links)
• Sup 30: Waveform (sound, ECG, Electr. Physio.)
synchronized with images
• Sup 31: Network Security (node authentication and
transport encryption)
• Sup 33: Softcopy Presentation State
• 42 Correction Items, Including:
– JPEG-LS, Thai & Korean, Time zones, Case Insensitive
Name Queries
January 12, 2002
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Supplements approved
in 2001
• Sup 40 DVD RAM Application Profiles
• Sup 50 Mammography Comp. Aided Detect. Reports
• Sup 52 General Purpose Worklist
– Reporting workflow management, image postprocessing,
computer aided detection, filming, quality control, etc.
• Sup 53 Content Mapping Resource
– codes and templates for Structured Reporting
• Sup 54 MIME Content Type
– for e-mailing DICOM persistent objects (images reports,
presentation states, key object selection, etc.
• Sup 59 Key Object Selection
January 12, 2002
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New Work Items
• New generations of image objects:
– Revised Secondary Capture Images (specific applications)
– Multiframe MR and CT (large number of dynamic
dimensions)
• Sup 41 Digital Signature
– secure transformation of images and reports
• Security on Storage Media (confidentiality)
• Attribute Level Confidentiality (de-identification)
January 12, 2002
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Current Direction
• Present focus is to meet new end-user
needs, adopt complementary and proven
standards. Key areas are:
– Security,
– New imaging technology,
and
– Image Distribution in the enterprise.
January 12, 2002
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Liaison with TC 215
• Good liaison since April 99. Cross-representation may
be the effective next step beyond TC 215 DICOM Task
Force.
• Procedure
– TC 215 has agreed to rely on DICOM for Medical Imaging
Standardization
– DICOM offers expertise in medical imaging, with world-wide
users and vendors representation.
– Need to ensure coherence with other ISO standards group on
imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)
• DICOM is ready to further develop its relationship with
TC 215.
January 12, 2002
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Trends in Imaging-IT:
Other
Clinical
System
Cardiology
PACS
HIS
1. Horizontal Integration
2. Vertical Integration
RIS
Radiology
PACS
3. Elect. Patient Record
VL, US, NM
PACS
Electronic Patient Record
At the desktop
January 12, 2002
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1. Horizontal Integration
• Image management system supports
archiving/retrieving of all types of images (incl.
visible light) and Structured Reports
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2. Vertical Integration
HIS
ADT
Patient Registration
Patient Registration
Order Placer
IMAGING:
• PACS / Archives
• Workstations
• Modalities
Image Creator
New Order
Image Display
The Healthcare Enterprise
Q /R
Images
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
PPS
In-Progress
/ Completed
RIS
January 12, 2002
Storage
Commit
Images
Stored
Acquisition
Modality
Modality Worklist
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Integration:
not only back-office!
Back-Office
Clinical
Information
System
messages
Integrated
Clinical Viewing
at the desktop
Front Office
January 12, 2002
Efficiency
Clinical
Information
System
Improve
Clinical
Decisions
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3. Electronic Patient Record
• Image Management system and Departmental Information
System must be EPR-prepared (Queries)
• EPR: emphasis today on desktop integration, should become
the integrated, secure, patient centric, source of health
information
• Web front-end:
– viewing not only of images but also waveforms,
measurements, reports, etc
– always need the capability to access the original medical
images
– support for DICOM Structured Reporting
January 12, 2002
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Ultimate goal: All the information the user needs
through one common and simple user interface
January 12, 2002
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4. Order and Results
Management
Clinical
Question
Other Clinical
Information
Systems
Multi-Media
Report with
RIS
references
PACS
January 12, 2002
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DICOM SR Creation - Example Radiology
RIS data
Header:
(DICOM) SR Object
Thorax
Report Type:…..
Report Creator
application
Findings:
…..
…..
Mass
…..
…..
Conclusions:
Image data
Daim.
Infiltr.
…..
…..
Image Refs.:(Pointer)
from PACS
select
From DICOM
standard:
January 12, 2002
Coding Schemes
Report Templates behind pop-up menus
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4. Orders and Results
Management
• Great opportunities for IHE.
• Important roles for HL7 Clinical Document
Architecture and DICOM Structured Reporting
• One should not consider DICOM SR as the only
possibility to integrate multi-speciality
information. Especially XML-based
implementations should be considered.
January 12, 2002
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5. Security
Web Viewer
Webserver
Security
At Modality
January 12, 2002
PACS Viewing
Station
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5. Security
• NEMA and COCIR address some major
issues as a result of HIPAA, e.g. remote
service.
• Security remains a challenge with
connected systems, and is of course
dependent on hospitals ensuring policies
and procedures
• Use of Audit trial standards in a multivendor environment needs further detailing
January 12, 2002
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6. Freedom of
Application Workspot
Web Viewer
Webserver
At Modality
January 12, 2002
PACS Viewing
Station
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Standards in Imaging-IT
1. Horizontal Integration
2. Vertical Integration
3. Electronic Patient Record
4. Orders and Results
Management
5. Security
6. Freedom of Application
Workspot
January 12, 2002
DICOM
IHE, DICOM, HL7
ISO/CEN,DICOM,HL7,XML
IHE, DICOM, HL7
IHE,IETF,DICOM,HL7,ASTM
ISO/CEN, CCOW, IETF,
DICOM, XML
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The (multi-vendor) Integrated Imaging
Solution
secure transport
digital signature
Image
Archive
Diagnostic
Workstation
Hanging
Protocols
January 12, 2002
Image
Server
Department
Info Server
General
Purpose
Worklist
Structured
Documents (XML)
Numeric report
QCA, LVA
Connection to
other Network
and/or
TeleCardiology
Email attachment
DICOM URL
CD
Exchange
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The distribution problem
HIS
Other
Clinical
System
RIS
Cardiology
PACS
Radiology
PACS
Electronic Patient Record
January 12, 2002
VL, US, NM
PACS
Header:
Thorax
Report
Type:
…..
…..
…..
Findings:
Mass
…..
….. Daim.
Conclusions:
Infiltr.
…..
…..
Ima
(Poi
gn
e t
Re
e r
f )
s
.
:
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