Post on 27-Mar-2015
Aspects of DICOMfor Patient Safety
Helmut Koenig, Siemens HealthcareHarry Solomon, GE Healthcare
Co-chairs, HL7/DICOM Imaging Integration WG
Topics
• Brief Intro to DICOM• Radiation Dose Reporting• Substance Administration• Adverse Event Reporting
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Digital Imaging and Communications in Medicine (DICOM) is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department
Published as NEMA PS3 and as ISO 12052
Relationships
• Memorandum of Understanding with HL7– Joint Working Group (Imaging Integration /
WG-20)
• Type B Liaison with ISO TC215 Health Informatics– DICOM is an ISO Standard “by reference”
• SDO Member of Integration the Healthcare Enterprise
• Liaison with International Health Terminology SDO– SNOMED license as primary external
vocabulary
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Key features of DICOM
• Focus on practical needs of biomedical imaging
• Object-oriented, persistent information objects
• Tagged data elements, binary encoding
• Client-server network services, service negotiation
• Image compression by encapsulation• Conformance Statements
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DICOM Network Services
• Information object exchange• Reliable object storage (commitment)• Object repository (PACS) query / retrieve• Modality worklist query • Performed procedure step status
notification• Image print• Others
Network Services are denoted “Service-Object Pair (SOP) Classes”
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The DICOM Change Process
• Continuous process for evolution of the standard– It’s just “DICOM”, not DICOM 3.0, 3.1, etc.– Conformance is to SOP Classes, not to a ‘version’ of the
Standard
• Change Proposals for minor corrections– About 100 / year
• Supplements for major changes – new object types, services, compression schemes– About 10 / year– Require Work Item approved by DICOM Standards
Committee
• Consolidated edition published ~ every 18 months– Most recently, July 2011– Available free at DICOM web site
Radiation Dose Structured Report
and Radiology Report Dose Summary
Dose SR
• Radiation Dose Structured Report is a SOP Class (unit of conformance)
• Standard templates – TID 10001 Projection X-Ray (including
Mammo)– TID 10011 CT
• Typically produced for each Study or for each Performed Procedure Step
• Each exposure event has a unique ID• Associated workflow profiled in IHE
Radiation Exposure Management (REM) Profile
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Templates
• Developed in conjunction with IEC and AAPM
• ~ 80 discrete data elements• Aligned with NEMA XR-25 CT Dose Check
Standard– Check parameters and authorizations captured
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Status
• Identified in ACR White Paper on Radiation Dose
• On FDA “radar” – identified in Radiation Dose Reduction White Paper
• Commitments from NEMA members to implement
• Interoperability testing at IHE Connectathons
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Dose Summary
• Standard sub-template for radiology reports– Specified as DICOM template– Standard transcoding to CDA
• Conveys summary of radiation dose data
• Conforms to German, French, other national regulations on dose reporting, ACR best practice
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Substance Administration
(Imaging Contrast)
Substance Administration
• Patient safety issue – “five rights” checking for imaging contrast agents– Point of use verification for substances
often “out of the loop” of hospital pharmacy systems
• Intended as DICOM interface to EHR / CDS functionality– Typically via gateway
• Three DICOM SOP Classes
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SOP Classes
• Query: Look up product characteristics – Given a barcode ID (from contrast agent bottle),
get name, active ingredient, concentration, etc.– Contrast attributes may be included in DICOM
image metadata
• Query: Check for substance contra-indications– Given agent, patient, route of administration;
get approval or warnings based on label and on patient record
• Report contrast used to Medication Administration Record
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Status
• Limited HL7 standards for these functions to which DICOM services may be mapped– Currently each implementation needs
custom development– Possible standard query definition
using pharmacy segments– RAS^O17 for MAR submission
• Not included in any IHE Profiles• No known product implementations
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Adverse Event Reporting
Adverse Events
• No specific DICOM services related to adverse event reports– Generally not considered within competency or scope
of radiology technologists / exams
• Performed Procedure Step discontinuation codes– Insufficient data to report nature of adverse event– Optional
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