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  • 1. Success of DICOM standard Cor Loef Industry Co-Chair DICOM Strategic Advisory Committee
  • 2. Success of DICOM standard
    • Mission and goal of the DICOM standard
    • Some recent new developments
    • View on the future of DICOM
    • Summary
  • 3. Mission and goal of DICOM
    • Mission of DICOM
      • Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information
    • Goals of DICOM
      • Achieve interoperability and improve workflow efficiency between imaging systems and other information systems
  • 4. Some recent new developments
    • 16 parts of official DICOM 2003 edition available at: http://medical.nema.org
    • Security
      • De-identification, Clinical Trials
    • Applications of structured reporting (DICOM SR) – Evidence documents:
      • Chest CAD
      • Cath Lab Reporting
      • OB-GYN, Vascular US, Echocardiography
  • 5. Some recent new developments
    • New Media
      • DVD-R, E-mail attachments, large capacity MODs
    • New Objects
      • Multi-frame MR
      • New CT, XA, VL
    • JPEG 2000
    • Configuration Management
  • 6. Multi-frame MR
    • New object definition supporting latest advancements in MR technology
    • Support for very large data sets, split of an acquisition between several multi-frame objects
    • New concepts – functional groups
  • 7. Ultrasound Procedure Reporting
    • A number of supplements covering different areas of US procedure reporting:
      • OB-GYN
      • Vascular
      • Echocardiography
    • Further advances the concept of Evidence Documents – objects generated by machine, that are not images but are carrying the supplemental coded information for the procedure to aid in diagnosis
  • 8. DICOM Object Access via Net
    • In addition to the e-mail distribution of DICOM objects, DICOM recently spearheaded a joint Work Item with ISO TC215 – WADO Web Access to DICOM Persistent Objects
      • In currently prototype phase
      • Will allow for web-access to images in different formats utilizing standardized URL (HTTP-GET)
      • In conjunction with standardized MIME type allows for access using a Web Browser
  • 9. Charter of Strategic Advisory Committee
    • To develop and maintain the long-term strategic plan of the DICOM Standards Committee;
    • To review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics;
    • To consider issues and opportunities related to the strategic evolution of DICOM;
    • To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN.
  • 10. Quality of care improved by information and IT
    • All relevant information the care giver and patient need, anywhere and anytime, for the best clinical decisions, through one common and simple user interface, adapted for the task.
  • 11. All relevant info accessible
  • 12. Trends in Imaging-IT
    • Horizontal Integration
    • Vertical Integration
    • Active workflow
    • Data explosion
    • Web based PACS
    HIS RIS Radiology PACS Cardiology PACS VL, US, NM PACS Web distribution Other Clinical System At the desktop
  • 13. Vertical Integration The Healthcare Enterprise HIS HIS Order Placer ADT Patient Registration RIS RIS IMAGING: IMAGING: • • PACS / Archives PACS / Archives • • Workstations Workstations • • Modalities Modalities Image Archive Image Manager Image Creator Image Display Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration New Order Procedure Scheduled Images Stored Storage Commit Q /R Images PPS In-Progress / Completed
  • 14. Active Workflow
  • 15. Workflow in Radiology Digital Radiology ..010011... Registration ..010011... Preparation ..010011... Examination ..010011... Archiving ..010011... Reporting ..010011... Transcription ..010011... Demonstration ..010011... Reviewing ..010011... Referral ..010011... Image Distribution ..010011... Post Examination
  • 16. User’s default display protocol
  • 17. Paradigm shift in PACS: Clinical Applications to PACS
  • 18. Multi-slice CT: 1000+ images
  • 19. Post-processing everywhere
    • Viewing and Advanced Image Processing:
      • clinical SW packages
      • move towards modalities, PACS and web
    3D Spine Endo3D Cardiac MR
  • 20. Post-processing everywhere
    • Analysis tools to enhance clinical decisions:
      • Echo measurements & calculations
      • Left Ventricular Analysis
      • Quantitative Coronary Analysis
      • Vascular X-Ray Analysis
      • Vascular X-Ray Post-Processing
  • 21. Horizontal Integration Radiology PACS Cardiology PACS Ultrasound PACS Visible Light PACS One Image Management Infrastructure Radiology workflow Cardiology workflow Ultrasound workflow Pathology workflow Hospital Information System, Master Person Index
  • 22. Horizontal Integration
    • Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports
  • 23. DICOM SR Creation - Example -Radiology Report Type : Findings : Conclusions: Image Refs.: Header : Image data from PACS Report Templates Coding Schemes behind pop-up menus (Pointer) select RIS data Thorax … .. … .. … .. Mass … .. … .. Diam. Infiltr. … .. … .. Report Creator application (DICOM) SR Object
  • 24. Web based PACS At Modality PACS Viewing Station Web Viewer Webserver
  • 25. Web and Security At Modality Web Viewer PACS Viewing Station Webserver Security
  • 26. “ Electronic Health Record”
    • Image Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve)
    • EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health information
    • Need for coded vocabularies to represent medical knowledge and the patient’s health condition
  • 27. “ Electronic Health Record”
    • Web front-end:
      • viewing not only of images but also waveforms, measurements, reports, lab results, etc
      • need the capability to access the original medical images
      • Support for (DICOM) Structured Reporting
      • XML and XML Schema for the exchange of clinical documents
  • 28. EHR: Visual Integation messages Clinical Information System Clinical Information System Back-Office Integrated Clinical Viewing at the desktop Front Office Efficiency Improve Clinical Decisions
  • 29. Summary
    • DICOM is well positioned to continue to serve integration needs of medical imaging, including workflow, evidence information recording, effective access to imaging results in the enterprise
    • Active cooperation with other standards assures DICOM objects integration into future EHR – whether by reference, or through well-defined trans-coding mechanisms.