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    • Success of DICOM standard Cor Loef Industry Co-Chair DICOM Strategic Advisory Committee
    • Success of DICOM standard
      • Mission and goal of the DICOM standard
      • Some recent new developments
      • View on the future of DICOM
      • Summary
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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.
    • 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.
    • All relevant info accessible
    • 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
    • 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
    • Active Workflow
    • 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
    • User’s default display protocol
    • Paradigm shift in PACS: Clinical Applications to PACS
    • Multi-slice CT: 1000+ images
    • Post-processing everywhere
      • Viewing and Advanced Image Processing:
        • clinical SW packages
        • move towards modalities, PACS and web
      3D Spine Endo3D Cardiac MR
    • 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
    • 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
    • Horizontal Integration
      • Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports
    • 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
    • Web based PACS At Modality PACS Viewing Station Web Viewer Webserver
    • Web and Security At Modality Web Viewer PACS Viewing Station Webserver Security
    • “ 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
    • “ 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
    • EHR: Visual Integation messages Clinical Information System Clinical Information System Back-Office Integrated Clinical Viewing at the desktop Front Office Efficiency Improve Clinical Decisions
    • 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.