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  1. 1. International Telecommunication Union Workshop on Standardization in E-health Geneva, 23-25 May 2003 Success of DICOMSuccess of DICOM standardstandard Cor Loef Industry Co-Chair DICOM Strategic Advisory Committee
  2. 2. ITU-T Success of DICOM standard o Mission and goal of the DICOM standard o Some recent new developments o View on the future of DICOM o Summary
  3. 3. ITU-T Mission and goal of DICOM o Mission of DICOM • Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information o Goals of DICOM • Achieve interoperability and improve workflow efficiency between imaging systems and other information systems
  4. 4. ITU-T Some recent new developments o 16 parts of official DICOM 2003 edition available at: o Security • De-identification, Clinical Trials o Applications of structured reporting (DICOM SR) – Evidence documents: • Chest CAD • Cath Lab Reporting • OB-GYN, Vascular US, Echocardiography
  5. 5. ITU-T Some recent new developments o New Media • DVD-R, E-mail attachments, large capacity MODs o New Objects • Multi-frame MR • New CT, XA, VL o JPEG 2000 o Configuration Management
  6. 6. ITU-T Multi-frame MR o New object definition supporting latest advancements in MR technology o Support for very large data sets, split of an acquisition between several multi- frame objects o New concepts – functional groups
  7. 7. ITU-T Ultrasound Procedure Reporting o A number of supplements covering different areas of US procedure reporting: • OB-GYN • Vascular • Echocardiography o 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. 8. ITU-T DICOM Object Access via Net o 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. 9. ITU-T Charter of Strategic Advisory Committee o To develop and maintain the long-term strategic plan of the DICOM Standards Committee; o To review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics; o To consider issues and opportunities related to the strategic evolution of DICOM; o To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN.
  10. 10. ITU-T 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. 11. ITU-T All relevant info accessible
  12. 12. ITU-T Trends in Imaging-IT o Horizontal Integration o Vertical Integration o Active workflow o Data explosion o Web based PACS HIS RIS Radiology PACS Cardiology PACS VL, US, NM PACS Web distribution Other Clinical System At the desktop
  13. 13. ITU-T Vertical Integration The Healthcare Enterprise HISHIS Order Placer ADT Patient Registration RISRIS IMAGING:IMAGING: •• PACS / ArchivesPACS / Archives •• WorkstationsWorkstations •• ModalitiesModalities Image Archive Image Manager Image Creator Image Display Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration NewOrder Procedure Scheduled Images Stored Storage Commit Q /R Images PPS In-Progress / Completed
  14. 14. ITU-T Active Workflow
  15. 15. ITU-T 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. 16. ITU-T User’s default display protocol
  17. 17. ITU-T Paradigm shift in PACS: Clinical Applications to PACS
  18. 18. ITU-T Multi-slice CT: 1000+ images
  19. 19. ITU-T Post-processing everywhere o Viewing and Advanced Image Processing: • clinical SW packages • move towards modalities, PACS and web 3D Spine Endo3D Cardiac MR
  20. 20. ITU-T Post-processing everywhere o 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. 21. ITU-T 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. 22. ITU-T Horizontal Integration o Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports
  23. 23. ITU-T DICOM SR Creation - Example -Radiology Report Type: Findings: Conclusions: Image Refs.: Header::RIS dataRIS data Image data from PACSImage data from PACS Report TemplatesReport Templates Coding SchemesCoding Schemes behind pop-up menusbehind pop-up menus ThoraxThorax …….... …….... …….... MassMass …….... …….... Diam.Diam. Infiltr.Infiltr. …….... …….... (Pointer) selectselect Report CreatorReport Creator applicationapplication (DICOM)SRObject(DICOM)SRObject
  24. 24. ITU-T Web based PACS At Modality PACS Viewing Station Web Viewer Webserver
  25. 25. ITU-T Web and Security At Modality Web Viewer PACS Viewing Station Webserver Security
  26. 26. ITU-T “Electronic Health Record” o Image Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve) o EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health information o Need for coded vocabularies to represent medical knowledge and the patient’s health condition
  27. 27. ITU-T “Electronic Health Record” o 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. 28. ITU-T EHR: Visual Integation messagesmessages ClinicalClinical InformationInformation SystemSystem ClinicalClinical InformationInformation SystemSystem Back-Office IntegratedIntegrated Clinical ViewingClinical Viewing at the desktopat the desktop Front Office EfficiencyEfficiency ImproveImprove ClinicalClinical DecisionsDecisions
  29. 29. ITU-T Summary o 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 o Active cooperation with other standards assures DICOM objects integration into future EHR – whether by reference, or through well-defined trans-coding mechanisms.