Structured Reporting, a Powerful DICOM mechanism
The contents of this whitepaper are public domain.
Structured Reporting (SR) contains of what you might think of as leafs (aka content nodes) and relationships that can be configured in any way to construct a tree structure. The contents of the leaves are defined, for example they contain findings, measurements, codes, names, date/times, and, probably the most important, references to other DICOM objects.
Because of the DICOM references, a SR can be very tightly connected with DICOM images, waveforms, the description of the presentation of images (so-called presentation states), and any other DICOM objects you can think of. The relationships between the leaves are also specified and can be things such as “has properties”, “context”, constraints, concept modifiers, etc. Combined with the capability to develop a structure, SR is a powerful tool.
2. SR Implementation
There are certain constraints on the type of structure you can build. There are actually three different SR versions, each with increasing complexity, the exchange of which can be negotiated up front by the parties that want to exchange the information, and, as is common for every DICOM compliant device, as specified in their conformance statements. However, to make it easier for the recipient of these objects, there are also templates defined, which can either be used with the “generic” SR objects, or, defined it its own right for specific applications.
It seems unlikely that all diagnostic reports be replaced by this new DICOM SR. Even although it is possible to include the full text report as a “blob” of text in a SR, it would not make use of the power and capabilities of SR. Currently, there is a relatively good infrastructure in the HL7 world with long established products that seem to deal with this information rather well. However, there are some applications that could greatly benefit from the tight connection between the information in the SR’s and other DICOM objects such as images, especially when using the restricted templates. These area’s are:
3. SR and HL7 CDAHow will SR relate to HL7? It seems to be a logical fit in the Clinical Document Architecture (CDA). We need to still do some work. The Image and Integration SIG is mapping the DICOM information model to the version 3 RIM and we are mapping attributes. The encoding of the tree structure is actually done with recursive sequences in DICOM, something that could map relatively easily into an XML framework. We are far from being done, but progress is definitely being made. Who knows, hopefully we will do a combined SR/CDA demonstration at the next Integrating the Healthcare Enterprise (IHE) demo at HIMSS and RSNA.
4. References[NEMA] "Digital Imaging and Communications in Medicine", http://medical.nema.org
[Clunie] "DICOM Structured Reporting", Dr. David A. Clunie, ISBN 0-9701369-0-0 http://www.pixelmed.com/
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