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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