Aspects of DICOM

for Patient Safety

Helmut Koenig, Siemens Healthcare

Harry 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

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 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

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 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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