Saturday, August 1, 2009

DICOM Structured Reporting, Part 2 of 2

Part two of a two-part series on DICOM structured reporting. The information found in this article can be used as part of a preparation program for the American Board of Imaging Informatics (ABII) Imaging Informatics Professional Certification Program, which awards the Certified Imaging Informatics Professional (CIIP) designation.

Perhaps the biggest issue for DICOM structured reporting is support—from the creation of the report at the modality to its display on the PACS workstation. I've gotten quite a few calls from users with concerns that their DICOM structured reports are not able to be communicated over their PACS. 

The first step in addressing this issue is that the PACS must be able to accept different DICOM objects. A DICOM object, as you might know, is represented by an SOP class. So what we need to look for is support for SOP classes, so that the PACS archive can handle them. 

The next issue is the support of the diagnostic workstations. When a workstation retrieves a structured report, say from an ultrasound modality, the report must be properly supported so that it can be properly displayed. 

Last, but not least, the reporting software must also support DICOM structured reports. A voice recognition system has to be able to support structured report information so it can automatically populate the appropriate sections of the diagnostic report. 

The DICOM conformance statement is what the system administrator will use to ascertain if their PACS vendor provides DICOM structured report support. The DICOM conformance statement typically has a table in the first or the second page that displays what SOP classes are supported by the PACS. Once you’ve determined whether or not the PACS supports DICOM structured reports, you will need to check the DICOM conformance statements for the diagnostic workstation and your reporting application. 

The next component that you need to look for is details about the content of the structured report. In some cases, certain institutions have specific requirements of what needs to be in the structured report. Depending on what these requirements are, this will require that certain information must be in the image header. 

So what do we need to look for? We need to look at the details of what is in the header, what is in the contents, and what information is in the structured report. First check the SOP class report. Second, check the contents in the templates in the structured report. 

There are three different SOP classes when it comes to structured reports. The SOP classes are divided among basic, enhanced, and comprehensive text. Most modalities support the comprehensive-text SOP. The reason being is that the comprehensive-text SOP doesn’t have any limitations as to the information it can contain. So, with regards to the SOP classes, you need to make sure that you support exactly the same structured report type on each device. 

When you look at a conformance statement of a DICOM structured report, after you make sure that the SOP classes match, the next thing you want to look for is the template identification. The templates are very important because they can be modified. A template is almost like a definition of a DICOM header within a structured format, but basically has the contents of the report. 

You need to check these templates because some of the information you require in your practice might not be there. You can go to the DICOM conformance statement and find out what exactly is filled in. 

DICOM structured reports are not rocket science. They are just like any DICOM objects and can be handled like DICOM images. Although they are currently used mostly by ultrasound systems, computer-aided detection (CAD) applications for digital mammography (and other modalities, such as CT) are using them, too. 

The biggest challenge to more widespread adoption of DICOM structured reporting is the support of PACS products. Unfortunately, PACS archives and workstations are lagging in this regard, as are voice recognition systems. 

In summary, you need to make sure to do two things: You need to look at the DICOM conformance statements for support for these SOP classes; and you want to make sure that the template information in these structured reports is appropriate and meets the requirements of your institution. In many cases the templates are configurable, so you can go back to your vendor and configure them accordingly. 

Structured reports represent major improvement for capturing some of the data from some modalities that can help radiologists be more efficient and effective—and can reduce errors and improve the quality of patient care. You just need to make sure that you have properly prepared your imaging information infrastructure.