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Slide 1-

DICOM in Cardiology Harry Solomon GE Medical Systems Information Technologies Tim Becker Christian Albrechts Universität zu Kiel
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Problem – how to preserve diagnostic quality images without 35mm cine film, but with universal exchangeability Solution – leverage radiology’s DICOM standard, extend it to media interchange on CD Solomon & Becker DICOM 20th Anniversary Conferece page 2 1992 Theme: Cine film replacement
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Cardiology talking to Radiology! DICOM (v.3) wasn’t even published yet! Workstations could not support data rate! Recordable data CDs didn’t exist! Needed a true international standard! Understanding images as data! Solomon & Becker DICOM 20th Anniversary Conferece page 3 What’s the big deal?
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DICOM Standard Supplements 1, 2, 3, 4 and 20 DICOM WG1 – Cardiac and Vascular Information International in scope Mission accomplished in only 4 years – universal acceptance of DICOM XA image exchange on CD-R Solomon & Becker DICOM 20th Anniversary Conferece page 4 The Results
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Opportunity – create a unified dataset with all of a patient’s cardiac exam data Solution – incorporate ultrasound and nuclear DICOM images, extend DICOM for hemodynamic and electrophysiologic waveforms, extend DICOM for cardiac measurements and reports, and get a bigger media Solomon & Becker DICOM 20th Anniversary Conferece page 5 1997 Theme: Digital Integrated Cardiac Patient Record
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Basic Ultrasound and Nuclear images – done by WGs 12 and 3 IVUS extension to Ultrasound done by WG1 – Supplement 48 Solomon & Becker DICOM 20th Anniversary Conferece page 6 Results: Image Objects (easy)
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DVD Media – Supplement 80 (2003) STD-XA1K-DVD : XA up to 1024²x12-bit STD-GEN-DVD-JPEG : anything on DVD Readers required to support both JPEG lossless and JPEG lossy Solomon & Becker DICOM 20th Anniversary Conferece page 7 Results: DVD Media (relatively easy)
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Waveform Interchange – Supplement 30 Hemodynamic Electrophysiology ECG (12-lead, general, ambulatory) Basic Audio Used prior work of CEN SCP-ECG and HL7 v.2.3 Waveform Observation Adoption of DICOM waveforms has been disappointing Solomon & Becker DICOM 20th Anniversary Conferece page 8 Results: Waveform Objects (a bit harder)
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Based on DICOM Structured Reporting Supplements 23 and 53 (2000/2001) Procedure Log, Hemodynamic and ECG Measurements, Cath Lab Report – Sup 66 (2003) Echo Measurements – Sup 72 (just done!) QCA/QVA Measurements – Sup 76 (in process) IVUS Measurements – Sup 77 (in process) CTA/MRA Measurements – just starting Solomon & Becker DICOM 20th Anniversary Conferece page 9 Measurements and Reports (hard)
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Demand – Bring it all together to support the Electronic Health Record Support the delivery of effective patient care. Facilitate management of chronic conditions. Improve efficiency of clinicians and administration. Improve patient safety. [IOM, 2003] Solomon & Becker DICOM 20th Anniversary Conferece page 10 2003 Theme: Cardiology Integrated in the Healthcare Enterprise
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Solution integrate with hospital information systems for consistent patient demographics link to non-hospital practice settings provide workflow management appropriate to cardiology integrate results into patient record consolidate data for longitudinal evaluation and on-going care extract data for outcomes research and public health support performance evalution Solomon & Becker DICOM 20th Anniversary Conferece page 11 2003 Theme: Cardiology Integrated in the Healthcare Enterprise
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In one survey, while the image pixel data was good, none of the DICOM image objects collected from production systems had completely correct patient demographics, hospital and equipment IDs, and acquisition datetime [Becker, Onnasch and Simon, 2001] Solomon & Becker DICOM 20th Anniversary Conferece page 12 Examples of the problem
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Integration requires a clear idea of the dataflow and workflow Data ownership: institution vs. cardiology practice – who “owns” the patient? Data sharing between practice office and hospital Unscheduled exams - “normal emergency” Getting available data without Scheduled Worklist Multi-modality exams, time synchronization, and automatic calibration ECGs: stored and real-time; broad access for viewing Results distribution Solomon & Becker DICOM 20th Anniversary Conferece page 13 The tasks ahead for Cardiology
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Workflows to be developed in a new effort: Integrating the Healthcare Environment - Cardiology Leading roles by American College of Cardiology (ACC) and European Society of Cardiology (ESC) with Healthcare Information and Management Systems Society (HIMSS) Integration Profiles – tie together all the pieces into a consistent workfow solving the real-world user’s problems More on IHE this afternoon Solomon & Becker DICOM 20th Anniversary Conferece page 14 IHE Cardiology
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Solomon & Becker DICOM 20th Anniversary Conferece page 15 Thank You