DICOM Update: DICOM structured reporting gains momentum

DICOM structured reporting gains momentumBy Herman Oosterwijk, president, OTech Inc.

The addition of a structured reporting capability to the DICOM standard has remained a draft proposal for several years, although some vendors and institutions have developed trial implementations. Driven by a need to include diagnostic reports in the Integrating Healthcare Enterprise initiative of the RSNA and HIMSS (PNN 4/99), the structured reporting effort appears finally to be picking up speed. A DICOM working group will devote time in its next few meetings to finalizing the proposal.

Although HL7’s text report exchange mechanism would seem to fit the need for a diagnostic reporting standard, that approach fails to provide the receiver with semantics or a structured format, nor does it offer a formal description of the relationship of the text report to the images. Furthermore, HL7 is unable to communicate measurements, which are necessary, for example, with ultrasound exams.

A structured report, on the other hand, provides a means to convey the report’s context, such as who generated the report or what imaging procedures were performed. In addition, users could provide patient and treatment information in a structured format, rather than creating a long string of text to provide those data.

Structured reporting also confers the ability to perform outcomes research and computer searches based on certain criteria. There is a mechanism within DICOM that covers report generation, called Interpretations and Results—the so-called DICOM results management services. This service is actually a requirement for a PACS to be installed within the U.S. Department of Defense (DOD).

Using DICOM Results management has several disadvantages, however. As with the HL7 interface, no structure or context information is provided. In addition, the protocol used to exchange this information is awkward and inefficient. The report generator indicates when a report is available, which requires the receiver to retrieve it.

The proposed structured reporting protocol is more in line with a client/server architecture, in which the client retrieves from the server the information in one large container, i.e., as a complete object containing the report and all the important information describing the context, etc.

Several modalities could greatly benefit from structured reporting. Ultrasound systems, for instance, record and exchange image measurements in a proprietary fashion or store this information as overlays on the images. Ophthalmologists and physicians using endoscopy would also benefit from recording their observations in a structured and defined manner.

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