dicom

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Telemedizin WS 08/09HL7 - DICOM - 1

DICOM

Health Level 7

HL 7

Digital Imaging and Communication in Medicine

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Communication in a hospital

Administration

Laboratory

Radiologie

surgery documentation

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Communicationin the past

• Individual interface between ever two systems

• High developing costsn * (n-1) interfaces for n systems

• extensive documentation• high maintenance costs• high expenditure with exchange of

equipment

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HL7

HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all.

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Communication with HL7

In 1987 the USA a working group was established with the goal:

• Supply of formats and protocols for data exchange in the health service

• Standardization of the contents• More efficient communication• Standardized language• Reduction of the implementation

expenditure• International Standard

http://hl7.org/ http://www.hl7.de/

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Messages

• Aufnahme, Verlegung, Entlassung(admission, discharge, transfer = ADT)

• Anfragen (queries)

• Untersuchungsergebnisse (result reports)

• Buchhaltung / Finanzen (finance)

• Patientenversorgung (patient care)

• Terminplanung (scheduling)

• Rezept (pharmacy prescription)

http://www.hl7.de/links/demodb/hl7v231.htm

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Events

The transmission of the messages is triggered by events

Example:A01 stationäre Aufnahme Admit

A02 Verlegung Transfer

A03 Entlassung Discharge

A08 Änderung Update

http://www.hl7.de/links/demodb/hl7v231event.htm

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Example

Administration

Laboratory

Radiologie

surgery documentation

A01

A01

A01

ACK

ACK

ACK

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Example

Administration

Laboratory

Patient unknown

query message

response message

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Composition of messages

• Messages consists of segments andbegin with a Message Segment Header MSH

• Segments consists of an ordered sequence of fieldsFields can be mandatory or optional

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Datatypes of fieldsST String XPN Person Name

TX Text XAD Adresse

FT Formatted Text XTN Telefon Number

NM Numeric ID Coded Value HL7 table

DT Date IS Coded Value user defined

TS Timestamp CN Composite

PL Person Location

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Example of Codetabelle

Attributwert Description Bezeichnung

F Female weiblich

M Male männlich

O Other andere

U Unknown unbekannt

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A01 ADMIT A PATIENTMSH Message HeaderEVN Event TypePID Patient Identification [PD1] Additional Demographics[ { NK1 } ] Next of Kin /Associated PartiesPV1 Patient Visit[ PV2 ] Patient Visit - Additional Info.[ { DB1 } ] Disability Information[ { OBX } ] Observation/Result[ { AL1 } ] Allergy Information[ { DG1 } ] Diagnosis Information[ DRG ] Diagnosis Related Group[ { --- PROCEDURE beginPR1 Procedures[{ROL}] Role} ] --- PROCEDURE end[ { GT1 } ] Guaranto[ { --- INSURANCE beginIN1 Insurance[ IN2 ] Insurance Additional Info.[ {IN3} ] Insurance Additional Info. - Cert.} ] --- INSURANCE end

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Notation of Cardinality

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Segments Used in DUMC ADT Messages

AL1 Allergy InformationDG1 Diagnosis InformationEVN Event TypeMRG Merge InformationMSH Message HeaderNK1 Next of KinOBX ObservationPID Patient IdentificationPV1 Patient VisitPV2 Patient Visit - Additional InformationZAP DUMC Appointment SegmentZID DUMC Patient Identification ExtensionZV1 DUMC Patient Visit Extension

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Example ADT – messageadmission of patients

A01 - Admit a PatientMSH|^~\&|DMCADT||RADIS1||199506281130||ADT^A01|

DMCADT950628113012000|P|2.2|||NEEVN|A01|199506281130|||MCKEL003PID|||H89213||BOOP^BETTY^B||19091012|F|JOHN

WRIGHT|W|3380 HIDDEN OAK AVE^^DURHAM^NC^27704||(919)555-7906|||U|UNK|241639|000000000

PV1||I|MIN^2411^01|3|||051001^MASSEY^E^WAYNE|||MRH||||C||||A||027|||||||||||||||||||A01||10|||199506281129

ZV1|S|I|NDG1||||CAUDA EQUINA SYN.||WDG1||||CAUDA EQUINA SYN.||A

DUMC HL7 ADT Specifications http://www.hl7.de/links/demodb/hl7v231eventA01.htm

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HL7 with XML

• Simpler to read• Simpler to validate• Bute the messages are much more

longer– Example :

• ADT - A01 message 500 characters• ADT - A01 as XML 2127 characters

Example

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CDAClinical Document Architecture

Document HierarchyHeader

Body

Header

Body

Header

Body

Header

Body

General dianostic finding

X - rax findingECG finding Endoscopy finding

Header

Body

Header

Body

Header

Body

X - rax CT MRT

Header

Body

Header

Body

gastro

oesophago

Level 1Unconstrained CDA

Level 2Section Leveltemplates

Level 3Entry Leveltemplates

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DICOMDigital Imaging and

Communication in Medicine• In the year 1983 the American college of Radiology

(ACR) and the National Electrical Manufactures Association (NEMA) created a committee. The goal was to develop a standard for medical pictures.

• In the year 1985 the first version of this standard was presented. The file format and electrical point to point a connection between two devices were defined.

• In the year 1993, DICOM 3.0 a further developed standard was presented, which made communication possible between different partners over a network.

http://www.iftm.de/dicom/einfuehrung.htm

http://medical.nema.org/

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Goal ofDICOM Standard

The goal of the DICOM Standard is to achieve compatibility and improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwideDescription of the semantics of instructions and the

appropriate files. Description of the range of the implemented standards Support of the communication in the networkOpen to new applicationsUse of existing international standards if possible and

preparation of own standards

http://medical.nema.org/

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StandardsInformation Object

DefinitionAbstract definition of objects for the

transmission of digital medical images and information according these images– Normalized classes contain only attributes,

which belong directly to the object; e.g.: the attributes of an x-ray

– Compound classes can contain also attributes, which belong indirectly to the object; e.g. the patient data and diagnoses to the x-ray

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StandardsService Class Specification

Spezification of services:A class of services joins one or more

information objects with services that can be performed with these objects.

Examples of services:Storing of dataSearchingWorking listsPrinting

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StandardsData Dictionary

• centralized registry which defines the collection of all DICOM Data

• For each element, the data dictionary specifies:— its unique tag, which consists of a group

and element number— its name— its value representation (character string,

integer, etc)— its value multiplicity (how many values per

attribute)

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StandardsData Structure and

Semantics• specifies how DICOM applications

construct and encode the Data Set information– For example specification of image

compression• addresses the encoding rules

necessary to construct a Data Stream

• defines the semantics of a number of generic functions

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StandardsMessage Exchange

specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages

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StandardsMessage Exchange

This Standard defines:— the operations and notifications made

available to Service Classes— rules to establish and terminate

associations provided by the communications support and the impact on outstanding transactions

— rules that govern the exchange of Command requests and responses

— encoding rules necessary to construct Command Streams and Messages.

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StandardsNetwork Communication

SupportMedia Storage and File Format

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StandardsMedia Storage Application

Profiles• specifies application specific

subsets of the DICOM Standard to which an implementation may claim conformance.

• Is required for the exchange of medical images and related data between different applications

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StandardsStorage Functions and Media

Formats for Data Interchange

facilitates the interchange of information between applications in medical environments by specifying:– A structure for describing the

relationship between the media storage model and a specific physical media and media format.

– Specific physical media characteristics and associated media formats.

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StandardsConformance

defines principles that implementations claiming conformance to theStandard shall follow– specifies the general requirements which

must be met by any implementation claiming conformance.

– defines the structure of a Conformance Statement.

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Standards

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Examples

• PACS Picture Archiving and Communication System http://www.vepro.com/USA/solutions/PACS.asp

RIS Radiologie Information Systemhttp://www.kliniken-heidenheim.de/klinik/

Kliniken_und_zentrale_Einrichtungen/Roentgendiagnostik/index.php

Integrationhttp://www.uni-mainz.de/FB/Medizin/Radiologie/agit/

berichte/dicom2004/01_Bilddatenmanagement.pdfhttp://www.hipax.de/start.htm

dicom

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