Towards standards for multimedia radiological reports
B. Gibaud1 , N. Brown2 and A. Todd-Pokropek3
1 Laboratoire
SIM, Faculté de Médecine, Av Pr. Léon
Bernard, F- 35043 Rennes, France
2 Sheiling, Swarraton, Hants , United Kingdom
3
INSERM U494, Fac. de Médecine, Hôpital Pitiè Salpétrière, Paris, France
Background and objectives
The DICOM standard published in 1993 [1] and a number of supplements issued since that date [e.g. 2] have brought a tremendous progress towards interoperability of the various equipment dealing with medical images in radiology. However, the way radiological reports are standardised in the DICOM standard is not fully satisfactory. In particular this specification does not address the potentially multimedia nature of these documents. A draft proposal called Structured Reporting [3] has been submitted a few months ago addressing some of these issues, but has not been accepted yet. Besides, new emerging technology, in particular from the web, seems very promising and is given a very prominent interest by the whole community interested in the representation and management of electronic patient records [4,5].
In this context, the Technical Committee 251 of CEN has launched in 1998 a project team dealing with the interoperability of multimedia medical records. Rather than trying to embrace all possible multimedia records, the PT decided to focus on a limited set of well-defined multimedia objects, namely radiological reports on the one side, and reports of medical procedures involving the acquisition of physiological signals on the other side, which also call for multimedia capabilities.
The subject of this paper is to describe the aim, methodology and preliminary results of this work, especially those concerning multimedia reports, which are of primary importance for PACS.
The general method of work will consist of three steps:
· The first consists in defining the user needs, i.e. to make explicit what these reports are or should be, why, by whom and how the reports are built up and used in the clinical practice, inside and outside imaging departments. This will be done from a number of scenarios, describing in text these processes. More formalised descriptions will be derived from these textual descriptions by means of Conceptual data models (to represent the information structure) and use cases and sequence diagrams for representing the processes. The UML (Unified Modelling Method) methodology will be used throughout this analysis and modelling task.
· (2) The second step will consist in assessing the applicability of existing (monomedia) standards in order to achieve the interoperability of the applications dealing with multimedia reports through their life cycle. In particular, the capabilities of existing DICOM entities, IODs and services will be analysed. The potential capabilities of emerging standards and PAS (Publicly Available Specification) from the web technology (such as HTML and XML) will be analysed in detail, notably regarding the organisation of the verbal parts of the reports and the establishment of relationships to the non-verbal data (images, curves, ROIs, etc.). This assessment will also take into account existing standards of TC251, especially those concerning the architecture of medical records and those dealing with the messages for diagnostic service requests and reports.
· The third step of the work will aim at deriving a number of recommendations to TC 251 WG IV regarding further standardisation in this field.
The results which will be presented will concern the two first phases mentioned above, namely the modelling of the needs in terms of interoperability of multimedia radiological reports and some aspects of the assessment of existing standards and PAS.
References
Corresponding author:
Mr. Bernard Gibaud
Laboratoire SIM
Faculté de Médecine,
Av Pr. Léon Bernard,
F- 35043 Rennes, France
e-mail :
Oral presentation at EuroPACS'98, Barcelona, Spain