CONFERENCE & SEMINAR
14 – 16 March 2013
Bangalore, India
Abstract Submission Form
Submission Deadline: 15 November 2012
Title: / Pediatric Echo Structured Reporting – An Experience SharingAuthor(s): / Bindhu M
Easwara Moorthy
Affiliation / Location: / Philips Electronics India Ltd., Bangalore, India
E-mail address of corresponding author: /
Preferred format: / _X__ Oral presentation or poster ___ Oral only ___ Poster only
Title: / Pediatric Echo Structured Reporting – An Experience Sharing
Abstract:
(200 – 750 words, in English) / Introduction
Ultrasound imaging devices need to exchange measurements/reports in a standard, coded manner, using well defined templates (DICOM Structured reporting (SR) templates).
DICOM structured reporting provides an efficient mechanism for the representation, generation, distribution and management of clinical reports.
Coded concepts and report templates represent the primitives of this reporting method. Reports are generated by instantiating corresponding template rows with data extracted from medical imaging devices.
Motivation
DICOM SR templates are available for many applications like obstetrics, cardiac, vascular. The cardiac DICOM SR template covers adult echo measurements and calculations comprehensively. There was no separate template for pediatric echo.
Although the echocardiogram measurements in adults and children are the same, echocardiography in adults encompasses a wide variety of cardiac pathology including acquired heart valve disease, disease of the heart muscle, coronary artery disease, intracardiac tumors, to name a few.
Whereas echocardiography in children, newborns and the unborn is primarily focused on congenital abnormalities that arise during pregnancy.
Thus there was a need to come out with a separate DICOM SR template for pediatric echo application. In 2010, DICOM introduced pediatric echo template supplement 78, standardizing the terms for pediatric echocardiography measurements.
This paper gives an overview of the differences between adult echo DICOM template and pediatric echo DICOM template, implementation experiences, and challenges faced.
Overview of the differences between adult echo and pediatric echo templates
Without the availability of pediatric echo template, the implementers had to use adult echo and represent the required pediatric related information as private extensions. With the definition of the new IOD in DICOM, implementation moved to support the new pediatric echo handling the differences between these templates
- The pediatric echo template provides the post-coordination definition of a measurement with a variety of concept modifiers. The finding site may be further specified within this template by the target site and target site modifiers.
On the other hand, the adult echo template has pre-co ordination definitions, meaning the template will have finding site but may not have a target site and target site modifiers. All of them would be combined as a single concept.
For Example:
A measurement A2Cs (Apical 2-Chamber) in pediatric echo template would define concept as “Major Axis”, finding site as “Ventricle”, target site as “Left Ventricle”, target site modifier as “End Sys”.
Whereas adult echo template defines the finding site as “Ventricle” and the concept as “Left Ventricle Systolic Major Axis” i.e. it groups the target site, target site modifier and concept together as a single concept.
- Coded concepts for congenital disease have been added to pediatric echo template.
- New definitions are added to pediatric echo template.
Example: Fetal measurements, Fetus characteristics etc.
Some definitions are retired
Example “End of systole” was replaced with
"End Systole"
- More patient characteristics definitions are added.
- In pediatric echo template in many context group NCDR2.0b (National Cardiovascular Data Registry) codes are replaced with equivalent SNOMED (Systematic Nomenclature for Medicine) codes.
Implementing pediatric echo structured reporting
The goal was to implement the DICOM structured reporting concept for pediatric echocardiography. Some of the challenges were
- Given the volume of adult echo measurements, mapping them to pediatric template was quite involved as
o Mapping the measurements is a manual task which required expert level knowledge of medical terminology and DICOM standards.
o Every measurement’s finding site was to be further specified with target site and target site modifier and the concept was to be replaced with newer definition this further required extreme analysis.
o Correctness of the dictionary could be ensured only by manual testing and reviewing.
- Developing a comprehensive, structured, dedicated DICOM dictionary database and efficient methods to retrieve and export the DICOM data.
Conclusion
The advent of DICOM standards for pediatric echocardiographic measurements helps the clinicians generate and store pediatric reports in a structured way without the use of private attributes. Thus increasing the interoperability of the reports.
This could be useful only when Imaging and PACS vendors adopt it simultaneously. DICOM has defined a number of specialized DICOM SRs in the last few years. Many of these are Ultrasound specific and can add a lot of value when implemented by Ultrasound Scanners. However the success of this is equally dependent on the adoption of these templates in the PACS Community.
What is the strategy recommended by DICOM for scanner manufacturers? Should we be the early adopters or wait till the PACS vendors start supporting them.