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DICOM & FHIR 
Marten Smits 
FHIR Developer Days 
November 25, 2014 
© 2014 HL7 ® International. Licensed under Creative Co...
Who am I? 
 Name: Marten Smits 
 Company: Furore 
 Background: 
 Medical Informatics at University of Amsterdam 
 Gra...
Outline 
 DICOM 
 RESTful DICOM 
 FHIR ImagingStudy 
 Use Cases 
 Demo 
 Problems 
3 
© 2014 HL7 ® International. Li...
DICOM 
 Digital Imaging and Communications in Medicine 
(DICOM) 
 DICOM is a specification for the creation, 
transmissi...
DICOM 
5 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks ...
DICOM 
6 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks ...
DICOM Structure 
7 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered t...
Native Dicom Model 
8 
 Flat structure 
(well, some of 
the datatypes 
are complex) 
© 2014 HL7 ® International. Licensed...
Dicom Tags 
 Unique id for an element of information 
 Composed of an ordered pair of number (a 
Group Number followed b...
Traditional DICOM 
transport 
10 
Get Image #1 
Return Image #1 
Get Image #2 
Return Image #2 
Viewer PACS 
…. 
Get Image...
RESTful DICOM 
11 
Get metadata 
Return metadata 
Viewer Choose which images you need PACS 
Get Image #1-1000 
Return Imag...
Store (STOW-RS) 
12 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered ...
Retrieve (WADO-RS) 
13 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are register...
Query (QIDO-RS) 
14 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered ...
Query (QIDO-RS) 
 Look up studies 
GET [base-url]/studies?... 
 Look up series in a study 
GET [base-url]/studies/{study...
QIDO-RS then WADO-RS 
16 
QIDO-RS: 
GET https://dicomweb.myhospital.com/studies/?00100010=THOMPSON 
Accept: application/js...
Information Entities (IE) 
 DICOM IEs can be compared to resources 
 Patient IE 
 Study IE 
 Series IE 
 Common Image...
Information Entities (IE) 
18 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are r...
FHIR ImagingStudy 
19 
 Biggest difference: Granularity 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7...
ImagingStudy and DICOM 
20 
http://hl7.org/implement/standards/fhir/imagingstudy-mappings.html 
© 2014 HL7 ® International...
FHIR ValueSets 
 ValueSets are also based on DICOM: 
 Modality 
 Availability 
 ImageModality 
21 
© 2014 HL7 ® Intern...
QIDO on FHIR? 
22 
QIDO-RS 
Query 
FHIR 
Server with 
QIDO-RS 
endpoint 
ImagingStudy 
Resources 
Native Dicom 
Model Obje...
FHIR on QIDO? 
23 
FHIR 
Search 
PACS with 
FHIR 
endpoint 
Dicom Native 
Models 
FHIR 
Resources 
© 2014 HL7 ® Internatio...
Why would we want this? 
24 
FHIR 
Server 
with 
QIDO-RS 
PACS 
DICOM web 
DICOM web 
Mobile app that speaks DicomWeb, doe...
Why would we want this? 
25 
PACS 
with FHIR 
search 
FHIR 
FHIR 
The EHR doesn’t need to speak DICOM anymore. 
© 2014 HL7...
Dicom Serialization 
 FHIR ImagingStudy to Dicom Attributes 
 34 data types need to be converted 
For example: 
 DateTi...
Code Examples 
27 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered tr...
Serialization 
 Complex Datatypes 
 Coding 
 HumanName 
28 
© 2014 HL7 ® International. Licensed under Creative Commons...
Serialization 
 Complex Datatypes 
 Coding 
 HumanName 
29 
© 2014 HL7 ® International. Licensed under Creative Commons...
Serialization 
 Data from other resources 
 Patient 
 Practitioner 
 Referenced 
 Retrieve referenced resource for in...
Serialization 
 Contained Resources 
 Dicom -> FHIR 
 Don’t need a patient endpoint 
 However: patient cannot be reuse...
QIDO Endpoints 
 Created QIDO Endpoints in FHIR 
 ImagingStudy based on QIDO-RS call 
32 
© 2014 HL7 ® International. Li...
Differences FHIR and 
DICOM 
 DICOM: GET /Instance?SOPInstanceUID=certainoid 
 Returns only one instance 
 FHIR: GET /I...
QIDO Endpoints 
 GET /Studies? 
 Return all ImagingStudy resources 
 GET /Series? 
 Return all series components from ...
Demo 
35 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks ...
Problems 
 DICOM and FHIR don’t share the same 
mandatory fiels 
 This could result in invalid DICOM or FHIR 
when a man...
Problems 
 Dicom allows search on all parameter, FHIR 
on just a few 
37 
© 2014 HL7 ® International. Licensed under Crea...
Problems 
 Not all QIDO-RS parameters implemented 
yet 
38 
© 2014 HL7 ® International. Licensed under Creative Commons. ...
Discussion and 
Questions? 
39 
 Contact: 
 Marten Smits 
 Furore, The Netherlands 
 m.smits@furore.com 
© 2014 HL7 ® ...
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FHIR and DICOM by Marten Smits Slide 1 FHIR and DICOM by Marten Smits Slide 2 FHIR and DICOM by Marten Smits Slide 3 FHIR and DICOM by Marten Smits Slide 4 FHIR and DICOM by Marten Smits Slide 5 FHIR and DICOM by Marten Smits Slide 6 FHIR and DICOM by Marten Smits Slide 7 FHIR and DICOM by Marten Smits Slide 8 FHIR and DICOM by Marten Smits Slide 9 FHIR and DICOM by Marten Smits Slide 10 FHIR and DICOM by Marten Smits Slide 11 FHIR and DICOM by Marten Smits Slide 12 FHIR and DICOM by Marten Smits Slide 13 FHIR and DICOM by Marten Smits Slide 14 FHIR and DICOM by Marten Smits Slide 15 FHIR and DICOM by Marten Smits Slide 16 FHIR and DICOM by Marten Smits Slide 17 FHIR and DICOM by Marten Smits Slide 18 FHIR and DICOM by Marten Smits Slide 19 FHIR and DICOM by Marten Smits Slide 20 FHIR and DICOM by Marten Smits Slide 21 FHIR and DICOM by Marten Smits Slide 22 FHIR and DICOM by Marten Smits Slide 23 FHIR and DICOM by Marten Smits Slide 24 FHIR and DICOM by Marten Smits Slide 25 FHIR and DICOM by Marten Smits Slide 26 FHIR and DICOM by Marten Smits Slide 27 FHIR and DICOM by Marten Smits Slide 28 FHIR and DICOM by Marten Smits Slide 29 FHIR and DICOM by Marten Smits Slide 30 FHIR and DICOM by Marten Smits Slide 31 FHIR and DICOM by Marten Smits Slide 32 FHIR and DICOM by Marten Smits Slide 33 FHIR and DICOM by Marten Smits Slide 34 FHIR and DICOM by Marten Smits Slide 35 FHIR and DICOM by Marten Smits Slide 36 FHIR and DICOM by Marten Smits Slide 37 FHIR and DICOM by Marten Smits Slide 38 FHIR and DICOM by Marten Smits Slide 39
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FHIR and DICOM by Marten Smits

FHIR and DICOM by Marten Smits

  1. 1. DICOM & FHIR Marten Smits FHIR Developer Days November 25, 2014 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  2. 2. Who am I?  Name: Marten Smits  Company: Furore  Background:  Medical Informatics at University of Amsterdam  Graduating project about FHIR, CDA and DCMs  Now: Developing FHIR Tools at Furore 2 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  3. 3. Outline  DICOM  RESTful DICOM  FHIR ImagingStudy  Use Cases  Demo  Problems 3 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  4. 4. DICOM  Digital Imaging and Communications in Medicine (DICOM)  DICOM is a specification for the creation, transmission, and storage of digital medical image and report data.  Who needs Dicom?  Hospitals, Clinics, Imaging Centers, and specialists. 4 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  5. 5. DICOM 5 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  6. 6. DICOM 6 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  7. 7. DICOM Structure 7 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  8. 8. Native Dicom Model 8  Flat structure (well, some of the datatypes are complex) © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  9. 9. Dicom Tags  Unique id for an element of information  Composed of an ordered pair of number (a Group Number followed by an Element Number)  Used to identify Attributes and corresponding Data Elements. 9 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  10. 10. Traditional DICOM transport 10 Get Image #1 Return Image #1 Get Image #2 Return Image #2 Viewer PACS …. Get Image #1000 Return Image #1000  One call and response per image  The same metadata with each image © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  11. 11. RESTful DICOM 11 Get metadata Return metadata Viewer Choose which images you need PACS Get Image #1-1000 Return Image #1-1000 Viewer  The same metadata is sent only once  Only one call and response for all images © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  12. 12. Store (STOW-RS) 12 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  13. 13. Retrieve (WADO-RS) 13 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  14. 14. Query (QIDO-RS) 14 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  15. 15. Query (QIDO-RS)  Look up studies GET [base-url]/studies?...  Look up series in a study GET [base-url]/studies/{studyUID}/series?...  Look up series GET [base-url]/series?...  Look up instances for a study/series GET [base-url]/studies/{studyUID}/series/{seriesUID}/instances?...  Look up instances by study GET [base-url]/studies/{studyUID}/instances?...  Look up instances GET [base-url]/instances?... 15 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  16. 16. QIDO-RS then WADO-RS 16 QIDO-RS: GET https://dicomweb.myhospital.com/studies/?00100010=THOMPSON Accept: application/json Json Response : Add Retrieve URL (0008,1190) "00081190": { "vr": "UT", "Value": [ "https://dicomweb.myhospital.com/studies/ 1.2.392.200036.9116.2.2.2.1762893313.1029997326.945873" ] } WADO-RS: GET https://dicomweb.myhospital.com/studies/ 1.2.392.200036.9116.2.2.2.1762893313.1029997326.945873 Accept: multipart/related; type=image/jpeg © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  17. 17. Information Entities (IE)  DICOM IEs can be compared to resources  Patient IE  Study IE  Series IE  Common Image IE (instance) 17 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  18. 18. Information Entities (IE) 18 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  19. 19. FHIR ImagingStudy 19  Biggest difference: Granularity © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  20. 20. ImagingStudy and DICOM 20 http://hl7.org/implement/standards/fhir/imagingstudy-mappings.html © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  21. 21. FHIR ValueSets  ValueSets are also based on DICOM:  Modality  Availability  ImageModality 21 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  22. 22. QIDO on FHIR? 22 QIDO-RS Query FHIR Server with QIDO-RS endpoint ImagingStudy Resources Native Dicom Model Objects © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  23. 23. FHIR on QIDO? 23 FHIR Search PACS with FHIR endpoint Dicom Native Models FHIR Resources © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  24. 24. Why would we want this? 24 FHIR Server with QIDO-RS PACS DICOM web DICOM web Mobile app that speaks DicomWeb, doesn’t need to speak FHIR as well © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  25. 25. Why would we want this? 25 PACS with FHIR search FHIR FHIR The EHR doesn’t need to speak DICOM anymore. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  26. 26. Dicom Serialization  FHIR ImagingStudy to Dicom Attributes  34 data types need to be converted For example:  DateTime -> date+time 26 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  27. 27. Code Examples 27 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  28. 28. Serialization  Complex Datatypes  Coding  HumanName 28 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  29. 29. Serialization  Complex Datatypes  Coding  HumanName 29 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  30. 30. Serialization  Data from other resources  Patient  Practitioner  Referenced  Retrieve referenced resource for information  DICOM to FHIR?  Contained?? 30 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  31. 31. Serialization  Contained Resources  Dicom -> FHIR  Don’t need a patient endpoint  However: patient cannot be reused 31 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  32. 32. QIDO Endpoints  Created QIDO Endpoints in FHIR  ImagingStudy based on QIDO-RS call 32 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  33. 33. Differences FHIR and DICOM  DICOM: GET /Instance?SOPInstanceUID=certainoid  Returns only one instance  FHIR: GET /ImagingStudy?|urn=certainoid  Searches for the imaging study with a certain instance oid  Return the entire ImagingStudy with all it’s instances  FHIR doesn’t return partial resources 33 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  34. 34. QIDO Endpoints  GET /Studies?  Return all ImagingStudy resources  GET /Series?  Return all series components from all ImagingStudy resources  GET /Instances?  Return all instances from all series from all ImagingStudy resources 34 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  35. 35. Demo 35 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  36. 36. Problems  DICOM and FHIR don’t share the same mandatory fiels  This could result in invalid DICOM or FHIR when a mandatory field is not present in the source 36 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  37. 37. Problems  Dicom allows search on all parameter, FHIR on just a few 37 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  38. 38. Problems  Not all QIDO-RS parameters implemented yet 38 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  39. 39. Discussion and Questions? 39  Contact:  Marten Smits  Furore, The Netherlands  m.smits@furore.com © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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FHIR and DICOM by Marten Smits

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