X.1.2 Reporting with Image References

To augment the basic dictation/transcription reporting use case, it is desired to select significant images to be attached (by reference) to the report. During the softcopy reading, the physician may select images from those displayed on his workstation (e.g., by a point-and-click function through the user interface). The selection of images is conveyed to the image repository (PACS) through a DICOM Key Object Selection (KO) document. When the report management system receives the transcribed dictation, it queries the image repository for any KO documents, and appends the image references from the KO to the transcription. In this process step, the report management system does not need to access the referenced images; it only needs to copy the references into the draft report. The correction and signature function potentially allows the physician to retrieve and view the referenced images, correct and change text, and to delete individual image references. See Figure X.1-2.


Figure X.1-2 Reporting Data Flow with Image References

The transcribed dictation must have associated with it sufficient key attributes for the report management system to query for the appropriate KO documents in the image repository (e.g., Study ID, or Accession Number).

Each KO document in this process includes a specific title “For Report Attachment”, a single optional descriptive text field, plus a list of image references using the SR Image Content Item format. The report management system may need to retrieve all KO documents of the study to find those with this title, since the image repository might not support the object title as a query return key.

Multiple KO instances may be created for a study report, e.g., to facilitate associating different descriptive text (included in the KO document) with different images or image sets. All KOs with the title “For Report Attachment” in the study are to be attached to the dictated report by copying their content into the draft report (see sections X.2 and X.3). (There may also be KOs with other titles, such as “For Teaching”, that are not to be attached to the report.)

The nature of the image reference links will differ depending on the format of the report. A DICOM SR format report will use DICOM native references, and other formats may use a hyperlink to the referenced images using the Web Access to DICOM Persistent Objects (WADO) service (see PS3.18).