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Roundtrip conversion between DICOM SR and FHIR representations for imaging measurements

Key Investigators

• Hans Meine (Fraunhofer MEVIS)
• Peter Oppermann (Fraunhofer MEVIS)
• Andrey Fedorov (BWH)
• Tobias Stein (DKFZ)
• Jasmin Metzger (DKFZ)
• Marco Nolden (DKFZ)
• Markus Herrmann (MGH & BWH CCDS)

Project Description

Our goal is to investigate and understand (the possibility of?) lossless, automatic, "roundtrip" conversion between DICOM Structured Reporting and FHIR representations for communicating imaging-derived measurements.

Objective

1. Understand and discuss capabilities of the two representations.
2. Understand possibility, limitations, support in tools for lossless interoperability between DICOM SR TID1500 instances and FHIR documents.

Approach and Plan

1. Put together pointers to relevant documentation, samples, tutorials to help get started a novice in the topic.
2. Define specific examples of varying complexity.
3. Create hand-coded or automatically generated representations of the same content using the two approaches.

Should we also consider TID2000 Basic Diagnostic Imaging Report?

Progress and Next Steps

1. Investigated, discussed, learned a lot, concluded that roundtrip conversion is not a good goal: DICOM should stay the primary storage of all details, FHIR should serve only as a medium for storing the most important results (with references to the underlying DICOM objects), in order to make them available together with other EHR data!
2. Put up code at https://github.com/hmeine/tid1500-fhir
3. Prepared Typescript-based expected FHIR results (autocompletion!) + conversion scripts to JSON
4. Created a script that uses dsr2xml (from dcmtk), parses the resulting XML, and creates FHIR resources
5. Created a second script uploads the result to a FHIR server (first checking for existing duplicates)

Illustrations

Background and References

Relevant FHIR resources for the diagnostic report and reported observations:

• DiagnosticReport resource: https://www.hl7.org/fhir/diagnosticreport.html
• codedDiagnosis: https://www.hl7.org/fhir/diagnosticreport-definitions.html#DiagnosticReport.codedDiagnosis
• result: https://www.hl7.org/fhir/diagnosticreport-definitions.html#DiagnosticReport.result
• image:https://www.hl7.org/fhir/diagnosticreport-definitions.html#DiagnosticReport.image
• observartion resource: https://www.hl7.org/fhir/observation.html

Other FHIR-related pointers:

• #FHIR and confusion about the 80/20 rule, and interesting discussion on this rule in the context of DICOM: FHIR Extensions, the 80/20 rule, DICOM and the LONG tail, by Grahame Grieve