Supplement 23 to Digital Imaging and Communications in Medicine (DICOM) is an introduction to the structured reporting (SR) classes, which are used for transmission and storage of clinical documents. The SR classes fully support both conventional free-text reports and structured information, thus enhancing the precision, clarity, and value of clinical documentation. In addition, the SR standard provides the capability to link text and other data to particular images or waveforms and to store the coordinates of findings. In other words, SR documents not only describe the specific features contained in images or waveforms but can also refer to any number of images or waveforms. Accordingly, SR bridges the traditional gap between imaging systems and information systems. Furthermore, SR plays an essential role in Integrating the Healthcare Enterprise by providing healthcare practitioners with an effective tool that encompasses a variety of clinical contexts. Harmonization of DICOM SR and the Health Level Seven clinical document architecture standard is under way.

Structured reporting (SR) was recently added to the Digital Imaging and Communications in Medicine (DICOM) standard to provide an efficient mechanism for the generation, distribution, and management of clinical reports. The main advantage of SR is the ability to link clinical documents with the referenced images for simultaneous retrieval and display. A generic SR toolkit that covers the different clinical reports used in today's healthcare enterprises was developed for picture archiving and communication system (PACS) workstations. The modules of the SR toolkit collaborate to automatically construct the DICOM SR files from the free-text input presented in hypertext markup language (HTML) by using the associated SR trees. The DICOM toolkit is reused for SR encoding and DICOM services. A setup module was required for creating both the standard and private SR templates used in different healthcare specialties. The SR manager transparently converts between the different SR document presentations, that is, DICOM SR files and HTML documents, to provide the end users with an easy-to-use toolkit. To evaluate and demonstrate the effectiveness of the SR toolkit in a pragmatic setting, the toolkit was integrated into PACS workstations.

Medical images are currently created digitally and stored in the radiology department's picture archiving and communication system (PACS). Reports are usually stored in the electronic patient record (EPR) of other information systems, such as the radiology information system (RIS) or the hospital information system (HIS). But high-quality service can only be provided if the EPR data is integrated with the PACS digital images. The clinician should be able to access both systems' data in an integrated and consistent way as part of the regular working environment, the HIS or the RIS. Additionally, this system should allow for teleconferences with other users, e.g., for consultations with a specialist in the radiology department. This paper describes a web-based solution that integrates the digital images of the PACS, the EPR/HIS/RIS data and a built-in teleconferencing functionality. The integration has been successfully tested with three different commercial RIS and HIS products. D

This paper describes the communication concept for a regional stroke network for the exchange of medical images and reports. The data transfer is realized with regular e-mail (SMTP). DICOM images are sent as DICOM compliant attachments. Private key encryption is used to ensure data security and privacy. All used protocols are standardized or de-facto standards and allow vendor-independent communication. Different problems and options of the concept realization are discussed.