DICOM SR reportsstates, flags and versions
A radiology report in DICOM is a Structured Report object with a state, a history and links to the study, the order and the images. This page lists the SOP Classes, the flags that say whether a report is final, the attributes that tie it together, and the rules for changing one.
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The IHE reporting transactions
Five transactions cover the life of a report. Four are DICOM and one is HL7.
| Transaction | From and to | Service | What happens |
|---|---|---|---|
| RAD-24 Report Submission | Report Creator to Report Manager | C-STORE | The creator sends the SR as a draft or final report. After storage it no longer changes that object. |
| RAD-25 Report Issuing | Report Manager to Report Repository | C-STORE | The manager sends unchanged drafts, new modified reports, or both. Sending drafts can be configured. |
| RAD-26 Query Reports | Report Reader to Report Repository, Report Manager or an external repository | C-FIND | Study Root, optionally Patient Root. Matches on the usual keys and on SR keys such as the flags. |
| RAD-27 Retrieve Reports | Repository, manager or an imaging document source to Report Reader | C-MOVE or C-GET, C-STORE | The selected SR is sent to the reader for viewing. |
| RAD-28 Structured Report Export | Report Manager to Enterprise Report Repository | HL7 ORU^R01 | A verified report goes out as an unsolicited HL7 result, as plain text. |
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The SR SOP Classes
The SR Storage SOP Classes of PS3.4. IHE needs the first for every report and the second when a report has numeric values.
| SOP Class | UID | IOD | In radiology reporting |
|---|---|---|---|
| Basic Text SR Storage | 1.2.840.10008.5.1.4.1.1.88.11 | Basic Text SR | The minimum. Report Creator, Report Manager and Report Repository must all handle it. |
| Enhanced SR Storage | 1.2.840.10008.5.1.4.1.1.88.22 | Enhanced SR | When the report has numeric values such as measurements. A Report Manager that can receive it must also be able to manage and create it. |
| Comprehensive SR Storage | 1.2.840.10008.5.1.4.1.1.88.33 | Comprehensive SR | Defined in PS3.4. The IHE reporting transactions are written for Basic Text SR and Enhanced SR. |
| Comprehensive 3D SR Storage | 1.2.840.10008.5.1.4.1.1.88.34 | Comprehensive 3D SR | Defined in PS3.4. Not used by the IHE reporting transactions. |
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Reports created in the IHE profile follow the DICOM template TID 2000 and use coded entries from the DICOM Content Mapping Resource (PS3.16). All reporting actors must be able to load configurable code tables. The Report Manager and Report Repository must support Level 2 (Full) storage: all Type 1, 2 and 3 attributes are stored.
Draft, complete and verified
The state of a report is carried by two attributes of the SR and by who verified it.
| Attribute | Tag | Meaning | Changed by |
|---|---|---|---|
| Completion Flag | (0040,A491) | COMPLETE when the report content is complete. Any other value means the report is still partial. | The Report Manager, when it completes a partial report by adding content. |
| Verification Flag | (0040,A493) | VERIFIED when the content has been checked for correctness. Any other value means it has not been verified. | The Report Manager, when verifying. The Verifying Observer Sequence is then filled in. |
| Verifying Observer Sequence | (0040,A073) | Who verified the report: organization, date and time, name and an identification code. | The Report Manager, at verification. |
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A final report is one with the Completion Flag COMPLETE and the Verification Flag VERIFIED. Reports with any other values are considered draft reports.
Attributes that tie a report together
How a report is linked to its study, its order, its images and its versions.
| Attribute | Tag | Purpose |
|---|---|---|
| Study Instance UID | (0020,000D) | The study the report belongs to. IHE recommends the Study Instance UID of the images reported on. |
| Referenced Request Sequence | (0040,A370) | The order behind the report: Study Instance UID, Accession Number (0008,0050), Requested Procedure ID (0040,1001), Requested Procedure Code Sequence (0032,1064), and Placer and Filler Order Number (0040,2016), (0040,2017). |
| Current Requested Procedure Evidence Sequence | (0040,A375) | References to the images and objects the report is based on, for the procedure being reported. |
| Pertinent Other Evidence Sequence | (0040,A385) | References to other studies the report refers to, such as priors. |
| Retrieve AE Title | (0008,0054) | In a reference, the AE title where the referenced object can be retrieved. Optional for a creator; a manager may fill in the AE title of a configured image manager. |
| Predecessor Documents Sequence | (0040,A360) | The earlier reports a new report is based on. It carries the version history. |
| Identical Documents Sequence | (0040,A525) | The other copies of the same report in other studies. The Retrieve AE Title is not sent in these items. |
| Concept Name Code Sequence | (0040,A043) | The code of the document title, which tells what kind of report it is. |
| Content Date and Time, Observation DateTime | (0008,0023), (0008,0033), (0040,A032) | When the content was created or observed. Exported as the HL7 observation date and time. |
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Changing a report
Reports are never edited in place. These are the rules that apply.
| Situation | What happens |
|---|---|
| Any change of content | PS3.4 Annex O.3: the changed SR gets a new SOP Instance UID if an attribute of the SR Document General or SR Document Content module is added, removed or updated, or if the Series or Study Instance UID is changed. |
| Complete or verify | The Report Manager creates a new report with the flag set (and the Verifying Observer filled in). It is in a different series than the original, unless creator and manager are the same device, and points back with the Predecessor Documents Sequence. |
| Amendment | IHE recommends a new SR that contains the original content plus the amendments, with the Predecessor Documents Sequence referring to the original. |
| Merging reports | A new report built from several earlier ones. If a Basic Text SR is merged with an Enhanced SR, the result is an Enhanced SR. |
| Adding measurements | A Basic Text SR becomes an Enhanced SR. If numeric values are removed, the manager may convert an Enhanced SR to a Basic Text SR. |
| Patient data changes | The Report Manager can generate a new version of a report with updated demographics after a Patient Update. |
| One report, several studies | One copy per study, each with its own SOP Instance UID and the same content, and an Identical Documents Sequence that lists the other copies in each. |
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Query keys for reports
The SR-specific keys IHE requires, in addition to the usual Study Root keys, when a reader queries for reports.
| Key | Tag | Use |
|---|---|---|
| Completion Flag | (0040,A491) | Ask for complete or partial reports. |
| Verification Flag | (0040,A493) | Ask for verified reports only, or for drafts. |
| Verifying Observer: name, date and time | (0040,A075), (0040,A030) | Who verified it and when. |
| Concept Name Code Sequence | (0040,A043) | The report title code. |
| Referenced Request Sequence | (0040,A370) | Match on the Accession Number or Requested Procedure ID of the order. |
| Content Date and Time, Observation DateTime | (0008,0023), (0008,0033), (0040,A032) | Optional matching keys. The repository returns them. |
No rows match the filter in this table.
Glossary
- SR (Structured Report)
- A DICOM document type that holds structured content, with a content tree of text, codes, measurements and references to images.
- SOP Instance UID
- The unique ID of one report. A changed report gets a new one.
- Draft and final report
- A final report has the Completion Flag COMPLETE and the Verification Flag VERIFIED. All others are drafts.
- Evidence sequence
- An SR list of the images and other objects the report is based on. They let a viewer open the images next to the report.
- Predecessor
- An earlier version of a report that a new report is based on.
- Template TID 2000
- A DICOM content template for diagnostic imaging reports, from the Content Mapping Resource (PS3.16). IHE uses it for the reports of its profile.
Summary
- IHE reports are DICOM SRs:
Basic Text SRat minimum,Enhanced SRwhen numeric values are needed. - Final means Completion Flag
COMPLETEand Verification FlagVERIFIED. Anything else is a draft. - A changed report gets a new
SOP Instance UIDand points to its predecessor with(0040,A360). Nothing is edited in place. - The report links to the study by
Study Instance UID, to the order with the Referenced Request Sequence, and to the images with the evidence sequences. - Reports are queried by the flags, the title code and the order references, and stored with Level 2 (Full) storage.
Common questions
Which SOP Class is used for a radiology report?
Basic Text SR Storage (1.2.840.10008.5.1.4.1.1.88.11) for a text report, and Enhanced SR Storage (1.2.840.10008.5.1.4.1.1.88.22) when the report contains numeric values such as measurements. Both are defined in PS3.4. IHE requires every reporting actor to handle Basic Text SR.
How do I know whether an SR report is final?
Check two attributes: Completion Flag (0040,A491) must be COMPLETE and Verification Flag (0040,A493) must be VERIFIED. If either has another value, the report is a draft. The Verifying Observer Sequence (0040,A073) says who verified it and when.
Why does a corrected report have a new SOP Instance UID?
Because PS3.4 requires it: when an attribute of the SR Document General or Content module is added, removed or updated, the SR gets a new SOP Instance UID. The new report refers to the old one with the Predecessor Documents Sequence (0040,A360), so a system can follow the versions.
How is a report connected to the images?
Through the Study Instance UID (IHE recommends using the one of the images reported on), and through the Current Requested Procedure Evidence Sequence (0040,A375) and the Pertinent Other Evidence Sequence (0040,A385), which reference the images the report is based on. The Retrieve AE Title in those references says where to get them.
How is a report connected to the order?
Through the Referenced Request Sequence (0040,A370), which holds the Accession Number, the Requested Procedure ID and the placer and filler order numbers. They are what lets the HL7 export fill OBR-2 and OBR-3 for the right order.
Is DICOM SR the only way to store a report?
No. The IHE Radiology profile uses DICOM SR, but many sites keep the report as text or PDF in the RIS and send it to the EHR over HL7. A PDF can also be stored in DICOM, but that is not the IHE reporting profile described here.