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This paper presents our contributions in the design and implementation of a DICOM compliant environment for structured reporting in echocardiography. A structuring methodology of the medical information aiming to extend the set of contexts and templates with those corresponding to non-numerical findings is the first major contribution. The enhancement of DICOM mechanisms used in the report creation process is another contribution that is essential in order to reach a practical solution. The third contribution refers to the design and implementation of a suite of software tools for coded concepts, context groups, templates and reports editing and management. Using the proposed methodology and the designed software environment, a group of physicians have created a series of DICOM compliant contexts and templates, and experimented the medical reporting for relevant echocardiography images.