THE DICOM 2014 Chengdu Workshop August 25, 2014 Chengdu, China DICOMweb TM Brad Genereaux, Agfa HealthCare Product Manager Industry Co-Chair, DICOM WG-27, Web Technologies

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Notice DICOMweb TM is a copyright of the National Electrical Manufacturers Association, Secretariat, DICOM Standards Committee. All rights reserved. 2

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Topics (hidden) Delivering imaging results to referring physicians, specialists and patients Driving use cases and the role of Web Services in an imaging environment Overview of the suite of DICOM Web Services Details of WADO, WADO-WS, WADO-RS, STOW, QIDO Practical interplay between DICOM information objects, DICOM web services and traditional DICOM services 3

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Image Lifecycle TaskUserLocationApplication Acquire ImagesTechnologistIn hospitalModality QA ImagesTechnologist / PACS Admin In hospitalPACS Read ImagesRadiologistIn hospitalPACS 4 DICOM … but that’s not all! PACS RIS

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Extended Image Lifecycle 5 Prior studies DICOM Long-term archives Other modalities DICOM 3D visualization … but that’s not all!

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Tertiary Image Lifecycle 6 Foreign studies ??? Regional archives Non-DICOM modalities ??? Medical Records ??? Mobile Devices Sharing Portals ???

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Tertiary Image Lifecycle TaskUserLocationApplication Acquire ImagesTechnologistIn hospitalModality QA ImagesTechnologist / PACS Admin In hospitalPACS Read ImagesRadiologistIn hospitalPACS Get Prior ExamsRadiologistIn hospital, get from remote location PACS Review ImagesReferring Physician Remote physician officeLightweight viewer Review Patient Record Attending Physician In hospitalEMR Physician RoundsCare TeamIn hospital and telepresence Web Portal Archive regionallyTechnologist / PACS Admin In hospital to remotePACS 7

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Tertiary Image Lifecycle 8 Foreign studies ??? Regional archives Non-DICOM modalities ??? Medical Records ??? Mobile Devices Sharing Portals ??? Network security and performance Does not understand DICOM

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Problems in a Global Space Network Security How do we encrypt in transit? How do we authenticate and authorize? Network Performance How do we negotiate protocols fast? How do we deal with low bandwidth and high latency connections? Understanding DICOM How do we cross the big gap for non-medical imaging solutions? How do we do this today outside of medical imaging? 9

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux The Internet The rise of the Hypertext Transport Protocol (HTTP) delivers an effective means to transfer images. But how? 10

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Internet File Transfer HTTP/1.1 is ubiquitous; readily available tools that form the foundation for data communication in the modern world Request/response protocol in the client/server computing model Can be streamed, multi-threaded Can resume after interruption Caching, authentication, and authorization all part of standard 11

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Weibo Photo Metadata Photo Height and width URL to retrieve Caption Tagged people Location Date and time Album Name Collection of images Cover photo Description Privacy Place 12

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Weibo Image Hierarchy 13 User Album 1 Album x Image 1 Image y Each user contains x albums, which contain y photos.

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Weibo API 14 (

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux What are APIs? REST? Application Programming Interface Methods to access an application’s data and workflow without using the application’s user interfaces REpresentational State Transfer An architectural style for standardizing data and workflow operations over HTTP Scalable, fault-tolerant, recoverable, secure, and loosely-coupled 15

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Three Levels of REST Level 1: Resources Level 2: Verbs Level 3: HATEOAS 16

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Level 1: Resources ResourceReturns /patientsA list of all patients /patients/bobDetails about “Bob” /patients/bob/reportsA list of all Bob’s reports /patients/bob/reports/1Details about Bob’s first report 17

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Level 2: Verbs VerbResults GET /patients/bob/reports/1Returns details about Bob’s first report POST /patients/bob/reports/1Creates a new report with an ID of 1 PUT /patients/bob/reports/1Updates report ID 1 with new information DELETE /patients/bob/reports/1Deletes report 1 18

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Level 3: HATEOAS Hypermedia as the engine of application state 19 "ids" : [ , , ] "links": [ { "rel": "Reports", "href": " }, { "rel": "Appts", "href": " }, { "rel": "Labs", "href": " } ]

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Back to Medical Imaging 20

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Instance UID Height Width Position Instance Medical Imaging Metadata Series UID Modality Description Series Number Body Part Series Study UID Date of Study Description Refer Physician Accession Availability Study 21

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Medical Imaging Hierarchy Patient 1 Study 1 1 Study x Each patienthas x studies, which has y series, Instance 1 Instance z Series 1 Series y which has z instances. … and could have f frames. 22

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Introducing DICOMweb TM Web standard for medical imaging Covers basic imaging interactions Query via QIDO-RS Retrieval via WADO (-RS, -URI, -WS) Storing via STOW-RS DICOMweb TM is a copyright of the National Electrical Manufacturers Association, Secretariat, DICOM Standards Committee. All rights reserved. 23

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux DICOMweb TM in practice Query (QIDO-RS) Query (QIDO-RS) Retrieve (WADO-RS) Retrieve (WADO-RS) Store (STOW-RS) Store (STOW-RS) 24

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Plugs into Web Infrastructure DICOMweb TM APIs Client (browser) User (clinician) Web Platform (.Net, J2EE) Backend Infrastructure (DICOM) Server Security 25

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Compatible with DICOM 26 ServiceDICOMDICOMwebDefinition QueryC-FINDQIDO-RSQuery by IDs for DICOM Objects using RESTful Services RetrieveC-MOVEWADO-RSWeb Access to DICOM Objects using RESTful Services WADO-WSWADO using WS-* Services (SOAP) WADO-URIWADO using URI StoreC-STORESTOW-RSStore via the Web using RESTful Services

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Web-friendly Structures CT Doe John XML 27

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Web-friendly Structures " ": { "vr": "DT", "Value": [" "] }, " ": { "vr": "CS", "Value": ["CT"] }, " ": { "vr": "PN", "Value": [ { "Alphabetic": { "Family": ["Doe"], "Given": ["John"] } }] }, " D": { "vr": "UI", "Value": [ " " ] } JSON 28

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Discovery via QIDO-RS 29

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux QIDO-RS Example StudyDateLink Abdomen CT Jan. 17, Chest CRJan. 23, What studies do you have for John Doe? studies/? =DOE^JOHN 30

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Retrieve via WADO-RS 31

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux WADO-RS Example Show me images for the Abdomen CT /series/4.5.6/ 32

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Upload with STOW-RS 33

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Stored STOW-RS Example Store this image 34

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux WADO-URI Similar to WADO-RS, but with one resource and all URI parameters WADO&studyUID= &seriesUID= &objectUID= http://server.com/wado/?requestType= WADO&studyUID= &seriesUID= &objectUID= One object at a time Supports rendering of objects in web formats, without metadata Also known as “plain” WADO 35

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux WADO-WS Access to DICOM objects via SOAP “Simple Object Access Protocol” Used in IHE XDS-I transactions XML – HTTP based protocol Supports rendering of objects in web formats Retrieves and filters metadata 36

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Coming Soon in DICOMweb TM WADO-RS to include rendering Currently only a feature of WADO-URI, -WS Discovery of server capabilities via “Server Options” Web workflow via Unified Procedure Step for RESTful Services (UPS-RS) 37

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux In Summary 38 Foreign studies Regional archives Non-DICOM modalities EMR Mobile Devices Sharing Portals Prior studies DICOM Long-term archives Other modalities 3D visualization DICOMweb

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Thank You! Questions? 39

August 2014, THE DICOM 2014 Chengdu Workshop DICOMweb TM – Brad Genereaux Image Sources