DICOM for Physicians : What can it do for you? Kevin O’Donnell Toshiba Medical Research Institute This talk will look at what DICOM does, and also serve as a preview for many of the talks that follow today. Q. What do you WANT it to do? – there’s a good chance it already does. Q. OK, first, what IS DICOM?

DICOM: A Standard DICOM is the standard for medical imaging. Widely implemented Managed process (NEMA) International scope (ISO) and many pages of detail information… What do we mean “standard” 3,000+ pages. Bet you don’t want to have to read it. Good news is that you don’t have to, but you should understand what it covers.

DICOM: A Family of Protocols Specifies how two systems exchange information Many kinds of Systems: Modalities, PACS, RIS, Workstations, EMR,… Many kinds of Information: Images, worklists, measurements, surfaces, audit logs, … DICOM is for Systems talking to each other about imaging Many protocols in the family – related but independent

Why should I care? Can I just ask for “DICOM”? * Yes, if you don’t care what pieces you get Pieces can be implemented independently Depends on what the product needs to do Won’t vendors just give me what I need? (We try to, but …) your input matters DICOM has it ≠ vendors use it (intelligently) Know what is possible Ask about your top priorities Ron Cowan’s talk will get into this process of selection.

Store Images DICOM stores your images * DICOM helps manage your Images All kinds of images CT, MR, X-Ray, Ultrasound, Angiography, PET, SPECT, Mammography, Dentistry*, Dermatology, Endoscopy, Ophthalmology, IVUS, Pathology * Scanned Documents, … Single & Multiframe; Volumes & Cines; B&W & Color; Original & Processed DICOM helps manage your Images Not just pixels; Significant meta-data Patient identification & demographics, the order, equipment, acquisition, workflow context, … PACS = database; DICOM = machine readable Can query/sort/autoroute/manage DICOM has been evolving for over 20 years; new modalities continue to emerge. Large hospitals are creating millions of frames per year. DICOM has been applied to vet, DICONDE and DICOS Allan Farman Talk & Dr. Pereira tomorrow Harry Solomon Talk

Store (Imaging) Data * Measurements Analysis Data OB-GYN (fetal size metrics, etc.) Echocardiography (size, flow, motion) CT/MR Vascular (vascular flow metrics) Ophthalmology (axial meas., perimetry) Analysis Location & characteristics of CAD findings for Mammography, Chest X-Ray, Colonoscopy Data Waveforms (ECG, EEG, Voice) Harry Solomon Talk on behalf of Andrei Leontiev What else can DICOM do for you?

Manage Acquisition Workflow * DICOM meets HL7 Patient management, order placement in HL7 RIS through Reporting in DICOM Modality Worklist Scheduled patient & exam information (electronic) Exam Status & Coordination Exam in-progress; complete; cancelled Storage Commitment Verify images on PACS before Modality deletes Niki Wirsz Talk Note capabilities of Worklist to specify protocols, provide admitting diagnosis, etc.

Display Images * Accuracy Convenience Information Screen calibration method & data (GSDF) Consistent presentation (GSPS) Modality calibration (Modality LUT) Also works for Printing Convenience Key image flagging Hanging Protocols Structured Display Information Meta-data can be overlaid Time & Space correlation Lawrence Tarbox Talk <<Picture of reading workstation>>

Distribute Images * by Local Network by Media by Internet Push & Pull (Query/Retrieve) by Media CD, DVD, BluRay, … USB Memory, USB HardDrive by Internet Email attachment Web Access to DICOM Objects (WADO) DICOM Data and/or Rendered pictures Registry & Repository architecture(XDS-I.b) Note that you can make remote systems appear on the local network Cor Loef’s Talk

Manage Other Workflows Reporting Workflow Worklists, status reporting Post-processing Workflow Radiotherapy Procedure plans, worklists, verification Substance Administration Identification Service (barcode) Verification Service

Store Advanced Image Processing & Visualizations Registrations Rigid & Deformable Different studies, modalities, atlases Segmentations Voxel Classification & Surface Definition Fusion Blended presentation Surgical Implants Implant models & implantation plans 3D Presentation States are WIP

Support Security & Privacy * Audit Trails Record creation, access & modification in central log De-identification Remove identifying details to various degrees * Encryption Encrypt data elements or entire objects Configuration Autoconfigure DICOM devices Lawrence Tarbox’s 2nd talk David Clunies talk and Jacques Fauquex talks tomorrow Just like when you plug a computer into a network.

Measure Quality & Performance Workflow Timestamps in data objects and workflow messages Report Turnaround Time, Exam Times, … QA Scans Store and flag phantom scans Radiation Dose Summary & detail for each procedure CT, Angiography/Fluoroscopy, Mammography, CR/DR Work in Progress for PET

… and More DICOM does a lot Today’s talks Tomorrows talks Future And we add to it every year. * Today’s talks most widely deployed features Tomorrows talks some of the exciting new features Future Tell us your needs Physicians have directly driven a number of additions Return to opening question. (What do you want it to do?) Harry Solomon Talk