DICOM INTERNATIONAL DICOM INTERNATIONAL CONFERENCE & SEMINAR April 8-10, 2008 Chengdu, China 1 WADO and beyond Emmanuel Cordonnier ETIAM

2 Presentation Contents WADO Objectives & Definition WADO Implementation Examples WADO Implementation Note WADO Evolution

3 WADO Objectives & Definition

4 WADO Origin: Proposal to DICOM & ISO in 1999 Because no specific Ad Hoc Group on Biomedical Imaging will be set up in ISO / TC215, new works on medical imaging must be done into DICOM (with a Category A Liaison Group between both) More and more it will be important that DICOM makes recommendations on the medical imaging aspects within non «pure» DICOM protocols DICOM «world» non DICOM world DICOM «object» DICOM WG10 NEMA Vienna - March 20,

Proposals to DICOM Item of the Proposals Supplement MIME type and file extension#54 (2001) URL reference to DICOM part 10 files#85 (2003) URL reference to DICOM services accessible from IT (web, ...). #85 (2003) #113 (2006) DICOM references into XML#85 (2003) Mapping of DICOM attributes to XML?? DICOM WG10 NEMA Vienna - March 20,

6 Syntax of the WADO HTTP GET method Syntax defined by the RFC2396 (URI) ? e.g: The « Web Access to DICOM Persistent Object » standard defines only the Path of the Web Enabled DICOM Server WADO Parameter(s)

7 Selection Parameters studyUID&seriesUID&objectUID [&frameNumber] –studyUID => UID of the study containing the object(s) –seriesUID => UID of the series containing the object(s) –objectUID => UID of the single object (Service Object Pair SOP) –frameNumber => number of the selected frame (multiframe image objects) – if NOT retrieved as application/dicom

8 Parameters when the object is return as application/dicom [transferSyntax][anonymize][charset] –transferSyntax => DICOM UID of the transferSyntax to be applied to the image (lossy/lossless compression). Implicit and Big Endian TS shall not be used. –anonymize => “=yes” for blanking all the personal healthcare information (patient name, study date…) as described in Sup. 55. Potentially the server can refuse to deliver an object if there are some risk the personal information is burned into the image (secondary capture…) –charset => for converting the text fields in a different character set (available also if object return as text/xxx )

9 Parameters when the object is return as image/xxx (1) [imageQuality] [presentationUID & presentationSeriesUID |[windowCenter & windowWidth]] –imageQuality => controls the level of compression (from 1 to 100) –presentation => UIDs of the Presentation State SOP and of its series to be applied on the image (P-values, and display size set to the original size if undefined) –windowCenter / windowWidth => controls the luminosity and the contrast of the B&W image

10 Parameters when the object is return as image/xxx (2) [region][rows][columns][annotation] –region => part of the image to be displayed, in relative coordinates (top left hand corner and bottom right hand extent) –rows => maximum number of pixels (vertical) –columns => maximum number of pixels (horizontal) –annotation => text to be superimposed of the image (“patient” and / or “technique” for demographic information and technical information, respectively)

11 Build the pixel area rows…&columns… Select the object studyUID&… Apply the presentation presentationUID&… or windowCenter… Providing a image as image/xxx Select a region region Burn the annotations CT WC-800 WW200 DOE annotation Generate the MIME type Content-Type: image/jpeg; name="Image.jpg" Content-Transfer-Encoding: base64 Content-Disposition: attachment; filename="Image.jpg" /9j/4AAQSkZJRgABAQEASABIAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAKCgkJChQODwwQFxQYGBcU FhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChMoGhYaKCgoKCgo KCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wgARCABkAGQDASIA AhEBAxEB/8QAGwABAQEBAQEBAQAAAAAAAAAAAAUEAwECBgf/xAAYAQEAAwEAAAAAAAAAAAAAAAAA AQIDBP/aAAwDAQACEAMQAAAB/qgAAAAAAABNpnSTVc6Sbpm2lO6RG0a7gAcZWztzcORR8tef9+6a 09xdPZncOjtAfH3Opls+oOrHlq8+Eubfoc3LpfXRn4ZaZUtOTXr0BfVPoKZxud1lzRdFJN5PSklI 8sIjJrNegLXAAAAAAAAAAAAAA//EACEQAAMAAQQCAwEAAAAAAAAAAAECAwQREhMUACAQNFAk/9oA CAEBAAEFAvyksxxl7DILsYJ2GVSyIrXoJVbf6zoKeT+lPscTS48WUWM8lSMQHWSPTs+r42rcI4EG contentType

12 Implementation of DICOM Principles of implementation Initial examples WADO in IHE XDS-I

13 Principles of implementation DICOM Objects Database DICOM Interface Web Interface DICOM Q/R Web Access to Dicom Persistent Objects DICOM Objects Database DICOM Interface Web Gateway DICOM Q/R Web Access to Dicom Persistent Objects Web Client System Direct Interface Gateway Flexibility for the client to be implemented either as new system or on existing system Flexibility for the client to be implemented either as new system or on existing system

14 A) retrieval of DICOM images in jpeg format Proof-of-concept implementation Windows NT-based host Microsoft IIS 5.1 Web Server WADO JPEG functionality added to the Web Extension for the DICOM server product Images retrieved using Internet Explorer 6.0 running on Windows XP using pre- determined UIDs Full implementation, including retrieval of images in native DICOM format, likely available in next release of the product

15 B) WADO Trial available on Internet

16 C) Viewer using WADO

17 D) WADO Gateway for reports

18 Implementations Overview

19 IHE XDS-I The IHE Radiology Domain has defined a « XDS content profile » for linking a Cross- Enterprise Document Sharing to the PACS The solution has been proposed as a « Manifest » (DICOM KOS) stored in the Document Repository The images are still stored in the PACS and accessed through their reference Because the XDS Consumer is web enabled, WADO is the natural retrieving method XDS-I has been largely demonstrated

20 IHE XDS-I: Diagram

21 WADO Implementation Note Retrieving Multiple Objects Managing WADO Reference Managing WADO URL “Left Part” Association of WADO and JPIP

22 Retrieving Multiple Objects OBJECTIVE –Applications aim to manage a reference to multiple DICOM Information Objects WADO LIMITATION –WADO does not provide any mechanism for retrieving multiple Objects PROPOSED SOLUTION –Multiple references The Application maintains all the reference to individual DICOM objects –Key Object Selection The Server can create a DICOM Key Object Selection for each set of DICOM Objects the Application has to access using WADO. The Application stores the link to this KOS and retrieve it first It opens it, and accesses all the referenced DICOM Objects

23 Managing WADO Reference OBJECTIVE –The Applications aim to display DICOM objects without necessarily activate a DICOM viewer WADO LIMITATION –WADO URL string implies only one kind of display (e.g. Jpeg thumbnail) PROPOSED APPROACH –As defined in the HL7, the application manages the link as follow: a.Reference of the (WADO) Server (WADO URL “left part”); b.DICOM UID of the Study; c.DICOM UID of the Series; d.DICOM UID of the SOP Instance; e.DICOM UID of the Class of the Object. –The Application may then build any WADO request

24 Managing WADO URL “left part” OBJECTIVE –Application have to maintain persistent links to DICOM objects WADO LIMITATION –DICOM WADO does not define the “left part” of the URL/URI SUGGESTED APPROACH –The Application maintains a “WADO Server ID” enabling to update the Server address for each object INCLUDING THE WADO LINK INTO A TEXT DOCUMENT –Into a document (e.g. PDF), the “left part” is a “virtual” DICOM server (e.g. mapped on both emission and reception sides on the actual WADO Server: Local DNS proxy for defining the correspondence between the server names (e.g. “LocalDICOMServer” alias of “server234”) Mapping between the URL invocation and the actual script page (e.g. “WADO” alias of “scripts/wado.js”)

25 Association of WADO and JPIP* OBJECTIVE –Providing streaming on referenced images WADO LIMITATION –WADO does not propose means for gradual retrieving of images PROPOSED APPROACH –Set WADO transferSyntax attribute to –Initiate a DICOM JPIP session * See presentation made by Lev Weisfeiler

26 Evolution of WADO Limitation of WADO Web Services New Work Item and Planning

27 Limitation of WADO One SOP Instance only in one call (no way for retrieving all the series/study) Suited for Web Browser based solution, less for direct with applications The URL based query is easy to write, but not adapted for being parsed No easy way to help the application development through WSDL

28 Web Services… why now? The WS are now “maturing” The deployment beyond web server to web server is emerging (application to appli.) The WS-I Profiles are defining a real interoperable solution, including (more or less!) the security and reliability aspects The MTOM mechanism for conveying binary content is now supported by development platforms (.Net, Java…)

29 Web Services for Dummies Submitting a form to a Web Server, you are using http POST based structured message, containing the « input fields » It may also contain files to be uploaded WS are using such mechanism for the request and the response, and define the structure of message in XML SOAP A WSDL (XML) file defines the syntax of the communication (request and response)

30 MTOM for Dummies Date: Thu, 09 Sep :47:52 GMT Server: Apache/ (Win32) mod_ssl/ OpenSSL/0.9.7d Keep-Alive: timeout=15, max=100 Connection: Keep-Alive Transfer-Encoding: chunked Content-Type: Multipart/Related;boundary=MIME_Boundary;type=application/xop+xml;charset=UTF-8;start- info="application/soap+xml" --MIME_Boundary Content-ID: Content-Type: application/xop+xml;charset=UTF-8;type="application/soap+xml" Content-Transfer-Encoding: binary --MIME_Boundary Content-ID: Content-Type: image/jpeg Content-Transfer-Encoding: binary ÿØÿàJFIF, (IMAGE 1 in BINARY) --MIME_Boundary Content-ID: Content-Type: image/jpeg Content-Transfer-Encoding: binary ÿØÿàJFIFÿÛ (IMAGE 2 in BINARY) --MIME_Boundary--

31 WADO in WS, which form? IHE ITI wrote White Paper on WS implementation, based on WS-I The XDS.b Retrieve Document Set transaction is similar to WS/WADO All the WADO query parameters can be directly transposed « as is » in WS The response structure can be derived from the Retrieve Document Set structure

32 WADO « brothers » WADO implies to have the reference A notification mechanism may be developed on WS (NADO) A Query by IDs mechanism may enable an application to obtain the reference (QIDO) A New Work Item will be propose at the next DSC (April 11, 2008)

33 Conclusion (for today) WADO is still in its “emerging” implementation, but promising WADO contributes to facilitate to co- existence of IS and PACS (e.g. XDS-I) Its evolution through Web Services may enhance the integration between PACS and EHRs