Harry Solomon, GE Healthcare RSNA 2007 What’s New in DICOM Harry Solomon, GE Healthcare RSNA 2007

Published as NEMA PS3 and as ISO 12052 DICOM is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department Published as NEMA PS3 and as ISO 12052 What's new in DICOM - RSNA 2007

Agenda The DICOM Change Process Images Image Processing & Reporting Workflow Specialties Get Involved! What's new in DICOM - RSNA 2007

The DICOM Change Process Continuous process for evolution of the standard It’s just “DICOM”, not DICOM 3.0, 3.1, etc. Conformance is to SOP Classes, not to a ‘version’ of the Standard Change Proposals for minor corrections About 100 / year Anybody can submit Supplements for major changes – new object types, services, compression schemes About 10 / year Require Work Item approved by DICOM Standards Committee Consolidated edition published every year Most recently, January 2007 Available free at DICOM web site What's new in DICOM - RSNA 2007

Information Object Definitions and Image Access Images Information Object Definitions and Image Access

Multiframe Images Multiframe objects to support 1000+ slice studies Image header supports functional group attributes changing during acquisition Dimensions allow multiple views of data Common structure used for all new image IODs Sup 110 Ophthalmic Coherence Tomography (Adopted August 2007) Sup 116 3-D X-ray (Adopted January 2007) Sup 117 Enhanced PET (in Letter Ballot) Sup 43 Enhanced Ultrasound (in Public Comment) Sup 125 Breast Tomosynthesis (in Public Comment) What's new in DICOM - RSNA 2007

Single-frame to MultiFrame N Objects, N Headers N Frames, One Header Fixed Header Per-frame header Dimension data Pixel data What's new in DICOM - RSNA 2007

The Per-Frame Header What's new in DICOM - RSNA 2007

Sup 119 Frame Level Retrieve If we have 1000+ slice image objects, how do we access the slice identified in the report as the Key Image? Or, how to access a short video clip of a long endoscopy video image object? Many similar use cases needing one frame or a small subset of frames from large multiframe image Purpose of retrieval may not be diagnostic; compression OK Proposed new Retrieve SOP Classes for subsets of frames Request can include a preferred transfer syntax (i.e., type of compression) Returned object is a derived image with the requested subset of frames, but with a different Instance UID In Public Comment What's new in DICOM - RSNA 2007

Sup 43 Enhanced Ultrasound Pixel frames may represent tissue, velocity, variance or power Multiple frames (up to 3) must be blended for proper display Enhanced blending pipeline required to render images In Public Comment What's new in DICOM - RSNA 2007

Image Processing & Reporting Segmentation, Registration, Structured Reporting

Sup 111 Segmentation Image Derived image object Multiframe, using functional group mechanism Multiple segments per object Each segment linked to a categorization Pixels show presence of category at pixel location Binary (1-bit/pixel) or fractional (probability or occupancy) Segments can be 2-D or 3-D 3-D segmentation is typically in same Frame of Reference as source image Segments can be displayed as overlays on source image Adopted August 2006 What's new in DICOM - RSNA 2007

Segmentation Example What's new in DICOM - RSNA 2007

Sup 132 Surface Segmentation Work in progress – just released for Public Comment Segmentation using 3-D surface mesh (rather than voxel volume) First use of mesh technology in DICOM Will also be used for future volumetric work, including implant specification and surgical planning In Public Comment What's new in DICOM - RSNA 2007

Sup 112 Deformable Spatial Registration Composite Object that supports multi-image alignment 3 step algorithm Pre-deformation matrix transform Deformation using 3D grid of 3D deformation vectors Post-deformation matrix transform Facilitates further image processing, especially multi-modality image fusion and image pasting applications Adopted August 2006 What's new in DICOM - RSNA 2007

Structured Reporting Additional Templates for standard SR SOP Classes Sup 128 Cardiac Stress Testing (Frozen Draft – passed Ballot, awaiting final SNOMED and IEEE codes) Sup 129 Cardiac Electrophysiology (in Public Comment) Templates for specialty SR SOP Classes Sup 127 CT Radiation Dose (Adopted October 2007) Sup 130 Ophthalmic Refractive SR (in Letter Ballot) Sup 126 Colon CAD (in preparation) Harmonization with HL7 Sup 114 DICOM Encapsulation of CDA Documents (Adopted January 2007) What's new in DICOM - RSNA 2007

Workflow Substance Administration, Unified Worklist, RT Workflow, Specimen Identification

Sup 107 Substance Administration Patient safety issue – “five rights” checking for contrast agents Point of use verification for substances often “out of the loop” of hospital pharmacy systems Three new DICOM services Typically Modality as SCU interacting with HIS via gateway SCP Query: Look up product characteristics Given a barcode ID (from contrast agent bottle), get name, active ingredient, concentration, etc. Query: Get substance administration approval Based on agent, patient, route of administration; get approval or warnings Report contrast used to HIS Medication Administration Record Adopted January 2007 What's new in DICOM - RSNA 2007

Sup 96 Unified Procedure Steps Simplification and merger of Worklist Management and Performed Procedure Steps 1:1 relationship between scheduled and performed steps A single IOD that combines attributes of both C-FIND to query worklists N-CREATE to create new scheduled procedure steps N-GET/N-SET to update N-EVENT-REPORT to monitor and report progress Intended to meet the needs of Radiation Therapy Scheduling and Monitoring Scheduling and Monitoring CAD systems Proposed new scheduling activities Frozen Draft for Trial Implementation What's new in DICOM - RSNA 2007

Sup 74 Radiotherapy Worklist Supports automated worklist management and machine parameter verification for the integration of multi-system radiation therapy planning and treatment First usage of Unified Procedure Step Also defines three new objects / SOP Classes RT Beams Delivery Instruction (Composite) RT Conventional Machine Verification (Normalized) RT Ion Machine Verification (Normalized) Real implementation and evaluation needed – in conjunction with IHE Radiation Oncology Frozen Draft for Trial Implementation What's new in DICOM - RSNA 2007

Sup 122 Specimen Identification Support for pathology lab workflow, specimen-based imaging Gross specimens, blocks, vials, slides Image-guided biopsy samples Retires current Specimen Identification Module, adds new Specimen Module at image level of hierarchy May affect applications that implement current Module (if any) Update to Modality Worklist to allow Specimen Module Enables automated slide scanning devices to fully populate header Update to Modality Performed Procedure Step to identify imaged specimen Allows LIS to track images for specimens In Public Comment What's new in DICOM - RSNA 2007

Specialties Biomed engineering Research / Biomarkers Surgery Supp 124 Communication of Display Parameters (in preparation) Administrative support for monitor calibration Research / Biomarkers Supp 118 Application Hosting (in preparation) Image analysis programs run on any workstation Surgery Sup 131 Implant Description (in preparation) Supports 3D model of bone-mountable implants Dentistry / Radiology Sup 123 Structured Display (in preparation) Captured screen layout of multiple images (with presentation states) for dental series, radiology conference, etc. What's new in DICOM - RSNA 2007

Get Involved! Get the DICOM Standard (free!) http://dicom.nema.org/medical/dicom/2007/ (annual issue) ftp://dicom.nema.org/medical/dicom/final (changes between issues) Ask questions/discuss on the DICOM Newsgroup http://groups.google.com/group/comp.protocols.dicom Respond to Supplements released for Public Comment http://www.dclunie.com/dicom-status/status.html Submit Change Proposals mailto:hclark@medicalimaging.org Join a DICOM Working Group See list in http://medical.nema.org/dicom/geninfo/Strategy.pdf Attend the DICOM International Conference and Seminar, Chengdu, China, April 8-10, 2008 http://dicom.nema.org/Dicom/DCS-2008/ Build the new DICOM capabilities into your products Your URL here! What's new in DICOM - RSNA 2007