Enhanced family of Image SOP Classes Wim Corbijn van Willenswaard Philips Healthcare Interoperability Architect Bangalore, India Chair WG16 (MRI)

Enhanced family of Image SOP Classes Enhanced Multi-Frame Introduction Multi Frame model Functional benefits Performance benefits Modalities and policy Conversion approach Conclusions March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Introduction Why Multi-Frame > 10 Years Why should we start implementing, it is new, nobody is supporting it! This is the classic chicken egg question. Modalities need to implement it but if PACS, Viewing stations and Workstation don’t support it why should the modalities create it. For most systems it still seems to feel as a completely new mechanism of storing images or frames. Well it is not new, exists already for more than 10 years. Has a “compact” format with a possibly a whole series in ONE object. And for most of the area’s a lot more standardized information that is available. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Introduction Standard object structure Sup XXX Enhanced Nuclear Medicine (Proposed) Sup 43 Enhanced US Volume (Approved 2010) Sup 141 Enhanced MR Color (Approved 2009) Sup 43 Enhanced Ultrasound (Approved 2009) Sup 125 Breast Tomosynthesis (Approved 2008) Sup 117 Enhanced PET (Approved 2008) Sup 110 Ophthalmic Coherence Tomography (Approved 2007) Sup 116 3-D X-Ray (Approved 2007) Sup 83 Enhanced XA/XRF Image (Approved 2004) Sup 58 Enhanced CT (Approved 2003) Sup 49 Enhanced MR (Approved 2001) This is the standard structure for all new objects. And there are already 10 SOP Classes released and there are more under development. For several area’s it is the only structure available there is no “classic” single frame variant! March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Multi Frame model Structure is the same as the standard structure having: Patient, Study and Series information The image level is present but is however different organized. Extra is the Dimension Organization March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Multi Frame model Organization is basically the same with only two major differences: It has several FRAMES in the image There is the DIMENSION ORGANIZATION that explains the relation between the different frames. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Single-frame to MultiFrame N Objects, N Headers One Header N frames Dimension data + Dimension data How does this look in the object Single Frame objects have many parameters in common. Fixed Header Per-frame header Object specific Pixel data March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes 7

Enhanced family of Image SOP Classes Functional benefits Single Frame (Classic objects) Multi-Frame Single frames can be compared to a jigsaw out of the box, you hope you have all the pieces. Multi frame gives you all the pieces and even tells you how they are organized. Most cases you will have only one multiframe object for a series, but with growing sizes you made have more. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Dimension organization makes it easier to view The dimension organization makes it a lot easier for the viewer as it tells were to put the pieces. So you not only get all the pieces of the puzzle but also their location. Even when there are multiple volumes available the dimension organization tells you all. You don’t need to know what it means, if you follow the instructions in the dimension organization you will get an overall image that the user will understand and can traverse in a sensible way. As display system you only need to be able to handle multi dimensional information. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Latest technology Dimension Organization Functional groups Dimension organization we have seen enables to guide the viewing system in the way the data should be displayed. This way there is a real decoupling between the viewing station and the acquisition station. Even images coming from new acquisition technologies that are unknown during development a viewer will be able to display them in a logical way. Functional groups means that the parameters are logical grouped together, no longer everything at the root level of the object. Through sequences the data is split in logical groups, gives you the opportunity to easily skip sets of parameters. For all new objects the standard is that all parameters are mandatory, so most of them are 1 or 1C. Where the functional group is mandatory under specific conditions. So if you have a diffusion scan the diffusion group macro is mandatory and will have all the standard attributes, only as technology is evolving you will see again type 3 attributes coming in again. But for new techniques this is even not necessary as the functional group can be made mandatory if the technique is used it can be added with type 1(C) attributes without any problem. This way viewers can rely much more on consistency over different vendors, as soon as there is agreement on a technique and the parameters involved the description can be made. This is not possible in a Classic object as you have no level to use for this Reducing the overhead by supplying all information once and in one object. This way you don’t have to traverse the total tree of Patient, Study, Series with every object coming in just to add the image data. Also when storing the objects as files this will save a lot of overhead, the gain in space might be not that much as the Pixel data is mostly the major part. But it makes quite of difference if you have to store 2000 Classic objects or only 1 Enhanced object. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Looking closer at the CT Image IOD we see not much difference at the top level The Synchronization module is really an addition And we see the mechanism used to make clear when a Functional Group must be available. Here we see that the Synchronization is required when time synchronization is used during the acquisition. The Enhanced General Equipment module is just introduced to tighten the requirements for 4 parameters, which are now mandatory (type 1). March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Looking closer at the CT Image IOD we see not much difference at the top level The Synchronization module is really an addition And we see the mechanism used to make clear when a Functional Group must be available. Here we see that the Synchronization is required when time synchronization is used during the acquisition. The Enhanced General Equipment module is just introduced to tighten the requirements for 4 parameters, which are now mandatory (type 1). March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Looking closer at the CT Image IOD we see not much difference at the top level The Synchronization module is really an addition And we see the mechanism used to make clear when a Functional Group must be available. Here we see that the Synchronization is required when time synchronization is used during the acquisition. The Enhanced General Equipment module is just introduced to tighten the requirements for 4 parameters, which are now mandatory (type 1). March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Looking closer at the CT Image IOD we see not much difference at the top level The Synchronization module is really an addition And we see the mechanism used to make clear when a Functional Group must be available. Here we see that the Synchronization is required when time synchronization is used during the acquisition. The Enhanced General Equipment module is just introduced to tighten the requirements for 4 parameters, which are now mandatory (type 1). March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Dimension organization we have seen enables to guide the viewing system in the way the data should be displayed. This way there is a real decoupling between the viewing station and the acquisition station. Even images coming from new acquisition technologies that are unknown during development a viewer will be able to display them in a logical way. Functional groups means that the parameters are logical grouped together, no longer everything at the root level of the object. Through sequences the data is split in logical groups, gives you the opportunity to easily skip sets of parameters. For all new objects the standard is that all parameters are mandatory, so most of them are 1 or 1C. Where the functional group is mandatory under specific conditions. So if you have a diffusion scan the diffusion group macro is mandatory and will have all the standard attributes, only as technology is evolving you will see again type 3 attributes coming in again. But for new techniques this is even not necessary as the functional group can be made mandatory if the technique is used it can be added with type 1(C) attributes without any problem. This way viewers can rely much more on consistency over different vendors, as soon as there is agreement on a technique and the parameters involved the description can be made. This is not possible in a Classic object as you have no level to use for this Reducing the overhead by supplying all information once and in one object. This way you don’t have to traverse the total tree of Patient, Study, Series with every object coming in just to add the image data. Also when storing the objects as files this will save a lot of overhead, the gain in space might be not that much as the Pixel data is mostly the major part. But it makes quite of difference if you have to store 2000 Classic objects or only 1 Enhanced object. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Dimension organization we have seen enables to guide the viewing system in the way the data should be displayed. This way there is a real decoupling between the viewing station and the acquisition station. Even images coming from new acquisition technologies that are unknown during development a viewer will be able to display them in a logical way. Functional groups means that the parameters are logical grouped together, no longer everything at the root level of the object. Through sequences the data is split in logical groups, gives you the opportunity to easily skip sets of parameters. For all new objects the standard is that all parameters are mandatory, so most of them are 1 or 1C. Where the functional group is mandatory under specific conditions. So if you have a diffusion scan the diffusion group macro is mandatory and will have all the standard attributes, only as technology is evolving you will see again type 3 attributes coming in again. But for new techniques this is even not necessary as the functional group can be made mandatory if the technique is used it can be added with type 1(C) attributes without any problem. This way viewers can rely much more on consistency over different vendors, as soon as there is agreement on a technique and the parameters involved the description can be made. This is not possible in a Classic object as you have no level to use for this Reducing the overhead by supplying all information once and in one object. This way you don’t have to traverse the total tree of Patient, Study, Series with every object coming in just to add the image data. Also when storing the objects as files this will save a lot of overhead, the gain in space might be not that much as the Pixel data is mostly the major part. But it makes quite of difference if you have to store 2000 Classic objects or only 1 Enhanced object. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits Latest technology Functional groups Most attributes are mandatory Reducing overhead Dimension organization we have seen enables to guide the viewing system in the way the data should be displayed. This way there is a real decoupling between the viewing station and the acquisition station. Even images coming from new acquisition technologies that are unknown during development a viewer will be able to display them in a logical way. Functional groups means that the parameters are logical grouped together, no longer everything at the root level of the object. Through sequences the data is split in logical groups, gives you the opportunity to easily skip sets of parameters. For all new objects the standard is that all parameters are mandatory, so most of them are 1 or 1C. Where the functional group is mandatory under specific conditions. So if you have a diffusion scan the diffusion group macro is mandatory and will have all the standard attributes, only as technology is evolving you will see again type 3 attributes coming in again. But for new techniques this is even not necessary as the functional group can be made mandatory if the technique is used it can be added with type 1(C) attributes without any problem. This way viewers can rely much more on consistency over different vendors, as soon as there is agreement on a technique and the parameters involved the description can be made. This is not possible in a Classic object as you have no level to use for this Reducing the overhead by supplying all information once and in one object. This way you don’t have to traverse the total tree of Patient, Study, Series with every object coming in just to add the image data. Also when storing the objects as files this will save a lot of overhead, the gain in space might be not that much as the Pixel data is mostly the major part. But it makes quite of difference if you have to store 2000 Classic objects or only 1 Enhanced object. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits General mechanism The enhanced structure is used as blueprint for all new objects So you will find the generic header, the shared information and the per-frame information in all new objects. Also the idea of attributes being mandatory is the same for all new objects This leads to the same kind of objects so interpretation of these objects is made simple, you can rely on the structure. It might not be nice if you would live in a city were all buildings would be exactly the same, but if you had to move it would help you in settling down again. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Functional benefits “Complete” set of frames Dimension makes it easier to view Latest technology General mechanism for all new objects. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Performance benefits One object defines full series Typically an object will describe a whole series, only when a series is too big it will be split in logical parts. So this means that all data for a whole body scan will be present in only one object. Together wit the dimension organization there is little logic needed to present the set of frames. In this case based on files it would mean only accessing one file instead of 25. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes US volume example? March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Performance benefits Storage simpler N Objects, N Headers Pixel data Per-frame header Fixed Header One Header N frames Dimension data + Dimension data We have already seen that there is a lot of duplication removed with the introduction of the enhanced multi-frame concept. Although this is not the major part of the objects it will lead to space reduction. The number of files involved makes that storage overhead is reduced significantly. Opening one file instead of 10, 20, 1000 or 64.000 March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Performance benefits Network overhead reduced. Multi- frame transfer time A s s o c i a t i o n DB 1delay only for the whole series= 3 hours gained Multi- frame transfer Imagine: 10.000 images = 10.000 delays of 1 sec ~3 hours delay Single frame transfer DB DB DB Store, parse, check C-Store request Dataset (attributes+pixels) C-Store response (acknowledgement) * Slide Courtesy: David A.Clunie March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Modalities INTRAVASCULAR OCT IMAGE IOD 18 IOD’s with Multi-Frame Dimension group ENHANCED X-RAY RF IMAGE IOD VL WHOLE SLIDE MICROSCOPY IOD ENHANCED MR IMAGE IOD BREAST TOMOSYNTHESIS IMAGE IOD MULTI-FRAME GRAYSCALE BYTE SC IMAGE IOD SEGMENTATION IOD MODULES X-RAY 3D Craniofacial Image IOD MR SPECTROSCOPY IOD ENHANCED X-RAY ANGIOGRAPHIC IMAGE IOD X-RAY 3D ANGIOGRAPHIC IMAGE IOD ENHANCED ULTRASOUND VOLUME IOD INTRAVASCULAR OCT IMAGE IOD MULTI-FRAME TRUE COLOR SC IMAGE IOD OPHTHALMIC TOMOGRAPHY IMAGE IOD Looking in the standard (2011 version) you will find 18 IOD’s based on the Enhanced mechanism and as said earlier more are in definition. I don’t expect you to memorize these if you can read them, the message is that it is already a large family of IOD’s and still growing. So if you are dealing with image objects you better start understanding the mechanism and implementing it in your product. ENHANCED MR COLOR IMAGE IOD MULTI-FRAME GRAYSCALE WORD SC IMAGE IOD ENHANCED CT IMAGE IOD ENHANCED PET IMAGE IOD March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Conversion New supplement coming: Multi-Frame Converted Legacy Images March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Conversion workflow Heterogeneous environment with conversion from single to multi-frame objects Idea is that it is easier and more beneficial for PACS and Workstations to have a faster mechanism for transportation. The installed base of Classic SF objects will stay there for several years. So by converting the objects in the PACS the most of the benefits of the MF will be there. Transfer speed, easier storage and full sets of images. The one that is only partly possible is the full set of parameters, as the information might not all be available in the Classic SF object. Some will be through Private attributes so it might be possible to use these during the conversion. But not all information will be there as new elements were defined. And the first basic conversion will not be cheap, but most likely will be compensated by the gain in the further workflow. March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Conversion Why conversion Enormous archive of Classic objects Supports the transition from Classic to Enhanced environment More often used on different places Transportation needs speeding up Leverage most of the benefits March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Conversion Requires Conversion done by independent stations Build knowledge for various vendors Relaxation of Manditoriness March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes Conclusion Huge potential benefit for using Enhanced objects Support is growing Pushed by Increased Interoperability Increasing datasets Potential Speed gain Higher availability Coming conversion definition Start using March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Enhanced family of Image SOP Classes References B. Revet: What’s New in DICOM SPIE 2012 http://? B. Erickson, D. Clunie: The New CT and MR DICOM Objects: Why All the Fuss? SCAR 2005 ftp://medical.nema.org/medical/dicom/Multiframe/Presentations/SCAR-2005/ K. Verduin: Enhanced MR addresses Multi-Vendor Interoperability issues in clinical radiology DICOM Conference China 2008 ftp://medical.nema.org/MEDICAL/Private/Dicom/Conferences/2008_China/Day_2/ http://dicom.nema.org/ March 2013 DICOM International Conference & Seminar Enhanced family of Image SOP Classes

Author Contact Wim Corbijn van Willenswaard Wim.Corbijn.van.Willenswaard@Philips.com Philips Innovation Campus Bengaluru Thank you for your attention ! March 2013 DICOM International Conference & Seminar Enhanced Multi-Frame