1. DICOM Standards Committee Meeting April 11, 2008 Chengdu, China DICOM Enhanced IODs in Mixed Environments

2. Enhanced IODs Released for most modalities –MR(2002) –CT(2003) –XA/XRF(2005) –3D XR(2007) –PET(2008) –US(2009?) (Public Comment done)

3. Implementation MR & CT (after 5 years) –some modalities installed; some PACS store prompted by demonstrations at SIIM & RSNA –display support weak/missing –workstation support largely absent XA/XRF (after 3 years) –small handful of implementations 3D XR (after 1 year) –none

4. Typical “Mixed Environment” Some new modalities that support; Some old modalities that don’t PACS can store; but only minimal display Maybe 1-2 Workstations support; Most workstations do not (CAD, 3D, Viewing, Clinical Packages)

5. Deployment No known fully Enhanced sites Some Mixed Environment Sites No known significant usage

6. Adoption: In Theory To adopt in mixed environment: –New Systems support both (enhanced & basic) –Assoc. Neg. to determine support –Configuration to set preference –Use Enhanced where possible (get benefit) –Provide Basic to older systems; either: “Down-convert” enhanced to basic, or Dual-store enhanced & basic throughout pipeline

7. Problem Down-conversion: an unsolved problem –basic images need too much tweaking Dual-store –Wastes bandwidth/storage –Introduces management issues No support of basic means that: –I have a partly crippled image network/workflow –I can’t provide images to other sites

8. Result Lack of technical solutions for mixed environments is obstructing adoption Essential problems: –All or nothing deployment –No incremental benefit Very poor dynamic

9. What do we do? Alternatives: Wait for sites to upgrade all systems –Limited User interest if no immediate benefit –Limited Vendor interest if limited user interest Devise/promote an intermediate benefit Devise a better way to support Basic