1. Harmonizing DICOM SR and AIM
Overlapping use cases
DICOM SR is a mechanism for encoding annotations that works with clinical PACS (encoded and stored like DICOM images)
AIM is a mechanism for encoding annotations that does not require DICOM expertise from developers and users
both have same ROI mechanisms: DICOM Segmentations, contours, etc.
Goal is to develop a bi-directional mapping for such use cases
allow DICOM SR based systems to send to AIM workstations
allow AIM workstations to send to DICOM PACS, voice recognition system
Primary use case is tumor measurement + questions/answers
e.g., tumor volume=x cm3, necrosis=present, edge=spiculated, ….

2. Motivation for Harmonization
Achieve interoperability between
AIM workstations
DICOM SR workstations
Store AIM content in PACS
all clinical PACS are DICOM-based
most support storage/regurgitation of DICOM SR
Make AIM content available in clinical reporting systems
most already accept DICOM SR input
e.g., for cardiac, ultrasound, radiation dose measurements

3. DICOM SR provides input to clinical reporting process
Structured content extracted into
“merge fields” in VR report template
“Evidence Document” SR
Voice Recognition System
Human Report
SR, CDA, text
DICOM Images from Modality
Image from David Weiss, Aunt Minnie 2013/01/18

4. PACS Store, Distribute, Review
AIM World
AIM Workstation
AIM Annotations
DICOM
Image
PACS Store, Distribute, Review
DICOM Segmentation

5. DICOM World DICOM Image PACS Store, Distribute, Review
DICOM Segmentation
Voice Recognition Reporting System
DICOM SR Workstation
DICOM SR

6. Combined AIM and DICOM World
AIM Workstation
AIM Annotations
GAP - interoperability
DICOM
Image
PACS Store, Distribute, Review
DICOM Segmentation
Voice Recognition Reporting System
DICOM SR Workstation
DICOM SR

7. Combined AIM and DICOM World
AIM Workstation
AIM Annotations
GAP – storage in PACS
DICOM
Image
PACS Store, Distribute, Review
DICOM Segmentation
Voice Recognition Reporting System
DICOM SR Workstation
DICOM SR

8. Combined AIM and DICOM World
AIM Workstation
AIM Annotations
DICOM
Image
PACS Store, Distribute, Review
GAP – use in
reporting system
DICOM Segmentation
Voice Recognition Reporting System
DICOM SR Workstation
DICOM SR

9. Gaps Filled by SR AIM Converter
AIM Workstation
AIM Annotations
DICOM
Image
PACS Store, Distribute, Review
Conversion AIM <-> SR
DICOM Segmentation
Voice Recognition Reporting System
DICOM SR Workstation
DICOM SR

10. Harmonization – Approach
Identify most common use cases
as used by projects (e.g., TCGA-*)
as implemented by tools (e.g., ePAD, NWU ClearCanvas, ATB)
examine model and objects produced for projects/by tools
Compare DICOM SR TID 1500 Measurement Report
Image Library, ROIs (contours, segmentations), measurements, qualitative (categorical) evaluations (coded questions + answers)
Define mapping in DICOM Standard Supplement 200
approved by DICOM Standards Committee as Work Item B
Implement bi-directional mapping tool
existing Java DICOM SR toolkit + XSL-T style sheet for transformation

11. Example of a Mapping Table
The following slides illustrate:
a DICOM SR template TID 1411, invoked by TID 1500
a relevant segment of the AIM UML model
an example of transcoded DICOM SR output
an extract of a mapping table for the same template as described in Sup 200 PC