1. DICOM Strategic Direction for Image Distribution
Cor Loef
co-chair DICOM Strategic Advisory Committee

2. Contents Scope of DICOM Standards Committee Trends in Imaging-IT
Standards in Imaging-IT
Objects, Information, EPR, Web-distribution, Desktop
January 12, 2002

3. Scope of DICOM Standards Committee
Mission of DICOM
Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information
Goals of DICOM
Achieve compatibility and improve workflow efficiency between imaging systems and other information systems
The DICOM Standards Committee exists to create and maintain international standards for communication of bio-medical diagnostic and therapeutic information in disciplines that use digital images and associated data. The goals of DICOM are to achieve compatibility and to improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide.
January 12, 2002

4. New: published in DICOM 2000
Sup 23: Structured Reporting (Pre-reports, image measurements, analysis results, diagnostics reports with qualified image links)
Sup 30: Waveform (sound, ECG, Electr. Physio.) synchronized with images
Sup 31: Network Security (node authentication and transport encryption)
Sup 33: Softcopy Presentation State
42 Correction Items, Including:
JPEG-LS, Thai & Korean, Time zones, Case Insensitive Name Queries
January 12, 2002

5. Supplements approved in 2001
Sup 40 DVD RAM Application Profiles
Sup 50 Mammography Comp. Aided Detect. Reports
Sup 52 General Purpose Worklist
Reporting workflow management, image postprocessing, computer aided detection, filming, quality control, etc.
Sup 53 Content Mapping Resource
codes and templates for Structured Reporting
Sup 54 MIME Content Type
for ing DICOM persistent objects (images reports, presentation states, key object selection, etc.
Sup 59 Key Object Selection
January 12, 2002

6. New Work Items New generations of image objects:
Revised Secondary Capture Images (specific applications)
Multiframe MR and CT (large number of dynamic dimensions)
Sup 41 Digital Signature
secure transformation of images and reports
Security on Storage Media (confidentiality)
Attribute Level Confidentiality (de-identification)
January 12, 2002

7. Current Direction
Present focus is to meet new end-user needs, adopt complementary and proven standards. Key areas are:
Security,
New imaging technology,
and
Image Distribution in the enterprise.
January 12, 2002

8. Liaison with TC 215
Good liaison since April 99. Cross-representation may be the effective next step beyond TC 215 DICOM Task Force.
Procedure
TC 215 has agreed to rely on DICOM for Medical Imaging Standardization
DICOM offers expertise in medical imaging, with world-wide users and vendors representation.
Need to ensure coherence with other ISO standards group on imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)
DICOM is ready to further develop its relationship with TC 215.
January 12, 2002

9. Trends in Imaging-IT: Cardiology PACS VL, US, NM
1. Horizontal Integration
HIS
RIS
2. Vertical Integration
Other
Clinical
System
3. Elect. Patient Record
Radiology
PACS
Electronic Patient Record
At the desktop
January 12, 2002

10. 1. Horizontal Integration
Image management system supports archiving/retrieving of all types of images (incl. visible light) and Structured Reports
January 12, 2002

11. 2. Vertical Integration HIS IMAGING: RIS • PACS / Archives
Workstations
Modalities
ADT
Patient Registration
Patient Registration
Image Creator
Image Display
Order Placer
New Order
Q /R
Images
RIS
The Healthcare Enterprise
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
Procedure Scheduled
Modality Worklist
PPS
In-Progress
/ Completed
Images
Stored
Storage
Commit
Acquisition
Modality
January 12, 2002

12. Integration: not only back-office!
Efficiency
messages
Clinical
Information
System
Back-Office
Integrated
Clinical Viewing
at the desktop
Front Office
Improve
Clinical
Decisions
January 12, 2002

13. 3. Electronic Patient Record
Image Management system and Departmental Information System must be EPR-prepared (Queries)
EPR: emphasis today on desktop integration, should become the integrated, secure, patient centric, source of health information
Web front-end:
viewing not only of images but also waveforms, measurements, reports, etc
always need the capability to access the original medical images
support for DICOM Structured Reporting
January 12, 2002

14. Ultimate goal: All the information the user needs through one common and simple user interface
January 12, 2002

15. 4. Order and Results Management
PACS
RIS
Other Clinical
Information
Systems
Multi-Media
Report with
references
Clinical
Question
January 12, 2002

16. DICOM SR Creation - Example -Radiology
RIS data
Report Type:
Findings:
Conclusions:
Image Refs.:
Header:
(DICOM) SR Object
Report Templates
From DICOM standard:
Thorax
…..
Mass
…..
Report Creator application
Daim.
Infiltr.
…..
Image data
(Pointer)
from PACS
select
Coding Schemes behind pop-up menus
January 12, 2002

17. 4. Orders and Results Management
Great opportunities for IHE.
Important roles for HL7 Clinical Document Architecture and DICOM Structured Reporting
One should not consider DICOM SR as the only possibility to integrate multi-speciality information. Especially XML-based implementations should be considered.
January 12, 2002

18. 5. Security Web Viewer Webserver Security PACS Viewing Station
At Modality
January 12, 2002

19. 5. Security
NEMA and COCIR address some major issues as a result of HIPAA, e.g. remote service.
Security remains a challenge with connected systems, and is of course dependent on hospitals ensuring policies and procedures
Use of Audit trial standards in a multi-vendor environment needs further detailing
January 12, 2002

20. 6. Freedom of Application Workspot
Web Viewer
Webserver
PACS Viewing
Station
At Modality
January 12, 2002

21. Standards in Imaging-IT
1. Horizontal Integration DICOM
2. Vertical Integration IHE, DICOM, HL7
3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML
4. Orders and Results IHE, DICOM, HL7 Management
5. Security IHE,IETF,DICOM,HL7,ASTM
6. Freedom of Application ISO/CEN, CCOW, IETF, Workspot DICOM, XML
January 12, 2002

22. The (multi-vendor) Integrated Imaging Solution
secure transport
digital signature
Connection to other Network
and/or TeleCardiology
attachment
DICOM URL
Image Archive
Image
Server
Department
Info Server
General
Purpose
Worklist CD
Exchange
Diagnostic Workstation
Hanging
Protocols
Structured
Documents (XML)
Numeric report
QCA, LVA
January 12, 2002

23. The distribution problem
HIS
Other
Clinical
System
RIS
Cardiology
PACS
Radiology
PACS
VL, US, NM
PACS
Report Type:
Findings:
Conclusions:
Image Refs.:
Header:
Thorax
…..
Mass
Daim.
Infiltr.
(Pointer)
Electronic Patient Record
URL/URI?
Webserver
Web Viewers
January 12, 2002