1. Bas Revet, Philips Healthcare – (Chair WG 6)
What’s New in DICOM DICOM SPIE MEDICAL IMAGING February 3013
Bas Revet, Philips Healthcare – (Chair WG 6)

2. Content The DICOM Standard Images
Beyond Radiology, Cardiology and Radio Therapy
Manipulating with Images
Analyzing Image Data and Documenting the Results
Imaging Workflow
Image Distribution
Application Distribution
Fitting DICOM in the IT world
The Standard is still evolving
SPIE Medical Imaging – Feb 2013

3. The DICOM Standard All almost 30 years going strong …
What and Who is DICOM
The DICOM Standard All almost 30 years going strong …
SPIE Medical Imaging – Feb 2013

4. The DICOM Standard
DICOM is the International Standard for Medical Imaging and related information
images,
waveforms,
derived measurements and assessments,
image presentation controls,
workflow management in the imaging dept.
Beyond Radiology and Cardiology: Pathology, Ophthalmology, Surgery, Dermatology, …
Published as NEMA PS3 and as ISO 12052
SPIE Medical Imaging – Feb 2013

5. The DICOM Work 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
Past year 4 are added to the standard
Require Work Item approved by DICOM Standards Committee
Consolidated edition published every year
Most recently, August 2011 (2011 version), waiting for 2013 version
Available free at DICOM web site
SPIE Medical Imaging – Feb 2013

6. The DICOM Working Groups
Produced by 28 Working Groups:
1 Cardiac and Vascular Information
15 Digital Mammography and CAD
2 Projection Radiography and Angiography
16 Magnetic Resonance
3 Nuclear Medicine
17 3D
4 Compression
18 Clinical Trials and Education
5 Exchange Media
19 Dermatologic Standards
6 Base Standard (coordination, main editor)
20 Integration of Imaging and Information Systems
7 Radiotherapy
8 Structured Reporting
21 Computed Tomography
9 Ophthalmology
22 Dentistry
10 Strategic Advisory
23 Application Hosting
11 Display Function Standard
24 Surgery
12 Ultrasound
25 Veterinary Medicine
13 Visible Light
26 Digital Pathology
14 Security
Web Technology for DICOM
Physicists
SPIE Medical Imaging – Feb 2013

7. Images Where it all started …
SPIE Medical Imaging – Feb 2013

8. ‘Classic’ Images First Generation of images: CR, CT, MR, US, MN
Secondary Capture (for what not fit)
Multi-frame XA and XRF, US, NM, PET
Digital Detector: DX, MG (mammo), IO (inter- oral)
Visible Light: Microscopy, Photographic, Video
Family RT data object, including Images
SPIE Medical Imaging – Feb 2013

9. ‘Enhanced’ Images
Extension of classic multi-frame images allowing the specification of properties of each frame
Enhanced MR, Spectroscopy
Enhanced CT
Enhanced XA and XRF
Enhanced PET
Enhanced US (3D)
Ophthalmic Tomography
X-Ray 3D Angiographic, Craniofacial, Breast Tomosynthesis
In development: Enhanced NM
Also used by: Segmentation, IVUS-OCT, etc.
SPIE Medical Imaging – Feb 2013

10. Multi-Frame Converted Legacy Image
Work in progress
Transfer of many image of large single frame MR and CT studies can consume considerable time ….
Transfer Time
Transfer Time
Response Time
Response Time
Combining all image into a multi-frame will reduce the transfer time
Transfer Time
Response Time
SPIE Medical Imaging – Feb 2013

11. Multi-Frame Converted Legacy Image
Build analog to ‘Enhanced’ multi-frame definitions for CT, MR or PET
Intended for PACS – PACS transfers or PACS workstation transfers
Receiving side may unpack multi-frame or handle it the same way and enhanced SOP Instance
Standard will specify how to convert the legacy images to multi-frame
See Supplement 157
Work in progress
SPIE Medical Imaging – Feb 2013

12. Multi-Frame Converted Legacy Image
SPIE Medical Imaging – Feb 2013

13. New Clinical Domains
Beyond Radiology, Cardiology and Radio Therapy Reusing proven concepts …
SPIE Medical Imaging – Feb 2013

14. Radiotheraphy Work in progress RT Second Generation – Data Objects
Radiotherapy Working Group decided to create a new family of SOP Classes
Based on the new Enhanced Multi-frame paradigm and other new DICOM developments
Preparing version for Public Comment (Supplement 147)
SPIE Medical Imaging – Feb 2013

15. Radiotheraphy Work in progress RT Second Generation – Workflow
For document management and resource reasons, patient positioning and workflow instructions
Early Draft (Supplement 160)
SPIE Medical Imaging – Feb 2013

16. Manipulating with Images Besides storage there is more …
Image Presentation
Manipulating with Images Besides storage there is more …
SPIE Medical Imaging – Feb 2013

17. Image Presentation Displaying and annotating images:
Grayscale Softcopy Presentation State
Color Softcopy Presentation State
Pseudo-Color Softcopy Presentation State
Blending
Organizing the display of studies
Structured Display (single study)
Hanging Protocols Storage (multi study cases)
SPIE Medical Imaging – Feb 2013

18. Image Presentation Linking image data: Spatial Registration (rigid)
Deformable Spatial Registration (flexible)
Selecting and annotating parts of images or volumes:
Segmentation
Surface Segmentation (using vertices)
SPIE Medical Imaging – Feb 2013

19. Measurements & Reporting
Analyzing Image Data and Documenting the Results On a well structured and interoperable way …
SPIE Medical Imaging – Feb 2013

20. Report Formats Highly structured:
Diagnostic and Evidence Reports in DICOM Structured Report Format
Dedicated SOP Classes:
ECG and other Waveform
Documents in a DICOM ‘jacket’:
Encapsulated PDF and HL7 CDA document streams
SPIE Medical Imaging – Feb 2013

21. DICOM Structured Reports
Report is stored in a tree of meaningful leaves (Content Items)
Documented relationship between the Content Items in a Template published in the standard
Robustness by specifying in a fixed nomenclature (Codes from SNOMED, LOINC, UCUM, DICOM, etc)
Encoded as normal DICOM Composite object
More complex than image due to nested structure
Equal format as image for easy storage in PACS, etc.
Templates (in Part 16) for
Diagnostic reports
Evident reports (measurements, logs, etc.)
Dose reports X-Ray, CT and NM/PET (Supplement 159)
Work in progress
SPIE Medical Imaging – Feb 2013

22. X-Ray Dose Reporting DICOM SR Templates for reporting X-Ray doses
Intervention and fluoroscopic X-Ray systems
CT systems
Extended with CR, Mobile X-ray systems
Provide a summary report for low end systems and comprehensive information of each irradiation event for intervention systems (including positioning parameters, etc.) for enhanced dose handling applications
New !
SPIE Medical Imaging – Feb 2013

23. Contrast Dose Reporting
DICOM SR Templates for reporting prescribed and applied contrast media (supplement 164)
Planned Dose (Protocol)
Planned Dose (Patient)
Actual applied dose
DICOM SR object use to contain dose related parameter.
Dedicated solution to communicate between Contrast manager and modality (SR is overkill)
Work in progress
SPIE Medical Imaging – Feb 2013

24. Imaging Workflow To enable a consistent distribution of information …
SPIE Medical Imaging – Feb 2013

25. Workflow
In a distributed environment it is crucial that identifying meta data is consistent on all systems
Cooperating system must able to keep track of progress
DICOM Worklist management and Procedure Step management implements dedicated work flow management control:
Pull model for querying a next (set of) activities
Push model to start and control activities
Reports with status and results of activities
SPIE Medical Imaging – Feb 2013

26. Worklow Services Modality Worklist / Performed Procedure Step:
Provide information for modality to perform an examination
Return status and result during and after examination
Unified Procedure Step:
Combines worklist and report functions
Allow scheduling
Baseline for complex work flow control
SPIE Medical Imaging – Feb 2013

27. Image Distribution Access to images without DICOM protocols …
SPIE Medical Imaging – Feb 2013

28. Protocols
‘Traditional’ DICOM protocols require a dedicated client and server not available outside Modality / PACS / Workstation domain
DICOM WADO defines access to DICOM formatted data using ‘web’ protocols:
HTTP
Web services
Enables web based applications (browsers, DICOM web viewers) accessing from (PACS) servers supporting this protocols anywhere on internet or intranet.
SPIE Medical Imaging – Feb 2013

29. RESTfull services
New family DICOM web protocols based on RESTful web services.
Web Access to DICOM Persistent Objects by RESTful Services (WADO-RS) – supplement 161
STore Over the Web by RESTful Services (STOW–RS) – supplement 163
Query based on ID for DICOM Objects by RESTful Services (QIDO-RS) – supplement 166
Work in progress
SPIE Medical Imaging – Feb 2013

30. Application Distribution Moving around applications …
Application Hosting
Application Distribution Moving around applications …
SPIE Medical Imaging – Feb 2013

31. Application Hosting
Today specialized and dedicated application for multi-platform requires an interface for each platform (expensive, little reuse) DICOM Application Hosting defines a common interface (independent technology) for control, data exchange and with the DICOM data model as basis. It is all in Part 19
SPIE Medical Imaging – Feb 2013

32. Fitting DICOM in the IT world Standards, IT management, Privacy …
IT, Privacy
Fitting DICOM in the IT world Standards, IT management, Privacy …
SPIE Medical Imaging – Feb 2013

33. IT Standards DICOM is using and following ‘common sense standards’:
TCP/IP for connection between application
ISO-OSI model for application / presentation layers
Web protocols for access non-DICOM application
IT management: DNS, NTP, DHCP, LDAP
Audit trail: SYSLOG – TLS
SPIE Medical Imaging – Feb 2013

34. Privacy
DICOM Meta Data consist of many sensitive data: names, IDs, addresses, phone numbers and other information that allows identification of a patient Depending on the purpose information must removed or replaced: teaching, clinical trials, remote access, remote service, etc. Rules specifying what action should take place are added in Part 15 Several options are available to extend the basic profile as needed
SPIE Medical Imaging – Feb 2013

35. DICOM Work in Progress
The Standard is still evolving And needs YOUR input and collaboration …
SPIE Medical Imaging – Feb 2013

36. WG 6 Work In Progress Supplement 121 Modality Protocol Storage
Supplement 124 Communication of Display Parameters
Supplement 147 Second Generation RT Objects
Supplement 156 Multi-dimensional Presentation State
Supplement 157 Multi-Frame Converted Legacy Images
Supplement 159 Radiopharmaceutical Administration Radiation Dose SR
Supplement 160 Second Generation RadioTherapy - Patient Positioning and Workflow
Supplement 161 WADO by means of RESTfull Services
Supplement 163 STore Over the Web by RESTful Services (STOW)
Supplement 164 Contrast Agent Administration SR Storage
Supplement 165 Breast Projection X-Ray Image
Supplement 166 Query based on ID for DICOM Objects by RESTful Services (QIDO)
Supplement 167 X-Ray 3D IOD Informative Annex
SPIE Medical Imaging – Feb 2013

37. Get Involved! Links to all information at MITA/NEMA
Get the DICOM Standard (free!)
ftp://medical.nema.org /medical/dicom/2011
Ask questions/discuss on the DICOM Newsgroup
Respond to Supplements released for Public Comment
Submit Change Proposals
mailto
Join a DICOM Working Group
See list in
SPIE Medical Imaging – Feb 2013

38. DICOM 2013 Conference For more info: http://dicomconference.org/
SPIE Medical Imaging – Feb 2013