1. DICOM INTERNATIONAL CONFERENCE & SEMINAR Oct 9-11, 2010 Rio de Janeiro, Brazil DICOM in Surgery - Recent activities and new DICOM Supplements Dr.-Ing. Oliver Burgert oliver.burgert@medizin.uni-leipzig.de Innovation Center Computer Assisted Surgery (ICCAS) Universität Leipzig Germany

2. Overview 1.DICOM WG-24 “Surgery” 2.Recently developed Supplements –Surface Segmentation –Implant Templates –Implantation Plan 3.Current project –Optical Surface Scan –Others 4.Conclusion 2

3. DICOM WG-24 „Surgery“ DICOM WG-24 aims on writing DICOM Supplements for Surgery. It has one permanent voting representative in WG-06 DICOM WG-24 has currently over 100 members from industry, medical practice and academia. Organization in –Clinical Project Groups –Technical Project Groups Everyone of you can participate! 3

4. DICOM WG-24 „Surgery“ DICOM Working Group 24 „Surgery“ –Surface Mesh –Implant Templates –Implantation Plans 4

5. 5 DICOM Surface Mesh Module DICOM Sup. 132 contains module for description of polyonal surfaces Methods: –Analysis of Surgical Workflows (DICOM WG-24) –Analysis of more than 25 file formats –Development of a DICOM data structure based on points and meshing

6. Implantation Planning  Digital implantation planning is of increasing importance  Issue: No commonly accepted file format for implant templates Digital 2D Planning Digital 3D Planning 6

7. Workflow Implantation Planning Start Planning Select & Load Images Extract Models Locate Anatomical Landmarks Select Template(s) Register Template(s) Finish Planning Predict Outcome Leg length change: 5mm Mobility: 60°

8. Implant Templates 2D Drawings 3D Models Anatomical landmarks Combination of components Meta-data –vendor –withdrawal –indication –…–… 8

9. Implantation Plan Implantations Plan Registration Visualization Intraoperative Information Component List Components Combination Connection templates Component connections Derived landmarks Planing Information User defined landmarks Patient Data

10. Information flow Modality (CT,MRT,…) Planing Workstation Navigation- system OR Display OR report Bilder Plan OR-Room PACS Plan Bilder 10

11. Information Objects 11

12. Attribute-Structure of Implant Templates Manufacturer Frame of Reference UID Implant Name Implant Size Implant Part Number Implant Template Version Replaced Implant Template Sequence Implant Type Original Implant Template Sequence Derivation Implant Template Sequence Effective DateTime Implant Target Anatomy Sequence Notification from Manufacturer Sequence […] Materials Code Sequence […] HPGL Document Sequence Contour Surface Number Reference Surface Model Parameter Sequence Surface Model Scaling Factor Mating Feature Sets Sequence […] Analog for: Implant Assembly Template Implant Template Group 12

13. Responsibility Update Withdrawal Archiving Data flow Implant Manufacturer Planning Software Vendor PACS Vendors Health care provider 13

14. Optical Surface Scanner - Use cases 14

15. Use Case: Septorhinoplasty 15

16. Optical Surface Scan, WG-24 meeting, 2010-06-23, C. Dressler Optical Surface Scanners Two possibilities to store scanner data Raw data 3d object Scanner External Post-processing PACS Point clouds, surface meshes, textures, device- specific attributes, 3d models

17. Changes to the DICOM Standard 17 Two new IODs Raw data Surfa ce New IEs each New M odules Point cloud module UV-Mapping module Using existing Points Macro New Macro Use the Mesh Module Add M odule New DCM codes Add Module Frame of Reference VL Photo IOD

18. 18 Attributes for Meshes In 2008, DICOM Supplement 132 “Surface Segmentation” was accepted. Points Topology Normals Properties X

19. 19 Coordinate Systems This request for DICOM Work Item is for the development of a Universal Coordinate System (or Universal DICOM Frame of Reference). This system will select as a “standard” one of several existing DICOM IOD’s or definitions (e.g. the image-centric, patient-centric, or environmental-centric coordinates). Work Plan: –1.Recruit members to contribute to this Work Item –2.Agree on “approach” –3.Select Universal Coordinate System or “Universal DICOM Frame of Reference” –4.Create list of IODs to be selected or written –5.Check for overlap with Workgroup 2 –6.Select “Use-Case” to serve as example –7.Complete request for Work Item –8.Review at next meeting (RSNA 2009) –9.Submit request for work item Interested?  Leonard Berliner, NY Methodist Hospital

20. DICOM WG-24 „Surgery“ - Conclusions Current Status: –Sup. 132 “Surface Segmentation”, introduces surface meshes (Standard since 2008, jointly with WG-17) –Sup. 131 defines “Implants”, (Letter Ballot finished) –Sup. 134 defines “Implantation Plans”, (Letter Ballot finished) Other Supplements are in preparation: –Optical Surface Scan Modality (Work Item granted) –Coordinate Systems –Attributes for Meshes –Volumetric Meshes –Patient Specific Implants We appreciate any input and discussion 20

21. DICOM INTERNATIONAL CONFERENCE & SEMINAR Oct 9-11, 2010 Rio de Janeiro, Brazil Thank you for your attention! I’m looking forward to your questions and contributions Acknowledgements The Innovation Center Computer Assisted Surgery (ICCAS) at the Faculty of Medicine at the University of Leipzig is funded by the German Federal Ministry for Education and Research (BMBF) and the Saxon Ministry of Science and the Fine Arts (SMWK) in the scope of the initiative “Unternehmen Region” with the grant numbers 03 ZIK 031 and 03 ZIK 032. It is also sponsored by funds of the European Regional Development Fund (ERDF) and the state of Saxony within the frame of measures to support the technology sector.