1. DICOM for Physicians : What can it do for you?
Kevin O’Donnell
Toshiba Medical Research Institute
This talk will look at what DICOM does, and also serve as a preview for many of the talks that follow today.
Q. What do you WANT it to do? – there’s a good chance it already does.
Q. OK, first, what IS DICOM?

2. DICOM: A Standard DICOM is the standard for medical imaging.
Widely implemented
Managed process (NEMA)
International scope (ISO)
and many pages of detail information…
What do we mean “standard”
3,000+ pages. Bet you don’t want to have to read it. Good news is that you don’t have to, but you should understand what it covers.

3. DICOM: A Family of Protocols
Specifies how two systems exchange information
Many kinds of Systems:
Modalities, PACS, RIS, Workstations, EMR,…
Many kinds of Information:
Images, worklists, measurements, surfaces, audit logs, …
DICOM is for Systems talking to each other about imaging
Many protocols in the family – related but independent

4. Why should I care? Can I just ask for “DICOM”? *
Yes, if you don’t care what pieces you get
Pieces can be implemented independently
Depends on what the product needs to do
Won’t vendors just give me what I need?
(We try to, but …) your input matters
DICOM has it ≠ vendors use it (intelligently)
Know what is possible
Ask about your top priorities
Ron Cowan’s talk will get into this process of selection.

5. Store Images DICOM stores your images * DICOM helps manage your Images
All kinds of images
CT, MR, X-Ray, Ultrasound, Angiography, PET, SPECT, Mammography, Dentistry*, Dermatology, Endoscopy, Ophthalmology, IVUS, Pathology * Scanned Documents, …
Single & Multiframe; Volumes & Cines; B&W & Color; Original & Processed
DICOM helps manage your Images
Not just pixels; Significant meta-data
Patient identification & demographics, the order, equipment, acquisition, workflow context, …
PACS = database; DICOM = machine readable
Can query/sort/autoroute/manage
DICOM has been evolving for over 20 years; new modalities continue to emerge.
Large hospitals are creating millions of frames per year. DICOM has been applied to vet, DICONDE and DICOS
Allan Farman Talk & Dr. Pereira tomorrow
Harry Solomon Talk

6. Store (Imaging) Data * Measurements Analysis Data
OB-GYN (fetal size metrics, etc.)
Echocardiography (size, flow, motion)
CT/MR Vascular (vascular flow metrics)
Ophthalmology (axial meas., perimetry)
Analysis
Location & characteristics of CAD findings
for Mammography, Chest X-Ray, Colonoscopy
Data
Waveforms (ECG, EEG, Voice)
Harry Solomon Talk on behalf of Andrei Leontiev
What else can DICOM do for you?

7. Manage Acquisition Workflow *
DICOM meets HL7
Patient management, order placement in HL7
RIS through Reporting in DICOM
Modality Worklist
Scheduled patient & exam information (electronic)
Exam Status & Coordination
Exam in-progress; complete; cancelled
Storage Commitment
Verify images on PACS before Modality deletes
Niki Wirsz Talk
Note capabilities of Worklist to specify protocols, provide admitting diagnosis, etc.

8. Display Images * Accuracy Convenience Information
Screen calibration method & data (GSDF)
Consistent presentation (GSPS)
Modality calibration (Modality LUT)
Also works for Printing
Convenience
Key image flagging
Hanging Protocols
Structured Display
Information
Meta-data can be overlaid
Time & Space correlation
Lawrence Tarbox Talk
<<Picture of reading workstation>>

9. Distribute Images * by Local Network by Media by Internet
Push & Pull (Query/Retrieve)
by Media
CD, DVD, BluRay, …
USB Memory, USB HardDrive
by Internet
attachment
Web Access to DICOM Objects (WADO)
DICOM Data and/or Rendered pictures
Registry & Repository architecture(XDS-I.b)
Note that you can make remote systems appear on the local network
Cor Loef’s Talk

10. Manage Other Workflows
Reporting Workflow
Worklists, status reporting
Post-processing Workflow
Radiotherapy
Procedure plans, worklists, verification
Substance Administration
Identification Service (barcode)
Verification Service

11. Store Advanced Image Processing & Visualizations
Registrations
Rigid & Deformable
Different studies, modalities, atlases
Segmentations
Voxel Classification & Surface Definition
Fusion
Blended presentation
Surgical Implants
Implant models & implantation plans
3D Presentation States are WIP

12. Support Security & Privacy *
Audit Trails
Record creation, access & modification in central log
De-identification
Remove identifying details to various degrees *
Encryption
Encrypt data elements or entire objects
Configuration
Autoconfigure DICOM devices
Lawrence Tarbox’s 2nd talk
David Clunies talk and Jacques Fauquex talks tomorrow
Just like when you plug a computer into a network.

13. Measure Quality & Performance
Workflow Timestamps
in data objects and workflow messages
Report Turnaround Time, Exam Times, …
QA Scans
Store and flag phantom scans
Radiation Dose
Summary & detail for each procedure
CT, Angiography/Fluoroscopy, Mammography, CR/DR
Work in Progress for PET

14. … and More DICOM does a lot Today’s talks Tomorrows talks Future
And we add to it every year. *
Today’s talks
most widely deployed features
Tomorrows talks
some of the exciting new features
Future
Tell us your needs
Physicians have directly driven a number of additions
Return to opening question. (What do you want it to do?)
Harry Solomon Talk