1. Introduction to DICOM HL7 May 2001 Working Group Meeting DICOM Tutorial Introduction to DICOM May 8, 2001, 9:00 – 10:30 a.m. Fred M. Behlen, Ph.D. Kurt Rossmann Laboratories for Radiologic Image Research Department of Radiology

2. DICOM Standard ACR-NEMA 1.0 –Published as NEMA PS3-1985 ACR-NEMA 2.0 –Published as NEMA PS-1988 Digital Imaging and Communications in Medicine (DICOM) 3.0 –Published as NEMA PS3-1993(94?), and (almost) annual updates thereafter. PS3-2000 now available.

3. Diagnostic Imaging DICOM Scope Patient Bedside Monitoring Administrative HIS/RIS... Lab Data... Medical Informatics Scope of DICOM

4. Scope of standards InformationRepre-TransferSignaling modelsentationmech-method syntaxanism DICOMXXX HL7XXX XMLX CORBAXX HTTP, FTPX TCP/IP, EthernetX

5. DICOM Standard The DICOM Standard is structured as a multi part document using the guidelines established in the following document: ISO/IEC Directives, 1989 Part 3: Drafting and Presentation of International Standards.

6. DICOM Standard PS 3.1:Introduction and Overview PS 3.2:Conformance PS 3.3:Information Object Definitions PS 3.4:Service Class Specifications PS 3.5:Data Structure and Encoding PS 3.6:Data Dictionary PS 3.7:Message Exchange PS 3.8:Network Communication Support for Message Exchange PS 3.9:Point to Point Communication Support for Message Exchange PS 3.10: Media Storage and File Format for Data Interchange PS 3.11: Media Storage Application Profiles PS 3.12: Storage Functions and Media Formats for Data Interchange PS 3.13: Print Management Point-to-Point Communication Support PS 3.14: Grayscale Standard Display Function PS 3.15: Security Profiles PS 3.16:Content Mapping Resource (2001)

7. DICOM Supplements PS 3.1: PS 3.2: PS 3.3: PS 3.4: PS 3.5: PS 3.6: PS 3.7: PS 3.8: PS 3.9: PS 3.10: PS 3.11: PS 3.12: PS 3.13: PS 3.14: PS 3.15: Introduction Part 1 changes … Part 3changes … Part 6 changes … Balloted SupplementPublished Standard

9. PS 3.1: Introduction and Overview Part 7: Message Exchange PS 3.3: Information Object Definitions PS 3.6: Data Dictionary PS 3.5: Data Structure and Semantics PS 3.8: Network Communication Support for Message Exchange TCP/IP OSI PS 3.9: Point to Point Communication Support for Message Exchange PS 3.4: Service Class Specifications PS 3.2: Conformance

10. Conformance DICOM Conformance Statement –Format and Content specified in Part 2 –Required for every claimed DICOM implementation If theres no Conformance Statement, its not DICOM. –Intended audience for Conformance Statement is engineer, not customer.

11. Vendor A STANDARDSTANDARD Customer conformance Vendor B conformance interoperation contract contract scope

12. Vendor A STANDARDSTANDARD Customer conformance Vendor B conformance interoperation contract B contract A contract A scope contract B scope (voila!)

13. Key Sections PS 3.3:Information Object Definitions PS 3.4:Service Class Specifications PS 3.6:Data Dictionary

14. DIMSE Services CompositeNormalized C-STOREN-EVENT-REPORT C-GETN-GET C-MOVEN-SET C-FINDN-ACTION C-ECHON-CREATE N-DELETE

16. PS 3.3:Information Object Definitions Computed Radiography Image Computed Tomography Image Magnetic Resonance Image Nuclear Medicine Image Ultrasound Image Ultrasound Multi-Frame Image Secondary Capture Image X-Ray Angiographic Image X-Ray RF Image Positron Emission Tomography Image Hardcopy Grayscale Image Hardcopy Color Image Digital X-Ray Image Digital Mammography X-Ray Image Digital Intra-Oral X-Ray Image

17. PS 3.3:Information Object Definitions Visible Light Image –VL Endoscopic Image –VL Microscopic Image –VL Slide-Coordinates Microscopic Image –VL Photographic Image Standalone Overlay Standalone Curve Standalone Pet Curve Stored Print Standalone Modality Lut Standalone VOI Lut Grayscale Softcopy Presentation State Basic Study Descriptor

18. PS 3.3:Information Object Definitions RT Image RT Dose RT Structure Set RT Plan RT Beams Treatment Record RT Brachytherapy Treatment Record RT Treatment Summary Record Waveform –Basic Voice Audio –12-Lead Electrocardiogram –General Electrocardiogram –Ambulatory Electrocardiogram –Hemodynamic –Basic Cardiac Electrophysiology Structured Report Document –Basic Text SR –Enhanced SR –Comprehensive SR

19. PS 3.4:Service Class Specifications Verification Storage Query/Retrieve Study Content Notification Patient Management Study Management Results Management Print Management Media Storage Storage Commitment Basic Worklist Management Queue Management Grayscale Softcopy Presentation State Storage Structured Reporting Storage

20. Service-Object Pairs (SOPs) XX XXXXXXXXXX X XX X XX X XX XX X Services Information Objects STORE

21. PS 3.5:Data Structure and Encoding Presentation Context –Abstract Syntax Endianism –Big Endian –Little Endian Value Representation –Implicit VR –Explicit VR –Transfer Syntax Uncompressed Compressed modes

22. Data Set and Data Elements

23. PS 3.3 Annex A IOD Modules

24. PS 3.3 Annex C Patient ID Module

25. PS 3.3 Annex C Pixel Module

27. Pixel Encoding

28. PS 3.6:Data Dictionary Tag Assignments –[xxxx,xxxx] –Name (non-canonical) –Value Representation –Value Multiplicity DICOM-assigned UIDs Terminology Mapping Resource Registry Registry of Templates

29. Diagnostic Imaging in the Patient Care Process Patient arrives Physician sees patient, writes order Patient goes to Imaging Department Patient is imaged Radiologist interprets images, writes report Physician looks at report (and often images) Physician treats patient based on report Patient discharged Imaging Department

30. Diagnostic Imaging in the Patient Care Process Hospital Enterprise Radiology Exam context Results, Images

31. Exam Context Patient identification Orders Other clinical information Scheduling (of some resources) Financial authorizations Imaging department obtains from the enterprise:

32. Patient & visit Study & acquisition Stored data

33. Patient & visit IODs Study & acquisition IODs Stored data IODs

34. Patient IDdomain^PatientID Placer Order Placer Order Number Filler Order Filler Order Number Requested Procedure Requested Procedure ID RP Study Instance UID Performed Procedure Step Performed Proc. Step UID Series Series UID Instance SOP Instance UID Scheduled Procedure Step Scheduled Proc. Step ID I-Patient IDdomain^PatientID I-Study Study Instance UID 1 1-n* 1 0-n 0-n** 0-m** 1 1-n 0-n** 0-m** 1 0-n 1 1-n 1 1-n 1 0-n *An Order Placer typically submit a single order (ORM), however, an Order Filler can expand that single order into multiple Requested Procedures. See IHE Y2TF Section 6 for more details. **See Section 6 for a thorough description of the cardinality relationship options of Modality Performed Procedure Step. ***The Performed Procedure Step UID is present as the Affected SOP Instance UID.

35. Patient IDdomain^PatientID Placer Order Placer Order Number Filler Order Filler Order Number Requested Procedure Requested Procedure ID RP Study Instance UID Performed Procedure Step Performed Proc. Step UID Series Series UID Instance SOP Instance UID Scheduled Procedure Step Scheduled Proc. Step ID I-Patient IDdomain^PatientID I-Study Study Instance UID 1 1-n* 1 0-n 0-n** 0-m** 1 1-n 0-n** 0-m** 1 0-n 1 1-n 1 1-n 1 0-n SR Instance SOP Instance UID

36. Results Reports Images Exam status Imaging department delivers to the enterprise:

37. http://www.rsna.org/IHE http://www.himss.org/IHE IHE Home Pages

38. http://medical.nema.org/dicom.html Committee for the Advancement of DICOM DICOM Resources Page http://www.merge.com/dicom/resources/ DICOM Home Pages