1. Harry Solomon, GE Healthcare RSNA 2007
What’s New in DICOM
Harry Solomon, GE Healthcare
RSNA 2007

2. Published as NEMA PS3 and as ISO 12052
DICOM is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department
Published as NEMA PS3 and as ISO 12052
What's new in DICOM - RSNA 2007

3. Agenda The DICOM Change Process Images Image Processing & Reporting
Workflow
Specialties
Get Involved!
What's new in DICOM - RSNA 2007

4. The DICOM Change 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
About 10 / year
Require Work Item approved by DICOM Standards Committee
Consolidated edition published every year
Most recently, January 2007
Available free at DICOM web site
What's new in DICOM - RSNA 2007

5. Information Object Definitions and Image Access
Images
Information Object Definitions and Image Access

6. Multiframe Images Multiframe objects to support 1000+ slice studies
Image header supports functional group attributes changing during acquisition
Dimensions allow multiple views of data
Common structure used for all new image IODs
Sup 110 Ophthalmic Coherence Tomography (Adopted August 2007)
Sup D X-ray (Adopted January 2007)
Sup 117 Enhanced PET (in Letter Ballot)
Sup 43 Enhanced Ultrasound (in Public Comment)
Sup 125 Breast Tomosynthesis (in Public Comment)
What's new in DICOM - RSNA 2007

7. Single-frame to MultiFrame
N Objects, N Headers
N Frames, One Header
Fixed Header
Per-frame header
Dimension data
Pixel data
What's new in DICOM - RSNA 2007

8. The Per-Frame Header
What's new in DICOM - RSNA 2007

9. Sup 119 Frame Level Retrieve
If we have slice image objects, how do we access the slice identified in the report as the Key Image?
Or, how to access a short video clip of a long endoscopy video image object?
Many similar use cases needing one frame or a small subset of frames from large multiframe image
Purpose of retrieval may not be diagnostic; compression OK
Proposed new Retrieve SOP Classes for subsets of frames
Request can include a preferred transfer syntax (i.e., type of compression)
Returned object is a derived image with the requested subset of frames, but with a different Instance UID
In Public Comment
What's new in DICOM - RSNA 2007

10. Sup 43 Enhanced Ultrasound
Pixel frames may represent tissue, velocity, variance or power
Multiple frames (up to 3) must be blended for proper display
Enhanced blending pipeline required to render images
In Public Comment
What's new in DICOM - RSNA 2007

11. Image Processing & Reporting
Segmentation, Registration, Structured Reporting

12. Sup 111 Segmentation Image
Derived image object
Multiframe, using functional group mechanism
Multiple segments per object
Each segment linked to a categorization
Pixels show presence of category at pixel location
Binary (1-bit/pixel) or fractional (probability or occupancy)
Segments can be 2-D or 3-D
3-D segmentation is typically in same Frame of Reference as source image
Segments can be displayed as overlays on source image
Adopted August 2006
What's new in DICOM - RSNA 2007

13. Segmentation Example
What's new in DICOM - RSNA 2007

14. Sup 132 Surface Segmentation
Work in progress – just released for Public Comment
Segmentation using 3-D surface mesh (rather than voxel volume)
First use of mesh technology in DICOM
Will also be used for future volumetric work, including implant specification and surgical planning
In Public Comment
What's new in DICOM - RSNA 2007

15. Sup 112 Deformable Spatial Registration
Composite Object that supports multi-image alignment
3 step algorithm
Pre-deformation matrix transform
Deformation using 3D grid of 3D deformation vectors
Post-deformation matrix transform
Facilitates further image processing, especially multi-modality image fusion and image pasting applications
Adopted August 2006
What's new in DICOM - RSNA 2007

16. Structured Reporting Additional Templates for standard SR SOP Classes
Sup 128 Cardiac Stress Testing (Frozen Draft – passed Ballot, awaiting final SNOMED and IEEE codes)
Sup 129 Cardiac Electrophysiology (in Public Comment)
Templates for specialty SR SOP Classes
Sup 127 CT Radiation Dose (Adopted October 2007)
Sup 130 Ophthalmic Refractive SR (in Letter Ballot)
Sup 126 Colon CAD (in preparation)
Harmonization with HL7
Sup 114 DICOM Encapsulation of CDA Documents (Adopted January 2007)
What's new in DICOM - RSNA 2007

17. Workflow
Substance Administration, Unified Worklist, RT Workflow, Specimen Identification

18. Sup 107 Substance Administration
Patient safety issue – “five rights” checking for contrast agents
Point of use verification for substances often “out of the loop” of hospital pharmacy systems
Three new DICOM services
Typically Modality as SCU interacting with HIS via gateway SCP
Query: Look up product characteristics
Given a barcode ID (from contrast agent bottle), get name, active ingredient, concentration, etc.
Query: Get substance administration approval
Based on agent, patient, route of administration; get approval or warnings
Report contrast used to HIS Medication Administration Record
Adopted January 2007
What's new in DICOM - RSNA 2007

19. Sup 96 Unified Procedure Steps
Simplification and merger of Worklist Management and Performed Procedure Steps
1:1 relationship between scheduled and performed steps
A single IOD that combines attributes of both
C-FIND to query worklists
N-CREATE to create new scheduled procedure steps
N-GET/N-SET to update
N-EVENT-REPORT to monitor and report progress
Intended to meet the needs of
Radiation Therapy Scheduling and Monitoring
Scheduling and Monitoring CAD systems
Proposed new scheduling activities
Frozen Draft for Trial Implementation
What's new in DICOM - RSNA 2007

20. Sup 74 Radiotherapy Worklist
Supports automated worklist management and machine parameter verification for the integration of multi-system radiation therapy planning and treatment
First usage of Unified Procedure Step
Also defines three new objects / SOP Classes
RT Beams Delivery Instruction (Composite)
RT Conventional Machine Verification (Normalized)
RT Ion Machine Verification (Normalized)
Real implementation and evaluation needed – in conjunction with IHE Radiation Oncology
Frozen Draft for Trial Implementation
What's new in DICOM - RSNA 2007

21. Sup 122 Specimen Identification
Support for pathology lab workflow, specimen-based imaging
Gross specimens, blocks, vials, slides
Image-guided biopsy samples
Retires current Specimen Identification Module, adds new Specimen Module at image level of hierarchy
May affect applications that implement current Module (if any)
Update to Modality Worklist to allow Specimen Module
Enables automated slide scanning devices to fully populate header
Update to Modality Performed Procedure Step to identify imaged specimen
Allows LIS to track images for specimens
In Public Comment
What's new in DICOM - RSNA 2007

22. Specialties Biomed engineering Research / Biomarkers Surgery
Supp 124 Communication of Display Parameters (in preparation)
Administrative support for monitor calibration
Research / Biomarkers
Supp 118 Application Hosting (in preparation)
Image analysis programs run on any workstation
Surgery
Sup 131 Implant Description (in preparation)
Supports 3D model of bone-mountable implants
Dentistry / Radiology
Sup 123 Structured Display (in preparation)
Captured screen layout of multiple images (with presentation states) for dental series, radiology conference, etc.
What's new in DICOM - RSNA 2007

23. Get Involved! Get the DICOM Standard (free!)
(annual issue)
ftp://dicom.nema.org/medical/dicom/final (changes between issues)
Ask questions/discuss on the DICOM Newsgroup
Respond to Supplements released for Public Comment
Submit Change Proposals
Join a DICOM Working Group
See list in
Attend the DICOM International Conference and Seminar, Chengdu, China, April 8-10, 2008
Build the new DICOM capabilities into your products
Your URL here!
What's new in DICOM - RSNA 2007