DICOM 2003: Expanding the standard’s Scope Andrei Leontiev Chairman, Working Group 6 IDX Systems Corporation

DICOM 2003 Vital Statistics

 11 new Supplements since publication of DICOM 2001  63 Correction Items  Major development of new IODs  Final Text of DICOM 2003 is available for download free of charge from DICOM web site: – http://medical.nema.org

Major focus of DICOM in 2002

 Security – De-identification, Clinical Trials  Applications of structured reporting (DICOM SR) – Evidence documents: – Chest CAD – Cath Lab Reporting – OB-GYN, Vascular US, Echocardiography

Major focus of DICOM in 2002

 New Media – DVD-R, E-mail attachments, large capacity MODs  New Objects – – Multi-frame MR New CT, XA, VL – WG2 and WG13 re-activated  JPEG 2000  Configuration Management  Standard Maintenance

Security – De-Identification

 Supplement 55  Allows the creator or sender of the objects to remove PHI without breaking standard requirements for Type 1, Type 2 attributes  Reversible – creator may keep original PHI in the object encrypted to prevent unauthorized access or exposure of information

Security – Clinical Trials

 Supplement 70 – builds upon the mechanisms of de-identification  Added Attributes to Information Object Definitions that allow creators identify subject, site, protocol and other clinical trial attributes in the SOP Instances submitted as part of a trial.

 Considers possibility of adding the trial identification attributes to an object at different points in workflow

Clinical Trials Workflow

Add CTI at site workstation Add CTI at CTCC workstation CTCC Workstation PACS Courier Media & Film CTI = Clinical Trial Identification Attributes CTCC = Clinical Trial Coordinating Center Translation  Scanning  DICOMDIR  Add CTI at CTCC QA/QC DICOM Push DICOM Inbox DICOM Push Database Quant & Analysis Blinded Read Translation  Transfer  Submission Add CTI at site scanner Add CTI at PACS FTP/e-Mail Clinical Trial Site Buffer Clinical Trial Coordinating Center

Content Mapping Resource

 Defines and maintains DICOM Context groups semantically-related collections of terms from SNOMED, LOINC, SCPECG, BI-RADS, UCUM  Includes large collection of DICOM-managed terms and DICOM templates  Extensive work with SR and coded terminology called for more rigid rules for use, maintenance and extension of DCMR

Content Mapping Resource

 WG 8 is charged with maintaining the DCMR and serving as liaison to other terminology development bodies – SNOMED, LOINC, HL7  WG6 keeps overall oversight authority on supplements  No Supplements featuring coded terminology work will be put for Letter Ballot until all terminology issues are solved by WG8 and/or related bodies.

Chest CAD

 New SR-based specialized SOP class.

 Extensive use of templates.

 Builds on the mechanisms defined for Mammography CAD  Separation into a SOP Class allows for precise control of the document’s structure  Introduced several templates that are being utilized by other SR-based SOP Classes – – Measurements Image library

Ultrasound Procedure Reporting

 A number of supplements covering different areas of US procedure reporting: – – – OB-GYN (Final Text) Vascular (Public Comment) Echocardiography (Public Comment)  Further advances the concept of Evidence Documents – objects generated by machine, that are not images but are carrying the supplemental information for the procedure to aid in diagnosis

Cath Lab Reporting

 Another example of Evidence Document object for Hemodynamics, and Electrocardiography Reporting  Introduces templates for Cath Lab reports  Also introduces the new Service Class for Procedure Logging – Allows equipment to identify the log events to the centralized logging system – Logs extensive amount of information collected by cath lab devices

New Imaging Objects

 Supplement 49 – Multi-frame MR  Similar approach for Multi-frame CT – Supplement 58  New efforts in development of enhanced Angiography and Projection Radiography objects – WG2 has been re-activated

Multi-frame MR

 New object definition supporting latest advancements in MR technology  Support for very large data sets, split of an acquisition between several multi-frame objects  New concepts – functional groups  Workshop on the subject at SPIE 2003

Workflow in Radiotherapy

 Major effort by WG7 – still several months away from Public Comment  Development of the workflow concepts and mechanisms for radiotherapy  Based on the General Purpose Worklist Service Classes  Likely to add ability to “push” work to systems such as Calculation Servers

Workflow in Radiotherapy

Host Archive Workflow Manager Performing Application Store SOP Instances

Create GPSPS Request Calculation Status

Transmit SOP Instances for Input and Relevant Information

Request Calculation (N-EVENT-REPORT) Get GPSPS Update GPSPS (IN PROGRESS) Create GPPPS (IN PROGRESS) Set GPPPS (COMPLETED) Update GPSPS (COMPLETED)

Store Results

Standard Maintenance

 63 Correction Items – ranging from typos to “jumbo patches” of recent definitions – Introduction of support for Chinese and UNICODE  Retirement of obsolete portions of the standard: – – – – ISO Networking Point-to point connectivity – Parts 9, 13 Storage Commitment Pull Model Overhaul and modernization of Part 1

Configuration Management

 Supplement 67 – in trial-use phase  Introduces use of LDAP and standardizes LDAP schema for maintenance of configuration parameters of DICOM devices  LDAP query to retrieve configuration parameters from LDAP server  Introduces use of industry standards – DNS, NTP, DHCP along with LDAP to support flexibility and robustness of configuration management

Configuration Management

 Covers most significant use cases: – – – – – Installation and auto-configuration of a new device Portable devices Mobile devices Small networks Mixed networks with legacy equipment  Main objective is to decrease service cost while maintaining reliable standard-based configuration management

New Transfer Syntaxes & Media

 New content (SR) requires different compression algorithms - Internet-standard “deflate” (zlib) transfer Syntax is added for SR Objects.  Many old JPEG syntaxes have never been used; retired but 4 of old JPEG syntaxes  Added JPEG 2000 (Jan 2002).

 WG13 resumed work on adoption MPEG as DICOM transfer syntax for Visual Light objects

New Transfer Syntaxes & Media

 New Media Technologies and requirements of applications prompting support for large-capacity media: – – – – DVD-RAM DVD-R (Public Comment) 640 MB, 1.3 GB, 2.3 GB 90mm MODs 4.1 GB 130 mm MODs  Internet e-mail is profiled like media (files and filesets)  DICOM MIME type (application/dicom) is registered with IETF

Conformance

 Huge Effort was put into overhauling existing Par 2 – Conformance (Public Comment)  New, more refined conformance Statement structure: – – Includes Executive Summary Mandatory sections on error handling, coded terminology, security  Main objective is to enhance readability of the statement and interoperability of products  New, much more comprehensive sample conformance statements reflecting specifics of different service classes

DICOM Object Access via Net

 In addition to the e-mail distribution of DICOM objects, DICOM recently spearheaded joint Work Item with ISO TC215 – Web Access to DICOM Persistent Objects (WADO) – In early stages of development – Will allow for web-access to images utilizing standardized URL – In conjunction with standardized MIME type should allow for access using a Web Browser

DICOM and other standards

 Joint Working group (WG20) with HL7 (Imaging Integration SIG), works on harmonization of DICOM and RIM, templates, imaging order and procedure definitions.

 Agreement between DICOM and SNOMED  WG10 works with ISO TC215 WG2  Liaison with JPEG

DICOM and other standards

 Continued cooperation with IHE: – General Purpose Worklist chosen as basis for Post-Processing Integration Profile (Year 4), Reporting Workflow Profile (Year 5) – New Evidence Documents Profile to embrace similar concept recent DICOM SR  Joint Work with IHE, HL7, ASTM on the Common Audit Log mechanisms

New supplements in the works

 New SR-based objects: – – – More US Evidence Documents New Service Class to Query for Patient History Breast Imaging Report  3D and n-D imaging: – – – Spatial Registration Multi-Dimensional Interchange 3D Ultrasound  Hanging Protocols

Conclusion

 16 parts of official DICOM 2003 edition are available at http://medical.nema.com

 DICOM is well positioned to continue serve integration needs of medical imaging, including workflow, evidence information recording, effective access to imaging results  Active cooperation with other standards assures DICOM objects integration into future HER – whether by reference, or through well-defined trans-coding mechanisms.