Debriefing on DICOM Standard of China

1. Debriefing on DICOM Standard of China Goldisc DICOM Key Laboratory of UESTC Chengdu Goldisc UESTC Multimedia Technology Co., Ltd. University of Electronic and Science Technology of China(UESTC) March,2011 Beijing

2. Main contents • Introduction to drafting standard • The progress of Standard staffing • Introduction on Standard submission draft • The clinical application of the DICOM standard • Future work

3. 1 Introduction to drafting standard • Background Health Standards Board authorized the University of Electronic Science and Technology of China(UESTC) and Chengdu Goldisc UESTC Multimedia Technology Co., Ltd to complete the work of drafting the DICOM Standard of China, which has been listed into the projects of 2009 of Health Standards Board.NO.2009-16-01. • The aim 1. Through the draft and application of the DICOM standard of China, we want to realize the ability of processing information in Chinese in some large medical equipments. Especially in some key process for PACS, such as the input of image information, image processing, the transmission of images, image archiving and the films print. 2. Add DICOM standard of China to the National DICOM standard, and make the DICOM standard of China become a major part of the national one. • The procedure for standard drafting (1) As the organizational units and main drafting units of the DICOM standard of China, UESTC and the Chengdu Electronic Science and Technology Multimedia Technology Co., Ltd. conducted researches on National DICOM standard from 1998, at the same time, they set up a work group. They issued the Draft Standard in 2006. (2) The work group who worked for CIMICS(China) made a comprehensive survey on the structure of PACS in medical institutions in China, and made a evaluation on the application of National DICOM standard in China's medical industry. They establish the basic framework for the Draft Standard, and conducted an extensive clinical testing. (3) They held Experts forums to discuss and modify the Draft Standard from 2008 to 2010. Finally they completed and submitted the Draft of DICOM standard of China on December 2010.

4. 1 Introduction to drafting standard • The principle for drafting 1. It can promote the medical images transfer ,archive and output correctly in Chinese environment, and ensure the consistency of medical information. 2. Reflect the Universality and Applicability • The national DICOM Standard specify the image format and communication process, but it doesn’t give the corresponding solutions on supporting and affecting extension in character set, data types and service types. The subject is focusing on these problems, propose the solution, and take university and applicability into consideration. And on this basis, we provide compliance test of film print and WORKLIST class for DICOM Standard. We promote to realize the application of the DICOM standard in China and the capacity of supporting Chinese. • At the same time, the standard refer to the Japanese and Korean DICOM standard, propose a “direct way” and a “composite approach ”,The two kinds of processing methods maximized the standard universality and applicability.

5. Main contents • Introduction to drafting standard • The progress of Standard staffing • Introduction on Standard submission draft • The clinical application of the DICOM standard • Future work

6. 2 The progress of Standard staffing • The project is in first reading state Finished works • Completed the standard setting, Completed the standard draft in the form of Technical Guidelines of Health standard； • Completed the compile of the documents； • Validation reports in standard methods(test reports from 3 hospitals, and equipment manufacturers ,such as agfa CR, fuji CR) • Completed the diagram for summary the consultation(18 copies sent and 12 copies received) • Completed the condition of funds consumption diagram

7. Main contents • Introduction to drafting standard • The progress of Standard staffing • Introduction on Standard submission draft • The clinical application of the DICOM standard • Future work

8. (1)Range This standard specifies the "China DICOM standard " character set standard and DICOM character set which is associated with the service class specifications, including format and communication, and at the same time we provide the description and methods for compliance test. (2)Normative Reference GB/T 2312 Guo-Biao Tuijian 2312 GBK Guo-Biao Kuozhan GB 18030-2000 Guo-Biao 18030-2000 DICOM Standard(2009) (3)Terminology and Definition DICOM (Digital Imaging and Communications in Medicine) PACS (Picture Archiving and Communication Systems) RIS (Radiology Information System) HIS (Hospital Information System) (4)Character Set solutions Chinese character set adopt GB2312(including GBK 12345 and GBK13000) or GBK or GB18030, we recommend GB18030. 3 The introduction of the submit version of the Standard

9. (5) The Chinese rule for DICOM standard of China(Extended character set and the rules) DICOM application entity can use extended character set to supply or replace the default character set. Extended character set is defined by attribute of Tag(0008,0005),Chinese character set defined as follows two ways: Direct way (0008,0005) domain for GB18030 or GBK or GB2312.The methods for processing the name and long text is as follows: a) the method for processing name: The format definition：Name(in PINYIN)= Chinese name = English (Name(in PINYIN) and English name can be omitted) For example: Chen^ShengBo=陈胜波= Chinese character internal code: 0x43 0x68 0x65 0x6E 0x5E 0x53 0x68 0x65 0x6E 0x67 0x42 0x6F 0x3D 0xB3 0xC2 0xCA 0xA4 0xB2 0xA8 0x3D b)the method for processing long text: For example: The first line. The second line. Chinese character internal code(GB18030、GB2312 character code ) such as: 0xB5 0xDA 0xD2 0xBB 0xD0 0xD0 0xCE 0xC4 0xD7 0xD6 0xA1 0xA3 0x0D 0x0A 0xB5 0xDA 0xB6 0xFE 0xD0 0xD0 0xCE 0xC4 0xD7 0xD6 0xA1 0xA3 0x0D 0x0A 3 The introduction of the submit version of the Standard

10. 3 The introduction of the submit version of the Standard (5) The Chinese rule for DICOM standard of China(Extended character set and the rules) • Composite Patten (0008,0005)domain is ISO 2022 GBKorISO 2022 GB2312 orISO 2022 GB18030, list in the following form At the same time, in order to content with the specification of number of DICOM data bytes in even, we specify that every row must begin in ASCII and end in ASCII either.

11. (5) The Chinese rule for DICOM standard of China(Extended character set and the rules) Composite Patten a)the method for processing name The format definition: Name(in PINYIN)= Chinese name = English (Name(in PINYIN) and English name can be omitted) For example: Chen^ShengBo=陈胜波= Chinese character internal code: 0x43 0x68 0x65 0x6E 0x5E 0x53 0x68 0x65 0x6E 0x67 0x42 0x6F 0x3D 0x1B 0x24 0x29 0x41 0xB3 0xC2 0xCA 0xA4 0xB2 0xA8 0x1B 0x28 0x42 0x3D 0x20 b)the method for processing long text For example: 1. The first line 2. The second line 3. The third line Chinese character internal code(1.2.3 are ASCII code ) such as: 0x31 0x2e 0x1B 0x24 0x29 0x41 0xB5 0xDA 0xD2 0xBB 0xD0 0xD0 0xCE 0xC4 0xD7 0xD6 0xA1 0xA3 0x1B 0x28 0x42 0x0D 0x0A 0x32 0x2e 0x1B 0x24 0x29 0x41 0xB5 0xDA 0xB6 0xFE 0xD0 0xD0 0xCE 0xC4 0xD7 0xD6 0xA1 0xA3 0x1B 0x28 0x42 0x0D 0x0A 0x33 0x2e 0x1B 0x24 0x29 0x41 0xB5 0xDA 0xC8 0xFD 0xD0 0xD0 0xCE 0xC4 0xD7 0xD6 0xA1 0xA3 0x1B 0x28 0x42 0x0D 0x0A 0x20 3 The introduction of the submit version of the Standard

12. 3 The introduction of the submit version of the Standard (5) The Chinese rule about DICOM standard of China(Impact the data type of DICOM)

13. (5)The Chinese rule for DICOM standard of China(DICOM server class that are impact by extended character set) This standard focus on input source DICOM WorkList service class 、output source DICOM Printservice class and DICOM Image format service class 3 The introduction of the submit version of the Standard

14. (6) Conformance Testing for DICOM standard of China Conformance Testing of WORKLIST a) The SCU port request Protocol Data Unit(PDU) when it build C-FIND, it must use character set TAG(0008,0005) which are defined in 5.1 in DATA ELEMENT of PDU’s message segment. b) After SCP port receive C-FIND request PDU from SCU port, when detect SCU port special character set which are defined in 5.1, and then package the character set into the data segment of PDU which response to C-FIND(TAG(0008,0005)), in addition, it should meet the corresponding rule for package the standard character set when package the data of (VALUE REPRESENTAION) SH,LO,ST,PN,LT,UT. c)After SCP port receive C-FIND request PDU from SCU port, it will detect the data segment TAG(0008,0005) of response PDU. If the data which are defined in 5.1, SCU port will resolve this data in corresponding package rules when it detect the data which equal to (VALUE REPRESENTATION) SH, LO,ST,PN,LT,UT. If the data equal to TAG(0008,0005) is not the character set which is defined in 5.1, we think that the SCP port is not satisfied with DICOM standard of China. 3 The introduction of the submit version of the Standard

15. (6)Conformance Testing for DICOM standard of China Conformance Testing of DICOM PRINT a) while requesting PDU with the SCU port structuring c-find ,it must use character set TAG(0008,0005) defined in 5.1 in data element of PDU’s message segment attribute list; The SCU port request Protocol Data Unit(PDU) when it build N-GET, it must use character set TAG(0008,0005) which are defined in 5.1 in DATA ELEMENT of PDU’s message segment. b) After SCP port receive N-GET request PDU from SCU port, when detect SCU port special character set which are defined in 5.1, and then package the character set into the data segment of PDU which response to N-GET(TAG(0008,0005)), in addition, it should meet the corresponding rule for package the standard character set when package the data of (VALUE REPRESENTAION) SH,LO,ST,PN,LT,UT. c) After SCP port receive N-GET request PDU from SCU port, it will detect the data segment TAG(0008,0005) of response PDU. If the data which are defined in 5.1, SCU port will resolve this data in corresponding package rules when it detect the data which equal to (VALUE REPRESENTATION) SH, LO,ST,PN,LT,UT. If the data equal to TAG(0008,0005) is not the character set which is defined in 5.1, we think that the SCP port is not satisfied with DICOM standard of China. d) When SCU affirm the character set which is form SCP port, it would packaging such series of server objects as BASIC FILM SESSION SOP CLASS, BASIC FILM BOX SOP CLASS, BASIC IMAGE BOX SOP CLASS and so on, and while the PDU’s data segment that request these class have VALUE REPRESENTATION as data elements SH, LO, ST, PN, LT, UT, SCU will packaging the data appoint to the corresponded standard of character. e) It is the same when SCP received each PDU which is sent form the port SCU, SCU will analysis these data element follow the corresponding rule packaging of the appoint character set when SCU has detected data element equal to(VALUE REPRESENTATION) SH,LO,ST,PN,LT,UT. 3 The introduction of the submit version of the Standard

16. Main contents • Introduction to drafting standard • The progress of Standard staffing • Introduction on Standard submission draft • The clinical application of the DICOM standard • Future work

17. 4 The status for clinical application of the standard (1)The testing result for Large-scale medical equipment ①The testing result of CR AGFA ADC SOLO CR are satisfied with DICOM standard of China(Verified by West China Second University Hospital of SiChuan University, The second people’s hospital of SiChuan) Fuji CR Console is partially satisfied with DICOM standard of China.(WORKLIST is satisfied but achive not, Verified by The No.2 People’s Hospital of Yinbin) ② CT, MR and film printer are not satisfied with the DICOM standard of China. (2) The verify state of Regional PACS ①The regional PACS of Nanhai District, Foshan City, Guangdong Province(19 hospitals) are fully satisfied with DICOM standard. The films which are achiving amount to 10T, about a hundred million films. ② The regional PACS of Zhongshan City, Guangdong Province(8 hospitals) are fully satisfied with DICOM standard. The films which are achiving amount to 30T, about three hundred million films. ③The project which is carrying out in Shenzhen(58 hospitals), the PACS are all fully satisfied with DICOM standard. The films which are achiving amount to 100T, about a billion films. From the above, the manufacturers from home or abroad are partially satisfied with the DICOM standard of China in their equipments and applications, but a large amount equipment are not. We hope we can promote the application area in Medical imaging fields through the release of the DICOM standard of China.

18. Main contents • Introduction to drafting standard • The progress of Standard staffing • Introduction on Standard submission draft • The clinical application of the DICOM standard • Future work

19. 5 Future work (1) Complete the work of First Review, Preliminary Review and Discussion of the DICOM standard of China before June,2011, On June, we will submit the standard and the standard will be announced. (2) At the end of 2011, CIMICS(China) will submit the standard to National DICOM institution, at that time, DICOM standard of China will add into the National DICOM standard. (3) We would like to build a Conformance Testing station for DICOM standard of China, and complete the procedure for testing and the construction of the testing platform for standard, under the leadership of the Ministry of Health and supervised by CIMICS(China).

20. Thank you! CIMICS(China) March 2011