DICOM Updates 2006: Enhancements & Extensions in Medical Imaging Standards

1. What’s New in DICOM Robert Horn Agfa Healthcare

2. 2006 Extensions • Upgrades to existing modalities • Additions of new modality objects • Safety and Security • User Interface support • Coordination with other standards

3. Upgrading Modalities • First, MR • Then, CT • Then, XA/XRF • Now, 3D Xray • Continues use of multi-frame with functional group macros to capture more frame to frame relationships than just time. • Concatenations for improved network performance and streaming • Incorporate standard DICOM attributes to describe the 3-D information gathered by modern X-ray equipment. • Tomographic Synthesis, etc. supported • Final Text (January 2007)

4. Ion Therapy • A new SOP class to describe the use of ion beam radiation therapy machines. • Extensive detail on beam setting options • Enhancements to patient position and fixation devices that will be retrofitted to other therapy systems. • Fits into the therapy workflows already defined for other kinds of radiation therapy machines.

5. CT/MR CardiovascularReport • An evidence document that captures measurement data derived from either CT or MR observations of the cardiovascular system. • The report incorporates; • Patient characteristics • Relevant images references • Procedure summaries • Automatically as well as manually detected findings • Information about the progress of finding properties over time (by comparison with predecessor preceding reports) • Observational Conclusions

6. JPIP • A transfer syntax is defined for supporting the JPEG Progressive Interactive Protocol. • This syntax is intended for supporting interactive access to large images or over slower links, and is not well suited to transfer of complete images with full fidelity.

7. Segmentation • This supplement defines voxel oriented tissue segmentations. • Segmentation allows fractional voxel assignment: e.g, 60% blood, 30% bone, 20% tissue. • IOD defines algorithm names and source data used. It does not include algorithm specifications. • IOD does not define presentation or visualization parameters. • A surface based segmentation IOD is in preparation.

8. Deformable Spatial Registration • This is an extension to the already define rigid spatial registration • An array of deformation mapping vectors is provided. • Deformable registrations are not expected to be reversible in general. If the registration is to be used reversibly, two registration IODs are needed.

9. Unified Procedure Steps • Out for Public Comment • Merges Worklist Management/Performed Procedure Step • A single IOD that combines both scheduled and performed attributes • C-FIND to query worklists • N-CREATE to create new 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

10. RT Worklist • First usage of Unified Procedure Step • Out for public comment • Provides automated worklist management for the integration of multi-site and multi-system radiation therapy.

11. Substance Administration • Verification of Substance Administration • Support 5-Rights process • Operational Concept • Scan patient ID (bracelet, etc.) • Scan substance (drug, etc.) • Query for permission to administer • Receive YES, Warnings, or NO • Substance Information Query • Scan substance • Obtain substance description and documentation • Assumes existance of an external Patient/Substance Information system that monitors prescriptions, administrations, allergies, etc.

12. Encapsulation of CDA • Similar to encapsulated PDF • Encapsulates HL7 CDA documents, providing a few crucial extracts (e.g. Patient ID, Document Title) so that a DICOM PACS archive can be used to storage and retrieve HL7 CDA documents.

13. Veterinary Extensions • These extensions rephrase the definition of some existing terms, like “patient name” to accommodate typical veterinary usages. • These extensions add attributes for “breed”, “digital identifier”, etc.

14. Tracking IT Improvements • IPv6 support • Small network configuration management • Email Transport • ZIP file format to hold DICOMDIR and DICOM files • Email transport • Can be either automated or manual. In summary, “create DICOM CD image, ZIP it, attach to an email” • In use by Dentistry and IHE

15. New efforts • Enhancements to Query and Retrieve especially intended to manage retrieval of subsets from large multi-frame objects • Graphic Displays • Structured Display • Display Calibration communication • Enhanced Presentation state • Colon CAD • Breast Tomosynthesis • Application Hosting (draft for trial use this year)

16. New Efforts (contd) • Ophthalmology • Ophthalmic Tomography (OCT and other technologies) • Refractive Reports • Pathology • revisions and clarifications to the specimen model • Whole slide imaging (uncompressed raw slide images are 350 gibagyte to 3.5 Terabytes) • Cardiac • Cardiac Stress Report • Electrophysiology Report

17. Web Site • http://medical.nema.org • Presentations (like this one) • Drafts, Minutes, etc. • Public Comment Documents • Letter Ballot Documents • The Approved supplements and CPs • The full DICOM Standard • Publicly available