DICOM 2003: Expanding the standard’s Scope

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Clinical Trials Workflow

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Workflow in Radiotherapy

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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.