HL7 May 2001 Working Group Meeting DICOM Tutorial Introduction to DICOM

1. May 8, 2001, 9:00 – 10:30 a.m. Fred M. Behlen, Ph.D. HL7 May 2001 Working Group MeetingDICOM TutorialIntroduction to DICOM Kurt Rossmann Laboratories for Radiologic Image Research Department of Radiology

2. ACR-NEMA 1.0 Published as NEMA PS3-1985 ACR-NEMA 2.0 Published as NEMA PS-1988 Digital Imaging and Communications in Medicine (DICOM) 3.0 Published as NEMA PS3-1993(94?), and (almost) annual updates thereafter.PS3-2000 now available. DICOM Standard

3. DICOM Scope Medical Informatics . . . PatientBedsideMonitoring Administrative HIS/RIS Lab Data . . . DiagnosticImaging Scope ofDICOM

4. Information Repre- Transfer Signaling model sentation mech- method Information Repre- Transfer Signaling model sentation mech- method syntax anism DICOM X X X HL7 X X X XML X CORBA X X HTTP, FTP X TCP/IP, Ethernet X Scope of standards

5. DICOM Standard “The DICOM Standard is structured as a multi‑part document using the guidelines established in the following document: — ISO/IEC Directives, 1989 Part 3: Drafting and Presentation of International Standards.”

6. PS 3.1: Introduction and Overview PS 3.2: Conformance PS 3.3: Information Object Definitions PS 3.4: Service Class Specifications PS 3.5: Data Structure and Encoding PS 3.6: Data Dictionary PS 3.7: Message Exchange PS 3.8: Network Communication Support for Message Exchange PS 3.9: Point‑to‑Point Communication Support for Message Exchange PS 3.10: Media Storage and File Format for Data Interchange PS 3.11: Media Storage Application Profiles PS 3.12: Storage Functions and Media Formats for Data Interchange PS 3.13: Print Management Point-to-Point Communication Support PS 3.14: Grayscale Standard Display Function PS 3.15: Security Profiles PS 3.16: Content Mapping Resource (2001) DICOM Standard

7. PS 3.1: PS 3.2: PS 3.3: PS 3.4: PS 3.5: PS 3.6: PS 3.7: PS 3.8: PS 3.9: PS 3.10: PS 3.11: PS 3.12: PS 3.13: PS 3.14: PS 3.15: DICOM Supplements Balloted Supplement Published Standard Introduction Part 1 changes … Part 3changes … Part 6 changes … …

9. PS 3.1: Introduction and Overview PS 3.6:DataDictionary PS 3.2: Conformance PS 3.4: Service Class Specifications PS 3.3:InformationObject Definitions PS 3.5: Data Structureand Semantics Part 7: Message Exchange PS 3.8: NetworkCommunication Supportfor Message ExchangeTCP/IP OSI PS 3.9: Point toPoint Communication Support for Message Exchange

10. DICOM Conformance Statement Format and Content specified in Part 2 Required for every claimed DICOM implementation “If there’s no Conformance Statement, it’s not DICOM.” Intended audience for Conformance Statement is engineer, not customer. Conformance

11. conformance Vendor A contractscope interoperation STANDARD contract conformance Customer Vendor B

12. contract Ascope conformance Vendor A contract A Customer interoperation (voila!) STANDARD contract B conformance Vendor B contract Bscope

13. PS 3.3: Information Object Definitions PS 3.4: Service Class Specifications PS 3.6: Data Dictionary Key Sections

14. DIMSE Services Composite Normalized C-STORE N-EVENT-REPORT C-GET N-GET C-MOVE N-SET C-FIND N-ACTION C-ECHO N-CREATE N-DELETE

16. Computed Radiography Image Computed Tomography Image Magnetic Resonance Image Nuclear Medicine Image Ultrasound Image Ultrasound Multi-Frame Image Secondary Capture Image X-Ray Angiographic Image X-Ray RF Image Positron Emission Tomography Image Hardcopy Grayscale Image Hardcopy Color Image Digital X-Ray Image Digital Mammography X-Ray Image Digital Intra-Oral X-Ray Image PS 3.3: Information Object Definitions

17. Visible Light Image VL Endoscopic Image VL Microscopic Image VL Slide-Coordinates Microscopic Image VL Photographic Image Standalone Overlay Standalone Curve Standalone Pet Curve Stored Print Standalone Modality Lut Standalone VOI Lut Grayscale Softcopy Presentation State Basic Study Descriptor PS 3.3: Information Object Definitions

18. RT Image RT Dose RT Structure Set RT Plan RT Beams Treatment Record RT Brachytherapy Treatment Record RT Treatment Summary Record Waveform Basic Voice Audio 12-Lead Electrocardiogram General Electrocardiogram Ambulatory Electrocardiogram Hemodynamic Basic Cardiac Electrophysiology Structured Report Document Basic Text SR Enhanced SR Comprehensive SR PS 3.3: Information Object Definitions

19. Verification Storage Query/Retrieve Study Content Notification Patient Management Study Management Results Management Print Management Media Storage Storage Commitment Basic Worklist Management Queue Management Grayscale Softcopy Presentation State Storage Structured Reporting Storage PS 3.4: Service Class Specifications

20. Service-Object Pairs (SOPs) Information Objects STORE Services

21. Presentation Context Abstract Syntax Endianism Big Endian Little Endian Value Representation Implicit VR Explicit VR Transfer Syntax Uncompressed Compressed modes PS 3.5: Data Structure and Encoding

22. Data Set and Data Elements

23. PS 3.3 Annex A IOD Modules

24. PS 3.3 Annex C Patient ID Module

25. PS 3.3 Annex C Pixel Module

26. PS 3.3 Annex C Pixel Module

27. Pixel Encoding

28. Tag Assignments [xxxx,xxxx] Name (non-canonical) Value Representation Value Multiplicity DICOM-assigned UIDs Terminology Mapping Resource Registry Registry of Templates PS 3.6: Data Dictionary

29. Patient arrives Physician sees patient, writes order Patient goes to Imaging Department Patient is imaged Radiologist interprets images, writes report Physician looks at report (and often images) Physician treats patient based on report Patient discharged Diagnostic Imaging in the Patient Care Process ImagingDepartment

30. Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Results, Images Radiology

31. Patient identification Orders Other clinical information Scheduling (of some resources) Financial authorizations Exam Context Imaging department obtains from the enterprise:

32. Patient& visit Study &acquisition Storeddata

33. Patient& visitIODs Study &acquisitionIODs StoreddataIODs

34. Patient Placer Order I-Study Filler Order I-Patient Scheduled Procedure Step Study Instance UID IDdomain^PatientID Scheduled Proc. Step ID Filler Order Number Placer Order Number IDdomain^PatientID 10-n 1 11-n* 11-n* 0-n Requested Procedure 1 1-n Requested Procedure IDRP Study Instance UID 0-n** 0-m** 1 1-n 0-n** 0-m** Performed Procedure Step Performed Proc. Step UID 11-n * An Order Placer typically submit a single order (ORM), however, an Order Filler can expand that single order into multiple Requested Procedures. See IHE Y2TF Section 6 for more details. ** See Section 6 for a thorough description of the cardinality relationship options of Modality Performed Procedure Step. *** The Performed Procedure Step UID is present as the Affected SOP Instance UID. Series Series UID 1 0-n Instance SOP Instance UID

35. Patient I-Study Scheduled Procedure Step Filler Order I-Patient Placer Order Filler Order Number Study Instance UID Placer Order Number IDdomain^PatientID Scheduled Proc. Step ID IDdomain^PatientID 10-n 1 11-n* 11-n* 0-n Requested Procedure 1 1-n Requested Procedure IDRP Study Instance UID 0-n** 0-m** 1 1-n 0-n** 0-m** Performed Procedure Step Performed Proc. Step UID 11-n Series Series UID 1 0-n SR Instance Instance SOP Instance UID SOP Instance UID

36. Reports Images Exam status Results Imaging department delivers to the enterprise:

37. http://www.rsna.org/IHE http://www.himss.org/IHE IHE Home Pages

38. http://medical.nema.org/dicom.html Committee for the Advancement of DICOM DICOM Resources Page http://www.merge.com/dicom/resources/ DICOM Home Pages