What's New in DICOM – it's been a very busy year! - NEMA

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5 Νοε 2013 (πριν από 3 χρόνια και 10 μήνες)

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What’s New in DICOM


DICOM Workshop @ SPIE MEDICAL IMAGING

February 3013

Bas Revet, Philips Healthcare


(Chair WG 6)


The DICOM Standard


Images


Beyond Radiology, Cardiology and Radio Therapy


Manipulating with Images


Analyzing Image Data and Documenting the Results


Imaging Workflow


Image Distribution


Application Distribution


Fitting DICOM in the IT world


The Standard is still evolving


Content

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SPIE Medical Imaging


Feb
2013

What and Who is DICOM

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The DICOM Standard


All almost 30 years going strong …

SPIE Medical Imaging


Feb
2013


DICOM is the International Standard for
Medical Imaging and related information



images,



waveforms,



derived measurements and assessments,



image presentation controls,



workflow management in the imaging dept.


Beyond Radiology and Cardiology:
Pathology, Ophthalmology, Surgery,
Dermatology, …


Published as NEMA PS3 and as ISO 12052


SPIE Medical Imaging


Feb
2013

4

The DICOM Standard

The DICOM Work Process


Continuous process for evolution of the standard


It’s just “DICOM”, not DICOM 3.0, 3.1, etc.


Conformance is to SOP Classes, not to a ‘version’ of the Standard


Change Proposals for minor corrections


About 100 / year


Anybody can submit


Supplements for major changes


new object types,
services, compression schemes


Past year 4 are added to the standard


Require Work Item approved by DICOM Standards Committee


Consolidated edition published every year


Most recently, August 2011 (2011 version), waiting for 2013 version


Available free at DICOM web site

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Feb
2013

The DICOM Working Groups

Produced by 28 Working Groups:


6


1
Cardiac and Vascular Information

15
Digital Mammography and CAD


2
Projection Radiography and Angiography

16
Magnetic Resonance


3
Nuclear Medicine

17
3D


4
Compression

18
Clinical Trials and Education


5
Exchange Media

19
Dermatologic Standards


6
Base
Standard
(coordination,

main editor)

20
Integration of Imaging and
Information Systems


7
Radiotherapy


8
Structured Reporting

21
Computed Tomography


9
Ophthalmology

22
Dentistry

10
Strategic Advisory

23
Application Hosting

11
Display Function Standard

24
Surgery

12
Ultrasound

25
Veterinary Medicine

13
Visible Light

26 Digital Pathology

14
Security

27
Web
Technology for
DICOM

28
Physicists

SPIE Medical Imaging


Feb
2013

Images


Where it all started …

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SPIE Medical Imaging


Feb
2013

‘Classic’ Images

First Generation of images:


CR, CT, MR, US, MN


Secondary Capture (for what not fit)


Multi
-
frame XA and XRF, US, NM, PET


Digital Detector: DX, MG (mammo), IO (inter
-
oral)


Visible Light: Microscopy, Photographic, Video


Family RT data object, including Images

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SPIE Medical Imaging


Feb
2013

‘Enhanced’ Images

9

Extension of classic multi
-
frame images allowing the
specification of properties of each frame



Enhanced MR, Spectroscopy


Enhanced CT


Enhanced XA and XRF


Enhanced PET


Enhanced US (3D)


Ophthalmic Tomography


X
-
Ray 3D Angiographic, Craniofacial, Breast
Tomosynthesis


In development: Enhanced NM


Also used by: Segmentation, IVUS
-
OCT, etc.

SPIE Medical Imaging


Feb
2013

Multi
-
Frame Converted
Legacy Image

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SPIE Medical Imaging


Feb
2013


Transfer of many image of large single frame MR
and CT studies can consume considerable time

Transfer Time

Transfer Time

Response Time

Response Time

….

Transfer Time

Response Time


Combining all image into a multi
-
frame will reduce
the transfer time

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SPIE Medical Imaging


Feb
2013

Multi
-
Frame Converted
Legacy Image


Build analog to ‘Enhanced’ multi
-
frame definitions
for CT, MR or PET


Intended for PACS


PACS transfers or PACS
workstation transfers


Receiving side may unpack multi
-
frame or handle it
the same way and enhanced SOP Instance


Standard will specify how to convert the legacy
images to multi
-
frame


See Supplement 157

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SPIE Medical Imaging


Feb 2013

Multi
-
Frame Converted
Legacy Image

New Clinical Domains

13

Beyond Radiology, Cardiology and
Radio Therapy


Reusing proven concepts …

SPIE Medical Imaging


Feb
2013

Radiotheraphy

RT Second Generation


Data Objects



Radiotherapy Working Group decided to
create a new family of SOP Classes


Based on the new Enhanced Multi
-
frame
paradigm and other new DICOM
developments


Preparing version for Public Comment
(Supplement 147)

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Feb
2013

Radiotheraphy

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SPIE Medical Imaging


Feb 2013

RT Second Generation


Workflow



For document management and resource
reasons, patient positioning and workflow
instructions


Early Draft
(Supplement 160)

Image Presentation

16

Manipulating with Images


Besides storage there is more …

SPIE Medical Imaging


Feb
2013


Displaying and annotating images:


Grayscale Softcopy Presentation State


Color Softcopy Presentation State


Pseudo
-
Color Softcopy Presentation State


Blending


Organizing the display of studies


Structured Display (single study)


Hanging Protocols Storage (multi study cases)

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Image Presentation

SPIE Medical Imaging


Feb
2013

Linking image data:


Spatial Registration (rigid)


Deformable Spatial Registration (flexible)


Selecting and annotating parts of images or
volumes:


Segmentation


Surface Segmentation (using vertices)

Image Presentation

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SPIE Medical Imaging


Feb
2013

Analyzing Image Data and
Documenting the Results


On a well structured and interoperable way …

19

Measurements & Reporting

SPIE Medical Imaging


Feb
2013

Highly structured:


Diagnostic and Evidence Reports in DICOM
Structured Report Format

Dedicated SOP Classes:


ECG and other Waveform

Documents in a DICOM ‘jacket’:


Encapsulated PDF and HL7 CDA document
streams

Report Formats

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Feb
2013

DICOM Structured Reports

21


Report is stored in a tree of meaningful leaves (Content Items)


Documented relationship between the Content Items in a
Template published in the standard


Robustness by specifying in a fixed nomenclature (Codes from
SNOMED, LOINC, UCUM, DICOM, etc)


Encoded as normal DICOM Composite object


More complex than image due to nested structure


Equal format as image for easy storage in PACS, etc.


Templates (in Part 16) for


Diagnostic reports


Evident reports (measurements, logs, etc.)


Dose reports X
-
Ray, CT and NM/PET (Supplement 159)

SPIE Medical Imaging


Feb
2013


DICOM SR Templates for reporting X
-
Ray
doses


Intervention and fluoroscopic X
-
Ray systems


CT systems


Extended with CR, Mobile X
-
ray systems


Provide a summary report for low end systems and
comprehensive information of each irradiation event
for intervention systems (including positioning
parameters, etc.) for enhanced dose handling
applications


X
-
Ray Dose Reporting

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SPIE Medical Imaging


Feb
2013

Contrast Dose Reporting

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SPIE Medical Imaging


Feb 2013


DICOM SR Templates for reporting prescribed
and applied contrast media
(supplement 164)


Planned Dose (Protocol)


Planned Dose (Patient)


Actual applied dose


DICOM SR object use to contain dose related
parameter.


Dedicated solution to communicate between Contrast
manager and modality (SR is overkill)


Imaging Workflow


To enable a consistent distribution of information …

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Workflow

SPIE Medical Imaging


Feb
2013

Workflow

25


In a distributed environment it is crucial that
identifying meta data is consistent on all systems


Cooperating system must able to keep track of
progress


DICOM
Worklist

management and Procedure
Step management implements dedicated work
flow management control:


Pull model for querying a next (set of)
activities


Push model to start and control activities


Reports with status and results of activities

SPIE Medical Imaging


Feb
2013

Modality Worklist / Performed Procedure Step:


Provide information for modality to perform an
examination


Return status and result during and after
examination

Unified Procedure Step:


Combines worklist and report functions


Allow scheduling


Baseline for complex work flow control

Worklow Services

26

SPIE Medical Imaging


Feb
2013

Image Distribution

27

Image Distribution


Access to images without DICOM protocols …

SPIE Medical Imaging


Feb
2013

‘Traditional’ DICOM protocols require a
dedicated client and server not available outside
Modality / PACS / Workstation domain

DICOM WADO defines access to DICOM
formatted data using ‘web’ protocols:


HTTP


Web services

Enables web based applications (browsers, DICOM
web viewers) accessing from (PACS) servers supporting
this protocols anywhere on internet or intranet.


Protocols

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SPIE Medical Imaging


Feb
2013


New family DICOM web protocols based on
RESTful web services.


Web Access to DICOM Persistent Objects by
RESTful Services (WADO
-
RS)


supplement 161


STore Over the Web by RESTful Services

(STOW

RS)


supplement 163


Query based on ID for DICOM Objects by RESTful
Services (QIDO
-
RS)


supplement 166

RESTfull services

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SPIE Medical Imaging


Feb 2013

Application Hosting

30

Application Distribution


Moving around applications …

SPIE Medical Imaging


Feb
2013

Today specialized and dedicated application for
multi
-
platform requires an interface for each
platform
(expensive, little reuse)


DICOM Application Hosting defines a common
interface (independent technology) for control,
data exchange and with the DICOM data model
as basis.


It is all in Part 19

Application Hosting

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SPIE Medical Imaging


Feb
2013

IT, Privacy

32

Fitting DICOM in the IT world


Standards, IT management, Privacy …

SPIE Medical Imaging


Feb
2013

DICOM is using and following ‘common sense
standards’:




TCP/IP for connection between application



ISO
-
OSI model for application / presentation layers



Web protocols for access non
-
DICOM application



IT management: DNS, NTP, DHCP, LDAP



Audit trail: SYSLOG


TLS

IT Standards

33

SPIE Medical Imaging


Feb
2013

DICOM Meta Data consist of many sensitive data:
names, IDs, addresses, phone numbers and other
information that allows identification of a patient

Depending on the purpose information must
removed or replaced:
teaching, clinical trials, remote
access, remote service, etc.

Rules specifying what action should take place are
added in Part 15

Several options are available to extend the basic
profile as needed

Privacy

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SPIE Medical Imaging


Feb
2013

DICOM Work in Progress

35

The Standard is still evolving


And needs YOUR input and collaboration …

SPIE Medical Imaging


Feb
2013

WG 6 Work In Progress

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SPIE Medical Imaging


Feb
2013


Supplement 121 Modality Protocol Storage


Supplement 124 Communication of Display Parameters


Supplement 147 Second Generation RT Objects


Supplement 156 Multi
-
dimensional Presentation State


Supplement 157 Multi
-
Frame Converted Legacy Images


Supplement 159 Radiopharmaceutical Administration Radiation Dose SR


Supplement 160 Second Generation
RadioTherapy

-

Patient Positioning
and Workflow


Supplement 161 WADO by means of
RESTfull

Services


Supplement 163
STore

Over the Web by
RESTful

Services (STOW)


Supplement 164 Contrast Agent Administration SR Storage


Supplement 165 Breast Projection X
-
Ray Image


Supplement 166 Query based on ID for DICOM Objects by
RESTful

Services (QIDO)


Supplement 167 X
-
Ray 3D IOD Informative Annex


Get Involved!


Links to all information at MITA/NEMA


http://dicom.nema.org/


Get the DICOM Standard (free!)


ftp://medical.nema.org /medical/dicom/2011


Ask questions/discuss on the DICOM Newsgroup


http://groups.google.com/group/comp.protocols.dicom


Respond to Supplements released for Public Comment


http://www.dclunie.com/dicom
-
status/status.html


Submit Change Proposals


mailto svastagh@medicalimaging.org


Join a DICOM Working Group


See list in http://medical.nema.org/dicom/geninfo/Strategy.pdf



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Feb
2013

DICOM 2013 Conference

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SPIE Medical Imaging


Feb 2013

For more info: http://dicomconference.org
/