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Keeping up with DICOM. Kevin O’Donnell Toshiba Medical Systems. DICOM is not Static. DICOM first published in 1993 Extended regularly to meet the expanding needs of Medical Imaging: Multi-slice CT 3D Ultrasound Web-based PACS USB Memory Sticks Clinical Measurements

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Keeping up with dicom l.jpg

Keeping up with DICOM

Kevin O’Donnell

Toshiba Medical Systems

Dicom is not static l.jpg
DICOM is not Static

  • DICOM first published in 1993

  • Extended regularly to meet theexpanding needs of Medical Imaging:

    • Multi-slice CT

    • 3D Ultrasound

    • Web-based PACS

    • USB Memory Sticks

    • Clinical Measurements

    • Radiation Dose Reporting

    • Image Registration & Segmentation

    • Computer Aided Detection/Diagnosis

    • and many, Many More . . .

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DICOM Working Groups

  • WG-1 – Cardiac/Vascular

  • WG-2 – X-Ray & Angio

  • WG-3 – Nuclear Medicine

  • WG-4 – Compression

  • WG-5 – Exchange Media

  • WG-6 – Base Standard

  • WG-7 – Radiotherapy

  • WG-8 – Structured Report

  • WG-9 – Ophthalmology

  • WG-10 – Strategic Advisory

  • WG-11 – Display

  • WG-12 – Ultrasound

  • WG-13 – Visible Light

  • WG-14 – Security

  • WG-15 – Mammo & CAD

  • WG-16 – MR

  • WG-17 – 3D

  • WG-18 – Clinical Trials

  • WG-19 – Dermatology

  • WG-20 – Integration (HL7)

  • WG-21 – CT

  • WG-22 – Dentistry

  • WG-23 – App. Hosting

  • WG-24 – Surgery

  • WG-25 – Veterinary

  • WG-26 – Pathology

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DICOM Change Process

  • Supplements for major changes

    • Extend Standard by adding new object types, new services, etc. (i.e. New SOP Classes)

    • About 10 / year

    • Developed by Working Groups

    • Require Work Item approved by DICOM Standards Committee

  • Change Proposals for minor corrections

    • About 100 / year

    • Anybody can submit

    • Backward Compatibility: Avoid changes that break existing implementations

    • Vendors responsible for monitoring final text change proposals

  • Consolidated edition published every year

    • Most recently, January 2008

    • Available free at DICOM web site

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DICOM Change Process

Development of a Supplement :

  • Work Item Proposal

    • Reviewed / Approved by DICOM Standards Committee

  • Working Drafts

    • Developed by Working Groups

  • Public Comment

    • Reviewed / Approved by DICOM WG-6

    • Published for 45-day Comment Period

  • Letter Ballot

    • Reviewed / Approved by DICOM WG-6

    • Voted on by DICOM Members

  • Final Text / Standard

    • Finalized by DICOM WG-6

    • Effective immediately; Incorporated during next publication

  • …typically a 1-2 year process

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Maintaining Compatibility

Extension vs. Versioning

  • DICOM is a family of SOP Classes

    • It’s just “DICOM”; Not DICOM 3.0, 3.1, etc.

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

    • New SOP Classes are added; Old SOP Classes don’t change

    • Most applications continue to support older SOP Classes when supporting new ones

  • Association Negotiation

    • Software can determine if two systems are compatible

    • Happens each time two DICOM systems open an association (connection)

    • They negotiate which SOP Classes will be used, and how (e.g. Transfer Syntax)

    • Based on what each system supports and/or prefers

  • DICOM Conformance Statement (DCS):

    • Humans can determine if two systems are compatible

    • When purchasing, compare the new system to your currently installed systems

      “This product supports this list of SOP Classes; here are some details about how the SOP Classes have been implemented and how the system behaves when it uses them”

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Enhanced Objects

  • “2nd Generation” objects for most modalities

    • Common approach to Multi-frame, multi-dimension objects

    • New Attributes (Private->Public)

      • Acquisition details, Clinical details

    • New SOPs for CT, MR, XA/XRF, 3D-XR, PET, OCT, 3D-US

  • Benefits

    • Convenient handling of 1000+ slice studies

    • Faster transfers (orders of magnitude)

    • Advanced structure for faster, advanced display

    • Support for modern/advanced protocols

      • e.g. in CT/MR: cardiac, gating, perfusion, diffusion, angio, fluoro, multi-stack spine, spectroscopy, functional imaging, color, raw data, …

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Fixed Header

Dimension data

Pixel data

Per-frame header

Multiframe Architecture

UsingSingle FrameObjects

N Objects, N Headers


N Frames, One Header

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Unified Procedure Step (UPS)

Addresses more advanced Workflow needs:

  • Adds “Push Workflow” & “Create Workitem”

    • Request another system to add item to worklist

  • Simplifies Implementation

    • General Purpose Worklist had N:M relation of SPS:PPS

    • State diagram was very complex

    • Unified PS contains details of both requested task & performed task

  • Adds “Cancel Request”

    • Lets systems request (and monitor) cancellation of a task

  • Improves Status/Result Monitoring

    • Getting PPS was awkward; required configuration and forwarding

  • 4 SOP Classes operating on 1 IOD

    • UPS Push, UPS Pull, UPS Watch, UPS Event

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Unified Procedure Step (UPS)

Other Interesting Features:

  • Allows Push, Pull, and Watch Workflows

  • Subscription-based Monitoring

  • Task Locking by performer

  • Deletion Locking by watchers

  • Allows Sub-contracting

    Likely Applications

  • Radiotherapy

    • Sup. 74 (Radiotherapy Worklists) is based on UPS

    • Automates worklists, verification steps, and beam delivery instructions

    • Now in Trial Implementation with IHE-RO

  • Softcopy Display Management

    • Sup. 124 plans to use UPS push workflow and monitoring features

  • Not intended to obsolete Modality Worklist

    • MWL has large install base and works well for most situations

  • Registration l.jpg

    • New SOP Classes

      • Rigid Registration Storage

      • Deformable Registration Storage

    • Records one or both of:

      • Transformations to map one or more data sets(e.g. images) into the space of another data set

      • Fiducials used for the registration

    • Example use:

      • Modality or workstation spatially registers two datasets

      • Registration object is stored to the PACS

      • Display station retrieves and applies the transformation;displays fused images

    Segmentation l.jpg

    • New SOP Classes

      • Segmentation Image Storage

        • Based on Pixels / Voxels

        • Binary (1-bit/pixel) or fractional(probability or occupancy)

      • Surface Segmentation Storage

        • Based on 3D Mesh

    • May record multiple segments representing:

      • Tissue type, organ surface, etc.

    • Example use:

      • Workstation analyzes images; segments tumor

      • Segmentation object is stored to the PACS

      • Display station retrieves/displays segmentation;perhaps for surgical planning

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    Dose Reporting

    • New SOP Class

      • X-Ray Radiation Dose SR Storage

      • Templates for Projection X-Ray, Mammo & CT

    • Records individual Irradiation Events

      • Does not depend on creation of digital images

      • Can be correlated with images for dose mapping

      • Driven by work of IEC and Euratom

    • IHE now working to facilitate deployment

    • Example Use:

      • Modality stores Dose Reports to PACS

      • Dose Monitoring system retrieves reports and generates weeklyanalysis of departmental dose; monitors compliance with policies

    How can you keep up l.jpg
    How can you keep up?

    • Download the current issue of the Standard (free)

      • Both PDF and Word

      • Both normal and “Diff” version (showing changes from previous issue)

    • Monitor and Implement CPs (Change Items)

      • Keep your product current

    • Review New Supplements

      • Current documents are visible at all stages of the process


    • Review the DICOM Strategy Document

      • Activity reports from all Working Groups

    • Attend the next DICOM International Conference and Seminar

      • Stay tuned!

    How can you contribute l.jpg
    How can you contribute!

    • Ask questions/discuss on the DICOM Newsgroup


    • Submit Change Proposals

      • if you find a gap, error, inconsistency or confusing text


    • Respond to Supplements released for Public Comment

      • Feedback is particularly welcome during Public Comment period


    • Join DICOM

      • Membership categories for users, vendors and national bodies


    • Participate in the DICOM Standards Committee and Working Groups

      • Submit new Work Item proposals

      • Help develop new Supplements