What

1
Whats New in DICOM

• Robert Horn, Agfa Healthcare
• RSNA 2008

2

• DICOM is the International Standard for Medical
  Imaging and related information
• images,
• waveforms,
• derived measurements and assessments,
• image presentation controls,
• and workflow management in the imaging
  department
• Published as NEMA PS3 and as ISO 12052

3
Agenda

• The DICOM Change Process
• Images
• Image Processing Reporting
• Workflow
• Specialties
• Get Involved!

4
The DICOM Change Process

• Continuous process for evolution of the standard
• Its 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
• About 10 / year
• Require Work Item approved by DICOM Standards
  Committee
• Consolidated edition published every year
• Most recently, January 2008
• Available free at DICOM web site

5
Highlighted CPs

• CP-874 (October 2008, this affects everything
  that uses ionizing radiation)
• Radiation Dose reporting (jumbo patch)
• Extensive clarifications to dose reporting, based
  on IHE review and early implementation efforts.
• Will be required for IHE Radiation Dose reports.
• Very large images (public comment)
• An extension for images larger than 64Kx64K.
• Veterinary Extensions (public comment, noteworthy
  as probably the largest page count for this year)
• Species extension CP-918
• View codes for quadrupeds CP-919
• The other 100 are all important within their
  domain.

6
Images

• Information Object Definitions and Image Access

7
Multiframe Images

• Multiframe objects to support 1000 slice studies
• Image header supports functional group attributes
  changing during acquisition
• Dimensions allow multiple views of data
• Common structure used for all new image IODs
• Sup 141 Enhanced MR Color (First Read)
• Sup 139 Enhanced XA/XRF Informative Annex (Public
  Comment 2008)
• Sup 43 Enhanced Ultrasound (in Public Comment)
• Sup 125 Breast Tomosynthesis (Adopted August
  2008)
• Sup 117 Enhanced PET (Adopted January 2008)
• Sup 110 Ophthalmic Coherence Tomography (Adopted
  August 2007)
• Sup 116 3-D X-ray (Adopted January 2007)
• Sup 83 Enhanced XA/XRF Image (Adopted 2004)
• Sup 58 Enhanced CT (Adopted 2003)
• Sup 49 Multiframe MR (Adopted 2001)

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Single-frame to MultiFrame
N Objects, N Headers
N Frames, One Header
9
The Per-Frame Header
10
Sup 119 Frame Level Retrieve

• If we have 1000 slice image objects, how do we
  access the slice identified in the report as the
  Key Image?
• Or, how to access a short video clip of a long
  endoscopy video image object?
• Many similar use cases needing one frame or a
  small subset of frames from large multiframe
  image
• Purpose of retrieval may not be diagnostic
  compression OK
• Proposed new Retrieve SOP Classes for subsets of
  frames
• Request can include a preferred transfer syntax
  (i.e., type of compression)
• Returned object is a derived image with the
  requested subset of frames, but with a different
  Instance UID

Balloted, Needs Final Text resolution of comments
11
Sup 43 Enhanced Ultrasound

• Pixel frames may represent tissue, velocity,
  variance or power
• Multiple frames (up to 3) must be blended for
  proper display
• Enhanced blending pipeline required to render
  images

In Public Comment
12
Specimen Identification

• Support for pathology lab workflow,
  specimen-based imaging
• Gross specimens, blocks, vials, slides
• Image-guided biopsy samples
• Retires current Specimen Identification Module,
  adds new Specimen Module at image level of
  hierarchy
• May affect applications that implement current
  Module (if any)
• Update to Modality Worklist to allow Specimen
  Module
• Enables automated slide scanning devices to fully
  populate header
• Update to Modality Performed Procedure Step to
  identify imaged specimen
• Allows LIS to track images for specimens

Adopted June 2008
13
More video transfer syntaxes

• MPEG-2 (Supplement 137, in Letter Ballot)
• Hi-def formats (e.g., BluRay)
• Hi-def TV shapes and frame rates
• Output format for many current Hi-def cameras
• DICOM size limit corresponds to 15-30 minutes of
  video per SOP instance.
• MPEG-4 (soon)
• Higher compression ratio than MPEG-2
• Higher computational requirements than MPEG-2
• These will be available for any image modality,
  although visible light is the expected type.

14
Image Processing Reporting

• Segmentation, Registration, Structured Reporting

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Sup 132 Surface Segmentation

• Derived image object
• Uses the new surface representation sequence
• Multiple segments per object
• Each segment linked to a categorization
• Each segment is a surface, which may have viewing
  hint.
• Surfaces are always 3-D
• 3-D segmentation is typically in same Frame of
  Reference as source image
• Surface Display methods are not specified,
  although display hints can be conveyed.

Adopted August 2008
16
Surface Segmentation

• Actual object contains digital parameters of a
  surface mesh.
• Display can be shaded image, or any other kind of
  user interface.

17
Structured Reporting

• Additional Templates for standard SR SOP Classes
• Sup 129 Cardiac Electrophysiology (in Public
  Comment)
• Sup 128 Cardiac Stress Testing (Final Text
  Codes provided October 2008)
• Templates for specialty SR SOP Classes
• Sup 126 Colon CAD (in preparation)
• Sup 130 Ophthalmic Refractive SR (Adopted January
  2008)
• Sup 127 CT Radiation Dose (Adopted October 2007)
• Harmonization with HL7
• Sup 114 DICOM Encapsulation of CDA Documents
  (Adopted January 2007)

18
Workflow

• Substance Administration, Unified Worklist, RT
  Workflow, Specimen Identification

19
Sup 96 Unified Procedure Steps

• Simplification and merger of Worklist Management
  and Performed Procedure Steps
• 11 relationship between scheduled and performed
  steps
• A single IOD that combines attributes of both
• C-FIND to query worklists
• N-CREATE to create new scheduled 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

Frozen Draft for Trial Implementation
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Sup 74 Radiotherapy Worklist

• Supports automated worklist management and
  machine parameter verification for the
  integration of multi-system radiation therapy
  planning and treatment
• First usage of Unified Procedure Step
• Also defines three new objects / SOP Classes
• RT Beams Delivery Instruction (Composite)
• RT Conventional Machine Verification (Normalized)
• RT Ion Machine Verification (Normalized)
• Real implementation and evaluation needed in
  conjunction with IHE Radiation Oncology

Frozen Draft for Trial Implementation
21
Specialties

• Biomed engineering
• Supp 124 Communication of Display Parameters (in
  preparation)
• Administrative support for automated and remote
  monitor calibration
• Research / Biomarkers
• Supp 118 Application Hosting (in preparation)
• Image analysis programs run on any workstation
• Surgery
• Sup 131 Implant Description (in preparation)
• Supports 3D model of bone-mountable implants
• Dentistry / Radiology
• Sup 123 Structured Display (Final Text, October
  2008)
• Captured screen layout of multiple images (with
  presentation states) for dental series, radiology
  conference, etc.

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Get Involved!

• Get the DICOM Standard (free!)
• http//dicom.nema.org/dicom/2008/
• Ask questions/discuss on the DICOM Newsgroup
• http//groups.google.com/group/comp.protocols.dico
  m
• Respond to Supplements released for Public
  Comment
• http//www.dclunie.com/dicom-status/status.html
• Submit Change Proposals
• mailtohclark_at_medicalimaging.org
• Join a DICOM Working Group
• See list in http//medical.nema.org/dicom/geninfo/
  Strategy.pdf
• Build the new DICOM capabilities into your
  products
• Your URL here!