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Peter Mildenberger (Radiology, University Mainz)

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DICOM-CDs for Communicating Radiological Images-The DRG (German Roentgen Society) to improve product quality and Workflow Quality Peter Mildenberger (Radiology ... – PowerPoint PPT presentation

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Title: Peter Mildenberger (Radiology, University Mainz)


1
DICOM-CDs for Communicating Radiological
Images - The DRG (German Roentgen Society) to
improve product quality and Workflow Quality
  • Peter Mildenberger (Radiology, University Mainz)
  • Jörg Riesmeier and Marco Eichelberg (Offis,
    Oldenburg)
  • Michael Walz (Tüv Süd, Eschborn)
  • Thomas Kauer (Informatics, University Erlangen)
  • Elmar Kotter (Radiology, University Freiburg)

2
Status
  • Imaging more an more digital
  • Film based communication declines
  • CD as substitute (if Teleradiology is not
    available)
  • Definition for CDs in DICOM (Part 10) and IHE-PDI
  • Digital available studies could be integrated in
    PACS-workflow

3
Status II
  • DICOM-CDs very often in use
  • Usability restricted by organisational and
    technical problems
  • E.g. machine readability (e.g., defect media)
  • Workflow integration (physician time for data
    handling)
  • Different contents
  • Limited quality of viewers
  • Not readable in 5 10

4
Consequences
  • Initiative by DRG (German Roentgen Association)
    since 2005
  • Together with OFFIS (IT Institute in Oldenburg,
    Germany)
  • Goals
  • Specifications for Products
  • Recommandations for Users
  • Testing Procedure for Products

5
Why a new initiative?
  • Standards free available
  • BUT often not correct and complete implemented
  • Many often small- companies
  • IHE-PDI at the moment only in some solutions
  • Testing of real products from the market

6
Results
  • Specification of DICOM-CDs for real use, based
    on DICOM Part 10 and IHE-PDI
  • National extensions, e.g. Cardio-profile
  • Recommandations for users, including IHE
  • Development of testing tools
  • Setup of procedures with technical and practical
    testing
  • Public process with public comment phases
  • Presentation to other institutions (SDOs,
    Societies, vendor organisations)

7
Specification of a best practice DICOM CD (1)
  • Detailed specification of a DICOM CD for a plug
    and play interchange of radiological images and
    reports
  • based on IHE Portable Data for Imaging
    specification
  • with some extensions (harmonisation in progress)
  • Principles
  • medical images in DICOM format are required
  • other non-DICOM content is allowed reports,
    discharge letters etc.
  • DICOM viewer application or IHE web content is
    allowed but optional
  • Vendors are encouraged to adapt their products to
    this requirements specification, which is freely
    available
  • http//www.dicom-cd.de/ (in German language)

8
Specification of a best practice DICOM CD (2)
  • Storage medium and file system requirements
  • CD-R and CD-RW with ISO 9660 file system (no
    packet writing)
  • multi-session allowed but may be dangerous
  • Malicious software
  • creator must ensure absence of malicious software
    (viruses, spyware etc.)
  • recommendation finalise CD label with tested
    for absence of malware
  • Labelling of the CD required
  • should contain patients name, birth date,
    creator, date of study and CD creation, type of
    content
  • DICOM viewing software (if present)
  • shall run without installation on normal
    (restricted) user account
  • must be able to correctly display all DICOM
    content of the CD
  • recommendation include PDF manual and printed
    short manual with CD
  • recommendation dont use autostart for the
    viewer

9
DICOM CD Tests at DRK 2006 (1)
  • At this years German Congress of Radiology (DRK
    2006), we invited Radiologists to submit
    DICOM-CDs for a short live test during the show
  • intended to provide an overview of the state of
    the art
  • also, a good test run for the initial prototype
    of the conformance test suite
  • CDs with real patient data required explicit
    consent
  • In total, 65 CDs representing 44 different
    products / versions from 27 different vendors
    tested
  • Not 100 coverage of the market, but a good
    overview
  • Test procedure
  • Automated test software for type of file system,
    directory structure, absence of malware and
    conformance of DICOMDIR (images not tested)
  • Manual test of DICOM viewer and web content (if
    present)
  • Visual inspection of CD labelling and manual (if
    present)

10
DICOM CD Tests at DRK 2006 (2)
  • Test results
  • almost 80 of the tested real world CDs failed!
  • this clearly shows that - despite all the
    activities of DICOM and IHE - a quality assurance
    program is really needed

11
DICOM CD Tests at DRK 2006 (3)
  • Typical DICOM errors
  • DICOM rules for filenames and directory names
    violated (beginners mistake!)
  • missing/empty required fields in DICOMDIR
  • syntax rules for DICOM data types violated
  • incorrect transfer syntax for DICOM images
    (implicit VR)
  • Typical problems with the DICOM viewer
  • required administrator privileges or does not run
    at all (Windows XP)
  • tries to install software components (Java or
    .NET runtime)
  • tries to write in C\WINDOWS
  • cannot display all images on the CD
  • often no documentation, no manual
  • CD labelling often missing, almost always
    incomplete
  • In summary, most of these problems would be easy
    to avoid for the software vendor

12
Validation Process Organisational Procedure
13
Summary
  • Clear need for a QA-programm
  • Specifications for Products available
  • Recommandations for users available
  • Test tools and rules implemented
  • More information
  • www.dicom-cd.de
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