DICOM Exchanging Imaging Data Various Modality Images Presentation

DICOM Exchanging Imaging Data Various Modality Images, Presentation States, Structured Reports Finding and Retrieving Imaging Objects DICOM Course – Singapore April 2005 C. Parisot - GE 1 DICOM Singapore 2005

DICOM. . . Is a GLOBAL STANDARD of Communication, developed under joint efforts of ACR (American College of Radiology) NEMA (National Electrical Manufacturers Assoc. ) ESC (European Society of Cardiology) ACC (American College of Cardiology) SFR (Société Française de Radiology) DRG (Deutschen Röntgengesellschaft) AAO (American Academy of Ophthalmology) AAD (American Academy of Dermatology) CAP (College of American Pathology) JIRA (Japaneese Radiology Vendors Association) COCIR (European Radiology Vendors Association) And 25 plus vendors…… C. Parisot - GE 2 DICOM Singapore 2005

DICOM first release approved October ’ 93 10 year anniversary • 20 Vendors at the ‘ 93 DICOM RSNA Demonstration • 40 Vendors at the ‘ 94 and 95 DICOM RSNA Demonstrations • More than 100 Vendors at RSNA 96 Since 1997 – Too many to count ! C. Parisot - GE 3 DICOM Singapore 2005

DICOM documents updated yearly DICOM 2004 is a compatible extension of DICOM 2003 + 27 Clarifications/Changes + 80 Supplements Available for free from the DICOM website: dicom. nema. org But DICOM 3. 0, DICOM 96, DICOM 98, DICOM 99, DICOM 2000 DICOM 2003 are only document publishing names. This has no direct impact on existing Product Conformance ! C. Parisot - GE 4 DICOM Singapore 2005

DICOM for Image Transfer IMAGE INFORMATION OBJECTS QUERY RETRIEVE STORAGE Networking Support, e. g. . TCP/IP Understanding Image transfer with DICOM. . . C. Parisot - GE 5 DICOM Singapore 2005

DICOM Spans Most of Medical Imaging INFORMATION OBJECTS 1993 CT, MR, CR Second. Capt. (SC) 1995 1996 X-Ray Cardio/Vasc X-Ray Fluoro IMAGE 1997 QUERY RETRIEVE 1998 STORAGE 1999 2001 DICOM runs on Internet and Networking Support TCP/IP Intranet C. Parisot - GE 2003 6 US NM PET RT X-Ray Digital RAD X-Ray Digital Mammo X-ray Intra-Oral Stored Print Pathology, Optalmo. Vaweform Structured Reporting , KOS, Present. States enhanced MR, e. CT, …. . DICOM Singapore 2005

DICOM Spans Most of Medical Imaging DICOM transfers not only Images, but also: 1993 1995 1996 - Therapy Plans, Structures, etc. - Soon Waveforms - Structured Reports CT, MR, CR Second. Capt. (SC) X-Ray Cardio/Vasc X-Ray Fluoro DICOM transfers not only Radiology 1997 images, but also: - Cardiology (X-Ray Angio, US, NM) - Oncology (RT Portal images) - Dentistery (X-ray Intra-Oral) - Pathology, Endoscopy, Microscopy, Optalmology, etc. 1998 1999 2001 2003 C. Parisot - GE 7 US NM PET RT X-Ray Digital RAD X-Ray Digital Mammo X-ray Intra-Oral Stored Print Pathology, Optalmo. Vaweform Structured Reporting, KOS, Present. States enhanced MR, e. CT, …. . DICOM Singapore 2005

What can I really do with DICOM TODAY ? • Build simple and easy-to-implement networks • Reap efficiency and productivity benefits • Invest in a necessary step for future PACS C. Parisot - GE 8 DICOM Singapore 2005

Simple Networks in Radiology and Teleradiology CT, MR, NM, US, Digitizer, CR, digital X-ray, PET DICOM SERVICES USED Imaging Equipment Local Area Network DICOM STORAGE QUERY/RETRIEVE Imaging Equipment DICOM STORAGE Analysis or Review Workstation ISDN Link or Dial-Up DICOM STORAGE Remote Workstation C. Parisot - GE A DICOM Network, today’s common foundation both inside Radiology and for Teleradiology 9 DICOM Singapore 2005

Networks in Radiology and Care Units with Cluster Archiving CT, MR, NM, US, Digitizer, CR, digital X-ray DICOM SERVICES USED Imaging Equipment Local Area Network DICOM STORAGE Cluster Archive ISDN Link or Dial-Up Remote WS DICOM STORAGE CT, MR, NM, US, Digitizer, CR, digital X-ray Imaging Equipment Cluster Archive DICOM QUERY/RETRIEVE DICOM STORAGE Analysis or Review Workstation Care Unit Analysis or Review Workstation A DICOM Network is the common foundation both inside Radiology and for Teleradiology C. Parisot - GE 10 DICOM Singapore 2005

What should I do to build a DICOM Image Transfer Network ? Three Steps: 1 - Clarify my Clinical Needs for Image Transfer and Image processing Applications 2 - Match Those Needs with DICOM Service Classes using the DICOM Conformance Statements 3 - Validate the Imaging Application Interoperability C. Parisot - GE 11 DICOM Singapore 2005

Step 2 - Compare DICOM Conformance Statements CT Scanner Conformance Statement Workstation Conformance Statement 1 -CT STORAGE SCP 1 -CT STORAGE SCU 2 -QUERY SCP 3 -RETRIEVE SCU 4 -MODALITY WORKLIST SCU 4 -MR STORAGE SCP SCU = Service Class USER 5 - BASIC PRINT SCU SCP = Service Class PROVIDER Matching DICOM Service Classes The necessary step to find what will work C. Parisot - GE 12 DICOM Singapore 2005

Service Object Pair (SOP) Class Patient Modul e General Series Module Image Plane Modu le Genera l Image Modul e Ima ge Mod ule Gener al Study Modul e Overla y Plane Modul e* Patient Study Module* Frame of Reference Module General Equipment Module Image Contra Pixel st/Bolu Module s Modul e VOI SOP LUT Comm Modul on e* Modul e Image Info. Obj. (the Data) + = Store Command (the Service) DICOM Communication (SOP Class) • CR Image Storage SOP Class • CT Image Storage SOP Class Modified Slide from Don Van Syckle C. Parisot - GE 13 DICOM Singapore 2005

Image IODs Patient Information Patient’s Name Patient’s ID Patient’s Birth Date Patient Module General Patient Study Module* Frame of General Series Reference Equipment Series Information Module Image Contrast/ Image General Image Plane Pixel Bolus Image Information Module VOI Overlay Image SOP LUT Plane Module Common Module* Module Study Information Not only contains pixel data but also key information about the image C. Parisot - GE 14 Patient’s Sex Patient’s Weight* Referring Physician’s Name Accession Number Study Instance UID Modified Slide from Jay Gaeta DICOM Singapore 2005

Storage • Send/Receive (i. e. push images on the network) • SOP Class dependent on IOD – CT, MR, US, CR/DR, X-ray, Secondary Capture, RT, NM, Structured Report… (i. e. not only images) • How the SCP stores the image is not defined by DICOM (i. e. storage of all data not guaranteed) • May send a study via multiple associations • May send more than one study on an association DICOM does NOT define an “one size fits all” image C. Parisot - GE 15 DICOM Singapore 2005

Storage Transfer – Push Images C-STORE-RQ … - C-STORE-RQ Command - Image Header Data (i. e. Name, ID, Row, Col. . ) Digital Modality Shared Archive - Pixel Data Storage SCU Storage SCP C-STORE-RSP… -C-STORE-RSP Command (Status) Multiple transfers usually occur on the same association C. Parisot - GE 16 Modified Slide from Don Van Syckle DICOM Singapore 2005

Query/Retrieve • Typically used by workstations for remote access and image retrieval from archives • Simple queries such as - “give me the patient name and ID for studies performed today” • Simple retrievals such as “give me images for Study XYZ • Based on information models – Patient model, Study model and Patient/Study only Enables the “pulling” of images C. Parisot - GE 17 Modified Slide from Don Van Syckle DICOM Singapore 2005

Verification • “Echo” to verify application level communication between two DICOM products • Often used for service diagnostics to determine if another product is on-line or off-line • Products who accept DICOM associations are required to support Verification as an SCP C-ECHO-RQ (no data set) C-ECHO-RSP (success status) Digital Modality Verification SCU C. Parisot - GE Shared Archive Modified Slide from Don Van Syckle 18 Verification SCP DICOM Singapore 2005

Query Remote Device C-FIND-RQ Workstation -C-FIND-RQ Command - Study=today, give me name/ID, etc. Query SCU Shared Archive C-FIND-RSP -C-FIND-RSP Command (Pending Status) - Study=Today, Joe Smith, 13456 -7 Query SCP C-FIND-RSP -Query remote database -Pending rsp for each match -One rsp for final status -C-FIND-RSP Command (Pending Status) - Study=Today, Phil Jones, 2761 -2 C-FIND-RSP -C-FIND-RSP Command (Success Status) C. Parisot - GE 19 Modified Slide from Don Van Syckle DICOM Singapore 2005

Retrieve – Pull Images C-MOVE-RQ Workstation -C-MOVE-RQ Command - Study Inst UID for images to pull. Shared Archive Retrieve SCU C-STORE-RQ Separate association then Move Retrieve SCP C-STORE-RSP (Typically for Multiple Images) Same association as Move-RQ C-MOVE-RSP -C-MOVE-RSP Command (Status) -Request Move “Pull” of images -Archive opens second association to send images (the roles change for storage) -Response on same association as C-Move-RQ C. Parisot - GE 20 Modified Slide from Don Van Syckle DICOM Singapore 2005

Three Device Move Retrieve SCU Retrieve SCP C-MOVE-RQ Workstation A After the image transfer completed C-MOVE-RSP during image transfer -Archive provides final Move-RSP status to A -All Retrieve SCPs required to support the Three Device Move C. Parisot - GE 21 P -R S OR E CST -A requests the Move of images to B -Archive opens second association to B -Archive sends images to B then closes assoc -Association between A and archive open OR E- RQ Shared Archive Workstation B Storage SCP Modified Slide from Don Van Syckle DICOM Singapore 2005

We hope you understood DICOM and are now ready to use it. Thank You ! charles. parisot @ med. ge. com C. Parisot - GE 22 DICOM Singapore 2005