What s New in DICOM Harry Solomon GE Healthcare

What’s New in DICOM Harry Solomon, GE Healthcare RSNA 2007 What's new in DICOM - RSNA 2007

DICOM is the International Standard for Medical Imaging and related information: images, waveforms, derived measurements and assessments, image presentation control, and workflow management for the imaging department Published as NEMA PS 3 and as ISO 12052 What's new in DICOM - RSNA 2007 2

Agenda • • • The DICOM Change Process Image Processing & Reporting Workflow Specialties Get Involved! What's new in DICOM - RSNA 2007 3

The DICOM Change 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 – About 10 / year – Require Work Item approved by DICOM Standards Committee • Consolidated edition published every year – Most recently, January 2007 – Available free at DICOM web site What's new in DICOM - RSNA 2007 4

Images Information Object Definitions and Image Access What's new in DICOM - RSNA 2007

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 110 Ophthalmic Coherence Tomography (Adopted August 2007) – Sup 116 3 -D X-ray (Adopted January 2007) – Sup 117 Enhanced PET (in Letter Ballot) – Sup 43 Enhanced Ultrasound (in Public Comment) – Sup 125 Breast Tomosynthesis (in Public Comment) What's new in DICOM - RSNA 2007 6

Single-frame to Multi. Frame N Objects, N Headers N Frames, One Header Fixed Header Per-frame header What's new in DICOM - RSNA 2007 Dimension data Pixel data 7

The Per-Frame Header What's new in DICOM - RSNA 2007 8

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 the requested subset of with frames, but with a different Instance UID In Public Comment What's new in DICOM - RSNA 2007 9

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 What's new in DICOM - RSNA 2007 10

Image Processing & Reporting Segmentation, Registration, Structured Reporting What's new in DICOM - RSNA 2007

Sup 111 Segmentation Image • Derived image object – Multiframe, using functional group mechanism • Multiple segments per object – Each segment linked to a categorization – Pixels show presence of category at pixel location – Binary (1 -bit/pixel) or fractional (probability or occupancy) • Segments can be 2 -D or 3 -D • 3 -D segmentation is typically in same Frame of Reference as source image • Segments can be displayed as overlays on source image Adopted August 2006 What's new in DICOM - RSNA 2007 12

Segmentation Example What's new in DICOM - RSNA 2007 13

Sup 132 Surface Segmentation • Work in progress – just released for Public Comment • Segmentation using 3 -D surface mesh (rather than voxel volume) • First use of mesh technology in DICOM – Will also be used for future volumetric work, including implant specification and surgical planning In Public Comment What's new in DICOM - RSNA 2007 14

Sup 112 Deformable Spatial Registration • Composite Object that supports multi-image alignment • 3 step algorithm – Pre-deformation matrix transform – Deformation using 3 D grid of 3 D deformation vectors – Post-deformation matrix transform • Facilitates further image processing, especially multimodality image fusion and image pasting applications Adopted August 2006 What's new in DICOM - RSNA 2007 15

Structured Reporting • Additional Templates for standard SR SOP Classes – Sup 128 Cardiac Stress Testing (Frozen Draft – passed Ballot, awaiting final SNOMED and IEEE codes) – Sup 129 Cardiac Electrophysiology (in Public Comment) • Templates for specialty SR SOP Classes – Sup 127 CT Radiation Dose (Adopted October 2007) – Sup 130 Ophthalmic Refractive SR (in Letter Ballot) – Sup 126 Colon CAD (in preparation) • Harmonization with HL 7 – Sup 114 DICOM Encapsulation of CDA Documents (Adopted January 2007) What's new in DICOM - RSNA 2007 16

Workflow Substance Administration, Unified Worklist, RT Workflow, Specimen Identification What's new in DICOM - RSNA 2007

Sup 107 Substance Administration • Patient safety issue – “five rights” checking for contrast agents – Point of use verification for substances often “out of the loop” of hospital pharmacy systems • Three new DICOM services – Typically Modality as SCU interacting with HIS via gateway SCP • Query: Look up product characteristics – Given a barcode ID (from contrast agent bottle), get name, active ingredient, concentration, etc. • Query: Get substance administration approval – Based on agent, patient, route of administration; get approval or warnings • Report contrast used to HIS Medication Administration Record Adopted January 2007 What's new in DICOM - RSNA 2007 18

Sup 96 Unified Procedure Steps • Simplification and merger of Worklist Management and Performed Procedure Steps – – – 1: 1 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 What's new in DICOM - RSNA 2007 19

Sup 74 Radiotherapy Worklist • Supports automated worklist management and machine parameter verification for the integration of multisystem 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 What's new in DICOM - RSNA 2007 20

Sup 122 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 In Public Comment What's new in DICOM - RSNA 2007 21

Specialties • Biomed engineering – Supp 124 Communication of Display Parameters (in preparation) – Administrative support for 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 3 D model of bone-mountable implants • Dentistry / Radiology – Sup 123 Structured Display (in preparation) – Captured screen layout of multiple images (with presentation states) for dental series, radiology conference, etc. What's new in DICOM - RSNA 2007 22

Get Involved! • Get the DICOM Standard (free!) – http: //dicom. nema. org/medical/dicom/2007/ (annual issue) – ftp: //dicom. nema. org/medical/dicom/final (changes between issues) • 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: hclark@medicalimaging. org • Join a DICOM Working Group – See list in http: //medical. nema. org/dicom/geninfo/Strategy. pdf • Attend the DICOM International Conference and Seminar, Chengdu, China, April 8 -10, 2008 – http: //dicom. nema. org/Dicom/DCS-2008/ • Build the new DICOM capabilities into your products – Your URL here! What's new in DICOM - RSNA 2007 23