HL 7 May 2001 Working Group Meeting DICOM

HL 7 May 2001 Working Group Meeting DICOM Tutorial Introduction to DICOM May 8, 2001, 9: 00 – 10: 30 a. m. Fred M. Behlen, Ph. D. Kurt Rossmann Laboratories for Radiologic Image Research Department of Radiology

DICOM Standard • ACR-NEMA 1. 0 – Published as NEMA PS 3 -1985 • ACR-NEMA 2. 0 – Published as NEMA PS-1988 • Digital Imaging and Communications in Medicine (DICOM) 3. 0 – Published as NEMA PS 3 -1993(94? ), and (almost) annual updates thereafter. PS 3 -2000 now available.

DICOM Scope Medical Informatics . . . Patient Bedside Monitoring Administrative HIS/RIS Lab Data . . . Diagnostic Imaging Scope of DICOM

Scope of standards Information Repre- Transfer Signaling model sentation mech- method syntax anism DICOM X X HL 7 X XML X CORBA X HTTP, FTP TCP/IP, Ethernet X X

DICOM Standard “The DICOM Standard is structured as a multi‑part document using the guidelines established in the following document: — ISO/IEC Directives, 1989 Part 3: Drafting and Presentation of International Standards. ”

DICOM Standard PS 3. 1: PS 3. 2: PS 3. 3: PS 3. 4: PS 3. 5: PS 3. 6: PS 3. 7: PS 3. 8: PS 3. 9: PS 3. 10: PS 3. 11: PS 3. 12: PS 3. 13: PS 3. 14: PS 3. 15: PS 3. 16: Introduction and Overview Conformance Information Object Definitions Service Class Specifications Data Structure and Encoding Data Dictionary Message Exchange Network Communication Support for Message Exchange Point‑to‑Point Communication Support for Message Exchange Media Storage and File Format for Data Interchange Media Storage Application Profiles Storage Functions and Media Formats for Data Interchange Print Management Point-to-Point Communication Support Grayscale Standard Display Function Security Profiles Content Mapping Resource (2001)

DICOM Supplements Balloted Supplement Introduction Part 1 changes … Part 3 changes … Part 6 changes … … Published Standard PS 3. 1: PS 3. 2: PS 3. 3: PS 3. 4: PS 3. 5: PS 3. 6: PS 3. 7: PS 3. 8: PS 3. 9: PS 3. 10: PS 3. 11: PS 3. 12: PS 3. 13: PS 3. 14: PS 3. 15:

PS 3. 1: Introduction and Overview PS 3. 4: Service Class Specifications PS 3. 6: Data Dictionary PS 3. 2: Conformance PS 3. 3: Information Object Definitions PS 3. 5: Data Structure and Semantics Part 7: Message Exchange PS 3. 8: Network Communication Support for Message Exchange TCP/IP OSI PS 3. 9: Point to Point Communication Support for Message Exchange

Conformance • DICOM Conformance Statement – Format and Content specified in Part 2 – Required for every claimed DICOM implementation • “If there’s no Conformance Statement, it’s not DICOM. ” – Intended audience for Conformance Statement is engineer, not customer.

Vendor A contract scope Customer contract conformance interoperation Vendor B STANDAR conformance

contract A scope A t c a r nt Vendor A conformance co Customer (voila!) interoperation co n tra contract B scope ct B Vendor B STANDAR conformance

Key Sections • PS 3. 3: Information Object Definitions • PS 3. 4: Service Class Specifications • PS 3. 6: Data Dictionary

DIMSE Services Composite Normalized C-STORE N-EVENT-REPORT C-GET N-GET C-MOVE N-SET C-FIND N-ACTION C-ECHO N-CREATE N-DELETE

PS 3. 3: Information Object Definitions • • • • Computed Radiography Image Computed Tomography Image Magnetic Resonance Image Nuclear Medicine Image Ultrasound Multi-Frame Image Secondary Capture Image X-Ray Angiographic Image X-Ray RF Image Positron Emission Tomography Image Hardcopy Grayscale Image Hardcopy Color Image Digital X-Ray Image Digital Mammography X-Ray Image Digital Intra-Oral X-Ray Image

PS 3. 3: Information Object Definitions • Visible Light Image – – • • VL Endoscopic Image VL Microscopic Image VL Slide-Coordinates Microscopic Image VL Photographic Image Standalone Overlay Standalone Curve Standalone Pet Curve Stored Print Standalone Modality Lut Standalone VOI Lut Grayscale Softcopy Presentation State Basic Study Descriptor

• • • PS 3. 3: Information Object Definitions RT Image RT Dose RT Structure Set RT Plan RT Beams Treatment Record RT Brachytherapy Treatment Record RT Treatment Summary Record Waveform – – – Basic Voice Audio 12 -Lead Electrocardiogram General Electrocardiogram Ambulatory Electrocardiogram Hemodynamic Basic Cardiac Electrophysiology Structured Report Document – – – Basic Text SR Enhanced SR Comprehensive SR

PS 3. 4: Service Class Specifications • • • • Verification Storage Query/Retrieve Study Content Notification Patient Management Study Management Results Management Print Management Media Storage Commitment Basic Worklist Management Queue Management Grayscale Softcopy Presentation State Storage Structured Reporting Storage

Service-Object Pairs (SOPs) Information Objects X X X X X Services X X X X STORE

PS 3. 5: Data Structure and Encoding • Presentation Context – Abstract Syntax • Endianism – Big Endian – Little Endian • Value Representation – Implicit VR – Explicit VR – Transfer Syntax • Uncompressed • Compressed modes

Data Set and Data Elements

PS 3. 3 Annex A IOD Modules

PS 3. 3 Annex C Patient ID Module

PS 3. 3 Annex C Pixel Module

PS 3. 3 Annex C Pixel Module

Pixel Encoding

PS 3. 6: Data Dictionary • Tag Assignments – – [xxxx, xxxx] Name (non-canonical) Value Representation Value Multiplicity • DICOM-assigned UIDs • Terminology Mapping Resource Registry • Registry of Templates

Imaging Department Diagnostic Imaging in the Patient Care Process • • Patient arrives Physician sees patient, writes order Patient goes to Imaging Department Patient is imaged Radiologist interprets images, writes report Physician looks at report (and often images) Physician treats patient based on report Patient discharged

Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Radiology Results, Images

Exam Context Imaging department obtains from the enterprise: • • • Patient identification Orders Other clinical information Scheduling (of some resources) Financial authorizations

Patient & visit Study & acquisition Stored data

Patient & visit IODs Study & acquisition IODs Stored data IODs

Patient IDdomain^Patient. ID I-Patient IDdomain^Patient. ID 1 0 -n 1 Placer Order Number 1 1 -n* Filler Order Number 1 1 -n* 1 1 -n Scheduled Procedure Step Scheduled Proc. Step ID 0 -n** 0 -m** * 0 -n Requested Procedure ID RP Study Instance UID I-Study Instance UID 0 -n** 0 -m** 1 Performed Procedure Step Performed Proc. Step UID An Order Placer typically submit a single order (ORM), however, an Order Filler can expand that single order into multiple Requested Procedures. See IHE Y 2 TF Section 6 for more details. ** See Section 6 for a thorough description of the cardinality relationship options of Modality Performed Procedure Step. *** The Performed Procedure Step UID is present as the Affected SOP Instance UID. 1 -n 1 1 -n Series UID 1 0 -n Instance SOP Instance UID

Patient IDdomain^Patient. ID I-Patient IDdomain^Patient. ID 1 0 -n 1 Placer Order Number 1 1 -n* Filler Order Number 1 1 -n* 1 1 -n Scheduled Procedure Step Scheduled Proc. Step ID 0 -n** 0 -m** 0 -n Requested Procedure ID RP Study Instance UID I-Study Instance UID 0 -n** 0 -m** 1 Performed Procedure Step Performed Proc. Step UID 1 -n 1 1 -n Series UID 1 0 -n SR Instance SOP Instance UID

Results Imaging department delivers to the enterprise: • Reports • Images • Exam status

IHE Home Pages http: //www. rsna. org/IHE http: //www. himss. org/IHE

DICOM Home Pages http: //medical. nema. org/dicom. html Committee for the Advancement of DICOM Resources Page http: //www. merge. com/dicom/resources/