Whats New in DICOM Robert Horn Agfa Healthcare

What’s New in DICOM Robert Horn, Agfa Healthcare (Chair WG 6) Presented by Bas. Revet, Philips Healthcare SPIE 2009

• 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 PS 3 and as ISO 12052 What's new in DICOM - RSNA 2008 2

Agenda • • • The DICOM Change Process Image Processing & Reporting Workflow Specialties Get Involved! What's new in DICOM - RSNA 2008 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 2008 – Available free at DICOM web site What's new in DICOM - RSNA 2008 4

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. • 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.

Images Information Object Definitions and Image Access What's new in DICOM - RSNA 2008 6

Multiframe. Images • Multiframeobjects to support 1000+ slice studies – Image header supportsfunctional groupattributes changing during acquisition – Dimensionsallow multiple views of data • Common structure used for all new image IODs – Sup 141 Enhanced MR Color (Letter Ballot) – 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) What's new in DICOM - RSNA 2008 7

Single-frame to. Multi. Frame N Objects, N Headers N Frames, One Header Fixed Header Per-frame header What's new in DICOM - RSNA 2008 Dimension data Pixel data 8

The Per-Frame Header What's new in DICOM - RSNA 2008 9

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 longendoscopy video image object? – Many similar use cases needing one frame or a small subset of frames from large multi-frame 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 aderived image with the requested subset of frames, but with a different Instance UID Second Ballot round, January 2009 What's new in DICOM - RSNA 2008 10

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 Preparing for Ballot What's new in DICOM - RSNA 2008 11

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 What's new in DICOM - RSNA 2008 12

More video transfer syntaxes • MPEG-2 (Supplement 137, Adopted 2009) – – Hi-def formats (e. g. , Blu. Ray) 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.

Image Processing & Reporting Segmentation, Registration, Structured Reporting What's new in DICOM - RSNA 2008 14

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. What's new in DICOM - RSNA 2008 Adopted August 2008 15

Surface Segmentation • Actual object contains digital parameters of a surface mesh. • Display can be shaded image, or any other kind of user interface. What's new in DICOM - RSNA 2008 16

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 HL 7 – Sup 114 DICOM Encapsulation of CDA Documents (Adopted January 2007) What's new in DICOM - RSNA 2008 17

Workflow Substance Administration, Unified Worklist, RT Workflow, Specimen Identification What's new in DICOM - RSNA 2008 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 queryworklists 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 2008 19

Sup 74 Radiotherapy. Worklist • Supports automatedworklist managementand machine parameter verificationfor 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 What's new in DICOM - RSNA 2008 20

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 3 D 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. What's new in DICOM - RSNA 2008 21

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. 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 • Build the new DICOM capabilities into your products – Your URL here! What's new in DICOM - RSNA 2008 22