What’s New in DICOMWhat’s New in DICOM

Robert HornRobert Horn

Agfa HealthcareAgfa Healthcare

Significant ExtensionsSignificant Extensions

Upgrades to existing modalitiesUpgrades to existing modalities

Additions of new modality objectsAdditions of new modality objects

Safety and SecuritySafety and Security

User Interface supportUser Interface support

Coordination with other standardsCoordination with other standards

Upgrading ModalitiesUpgrading Modalities

First, MRFirst, MR

Then, CTThen, CT

Then, XA/XRFThen, XA/XRF

Now, 3D XrayNow, 3D Xray

Continues use of multi-frame with functional group macros to Continues use of multi-frame with functional group macros to capture more frame to frame relationships than just time.capture more frame to frame relationships than just time.

Concatenations for improved network performance and streamingConcatenations for improved network performance and streaming Incorporate standard DICOM attributes to describe the 3-D Incorporate standard DICOM attributes to describe the 3-D

information gathered by modern X-ray equipment.information gathered by modern X-ray equipment. Tomographic Synthesis, etc. supportedTomographic Synthesis, etc. supported Letter Ballot (October 2006)Letter Ballot (October 2006)

Ion TherapyIon Therapy

A new SOP class to describe the use of ion beam radiation A new SOP class to describe the use of ion beam radiation therapy machines.therapy machines.

Extensive detail on beam setting optionsExtensive detail on beam setting options Enhancements to patient position and fixation devices that will be Enhancements to patient position and fixation devices that will be

retrofitted to other therapy systems.retrofitted to other therapy systems. Fits into the therapy workflows already defined for other kinds of Fits into the therapy workflows already defined for other kinds of

radiation therapy machines.radiation therapy machines.

CT/MR CardiovascularCT/MR CardiovascularReportReport

An evidence document that captures measurement data An evidence document that captures measurement data derived from either CT or MR observations of the derived from either CT or MR observations of the cardiovascular system.cardiovascular system.

The report incorporates;The report incorporates;

Patient characteristicsPatient characteristics Relevant images referencesRelevant images references Procedure summariesProcedure summaries Automatically as well as manually detected findingsAutomatically as well as manually detected findings Information about the progress of finding properties over time (by Information about the progress of finding properties over time (by

comparison with predecessor preceding reports)comparison with predecessor preceding reports) Observational ConclusionsObservational Conclusions

Radiation DoseRadiation Dose

A structured report to describe the radiation dose from A structured report to describe the radiation dose from various forms of projection X-ray devices: CR, DX, various forms of projection X-ray devices: CR, DX, Angiography, Flouroscopy, etc.Angiography, Flouroscopy, etc.

Three levels of detail for the descriptionThree levels of detail for the description Based on recent IEC recommendations for reporting radiation doseBased on recent IEC recommendations for reporting radiation dose

Addition of CTDIvol information to both the old and the new Addition of CTDIvol information to both the old and the new CT objects.CT objects.

More extensive structured report, like that for projection More extensive structured report, like that for projection radiography, awaits agreed recommendations from the CT radiography, awaits agreed recommendations from the CT radiation dose experts.radiation dose experts.

Radiation dose (contd)Radiation dose (contd)

Patient records reports are not defined. The structured Patient records reports are not defined. The structured report describes the dose from each individual irradiation report describes the dose from each individual irradiation event so that overall patient dose can be analyzed.event so that overall patient dose can be analyzed.

Radiation dose reports can describe any irradiation event, Radiation dose reports can describe any irradiation event, and need not correspond to diagnostic studies.and need not correspond to diagnostic studies.

JPIPJPIP

A transfer syntax is defined for supporting the JPEG A transfer syntax is defined for supporting the JPEG Progressive Interactive Protocol. Progressive Interactive Protocol.

This syntax is intended for supporting interactive access to This syntax is intended for supporting interactive access to large images or over slower links, and is not well suited to large images or over slower links, and is not well suited to transfer of complete images with full fidelity.transfer of complete images with full fidelity.

RetirementRetirement

When features are retired from DICOM it means:When features are retired from DICOM it means: We remove them from the subsequent publications of We remove them from the subsequent publications of

the standard, so old versions of the standard should be the standard, so old versions of the standard should be archived.archived.

We stop maintaining those features for fixing problems We stop maintaining those features for fixing problems or coordinating additions to the standard.or coordinating additions to the standard.

Features are retired because:Features are retired because: They are not being usedThey are not being used They might be redundant with existing or new objectsThey might be redundant with existing or new objects They are not recommended for implementation by new They are not recommended for implementation by new

products.products.

Retirement (contd)Retirement (contd)

Retirement candidates are:Retirement candidates are: Basic Study Content NotificationBasic Study Content Notification Detached Patient ManagementDetached Patient Management Detached Study and Study Component ManagementDetached Study and Study Component Management Detached Results and Interpretation ManagementDetached Results and Interpretation Management Print Queue ManagementPrint Queue Management Stored PrintStored Print Standalone Overlays, Curves, VOI LUT and Modality LUT StorageStandalone Overlays, Curves, VOI LUT and Modality LUT Storage Multi-Referenced File Directory Record, and TOPICMulti-Referenced File Directory Record, and TOPIC Floppy disk and obsolete MOD formats and profilesFloppy disk and obsolete MOD formats and profiles Patient Study Only Query Patient Study Only Query CurvesCurves Print OverlayPrint Overlay Overlays in images in high bitsOverlays in images in high bits

SegmentationSegmentation

This supplement defines voxel oriented tissue This supplement defines voxel oriented tissue segmentations.segmentations.

Segmentation allows fractional voxel assignment: Segmentation allows fractional voxel assignment: e.g, 60% blood, 30% bone, 20% tissue.e.g, 60% blood, 30% bone, 20% tissue.

IOD defines algorithm names and source data IOD defines algorithm names and source data used. It does not include algorithm specifications.used. It does not include algorithm specifications.

IOD does not define presentation or visualization IOD does not define presentation or visualization parameters.parameters.

A surface based segmentation IOD is in A surface based segmentation IOD is in preparation.preparation.

Deformable Spatial Deformable Spatial RegistrationRegistration

This is an extension to the already define This is an extension to the already define rigid spatial registrationrigid spatial registration

An array of deformation mapping vectors An array of deformation mapping vectors is provided.is provided.

Deformable registrations are not expected Deformable registrations are not expected to be reversible in general. If the to be reversible in general. If the registration is to be used reversibly, two registration is to be used reversibly, two registration IODs are needed.registration IODs are needed.

Unified Procedure StepsUnified Procedure Steps

Recently out for Public CommentRecently out for Public Comment

Merges Worklist Management/Performed Procedure Merges Worklist Management/Performed Procedure Step Step A single IOD that combines both scheduled and performed attributesA single IOD that combines both scheduled and performed attributes C-FIND to query worklistsC-FIND to query worklists N-CREATE to create new procedure stepsN-CREATE to create new procedure steps N-GET/N-SET to update N-GET/N-SET to update N-EVENT-REPORT to monitor and report progressN-EVENT-REPORT to monitor and report progress

Intended to meet the needs ofIntended to meet the needs of Radiation Therapy Scheduling and MonitoringRadiation Therapy Scheduling and Monitoring Scheduling and Monitoring CAD systemsScheduling and Monitoring CAD systems Proposed new scheduling activitiesProposed new scheduling activities

RT Worklist RT Worklist

First usage of Unified Procedure StepFirst usage of Unified Procedure Step

Out for public commentOut for public comment

Provides automated worklist management Provides automated worklist management for the integration of multi-site and multi-for the integration of multi-site and multi-system radiation therapy.system radiation therapy.

Substance AdministrationSubstance Administration

Verification of Substance AdministrationVerification of Substance Administration Support 5-Rights processSupport 5-Rights process Operational ConceptOperational Concept

• Scan patient ID (bracelet, etc.)Scan patient ID (bracelet, etc.)• Scan substance (drug, etc.)Scan substance (drug, etc.)• Query for permission to administerQuery for permission to administer• Receive YES, Warnings, or NOReceive YES, Warnings, or NO

Substance Information QuerySubstance Information Query Scan substanceScan substance Obtain substance description and documentationObtain substance description and documentation

Assumes existance of an external Patient/Substance Assumes existance of an external Patient/Substance Information system that monitors prescriptions, Information system that monitors prescriptions, administrations, allergies, etc.administrations, allergies, etc.

Encapsulation of CDAEncapsulation of CDA

Similar to encapsulated PDFSimilar to encapsulated PDF

Encapsulates HL7 CDA documents, Encapsulates HL7 CDA documents, providing a few crucial extracts (e.g. providing a few crucial extracts (e.g. Patient ID, Document Title) so that a Patient ID, Document Title) so that a DICOM PACS archive can be used to DICOM PACS archive can be used to storage and retrieve HL7 CDA documents.storage and retrieve HL7 CDA documents.

Veterinary ExtensionsVeterinary Extensions

These extensions rephrase the definition These extensions rephrase the definition of some existing terms, like “patient of some existing terms, like “patient name” to accommodate typical veterinary name” to accommodate typical veterinary usages.usages.

These extensions add attributes for These extensions add attributes for “breed”, “digital identifier”, etc.“breed”, “digital identifier”, etc.

Tracking IT ImprovementsTracking IT Improvements

IPv6 supportIPv6 support

Small network configuration managementSmall network configuration management

Email TransportEmail Transport ZIP file format to hold DICOMDIR and DICOM filesZIP file format to hold DICOMDIR and DICOM files Email transportEmail transport

New effortsNew efforts

Enhancements to Query and RetrieveEnhancements to Query and Retrieve

Pathology (especially revisions and clarifications to Pathology (especially revisions and clarifications to the specimen model)the specimen model)

Structured DisplayStructured Display

Colon CADColon CAD

Display Calibration communicationDisplay Calibration communication

Breast TomosynthesisBreast Tomosynthesis

Very Large Images (full slide microscopy)Very Large Images (full slide microscopy)

Surgical Support (very long term)Surgical Support (very long term)

Application HostingApplication Hosting

Web SiteWeb Site

http://medical.http://medical.nemanema.org.org Presentations (like this one)Presentations (like this one) Drafts, Minutes, etc.Drafts, Minutes, etc. Public Comment DocumentsPublic Comment Documents Letter Ballot DocumentsLetter Ballot Documents The Approved supplements and CPsThe Approved supplements and CPs The full DICOM StandardThe full DICOM Standard

Publicly availablePublicly available