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What’s New in DICOM
Robert Horn, Agfa Healthcare
SPIE Medical Imaging, 2008
2 SPIE February 2008, San Diego
DICOM Administrative Information
• DICOM is also ISO 12052.• The most recent published version, Supplements,
Change Items, etc. remain at NEMA
• MITA (Medical Imaging and Technology Alliance)• is the new name for the medical division of NEMA.
• 2008 Version is published• ftp://medical.nema.org/dicom/medical/2008
3 SPIE February 2008, San Diego
Multiframe Image SOP Classes
• 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)
4 SPIE February 2008, San Diego
Multiframe object structure
N Objects, N Headers
N Frames, One Header
Pixel dataDimension dataPer-frame headerFixed Header
5 SPIE February 2008, San Diego
The Per-Frame Header
Other attributes
Per-frame Functional Groups Sequence
Shared Functional Groups Sequence
> Functional Group A
> Functional Group B
> Functional Group M
…..
Other attributes
Functional Groups with attributes constant
for all frames
Item 1 (Frame 1) Sequence of
Functional Groups for each individual frame
Pixel Data
Frame 1
Frame 2
Frame n
…..
> Functional Group C
> Functional Group B
> Functional Group M
…..
Item n (Frame n)
> Functional Group C
> Functional Group B
> Functional Group M
Item 2 (Frame 2)
> Functional Group C
…..
…..
…..
…..
> Functional Group K
6 SPIE February 2008, San Diego
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 with the requested subset of
frames, but with a different Instance UIDIn Letter Ballot
7 SPIE February 2008, San Diego
Sup 43 Ultrasound
• Pixel frames may represent echo power, doppler shift, or doppler variance
• Multiple frames (up to 3) can be blended for proper display
• An enhanced blending pipeline is required to render images
Data Frame Modality
LUT (identity)
VOI LUT(optional)
PrimaryRGBAPalette
Color LUT
(optional)
Data Frame
Data Frame Modality
LUT (identity)
VOI LUT(optional)
SecondaryRGBAPalette
Color LUT
(optional)
OpacityLUT
(optional)
RGB
ProfileConnection
Space Transformation
RGB
ICC Input Profile
Real World Value Mapping
Real World Value Mapping
Presentation LUT
(identity)
Gray Scale Output asP-Values
Color Output as
PCS-Values
RGB (Input 1)
Real World Value +Units
Alpha 1
Alpha 2
RGB
RGB (Input 1)
Real World Value Mapping
Real World Value +Units
Alpha, Beta(Constants)
RGB (Input 2)
Convert to RGB (R=B=G)
Blending Operation
Multiply inputs and add the result
(Alpha 1) x Input 1 +
(Alpha 2) x Input 2
CLAMP
OR
OR
Alpha
(1-Alpha), Alpha
Alpha
MSB’s
LSB’s
Alpha,BetaLUT
outputs
OR
Modality LUT
(identity)
VOI LUT(optional)
In Public Comment
8 SPIE February 2008, San Diego
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
9 SPIE February 2008, San Diego
Sup 132 Surface Segmentation
• 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
10 SPIE February 2008, San Diego
Sup 112 Deformable Spatial Registration
• Composite Object that supports multi-image alignment
• 3 step algorithm• Pre-deformation matrix transform • Deformation using 3D grid of 3D deformation vectors• Post-deformation matrix transform
• Facilitates further image processing, especially multi-modality image fusion and image pasting applications
Adopted August 2006
11 SPIE February 2008, San Diego
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 (Adopted January 2008)• Sup 126 Colon CAD (Public Comment)
• Harmonization with HL7• Sup 114 DICOM Encapsulation of CDA Documents (Adopted
January 2007)• Sup 135 SR HL7 CDA Mapping (Public Comment)
• Mapping is only for Basic Imaging Reports
12 SPIE February 2008, San Diego
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
13 SPIE February 2008, San Diego
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
14 SPIE February 2008, San Diego
Sup 74 Radiotherapy Worklist
• Supports automated worklist management and machine parameter verification for 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
15 SPIE February 2008, San Diego
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
• 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 Letter Ballot
16 SPIE February 2008, San Diego
Specialties
• Biomed engineering• Supp 124 Communication of Display Parameters (in
preparation)• Administrative support for monitor calibration
• Surgery• Sup 131 Implant Description (in preparation) • Supports 3D 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.
17 SPIE February 2008, San Diego
Sup 118 Application Hosting
• Experimental trials are underway• February 2008 meeting to prepare public
comment text for March 2006 WG-06 meeting• New approaches to DICOM Information Object
exchange• Native (shared memory) using DICOM encoding• Native Model
• DOM-like model defined using DICOM terminology
• Abstract Model• DOM-like model of generic image attributes• Usable for any image type (TIFF, DICOM, etc.)