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Enhancements in DICOM Standards: Key Updates for Modern Medical Imaging

The latest update to DICOM standards includes significant extensions and upgrades crucial for enhancing imaging modalities. Noteworthy developments encompass safety and security improvements, incorporation of 3D X-ray attributes, and structured reports for radiation dose assessment. The introduction of a new SOP class for ion beam radiation therapy and the CT/MR cardiovascular report enhances diagnostic capabilities. Also notable are the improvements in user interfaces, support for dynamic imaging, and retirement of outdated features, aiming for streamlined workflows in modern healthcare practices.

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Enhancements in DICOM Standards: Key Updates for Modern Medical Imaging

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  1. What’s New in DICOM Robert Horn Agfa Healthcare

  2. Significant Extensions • Upgrades to existing modalities • Additions of new modality objects • Safety and Security • User Interface support • Coordination with other standards

  3. Upgrading Modalities • First, MR • Then, CT • Then, XA/XRF • Now, 3D Xray • Continues use of multi-frame with functional group macros to capture more frame to frame relationships than just time. • Concatenations for improved network performance and streaming • Incorporate standard DICOM attributes to describe the 3-D information gathered by modern X-ray equipment. • Tomographic Synthesis, etc. supported • Letter Ballot (October 2006)

  4. Ion Therapy • A new SOP class to describe the use of ion beam radiation therapy machines. • Extensive detail on beam setting options • Enhancements to patient position and fixation devices that will be retrofitted to other therapy systems. • Fits into the therapy workflows already defined for other kinds of radiation therapy machines.

  5. CT/MR CardiovascularReport • An evidence document that captures measurement data derived from either CT or MR observations of the cardiovascular system. • The report incorporates; • Patient characteristics • Relevant images references • Procedure summaries • Automatically as well as manually detected findings • Information about the progress of finding properties over time (by comparison with predecessor preceding reports) • Observational Conclusions

  6. Radiation Dose • A structured report to describe the radiation dose from various forms of projection X-ray devices: CR, DX, Angiography, Flouroscopy, etc. • Three levels of detail for the description • Based on recent IEC recommendations for reporting radiation dose • Addition of CTDIvol information to both the old and the new CT objects. • More extensive structured report, like that for projection radiography, awaits agreed recommendations from the CT radiation dose experts.

  7. Radiation dose (contd) • Patient records reports are not defined. The structured report describes the dose from each individual irradiation event so that overall patient dose can be analyzed. • Radiation dose reports can describe any irradiation event, and need not correspond to diagnostic studies.

  8. JPIP • A transfer syntax is defined for supporting the JPEG Progressive Interactive Protocol. • This syntax is intended for supporting interactive access to large images or over slower links, and is not well suited to transfer of complete images with full fidelity.

  9. Retirement • When features are retired from DICOM it means: • We remove them from the subsequent publications of the standard, so old versions of the standard should be archived. • We stop maintaining those features for fixing problems or coordinating additions to the standard. • Features are retired because: • They are not being used • They might be redundant with existing or new objects • They are not recommended for implementation by new products.

  10. Retirement (contd) • Retirement candidates are: • Basic Study Content Notification • Detached Patient Management • Detached Study and Study Component Management • Detached Results and Interpretation Management • Print Queue Management • Stored Print • Standalone Overlays, Curves, VOI LUT and Modality LUT Storage • Multi-Referenced File Directory Record, and TOPIC • Floppy disk and obsolete MOD formats and profiles • Patient Study Only Query • Curves • Print Overlay • Overlays in images in high bits

  11. Segmentation • This supplement defines voxel oriented tissue segmentations. • Segmentation allows fractional voxel assignment: e.g, 60% blood, 30% bone, 20% tissue. • IOD defines algorithm names and source data used. It does not include algorithm specifications. • IOD does not define presentation or visualization parameters. • A surface based segmentation IOD is in preparation.

  12. Deformable Spatial Registration • This is an extension to the already define rigid spatial registration • An array of deformation mapping vectors is provided. • Deformable registrations are not expected to be reversible in general. If the registration is to be used reversibly, two registration IODs are needed.

  13. Unified Procedure Steps • Recently out for Public Comment • Merges Worklist Management/Performed Procedure Step • A single IOD that combines both scheduled and performed attributes • C-FIND to query worklists • N-CREATE to create new 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

  14. RT Worklist • First usage of Unified Procedure Step • Out for public comment • Provides automated worklist management for the integration of multi-site and multi-system radiation therapy.

  15. Substance Administration • Verification of Substance Administration • Support 5-Rights process • Operational Concept • Scan patient ID (bracelet, etc.) • Scan substance (drug, etc.) • Query for permission to administer • Receive YES, Warnings, or NO • Substance Information Query • Scan substance • Obtain substance description and documentation • Assumes existance of an external Patient/Substance Information system that monitors prescriptions, administrations, allergies, etc.

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

  17. Veterinary Extensions • These extensions rephrase the definition of some existing terms, like “patient name” to accommodate typical veterinary usages. • These extensions add attributes for “breed”, “digital identifier”, etc.

  18. Tracking IT Improvements • IPv6 support • Small network configuration management • Email Transport • ZIP file format to hold DICOMDIR and DICOM files • Email transport

  19. New efforts • Enhancements to Query and Retrieve • Pathology (especially revisions and clarifications to the specimen model) • Structured Display • Colon CAD • Display Calibration communication • Breast Tomosynthesis • Very Large Images (full slide microscopy) • Surgical Support (very long term) • Application Hosting

  20. Web Site • http://medical.nema.org • Presentations (like this one) • Drafts, Minutes, etc. • Public Comment Documents • Letter Ballot Documents • The Approved supplements and CPs • The full DICOM Standard • Publicly available

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