GE Medical Systems

The Basic Structure of DICOM
Charles Parisot, GE Medical Systems

SSRPM Course – Neuchâtel – June 2003
C. Parisot

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The Structure of DICOM

DICOM...
Is a GLOBAL STANDARD of Communication, developed under joint efforts by ACR (American College of Radiology) NEMA (National Electrical Manufacturers Assoc.) ESC (European Society of Cardiology) ACC (American College of Cardiology) SFR (Société Française de Radiology) DRG (Deutschen Röntgengesellschaft) AAO (American Academy of Ophthalmology) AAD (American Academy of Dermatology) CAP (College of American Pathology) JIRA (Japaneese Radiology Vendors Association) COCIR (European Radiology Vendors Association) And 25 plus vendors……
C. Parisot

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The Structure of DICOM

• DICOM 3.0 approved October ‘93 • 20 Vendors at the ‘93 DICOM RSNA Demonstration • 40 Vendors at the ‘94 and '95 DICOM RSNA Demonstrations • More than 100 Vendors at RSNA 96

Since 1997 – Too many to count !
C. Parisot

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The Structure of DICOM

DICOM 2003 are only document publishing names.com or Free on the web : http://medical. DICOM 99. DICOM 98.org/dicom. This has no direct impact on existing Product Conformance ! C. DICOM 2001.html DICOM 3. DICOM 2000.nema.DICOM documents updated yearly DICOM 2003 is a compatible extension of DICOM 2001 + 27 Clarifications/Changes + 3 Supplements Available from Global Engineering Documents: http://global.0. DICOM 96. Parisot 4 The Structure of DICOM .ihs.

.g. Parisot DICOM for Media Interchange/Archiving 5 The Structure of DICOM . TCP/IP and .. e.The 4 dimensions of DICOM DICOM for Image Management DICOM for Network Image Transfer DICOM for Network Printing IMAGE IMAGING MANAGEMENT QUERY RETRIEVE IMAGE INFORMATION OBJECTS HARD COPY PRINTING STORAGE Networking Support. C..

g... TCP/IP Understanding Image transfer with DICOM . e.. Parisot 6 The Structure of DICOM .Dimensions #1 DICOM for Image Transfer IMAGE QUERY RETRIEVE STORAGE IMAGE INFORMATION OBJECTS Networking Support. C.

Second. MR. MR. Parisot 2003 Advanced MR. Optalmo. CR CT. Advanced CT.DICOM Spans Most of Medical Imaging INFORMATION OBJECTS 1993 1995 1996 1997 CT.. . Optalmo. Capt. MR. Vaweform Structured Reporting The Structure of DICOM IMAGE QUERY RETRIEVE STORAGE 1998 1999 2001 7 DICOM runs on Internet and Networking Support TCP/IP Intranet C. …. (SC) X-Ray Cardio/Vasc Cardio/Vasc X-Ray Fluoro US NM PET RT X-Ray Digital RAD X-Ray Digital Mammo X-ray Intra-Oral IntraStored Print Pathology.

Waveforms . Vaweform Structured Reporting The Structure of DICOM DICOM transfers not only Radiology images. Optalmo. …. Optalmo. MR. Advanced CT.Cardiology (X-Ray Angio. Capt.Pathology. etc. but also: .DICOM Spans Most of Medical Imaging DICOM transfers not only Images.Therapy Plans. Endoscopy. NM) . Microscopy.Dentistery (X-ray Intra-Oral) . Parisot .Structured Reports 1993 1995 1996 1997 1998 1999 2001 8 CT. Second. but also: . Optalmology. etc. US. CR CT.. MR. (SC) X-Ray Cardio/Vasc Cardio/Vasc X-Ray Fluoro US NM PET RT X-Ray Digital RAD X-Ray Digital Mammo X-ray Intra-Oral IntraStored Print Pathology. . C. MR.Oncology (RT Portal images) . Structures. 2003 Advanced MR.

What can I really do with DICOM TODAY ? • Build simple and easy-to-implement networks • Reap efficiency and productivity benefits • Invest in a necessary step for future PACS C. Parisot 9 The Structure of DICOM .

Simple Networks in Radiology and Teleradiology CT. Parisot 10 The Structure of DICOM . MR. PET XCT. CR. NM. CR. MR. today’s common foundation both inside Radiology and for Teleradiology C. digital X-ray. Digitizer. digital X-ray. PET XLocal Area Network Imaging Equipment DICOM SERVICES USED Imaging Equipment DICOM STORAGE QUERY/RETRIEVE ISDN Link or Dial-Up DialAnalysis or Review Workstation DICOM STORAGE DICOM STORAGE Remote Workstation A DICOM Network. Digitizer. US. NM. US.

US. Parisot 11 The Structure of DICOM . Digitizer. MR. Digitizer. digital X-ray XImaging Equipment DICOM SERVICES USED DICOM STORAGE Cluster Archive DICOM STORAGE Cluster Archive ISDN Link or Dial-Up Dial- DICOM QUERY/RETRIEVE DICOM STORAGE Analysis or Review Workstation Care Unit Analysis or Review Workstation Remote WS DICOM STORAGE A DICOM Network is the common foundation both inside Radiology and for Teleradiology C.Networks in Radiology and Care Units with Cluster Archiving CT. NM. MR. CR. NM. CR. US. digital X-ray XImaging Equipment Local Area Network CT.

What should I do to build a DICOM Image Transfer Network ? Three Steps: 1 .Validate the Imaging Application Interoperability C.Clarify my Clinical Needs for Image Transfer and Image processing Applications 2 .Match Those Needs with DICOM Service Classes using the DICOM Conformance Statements 3 . Parisot 12 The Structure of DICOM .

Parisot 13 The Structure of DICOM .BASIC PRINT SCU Matching DICOM Service Classes The necessary step to find what will work C.Step 2-Compare DICOM Conformance Statements CT Scanner Conformance Statement Workstation Conformance Statement 1-CT STORAGE SCU 2-QUERY SCP 3-RETRIEVE SCP 4-MODALITY WORKLIST SCU SCU = Service Class USER SCP = Service Class PROVIDER 1-CT STORAGE SCP 2-QUERY SCU 3-RETRIEVE SCU 4-MR STORAGE SCP 5.

2.23.1.5.10008.19.1.113619.840.1584567.2 C.123.4465.1.DICOM: Service-Object Pair Example: CT Image Storage Service: “Store” Generic Sentence: Object: “CT Image ” SOP Class " Store CT Image " Unique ID: 1.2 SOP Instance "" Store this CT Image " SOP Instance Store this CT Image " " SOP Instance "" Store this CT Image " SOP Instance Store this CT Image " SOP Instance "" Store this CT Image " SOP Instance Store this CT Image Specific Sentence (SOP Instance): Absolutely unique instance ! Unique ID: 1.4.2.840. Parisot 14 The Structure of DICOM .3.

Association Establishment Image Source Services offered (SOP Classes UID) and associated coding (Transfer Syntaxes UID) Image Server User of the Storage Service C-Store Request Sending of a message with header + pixels according to one of the accepted transfer syntaxes C-Store Response Success / Failed C-Store Request C-Store Response Provider of the Storage Service C.In practice. how does it work. Parisot 15 The Structure of DICOM ...

Parisot 16 The Structure of DICOM .Image Information Object Definitions (IOD) Patient Information Study Information Patient Module Patient’s Name Patient’s ID Patient’s Birth Date Patient’s Sex Patient’s Weight* Referring Physician’s Name Accession Number Study Instance UID General Patient Study Study Module Module* Frame of General General Series Reference Equipment Series Information Module Module Module Image Image Contrast/ General Image Plane Pixel Bolus Image Information Module Module Module Module VOI Overlay Image SOP LUT Plane Module Common Module* Module Module* Not only contains pixel data but also key information about the image C.

. Parisot 17 The Structure of DICOM ..... Receiver Tag VR Value Length Value Field Optional Field: Value Representation Dependent on Transfer Syntax Unique tag defined in DICOM Data Dictionary C. .DICOM Encoding Message = Data Set Data Data Data Data Element Element Element Element Sender ...

Validate the Imaging Application Interoperability C. Parisot 18 The Structure of DICOM .Clarify my Clinical Needs for Image Transfer and Image processing Applications 2 . So it will simply Plug and Play ? Do not Forget Step 3 ! 1 .Match Those Needs with DICOM Service Classes using the DICOM Conformance Statements 3 .Great.

Application Interoperability(1) CT Scanner Conformance Statement CT Object Implementation 3D Application Conformance Statement CT Object Requirements Private Attributes Optional Attributes REQUIRED DICOM Attributes Application required DICOM Attributes DICOM Addresses Plug and Play Only for Applications with Basic Information Requirements C.Step 3 . Parisot 19 The Structure of DICOM .

Step 3 .Application Interoperability(2) MR Scanner Conformance Statement MR Image Object Implementation Image Filtering Application Conformance Statement MR Object Requirements Private Attributes REQUIRED DICOM Attributes Application required DICOM Attributes Applications with Complex Information Requirements May not be Plug and Play C. Parisot 20 The Structure of DICOM .

Parisot Application required DICOM Attributes Applications Should Avoid Use of Optional Attributes 21 The Structure of DICOM .Step 3 .Application Interoperability(3) To Maximize Application Interoperability Optional Attributes REQUIRED DICOM Attributes Modalities Should Support all Applicable Optional Attributes C.

In the (few) Cases Imaging Application Use Complex Attributes: ==> Interoperability Should be Carefully Analyzed (Conformance Statements) and Validated in Clinical Environment. Parisot 22 The Structure of DICOM .Application Interoperability can Be Maximized (Previous Slide) ==> Select Products With Good Design.Fix the Standard ? No.So What Should Be Done ? 1 . The Standard has to strike the proper balance between: • Plug and Play • Variety of Modality and Applications • Innovation and Need for New Attributes ==> Document in the Conformance Statements Attributes Support 2 . 3 . C.

Dimensions #2 DICOM for Network Printing HARD COPY PRINTING Networking Support....g. e. TCP/IP Understanding Film Printing with DICOM . Parisot 23 The Structure of DICOM . C.

DICOM Print Management today DICOM New Printer DICOM Spooler Finally a Standard Interface to Share Printers OLD and NEW Old Printer • DICOM print (Grayscale and/or color) links Cameras with Workstations and Modalities on a standard network • All necessary Features available for digital hardcopy devices. Parisot 24 The Structure of DICOM . • Print Consistency (Print Presentation LUT) becoming available C.

TCP/IP Understanding Information Management with DICOM . C.Dimensions #3 DICOM for Imaging management IMAGING MANAGEMENT Networking Support.g... Parisot 25 The Structure of DICOM .. e.

procedure into a modality. Broad Availability in 1999 C. study identifiers. Parisot 26 The Structure of DICOM . scheduling. Modality Request Worklist Worklist Image Information Management (PACS) RIS HIS Increases operator productivity and avoids typing errors First Products available since 1997.DICOM Modality Worklist • Provides integration of modalities with Radiology Information Systems and PACS • Automatic download of patient demographics.

Parisot 27 The Structure of DICOM . • Modality image deletion is only allowed if storage has been committed Scanner Image Send Storage Commit Request Storage Committed Archive or Short Term Storage Device Products broad availability since 2001 C.DICOM Storage Commitment • Enables an image source to obtain the commitment that images have been stored for safekeeping.

• Complement to Modality W/L. Parisot 28 The Structure of DICOM . Contrast. Dose.DICOM Performed Procedure Step • Allows Modalities to Upload in HIS/RIS/PACS of Acquisition Administrative Data (Proc. etc. Started/Complete.). Modality Performed Procedure Step Started PPS Completed RIS Image Information Management (PACS) HIS First products introduced in 2001 Broad availability in 2003 C. Increases Overall Radiology Department Productivity.

4 DICOM Service Classes for Integration Worklist Modality Worklist RIS Store Images PACS & Archive Storage Commitment List of Images Storage Commitment Modality Performed Procedure Step C. Dose. Parisot Performed Step: Status = Completed Performed CT Head Pat Name/ID. Study UID Complete List of Images 29 A Closed Loop •Match Procedure with Order •Update IS Scheduling •Support Billing Based on MPPS The Structure of DICOM . Accession #.

Parisot 30 The Structure of DICOM ..Dimensions #4 DICOM for Media Interchange/Archive MEDICAL DIRECTORY DICOM File Format ALL DICOM INFORMATION OBJECTS CD-R CD- 5 1/4 MOD 3 1/2 MOD 3 1/2 Floppy Carrying DICOM Images Stored on Media . C..

Parisot 31 The Structure of DICOM ..Since 1996 ! The DICOM Directory facilitates media browsing Same Image Objects on Media and on the Network MEDICAL DIRECTORY DICOM File Format ALL DICOM INFORMATION OBJECTS DICOM defines a generic File Format MEDIA FORMAT AND PHYSICAL MEDIA DVD-RAM CD-R CDDVD- 5 1/4 MOD 3 1/2 MOD 3 1/2 Floppy DICOM Relies on Broadly Available Media Storage Technology C..Media Interchange Too ! ..

DICOM MEDIA STORAGE Open and Flexible Media • Cardiac DICOM CD-R broadly used • General Purpose CD-R (640MB) broadly used • MODs for CT/MR. NM available • CD-R for CT/MR also available • DVD Now introduced DICOM General Purpose CD-R. Even given to patients ! C. Parisot 32 The Structure of DICOM . the film substitute. US.

Dimensions #5 DICOM for Network Image Transfer DICOM for Image Management DICOM for Network Printing IMAGING MANAGEM ENT IMAGE QUERY RETRIEVE HARD COPY IMAGE INFORMATION OBJECTS PRINTING STORAGE Networking Support. e...g. Parisot 33 The Structure of DICOM . TCP/IP DICOM for Media Interchange/Archiving and soon DICOM for Image Display Consistency.. C.

Image Consistency critical for other Departments Imaging Department Other Department Acquire Display Print Review (Web) .

What the Radiologist Displays: Area Of Interest What the Reviewing Physician Sees: Presentation State The Radiologist’s Transformations Are Saved Area Of Interest Annotate Zoom Or ina ig e ag Consistent Presentation of m lI Images On a Calibrated Display Flip Original Image Window Level Original Image The Radiologist’s Transformations Are Lost Original Image Inconsistent Presentation On an Uncalibrated Display .

and DICOM in Products C... Parisot 36 The Structure of DICOM ... . e... TCP/IP DICOM Experience...g..DICOM Implementation IMAGING MANAGEM ENT IMAGE QUERY RETRIEVE HARD COPY IMAGE INFORMATION OBJECTS PRINTING STORAGE Networking Support.

• New Objects are under definition for advanced MR. Parisot 37 The Structure of DICOM . Radiotherapy and enters Pathology. • Reporting is a growing area of focus. • DICOM is looking outwards for integration with other emerging and complementary healthcare standards HL7. • Security is addressed (Node Authentication and Encryption done. improving and here to stay C. DICOM is growing. Signature approved). A Reporting object and key object selection has been approved. and Internet. VL Movies(MPEG2). Opthalmology and Vital Signs. It is in Cardiology.DICOM in ‘03 . • DICOM reaches well beyond Radiology. Gastroenterology.An Alive and Growing Standard • JPEG 2000 for better Lossless/Lossy adopted. Advanced CT.

• Supports cross-vendor testing.g.Experience with DICOM • All vendors committed to DICOM support (e. Vendors cooperation results in issue analysis.g. Europe. Parisot 38 The Structure of DICOM . • DICOM is an internationally accepted standard. Asia without at least one imaging system with DICOM. >80 products are offered by GE with DICOM support).com/dicom ). for GE at: ge. • Probably difficult to find a hospital in America. Most use DICOM every day. • Conformance statements are available from most vendors through Internet (e. C. thousand of times.

parisot @ med . Parisot 39 The Structure of DICOM . ge . com GE DICOM Conformance Statements: ge.Thank You ! charles .com/dicom C.