http://medical.nema.

org/
RADIOLOGY
The DICOM Standard
RESEARCH

DICOM & IHE : An Update On

-> the DICOM Standard
-> the IHE Radiology Framework

Michael Flynn, PhD

mikef@rad.hfh.edu
AAPM 2009

DICOM Parts DICOM Review

• PS 3.1 Introduction and Overview DICOM

• PS 3.2 Conformance
• PS 3.3 Information Object Definitions
• PS 3.4 Service Class Specifications • Utilizes an open standards development
•
•
PS
PS
3.5
3.6
Data Structures and Encoding
Data Dictionary
process that encourages the involvement
• PS 3.7 Message Exchange and consensus of both vendors and users
• PS 3.8 Network Communication Support for Message Exchange
• PS 3.10 Media Storage and File Format for Data Interchange
• PS 3.11 Media Storage Application Profiles • Specification of a conformance mechanism
• PS 3.12 Media Formats and Physical Media for Data Interchange so that a user can decide whether or not
• PS 3.14 Grayscale Standard Display Function devices are likely to interoperate
• PS 3.15 Security Profiles
• PS 3.16 Content Mapping Resource
• PS 3.17 Explanatory Information
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• PS 3.18 Web Access to DICOM Persistent Objects (WADO)

3 4

1
 DICOM Review DICOM Standards Committee (DSC)

• DICOM Standards Committee (DSC)

• DICOM’s executive body whose members
• Development of DICOM Standard is done
are imaging equipment manufacturers, through committees termed “Working
physician organizations, and others Groups” (WG)
• 26 manufacturer members • AAPM Members can participate in any WG
• 20 other members to develop the Standard

• DICOM's activities are coordinated • WG propose work items based on

through a general secretariat at MITA suggestions from members or at the
• formerly NEMA direction of the DSC
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5 6

DICOM WGs 1-6 DICOM WGs 7-12

WG
# Working Group Name Relevance to Radiology WG# Working Group Name Relevance to Radiology
1 Cardiac and Vascular Cardiovascular imaging, stress nuclear cardiology 7 Radiotherapy Radiation therapy, including ion therapy
Information structured reporting
8 Structured Reporting Standardized vocabularies, encoding of
2 Projection Radiography Development of enhanced x-ray and angiography structured reports, and integration with
and Angiography information objects
10 Strategic Advisory Long-range planning; coordination of DICOM with
3 Nuclear Medicine Nuclear medicine and PET other international standards organizations
4 Compression Application of data compression standards, such 11 Display Function Presentation and display of images on
as JPEG 2000 and JPIP Standard workstations, i.e., “hanging protocols.”
5** Exchange Media Distribution of images on CD-ROMs, DVDs, and
12 Ultrasound Ultrasound imaging, including echocardiography;
USB “flash” drives
3D/4D images
6 Base Standard Detailed technical evaluation of proposed
additions or changes to the DICOM standard
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** Not currently active 7 8

2
 DICOM WGs 14-18 DICOM WGs 19-26

WG# Working Group Name Relevance to Radiology

WG# Working Group Name Relevance to Radiology 19** Dermatology Standards Dermatology
14 Security Secure information exchange 20 Integration of Imaging Coordination of DICOM with Health Level Seven
and Information (HL7) standard for messaging between health
15 Digital Mammography Breast imaging; structured reporting of Systems information systems
and CAD computed-aided detection and diagnosis (CAD) 21** Computed Tomography CT imaging and dosimetry reporting
results for mammography and CT colonography
22 Dentistry Dentistry
16 Magnetic Resonance MRI
23 Application Hosting Develop specifications for interfaces between
hosted application software
17 3D Volumetric (multiframe) imaging modalities,
including CT, MR, and ultrasound 24 DICOM in Surgery Image-guided surgery and other surgical data
25** Veterinary Applications Veterinary
18* Clinical Trials and Application of imaging to clinical trials and
Education medical education 26 Pathology Pathology Applications
27 Web Technology Web service extensions
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** Not currently active

* starting activity 9 10

DICOM “workflow” DICOM “workflow”

• Output of any work item is submitted to

• Work items are divided into Supplements the Base Standards Working Group (WG6)
and Change Orders for review throughout the process
• WG6 may request changes or clarification to
• Supplements define new objects, content or the work item to ensure it complies with
structure Standard

• Change Orders modify the existing • Once the work item is complete WG6
Standard petitions the DSC to approve work item and
send out for public comment
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3
 DICOM “workflow” Changes to Standard

• After public comment and all issues listed in the

comments are responded to, the DSC authorizes • Currently over 100 approved Supplements
the work item for letter ballot by DICOM incorporated into Standard
members • Over 20 in progress or in comment stage

• Change proposals do not require the same rigorous

review process and are often “batched” for public • Currently over 1000 Change Proposals
comment and letter ballot, incorporated into Standard
• Some Change proposals can be instituted without • Ongoing process with changes being
comment or ballot if the change is required to reviewed at every WG6 meeting
reduce potential patient care issues or it is
typographical or trivial in nature
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Recent DICOM Enhancements Topics

that are important to Medical Physicists

• Clinical Trial De-identification Profiles,

A. De-Identification
• Surface Segmentation Storage SOP Class,
B. Surface Segmentation
• CT Radiation Dose Reporting (Dose SR), C. CT Dose Reporting
• Tomosynthesis Image Storage SOP Class, D. Breast Tomosynthesis
• JPEG 2000 Transfer Syntaxes E. JPEG2000 & JPIP
and Interactive Protocol F. Enhanced CT/MR
• Enhanced CT and MR Image Storage SOP Class.
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 A – De-Identification Topics

Clinical Trial De-identification Profiles

• Working Group 18 Clinical Trials

• Supplement 142 A. De-Identification
• Working draft 3, 2008 B. Surface Segmentation
C. CT Dose Reporting
“The existing confidentiality profile in PS 3.15 lists possible D. Breast Tomosynthesis
attributes that may cause identity leakage, without weighing
the relative merits of their inclusion or replacement, or
describing strategies to prioritize or selectively replace
E. JPEG2000 & JPIP
attribute values. F. Enhanced CT/MR
WG 18 has determined that it is necessary to add additional
confidentiality profiles to the DICOM Standard that are
appropriate to specific types of trials, both to provide
instruction for implementers, to assure compliance, and to
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provide guidance for sites and trial administrators that has

been subject to expert review.
17 18

B – Surface Segmentation B – Surface Segmentation

Polygonal Segmentation Storage SOP Class • All images are stored as 2D frames
• If more than one image is acquired, and there is
• Working Group 17 (3D) & 24 (Surgery) some information linking the images (e.g. cross
• Supplement 132 sectional images, temporal images, etc.) the images
can be stored as multi-frame objects
• Standard, 2008 • The images are still single 2D frames

The Supplement contains a new Common Surface

Mesh Module that is used do encode the
segmentation data. It is intended for composite
data objects of any modality or clinical specialty.
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5
 B – Surface Segmentation B – Surface Segmentation

• 3D reconstructions can be created from the multi-

frame objects • Surface renderings
• Yet results can only be saved as “snapshots” of are commonly
derived from
specific views (i.e. single- or multi-frame images)
polygonal surface
primitives

• This supplement
provides a method in
DICOM to store
these primitives
instead of images
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From Osirix

21 22

Topics C – CT Dose Reporting

CT Radiation Dose Reporting (Dose SR)

A. De-Identification • Working Group 21 (CT)

• Supplement 127
B. Surface Segmentation
• Standard, 2007
C. CT Dose Reporting
D. Breast Tomosynthesis “The Computed Tomography X-Ray dose report is based on
the SOP class of ‘X-Ray Radiation Dose SR’. Specific
E. JPEG2000 & JPIP templates for the recording of the dose and the acquisition
F. Enhanced CT/MR parameters in a CT environment have been developed.

The development of the CT Dose Report Template was

accomplished by the DICOM WG 21 and by IEC SC62B
MT30, which have defined a common set of dose-related
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information ...

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6
 C - SR Dose IOD C – CT dose content

CT SR Dose IOD Modules and Structure

• CT Acquisition Parameters
IE Module Reference Description
Patient Patient C.7.1.1 Describes the identity of patient • The tube voltage and the tube current are stated.
Clinical Trial Subject C.7.1.3 Identify clinical trial subject • The effective exposure in mAs is stated.
Study General Study C.7.2.1
Describes the study performed upon
patient
• The exposure time and the scanning length are stated.
Patient Study C.7.2.2 Describes information about study • Acquisition parameters related to the volume acquisition
Clinical Trial Study C.7.2.3 Identify context of clinical trial
are stated (collimation, pitch factor).
Series SR Document Series C.17.1 Defines attributes of the SR document • For each CT Acquisition (irradiation event):
Clinical Trial Series C.7.3.2 Identify context of clinical trial • The CITDIvol and DPL are stated.
Frame of
Reference
Synchronization C.7.4.2 Synchronization to patient study • The corresponding CTDIfreeair is stated.
Equipment General Equipment C.7.5.1 Attributes to identify the equipment • The effective dose may be stated (optional).
Document SR Document General C.17.2 General context of SR document
Specifies the attributes contained in the • The parameters used are stated.
SR Document Content C.17.3
SR
• The reference values for dose estimation and calculation
SOP Common C.12.1 DICOM basic for definition of object
are stated, e.g. calibration factor, effective dose type
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CT Accumulated Accumulated irradiation for an entire
template
Irradiation Dose Study examination
CT Irradiation Event template 1 to n separate irradiation events

25 26

Topics D – Breast Tomosynthesis

Breast Tomosynthesis Image Storage SOP Class

• Working Groups 2 (xray), 15 (mamm)

A. De-Identification
• Supplement 125
B. Surface Segmentation
• Standard, 2008
C. CT Dose Reporting
D. Breast Tomosynthesis The scope of this Supplement is to customize the X-
E. JPEG2000 & JPIP Ray multi-dimensional storage SOP Class .. to define
F. Enhanced CT/MR the 3D volume or volumes created from digital
breast tomosynthesis x-ray projections.”
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7
 B – Breast Tomosynthesis Topics

UID Value UID Name UID Type Part

A. De-Identification
1.2.840.10008.5.1.4.1.1.13.1.3 Breast Tomosynthesis SOP PS 3.4
Image Storage Class

B. Surface Segmentation
New object modules defined for C. CT Dose Reporting
• Breast tomosynthesis contributing D. Breast Tomosynthesis
sources (Part 3 - C.8.21.2.3) E. JPEG2000 & JPIP
• Breast tomosynthesis acquisition F. Enhanced CT/MR
(Part 3 - C.8.21.2.3)
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E – JPEG2000 & JPIP E - JPIP: Implementations

JPEG 2000 Interactive Protocol

• Working Group 4 (Compression)

• Supplement 106 • Many PACS systems provide services for client
• Final Text, January 26, 2006 access to images using proprietary progressive
“This Supplement extends the Pixel Data Module to streaming technology.
allow reference to a JPIP URL to access pixel data,
rather than encoding it in the image instance…The use • DICOM JPIP provides a standardized method
cases for this extension to the standard relate to an that might have particular use in an open-source
application's desire to gain access to a portion of application.
DICOM pixel data without the need to wait for
reception of all the pixel data. Examples are:
1) Stack Navigation of a large CT Study.
2) Large Single Image Navigation
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3) Thumbnails
4) Display by Dimension 31 32

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 Image Streaming GUIs DICOM SUP 106 (2006), JPIP

JPIP facilitates advanced image viewing GUIs

DICOM JPIP REFERENCED TRANSFER SYNTAX
1.2.840.10008.1.2.4. 94

“This Supplement extends the Pixel Data Module to

allow reference to a JPIP URL to access pixel data,
rather than encoding it in the image instance.”

“Data Element (7FE0,0010) Pixel Data shall not be

present, but rather pixel data shall be referenced via
Data Element (0028,7FE0) Pixel Data Provider URL”
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33 34

E - JPIP: Tag (0028,7FE0) E - JPIP: Informative Annex

Annex X
Supplement 106 establishes a JPIP transfer syntax and JPIP Referenced Pixel Data
adds a tag that provides a URL to the image data that is Transfer Syntax Negotiation
used instead of the traditional pixel data tag (7FE0,0010). Case 1: AE1 and AE2 both support both a JPIP Referenced Pixel
Data Transfer Syntax and a non-JPIP Transfer Syntax
• AE1
makes a C-MOVE request to AE2
• AE2
proposes two presentation contexts to AE1, one for with
a JPIP Referenced Pixel Data Transfer Syntax, and the
other with a non-JPIP Transfer Syntax
• AE1
accepts both presentation contexts
• AE2
may choose either presentation context to send the object
• AE1
must be able to either receive the pixel data in the C-
STORE message, or obtain it from the provider URL
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 DICOM with JPIP: Diagram Topics

A. De-Identification
B. Surface Segmentation
C. CT Dose Reporting
D. Breast Tomosynthesis
E. JPEG2000 & JPIP
F. Enhanced CT/MR
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Weisfeiler, Dicom WG4, Feb 2006 37 38

F – enhanced MR F - eMR: Multiframe

24 Dynamic Functional Groups
Enhanced MR Image Storage SOP Class Pixel Measures MR Image Frame Type

Frame Content MR Timing & Parameters

• Working Group 16 (MR)
Plane Position MR FOV/Geometry
• Supplement 49
• Final Text, 26 March, 2002 Plane Orientation MR Echo
Referenced Image MR Modifier
“The supplement describes 3 new IODs: Derivation Image MR Image Modifier
1. Enhanced MR Image MR Receive Coil
Cardiac Trigger
2. MR Spectroscopy MR Transmit Coil
3. Raw Data Frame Anatomy
MR Diffusion
Pixel value Transformation
“A Multi-Frame concept is introduced which allows Frame VOI LUT
MR Averages
attributes grouped together to vary on a frame by MR Spatial Saturation
frame base. This method is modality independent. Real World Value Mapping
MR Metabolite Map
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MR Velocity Encoding
39 From Charles Parisot , May 5, 2002, Korean PACS Conference 40

10
 F - eMR: Multiframe F - eMR: Image Description Macro
24 Dynamic Functional Groups MR Image Instance
• Supplement 49 proposes a reasonably orthogonal set of
For a Specific MR Image Instance :
attributes for image type useful to reading applications:
• some Functional Groups are Shared Functional
shared across all frames, Groups
• some vary per frame Attributes • Image Type (0008,0008) values:
For all frames 1: Original/Derived – redefined
Pixel Measures MR Image Frame Type
Frame Content MR Timing & Related Parameters Per Frame Functional
2: Primary/Secondary – Only Primary valid for MR
Plane Position MR FOV/Geometry Group Sequence 3: Image Flavor – the overall most important
Plane Orientation MR Echo
Referenced Image MR Modifier Frame 1 characteristic of this Image – e.g. flow encoded,
Derivation Image MR Image Modifier attributes max-IP, Perfussion, Stress, T1, T2, etc.
Cardiac Trigger MR Receive Coil
MR Transmit Coil Frame 2 4: Derived Contrast – Diffusion aniso, Subtraction,
Frame Anatomy
MR Diffusion attributes
Pixel value Transformation
MR Averages
Velocity, None – generally an indication of post
Frame VOI LUT
MR Spatial Saturation processing performed
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Real World Value Mapping
MR Metabolite Map
MR Velocity Encoding

From Charles Parisot , May 5, 2002, Korean PACS Conference 41 From Charles Parisot , May 5, 2002, Korean PACS Conference 42

F - eMR: Image Description Macro F - eMR: color, spectroscopy

• Other Image Types are separate attributes:

• Pixel Presentation
(Palette) Color/Monochrome (color supported or not) Color
• Volumetric Properties
Volume, Sampled, Distorted (used by Grx, 3D to determine image
compatibility with the application)
• Volume Based Calculation Technique
MAX_IP, MPR, Curved-MPR… (used by Grx, 3D to determine image
compatibility)
• Complex Image Component Spectroscopy
Magnitude, Phase, Real, Imaginary (standard MR transformations of
the raw data)
• Acquisition Contrast
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T1, T2, Perfusion, Combination… (MR acquisition contrast types)

From Charles Parisot , May 5, 2002, Korean PACS Conference 43 From David Clunie , May 22, 2004, SCAR Hot Topics 44

11
 F - eMR: mandatory tags F – enhanced CT

A large percent of the new tags in the Enhanced CT Image Storage SOP Class
enhanced MR object are mandatory and are
those in the enhannced CT object. • Working Group 21 (CT)
• Supplement 58
• Final Text, January 14, 2004
(Amended July 5, 2004)

“.. it is necessary to create a new CT object to meet

the needs of state of the art CT technology that
has evolved substantially since the existing CT
object was standardized in 1993.”

“Furthermore, new applications such as cardiac CT,

gated studies, perfusion CT, CT fluoroscopy,
contrast tracking and post-processing are not
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supported by the current standard. ...”

From David Clunie , May 22, 2004, SCAR Hot Topics 45 46

F - eCT: Spiral Pitch F - eCT: Acquisition Type

4 mandatory tags in the CT table Dynamics Macro are The Acquisition Type (0008,9303) contains a
unambiguously defined in an informative paragraph . description of the method used during acquisition
C.8.15.3.4.1 Spiral Pitch Factor of the frame from a list of defined terms .
The formula for Spiral Pitch Factor (0018,9311) in terms of Table
Feed per Rotation (0018,9310) and Total Collimation Width C.8.15.3.2.1 Acquisition Type
(0018,9307) is: Acquisition Type (0018,9302) has the following Defined Terms:
Spiral Pitch Factor = (Table Feed per Rotation (mm)) / • SEQUENCED identifies that the acquisition was performed by acquiring single
or multi detector data while rotating the source about the gantry while the table
(Total Collimation Width (mm)) is not moving. Additional slices are acquired by incrementing the table position
and again rotating the source about the gantry while the table is not moving.
An example calculation of Spiral Pitch Factor (0018,9311) for a
• SPIRAL identifies that the acquisition was performed by acquiring data while
single slice spiral acquisition of an image with a Total Collimation rotating the source about the gantry while continuously moving the table.
Width of 2.5mm and a Table Feed per Rotation of 10mm is: • CONSTANT_ANGLE identifies that the acquisition was performed by holding
Spiral Pitch Factor = (10 mm)/(2.5 mm) = 4.0 the source at a constant angle and moving the table to obtain a projection
image (e.g., a localizer image).
An example calculation of Spiral Pitch Factor (0018,9311) for a
• STATIONARY identifies that the acquisition was performed by holding the
multiple slice spiral acquisition having a Total Collimation Width table at a constant position and acquiring multiple slices over time at the same
of 20mm and a Table Feed per Rotation of 10mm is: location.
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Spiral Pitch Factor = (10 mm)/(20 mm) = 0.5 • FREE identifies that the acquisition was performed while rotating the source
about the gantry while the table movement is under direct control of a human
operator or under the control of an analysis application (e.g., fluoroscopic
47 image). 48

12
 F - eCT: Dynamic Contrast F - eCT: Multi Frame Performance

• Reduced communication latency (delay)

• Conventional hanging protocols are rarely • Opportunity for inter-slice (3D) compression
sophisticated enough to recognize multiple phases From David Clunie , 2006, New DICOM Objects
of contrast enhancement, e.g., during CT of liver
• Old DICOM objects have no standard information
about contrast phase
• New objects name phases of contrast
administration for each frame
PRE-CONTRAST, POST-CONTRAST,
IMMEDIATE, DYNAMIC,
STEADY-STATE, DELAYED, ARTERIAL,
CAPILLARY, VENOUS,
PORTAL-VENOUS
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From David Clunie , 2006, New DICOM Objects 49 50

F - eMR & eCT conformance Questions?

• The enhanced CT and MR objects were incorporated

in the DICOM standard in 2003 and 2004.
• Implementation testing & demonstration

?
• June 2005 - SCAR demonstration
• November 2005 - RSNA InfoRAD demonstration
• Despite strong industry involvement in the
development of the objects, support has not been
available on commercial CT and MR systems

SOP Class UIDs

• Enhanced CT 1.2.840.10008.5.1.4.1.1.2.1
• Enhanced MT 1.2.840.10008.5.1.4.1.1.4.1
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13
 http://www.ihe.net/
IHE IHE

IHE: Integrating the Healthcare Enterprise

• “IHE is an initiative by healthcare professionals and
industry to improve the way computer systems in
healthcare share information.”
• “IHE promotes the coordinated use of established
standards such as DICOM and HL7 to address specific
clinical need in support of optimal patient care.”
• “Systems developed in accordance with IHE
communicate with one another better, are easier to
implement, and enable care providers to use
information more effectively.”
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http://www.ihe.net/
53 54

IHE Member Organizations IHE Domains

IHE: Active Domains

IHE: Member Organizations

• Cardiology • Radiation Oncology

• 27 Healthcare Professional Associations
• Eye Care • Radiology
AAPM, ASTRO, RSNA, SNM …
• IT Infrastructure • Mammography
• 104 Healthcare companies
• Laboratory • Nuclear Medicine
• 8 Government Agencies
• Patient Care
CDC, NIST, VA …
Coordination
• 7 Standards Organizations
• Patient Care Devices
• 8 Healthcare provider organizations
• Quality
• 8 Healthcare education & research orgs.
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http://www.ihe.net/ http://wiki.ihe.net/
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 Recent IHE Profiles Recent IHE Enhancements
that are important to Medical Physicists

IHE Profiles relevant to Medical Physics

• [NTPL-S] Normal Treatment Planning-Simple • Radiation exposure monitoring (REM),
• [MMR-RO] Multimodality Registration, Rad. Onc. • Mammography acquisition workflow(MAWF),
• [TRWF] RT Treatment Workflow • Extensions to the Portable Data for Imaging
• [PWF] Post-Processing Workflow (PDI) integration profile,
• [NM] Nuclear Medicine Image • Basic Image Review Profile (BIR),
• [FUS] Image Fusion (in Trial) • MR Diffusion Imaging (MDI), and
• [REM] Radiation Exposure Monitoring • CT/MR Perfusion Imaging with Contrast (PIC).
• [MAMMO] Mammography Image
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• [PDI] Portable Data for Imaging

57 58

Topics IHE - REM

A. REM – Rad. Exp. Monitoring

B. MAWF – Mamm. Acq. workflow
C. PDI – New Extensions
D. BIR – Basic Image Review
E. MDI – MR Diffusion imaging
F. PIC – CT/MR Perfusion imaging
This profile facilitates the collection and
distribution of information about
estimated patient radiation exposure
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resulting from imaging procedures.

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15
 IHE – REM Actors IHE – REM Actors

The profile describes relevant

ACTORS transactions between actors.
• Acquisition Modality - <Creates and stores Dose SR.
• Image Manager/Archive - <Accepts/Commits dose
data and supports Q/R.
• Dose Information Consumer – Responsible for
supplemental handling of irradiation events, generally
on an individual basis, e.g. display, analysis, or
further processing.
• Dose Information Reporter – Responsible for the
aggregation, analysis, reporting and business logic
related to irradiation events
• Dose Register – Collates information about
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irradiation events from a number of facilities

61 62

IHE – REM Use IHE – REM Q & A

REM General Use Case
Q & A from the Trial Implimentation Draft, July 2008

• Is there any need for translating the dose objects into an HL7 format?
• Answer: No needs could be identified at this time, but the possibility of
sending data into HL7 was acknowledged. It will not be addressed now.
• Should we include dose from Radiotherapy procedures in the profile?
• Answer: Not yet. Focus on imaging initially. RT can be added later.
• Should we include dose from SPECT/PET procedures in the profile?
• Answer: Not yet. The dose SR work in DICOM does not exist for these
modalities. When it does, they could be added.
• Should IHE make equipment identification details mandatory?
• Answer: Yes. A DICOM CP will be submitted to add the Enhanced
Equipment Module (C.7.5.2) to the Radiation Dose IOD. (Manufacturer,
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model and serial number attributes would then be Type 1).

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 IHE – REM Connectathon Topics

Every year, IHE conducts a connectathon to

demonstate vendor implementations of new profiles.
http://sumo.irisa.fr/con_result/

A. REM – Rad. Exp. Monitoring

B. MAWF – Mamm. Acq. workflow
C. PDI – New Extensions
D. BIR – Basic Image Review
E. MDI – MR Diffusion imaging
F. PIC – CT/MR Perfusion imaging
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65 66

IHE - MAWF IHE – exam type change

Mammography Acquisition
Workflow describes mechanisms The MAWF profile graphically
to handle situation-specific illustrates the use cases considered.
exceptions to routine image
acquisition scenarios based on
the IHE Radiology Scheduled
Workflow Integration Profile.

• It defines how a Modality communicates ad-hoc procedure changes

when supplemental images are taken or when the exam type changes.
• It defines interactions between Digital X-ray (FFDM) Modalities and
systems managing departmental workflow when an examination is
begun in one room and is finished in another room.
• It defines how corrections to view labels at the Modality are
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communicated to and used by an Image Archive.

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 IHE – MAWF Open Issue Topics

Open Issues (July 2008)

• “While working on this Profile and finding technical

solutions to its underlying use cases, the Technical A. REM – Rad. Exp. Monitoring
Committee requested changes to the DICOM
standard to realize needed Actor behavior. B. MAWF – Mamm. Acq. workflow
• This includes one new attribute in MPPS and images, C. PDI – New Extensions
as well as code extensions to the Content Mapping
Resource (see vol. 1, Appendix B).
D. BIR – Basic Image Review
• Corresponding Change Proposals to the DICOM E. MDI – MR Diffusion imaging
Standards were submitted. This IHE Profile F. PIC – CT/MR Perfusion imaging
specification depends on these Change Proposals to
be accepted and finalized. The IHE Radiology
Technical Committee will stay in contact with the
DICOM Committees and update this Profile as
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necessary based on the actions taken by DICOM. “

69 70

IHE – PDI extensions Topics

June 21, 2009

A. REM – Rad. Exp. Monitoring

Trial Implementation Draft

B. MAWF – Mamm. Acq. workflow

C. PDI – New Extensions
D. BIR – Basic Image Review
This supplement adds options to the Portable Data for
Imaging Integration Profile, E. MDI – MR Diffusion imaging
• To broaden from CD media only to include DVD and USB, F. PIC – CT/MR Perfusion imaging
• To add support for lossless and lossy compression ,
• To add an application on the media to decompress and
decrypt the contents to send over the network.
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71 72

18
 IHE – PDI extensions IHE – BIR objective

It is common practice for imaging facilities to distribute images on

June 10, 2009 CDs, and for receiving physicians to review those images using a
viewer included on the CD.
Trial Implementation Draft Physicians have increasingly expressed frustration that frequently:
• viewers do not run successfully,
• viewers do not load the images successfully,
• the viewer loads too slowly,
• the viewer claims to be "not of diagnostic quality,"
• functions critical to review are missing from the viewer or
“Working closely with representatives of the American
• the various viewers encountered on CDs have unique graphical user
Medical Association and the American Association of interfaces that do not provide obvious access to basic functions.
Neurological Surgeons, the IHE Radiology Technical The impact is delayed care, inaccessible information, repeat
Committee has developed this profile to define the examination and irradiation, and poor use of valuable clinician time.
appropriate baseline functionality and behaviors for Creators of CDs may be unaware of the problems encountered by the
image viewing software on CD.” physicians receiving the CDs and thus critical feedback about these
issues is not communicated to the vendor of the system.
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73 74

IHE – BIR minimum computer IHE – BIR mouse W/L functions

• For grayscale images, a tool shall be provided to select the

Minimum hardware and software use of the mouse to window the images in all tiles of the
• One x86 (Intel or AMD) processor or core currently selected viewport. This support shall include:
• Windows XP Home Edition and Windows Vista Home Basic Edition • a tool that selects windowing by mouse movement with the
• .NET 2.0 framework installed left (or only) mouse button held down
• 512MB RAM for XP and 1024 MB RAM for Vista • acceleration of the rate of windowing by a keyboard
• Graphics hardware and a single monitor of any type supported by modifier or detection of the rate of mouse movement
Windows at 1024x768 resolution in 24 bit RGB color • Another tool is provided to toggle between two modes of
• a mouse or other pointing device with a single button windowing behavior, Center/Width and Clamped. When the
• one drive that supports reading writable CD and DVD media Window tool is selected and the mode is Center/Width:
• a consumer-grade printer • horizontal movement of the mouse to the right will widen
• without requiring installation of, or permission to install, the window width (flatten the perceived contrast)
applications, frameworks (such as Java or other .NET versions), • vertical movement of the mouse upwards will lower the
libraries (such as DLLs or ActiveX controls), device or graphics window center (increase the perceived brightness)
drivers or software other than those shipped with the basic • When the Window tool is selected and the mode is Clamped:
operating system • the bottom of the window shall be clamped to a rescaled
• without requiring the presence of a network connection (for pixel value of 0
AAPM 2009

AAPM 2009

download of software, licensing or registration or exchange of any • vertical movement upward shall lower the upper limit of
other information whether via the Internet or local area network) the window (increase the perceived brightness)
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 IHE – BIR ICONS Topics

37 standard icons are defined along and

the function specifically delineated.

A. REM – Rad. Exp. Monitoring

B. MAWF – Mamm. Acq. workflow
C. PDI – New Extensions
Patient B-W W-B Localizer
Selection Reversal Lines
WL Mode D. BIR – Basic Image Review
E. MDI – MR Diffusion imaging
F. PIC – CT/MR Perfusion imaging

WL Default
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Annotation CINE ZOOM

Values

77 78

IHE – DIFF display IHE – Diffusion display

• MR Diffusion Imaging creates stacks of images

June 21, 2009 (slices) with different meaning and derived contrast
Trial Implementation Draft by using techniques of MR Diffusion Weighted
Imaging (DWI).
• This Integration Profile defines how a set of images
resulting from a completed MR Diffusion exam are
• “The MR Diffusion Imaging Integration Profile stored and archived into frames of one Enhanced MR
leverages enhanced MR diffusion images containing DICOM (Multi-frame) object so that they can later
standard attributes for Diffusion B value, Diffusion be retrieved and displayed in an unambiguous way on
gradient orientation and Diffusion image type. image viewers supporting Enhanced MR DICOM
• These objects are exchanged in an interoperable way objects.
allowing correct and convenient display.
• This enables widespread and adequate review and
• Applications using older single-frame DICOM image interpretation of b=0, ISOTROPIC and ADC diffusion
objects depended on knowledge of private attributes
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AAPM 2009

for this information..” frames by radiologists in an environment where all

Actors support the Enhanced MR DICOM objects
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 IHE – DIFF tags Topics

This profile requires certain DICOM tags be

present in addition to mandatory enhanced MR tags.

A. REM – Rad. Exp. Monitoring

B. MAWF – Mamm. Acq. workflow
C. PDI – New Extensions
D. BIR – Basic Image Review
E. MDI – MR Diffusion imaging
F. PIC – CT/MR Perfusion imaging

The values of these tags are used to establish the manner in which
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diffusion imaging sequences are stored in the multi-frame object

81 82

IHE – PERF display IHE – Perfusion display

June 21, 2009 • CT/MR Perfusion Imaging with Contrast creates stacks
Trial Implementation Draft of images at different timeslots, in order to
demonstrate the uptake of a contrast agent over time.
• This Integration Profile defines how these perfusion
images are stored and archived into frames of one
• “The CT/MR Perfusion Imaging with Contrast Enhanced DICOM (Multi-frame) object so that they can
Integration Profile facilitates the exchange of later be retrieved and displayed in an unambiguous way
contrast enhanced images containing standard on image viewers supporting Enhanced DICOM objects.
attributes for timing and position. • This enables widespread and adequate review and
• The exchange of these attributes allow for correct interpretation of contrast-enhanced frames by
and convenient display. radiologists in an IT environment where all Actors
• Applications using the older single-frame DICOM support the Enhanced CT or Enhanced MR DICOM
image objects depended on proprietary assumptions objects.
about which timing attributes 75 were expected to
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AAPM 2009

be present, and were not generally interoperable.”

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 IHE – PERF tags DICOM & IHE

Similar to the DIFF profile, this profile

requires certain tags to be used to facilitate DICOM Standards Committee
perfusion images storage and display. &
Integrating the Healthcare Enterprise (IHE) International
Memorandum of Understanding
Effective Date: May 15, 2009

• The DSC will become a member of IHE International and appoint a liaison
representative. Likewise, IHE International will become a member of the
DSC and appoint one voting representative
• Each organization must execute the other’s Intellectual Property Agreement.
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85 86

Questions?

?
AAPM 2009

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