1 query techniques for accessing imaging information
TRANSCRIPT
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Query Techniques for Accessing Imaging Information
Query Techniques for Accessing Imaging Information
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Session InformationSession Information
• Session #: 754• Title: Query Techniques for Accessing
Imaging Information• Date/Time: August 11, 2010 – 1:30 –
3:00
• Session #: 754• Title: Query Techniques for Accessing
Imaging Information• Date/Time: August 11, 2010 – 1:30 –
3:00
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Presented byPresented by
• Roy Seabolt• VA VistA Imaging Team• Harris Corporation• Silver Spring, MD
• Roy Seabolt• VA VistA Imaging Team• Harris Corporation• Silver Spring, MD
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IntroductionIntroduction• Presenter Background
– Over 25 years of varied IT experience– Commercial Healthcare IT since 1996– VA Healthcare since 2009
– Medical Imaging specialties include• Business Analysts (Patch 66 and Patch 116)• DICOM and HL7• Workflow Analysis and Redesign
• Presenter Background– Over 25 years of varied IT experience– Commercial Healthcare IT since 1996– VA Healthcare since 2009
– Medical Imaging specialties include• Business Analysts (Patch 66 and Patch 116)• DICOM and HL7• Workflow Analysis and Redesign
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DisclaimerDisclaimer
• It should be noted that I am a contractor for the Department of Veterans Affairs and any mention of 3rd party products in this presentation is purely for reference purposes and in no way should be considered an endorsement of that product.
• Contents may not necessarily reflective of VA policy.
• It should be noted that I am a contractor for the Department of Veterans Affairs and any mention of 3rd party products in this presentation is purely for reference purposes and in no way should be considered an endorsement of that product.
• Contents may not necessarily reflective of VA policy.
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Session OutlineSession Outline
• Uses of clinical image information• Building image access into workflow• How medical information standards
improve image availability• Building effective queries• The future: cross-agency
interoperability
• Uses of clinical image information• Building image access into workflow• How medical information standards
improve image availability• Building effective queries• The future: cross-agency
interoperability
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Session ObjectivesSession Objectives• At the end of this session:
– Identify the clinicians and administrators who need to retrieve image information
– Distinguish at least 3 purposes for using archived images
– Explain the characteristics of VistA Imaging Query/Retrieve
– Choose appropriate attributes for image identification
– Build fast, effective queries for retrieving images
• At the end of this session:– Identify the clinicians and administrators
who need to retrieve image information– Distinguish at least 3 purposes for using
archived images– Explain the characteristics of VistA
Imaging Query/Retrieve– Choose appropriate attributes for image
identification– Build fast, effective queries for
retrieving images
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What is DICOM?What is DICOM?
•DICOM–Digital– Imaging &–Communications in–Medicine
•DICOM–Digital– Imaging &–Communications in–Medicine
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Purpose of DICOM?Purpose of DICOM?• To facilitate communication between various
imaging modalities and other components• The standard to allow a common set of rules
and protocols between vendors in the Medicine field, specifically radiology (imaging)
• Predecessor to the DICOM standard was ACR-NEMA 2.0
• Introduced in 1993 at RSNA• Most widely adopted standard in use in the
medical imaging field• DICOM Standard available at:
http:/medical.nema.org/DICOM/
• To facilitate communication between various imaging modalities and other components
• The standard to allow a common set of rules and protocols between vendors in the Medicine field, specifically radiology (imaging)
• Predecessor to the DICOM standard was ACR-NEMA 2.0
• Introduced in 1993 at RSNA• Most widely adopted standard in use in the
medical imaging field• DICOM Standard available at:
http:/medical.nema.org/DICOM/
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Parts of the DICOM Standard
Parts of the DICOM Standard
1. Introduction and Overview2. Conformance3. Information Object Definitions4. Service Class Specifications5. Data Structures and Encoding6. Data Dictionary7. Message Exchange8. Network Message Support for Message
Exchange10.Medical Storage and File Format for
Media Interchange
1. Introduction and Overview2. Conformance3. Information Object Definitions4. Service Class Specifications5. Data Structures and Encoding6. Data Dictionary7. Message Exchange8. Network Message Support for Message
Exchange10.Medical Storage and File Format for
Media Interchange
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Parts of the DICOM Standard
Parts of the DICOM Standard
11.Media Storage Application Profiles12.Media Formats and Physical Media for Media
Interchange13.Print Management Point-to-Point
Communications Support
14.Grayscale Standard Display Function15.Security Profiles16.Content Mapping Resource17.Explanatory Information18.Web Access to DICOM Persistent
Objects
11.Media Storage Application Profiles12.Media Formats and Physical Media for Media
Interchange13.Print Management Point-to-Point
Communications Support
14.Grayscale Standard Display Function15.Security Profiles16.Content Mapping Resource17.Explanatory Information18.Web Access to DICOM Persistent
Objects
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Some Terms to KnowSome Terms to Know
• PACS – Picture Archival and Communication System.System designed to store and retrieve a patient’s medical Images. Historically Radiology-centered.
•cPACS – Commercial PACS •Mini-PACS – Specialized PACS •Modality – an image
capture/processing device that complies with the DICOM Standard.
•DICOM Q/R – DICOM Query/Retrieve
• PACS – Picture Archival and Communication System.System designed to store and retrieve a patient’s medical Images. Historically Radiology-centered.
•cPACS – Commercial PACS •Mini-PACS – Specialized PACS •Modality – an image
capture/processing device that complies with the DICOM Standard.
•DICOM Q/R – DICOM Query/Retrieve
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Some Terms to KnowSome Terms to Know
• Attribute tag: A unique identifier for an Attribute of an Information Object composed of an ordered pair of numbers (a Group Number followed by an Element number).
• Message – Describes Command and Data Sets. The data sets generally contains the demographic header and assigned image(s).
• Attribute tag: A unique identifier for an Attribute of an Information Object composed of an ordered pair of numbers (a Group Number followed by an Element number).
• Message – Describes Command and Data Sets. The data sets generally contains the demographic header and assigned image(s).
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Common Acronyms in DICOM
Common Acronyms in DICOM
• AET - Application Entity Title • DIMSE – DIcom Message Service Element• SCP – Service Class Provider• SCU – Service Class User• UID – Unique Identifier
– Study Instance UID– Series Instance UID– SOP Instance UID
• AET - Application Entity Title • DIMSE – DIcom Message Service Element• SCP – Service Class Provider• SCU – Service Class User• UID – Unique Identifier
– Study Instance UID– Series Instance UID– SOP Instance UID
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DICOM Information ObjectsDICOM Information Objects
• Image – Original DICOM Object
• Other Objects– Encapsulated PDF Files– Structured Reports– Radiation Therapy Plans– Waveform Files
• Image – Original DICOM Object
• Other Objects– Encapsulated PDF Files– Structured Reports– Radiation Therapy Plans– Waveform Files
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DICOM ObjectsDICOM Objects• DICOM Images are a Composite
Format– Image data of the actual picture (pixels)– A “Header” area at the beginning
containing DICOM elements• Patient Identifying information• Exam information (Accession number, study
date)• Image information (geometry, attributes)
• DICOM Images are a Composite Format– Image data of the actual picture (pixels)– A “Header” area at the beginning
containing DICOM elements• Patient Identifying information• Exam information (Accession number, study
date)• Image information (geometry, attributes)
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DICOM Object DefinitionsDICOM Object Definitions• Each type of DICOM object:
– Has a unique identifier (SOP Class UID)– Is composed of elements– Each element has a specific definition
• Type 1 fields = Required• Type 2 fields = Required
(must be present, but may be empty)• Type 3 fields – Optional
– Tags (Elements)• Public Tags• Private Tags
• Each type of DICOM object:– Has a unique identifier (SOP Class UID)– Is composed of elements– Each element has a specific definition
• Type 1 fields = Required• Type 2 fields = Required
(must be present, but may be empty)• Type 3 fields – Optional
– Tags (Elements)• Public Tags• Private Tags
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DICOM ElementsDICOM Elements• Group/Element – Unique address
representing each unit of information stored in the message header
• Each Group - represents a type of information– Patient– General Study– Series– Image
• Group/Element – Unique address representing each unit of information stored in the message header
• Each Group - represents a type of information– Patient– General Study– Series– Image
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DICOM ModulesDICOM Modules• Patient Module
– (0x00100010,PN,“PATIENT^Name") # Patient's Name
– (0x00100020,LO,"5MR2") # Patient ID– (0x00100030,DA,"19500112") #
Patient's Birth Date– (0x00100040,CS,"M ") # Patient's Sex– (0x00101030,DS,"70") # Patient's
Weight
• Patient Module– (0x00100010,PN,“PATIENT^Name") #
Patient's Name– (0x00100020,LO,"5MR2") # Patient ID– (0x00100030,DA,"19500112") #
Patient's Birth Date– (0x00100040,CS,"M ") # Patient's Sex– (0x00101030,DS,"70") # Patient's
Weight
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DICOM ModulesDICOM Modules• Series Module
– (0x00185100,CS,"HFS ") # Patient Position– (0x0020000D,UI,"1.3.6.1.4.1.5962.1.2.5.2004
0826185059.5457") # Study Instance UID– (0x0020000E,UI,"1.3.6.1.4.1.5962.1.3.5.1.20
040826185059.5457") # Series Instance UID– (0x00200010,SH,"5MR2") # Study ID– (0x00200011,IS,"1 ") # Series Number– (0x00200012,IS,"13") # Acquisition Number– (0x00200013,IS,"5 ") # Instance Number
• Series Module– (0x00185100,CS,"HFS ") # Patient Position– (0x0020000D,UI,"1.3.6.1.4.1.5962.1.2.5.2004
0826185059.5457") # Study Instance UID– (0x0020000E,UI,"1.3.6.1.4.1.5962.1.3.5.1.20
040826185059.5457") # Series Instance UID– (0x00200010,SH,"5MR2") # Study ID– (0x00200011,IS,"1 ") # Series Number– (0x00200012,IS,"13") # Acquisition Number– (0x00200013,IS,"5 ") # Instance Number
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DICOM ModulesDICOM Modules• Image Module
– (0x00280002,US,0x0001) # Samples per Pixel– (0x00280004,CS,"MONOCHROME2 ") #
Photometric Interpretation– (0x00280010,US,0x0400) # Rows– (0x00280011,US,0x0400) # Columns– (0x00280030,DS,"0.195313","0.195313 ") #
Pixel Spacing– (0x00280100,US,0x0010) # Bits Allocated– (0x00280101,US,0x000C) # Bits Stored– (0x00280102,US,0x000B) # High Bit– (0x00280103,US,0x0000) # Pixel
Representation– (0x00281050,DS,"1000") # Window Center– (0x00281051,DS,"2000") # Window Width
• Image Module– (0x00280002,US,0x0001) # Samples per Pixel– (0x00280004,CS,"MONOCHROME2 ") #
Photometric Interpretation– (0x00280010,US,0x0400) # Rows– (0x00280011,US,0x0400) # Columns– (0x00280030,DS,"0.195313","0.195313 ") #
Pixel Spacing– (0x00280100,US,0x0010) # Bits Allocated– (0x00280101,US,0x000C) # Bits Stored– (0x00280102,US,0x000B) # High Bit– (0x00280103,US,0x0000) # Pixel
Representation– (0x00281050,DS,"1000") # Window Center– (0x00281051,DS,"2000") # Window Width
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• Every single image contains all three
of these Instance UIDs.• Every single image contains all three
of these Instance UIDs.
Instance UIDs (Unique Identifiers)
Instance UIDs (Unique Identifiers)
The Instance UIDs are the key to the relationship • each Image within a
Series and • each Series within a
Study
• The Study UID should be generated by the VI Text Gateway (will contain the VI root of 1.2.840.113754)
• Series and Image are generated by the modality vendor (or creator of the object).
The Instance UIDs are the key to the relationship • each Image within a
Series and • each Series within a
Study
• The Study UID should be generated by the VI Text Gateway (will contain the VI root of 1.2.840.113754)
• Series and Image are generated by the modality vendor (or creator of the object).
Image Instance UID
Series Instance UID
Study Instance UID
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Sample UID’sSample UID’s
• Study (Study root - FDA) [HIS/RIS]1.2.840.113754.1.4.660.xxxxxx.xxxx.x.xxx
• Series Instance UID (modality)1.2.840.0000001.xxxxxx.xxxxxx.xxxxx
• SOP Instance UID (modality/unique)1.2.840.113747.xxxxxx.xxxxxx.xxxxxx.xxx
• Study (Study root - FDA) [HIS/RIS]1.2.840.113754.1.4.660.xxxxxx.xxxx.x.xxx
• Series Instance UID (modality)1.2.840.0000001.xxxxxx.xxxxxx.xxxxx
• SOP Instance UID (modality/unique)1.2.840.113747.xxxxxx.xxxxxx.xxxxxx.xxx
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CR Study – 2 Series/5 imagesCR Study – 2 Series/5 images
• Study Instance UID =1.2.840.111111.111111
• Study Instance UID =1.2.840.111111.111111
# Series Instance UID Study Instance UID
1 1.2.840.222222.222222.1 1.2.840.333333.333.1
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1.2.840.222222.222222.11.2.840.222222.222222.1
1.2.840.333333.333.21.2.840.333333.333.3
4 1.2.840.222222.222222.2 1.2.840.333333.777.4
5 1.2.840.222222.222222.2 1.2.840.333333.787.5
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Why is this important?Why is this important?
• Each DICOM Object stands alone– Database stores list of studies and pointers
to DICOM Objects on the file system– DICOM Objects are not stored in database– Allows processing against the object
independent of a database– Allows DIMSE communication on individual
objects
• Object definition travels with the object (copy)
• Each DICOM Object stands alone– Database stores list of studies and pointers
to DICOM Objects on the file system– DICOM Objects are not stored in database– Allows processing against the object
independent of a database– Allows DIMSE communication on individual
objects
• Object definition travels with the object (copy)
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DICOM – ValidationDICOM – Validation
• Types of Validation– DICOM Modality Worklist– Image (object) Storage– Workstation – Query/Retrieve (NEW)
• VA Approved List
• Types of Validation– DICOM Modality Worklist– Image (object) Storage– Workstation – Query/Retrieve (NEW)
• VA Approved List
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DICOM Conformance StatementsDICOM Conformance Statements
• Vendor DICOM Conformance Statement– Which DICOM operations vendor
supports– How they support them
• VistA Imaging DCS– Which DICOM operations VistA Imaging
supports– How VistA Imaging supports them
• Vendor DICOM Conformance Statement– Which DICOM operations vendor
supports– How they support them
• VistA Imaging DCS– Which DICOM operations VistA Imaging
supports– How VistA Imaging supports them
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Purpose of Modality ValidationPurpose of Modality Validation
• Verify that vendor:– Performs DICOM operations based on
what is stated in their DCS– Creates valid DICOM Objects (EPDF’s)
• Verify that VistA Imaging:– Can communicate with modality device– Can perform necessary DICOM
commands
• Verify that vendor:– Performs DICOM operations based on
what is stated in their DCS– Creates valid DICOM Objects (EPDF’s)
• Verify that VistA Imaging:– Can communicate with modality device– Can perform necessary DICOM
commands
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Purpose of Q/R ValidationPurpose of Q/R Validation
• Verify that vendor:– Performs DICOM operations based on
what is stated in their DCS– Vendor properly supports
Query/Retrieve commands and can communicate with VistA Imaging PACS
– Creates valid DICOM Objects (3D reconstruction)
• Verify that vendor:– Performs DICOM operations based on
what is stated in their DCS– Vendor properly supports
Query/Retrieve commands and can communicate with VistA Imaging PACS
– Creates valid DICOM Objects (3D reconstruction)
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What is DICOM Query/Retrieve?What is DICOM Query/Retrieve?
•Query/Retrieve is:– a mechanism used by DICOM
Compliant medical devices to find– and retrieve studies (DICOM
Objects) from another medical device containing the desired information using the protocols defined in the DICOM Standard
•Query/Retrieve is:– a mechanism used by DICOM
Compliant medical devices to find– and retrieve studies (DICOM
Objects) from another medical device containing the desired information using the protocols defined in the DICOM Standard
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What can DICOM Q/R pull?What can DICOM Q/R pull?
DICOM Q/R can access any supported DICOM object
DICOM Q/R can access any supported DICOM object
DICOM (YES) Non-DICOM (NO)
MRIs Rich Text Reports
US Scanned Documents
CTs Patient Photo’s
Dental Images Digital Camera pictures
Ophthalmic Images
X-Rays DICOM (NO)
Encapsulated PDF’s Unsupported SOP Classes
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Who would use DICOM Q/R?Who would use DICOM Q/R?
• Who would use DICOM Q/R to access DICOM Objects:– VistA Imaging Coordinators– CACs– CIS– Rad Techs (mammo’s, 3D workstations,
CAD)– Cardiologist and other specialists– Mini-PACS users (US, dental)– cPACS users– File Room (ROI Request)
• Who would use DICOM Q/R to access DICOM Objects:– VistA Imaging Coordinators– CACs– CIS– Rad Techs (mammo’s, 3D workstations,
CAD)– Cardiologist and other specialists– Mini-PACS users (US, dental)– cPACS users– File Room (ROI Request)
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How Q/R improves Patient CareHow Q/R improves Patient Care
• Q/R from any facility/any 3rd party device
• Q/R from any facility/any 3rd party device
Army Germany
San Antonio Army
VA TampaVA Tampa(Caregiver))(Caregiver))
VA VA MinneapolisMinneapolis
(Tour of (Tour of duty)duty)
VA VA RichmondRichmondPolytramaPolytrama
VA VA Palo AltoPalo Alto(Training)(Training)
Austin
VA Medical Center
DoD Medical Treatment Facility
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Examples of Q/R useExamples of Q/R use
• A Q/R User can be any device that supports standard DICOM Query and Retrieve Request functionality
• DICOM objects can be sent to any device that supports Storage Server functionality
• Some devices that support the above:– 3D reconstruction workstations– Orthopedic Template workstations– Digital Mammo modalities– cPAC and mini-PACS
• A Q/R User can be any device that supports standard DICOM Query and Retrieve Request functionality
• DICOM objects can be sent to any device that supports Storage Server functionality
• Some devices that support the above:– 3D reconstruction workstations– Orthopedic Template workstations– Digital Mammo modalities– cPAC and mini-PACS
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Traditional Database QueryTraditional Database Query
• Single user, single database, single storage system
• Single user, single database, single storage system
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Traditional Database QueryTraditional Database Query
• SQL Database– Single database– Single storage system
• SQL Query– SELECT <ALL> FROM <Source>
WHERE <field name> = <Criteria>
– SELECT <ALL> FROM <Orders>WHERE <Accession_Nbr> = 062010-771
• SQL Database– Single database– Single storage system
• SQL Query– SELECT <ALL> FROM <Source>
WHERE <field name> = <Criteria>
– SELECT <ALL> FROM <Orders>WHERE <Accession_Nbr> = 062010-771
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DICOM Query RetrieveDICOM Query Retrieve
Machine to machine interface
User control over Study selection
Real-time data retrieval
Uses messages and commands based on the DICOM Standard to execute request
Machine to machine interface
User control over Study selection
Real-time data retrieval
Uses messages and commands based on the DICOM Standard to execute request
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DICOM Q/R RetrieveDICOM Q/R RetrieveMulti-step process
Query Master database
Retrieve from multiple data stores
Uses DICOM Services (messages) to execute C-FIND
C-MOVE
C-STORE
Multi-step process Query Master database
Retrieve from multiple data stores
Uses DICOM Services (messages) to execute C-FIND
C-MOVE
C-STORE
3D Reconstruction Workstation
Query Request
Retrieve Request
Sending Images
DICOM Gateway
DICOM Q/R Process
Get requested Info
Get images
Database
Images
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• •
Send DICOM MessageSend DICOM Message
SCU SCP
Associate-Request
Associate-Accept
Message
Release-Request
Release-Response
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DICOM Query/Retrieve ServicesDICOM Query/Retrieve Services
• The complete cycle consists of 3 Services defined in the DICOM Standard:
• The complete cycle consists of 3 Services defined in the DICOM Standard:Function Service Role
Query C-FIND SCU
Retrieve C-MOVE SCU/SCP
Retrieve C-Store SCP
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DICOM C-FIND ServiceDICOM C-FIND Service• C-Find - implements an SCU role
using the C-FIND message service. – this is a very simple operation rather akin to a SQL
query, whereby a dataset is passed from the SCU to the SCP containing 2 sorts of attribute:
• Those which need to be matched • Those to be returned to the SCU
– The SCP responds by sending a number of matching datasets, followed by a "complete" response to say that it has finished.
– Response list is returned of all studies meeting QUERY criteria
– Patient Name– Patient ID– Study Accession Number– Study Instance UID
• C-Find - implements an SCU role using the C-FIND message service.
– this is a very simple operation rather akin to a SQL query, whereby a dataset is passed from the SCU to the SCP containing 2 sorts of attribute:
• Those which need to be matched • Those to be returned to the SCU
– The SCP responds by sending a number of matching datasets, followed by a "complete" response to say that it has finished.
– Response list is returned of all studies meeting QUERY criteria
– Patient Name– Patient ID– Study Accession Number– Study Instance UID
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Q/R C-Find Request ExampleQ/R C-Find Request Example A 3D Reconstruction Workstation is playing the role of the
Query Requestor.
The User at the 3D workstation plans to build a 3D reconstruction image of a CT study.
The User must first query VistA to see if the CT study is available.
The User performs a Query Request to VistA from the 3D workstation.
The User receives a response list containing the desired CT study. The User now knows the CT study is available on VistA.
A 3D Reconstruction Workstation is playing the role of the Query Requestor.
The User at the 3D workstation plans to build a 3D reconstruction image of a CT study.
The User must first query VistA to see if the CT study is available.
The User performs a Query Request to VistA from the 3D workstation.
The User receives a response list containing the desired CT study. The User now knows the CT study is available on VistA.
Database3D Reconstruction Workstation
DICOM Q/R Process
Query
Response List
Check Database
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DICOM C-Move ServiceDICOM C-Move Service
• C-Move – This requests the C-MOVE SCP to act as a C-STORE SCU and to copy composite instance to a requested AET using the C-Move message service.
– It sends query keys (Study Instance UID) to an SCP and awaits responses.
– It will accept associations for the purpose of receiving images sent as a result of the C-MOVE request. Note that the use of the term "move" is a misnomer. The C-MOVE operation actually performs an image copy (no images will be deleted from the SCP)
– SCP can be anywhere in the network
• C-Move – This requests the C-MOVE SCP to act as a C-STORE SCU and to copy composite instance to a requested AET using the C-Move message service.
– It sends query keys (Study Instance UID) to an SCP and awaits responses.
– It will accept associations for the purpose of receiving images sent as a result of the C-MOVE request. Note that the use of the term "move" is a misnomer. The C-MOVE operation actually performs an image copy (no images will be deleted from the SCP)
– SCP can be anywhere in the network
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DICOM C-Store ServeDICOM C-Store Serve
• C-Store - The most basic DICOM operation, otherwise known as "DICOM Push" allows an SCU to send a Composite Instance to an SCP.
– it is used to send images from a modality to PACS
– or create the delivery mechanism for C-MOVE - Store selected DICOM Objects from the initial DICOM Query request
• Writes the DICOM Object to storage
• C-Store - The most basic DICOM operation, otherwise known as "DICOM Push" allows an SCU to send a Composite Instance to an SCP.
– it is used to send images from a modality to PACS
– or create the delivery mechanism for C-MOVE - Store selected DICOM Objects from the initial DICOM Query request
• Writes the DICOM Object to storage
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Q/R C-Move/C-Store Retrieve Example
Q/R C-Move/C-Store Retrieve Example
The 3D Reconstruction Workstation is taking the role of the Move Requestor and Storage Server.
The User knows the study is available on VistA.
The User selects the study and indicates that the images should be sent from VistA to the 3D workstation (This is a Move Request).
The DICOM Gateway retrieves the images for the CT study and sends each image to the 3D workstation. Sending of images continues until the complete CT study is sent to the 3D workstation.
The User may now perform the 3D reconstruction.
The 3D Reconstruction Workstation is taking the role of the Move Requestor and Storage Server.
The User knows the study is available on VistA.
The User selects the study and indicates that the images should be sent from VistA to the 3D workstation (This is a Move Request).
The DICOM Gateway retrieves the images for the CT study and sends each image to the 3D workstation. Sending of images continues until the complete CT study is sent to the 3D workstation.
The User may now perform the 3D reconstruction.
DICOM Q/R Process
3D Reconstruction Workstation
Database
DICOM GatewayGet requested Info
Sending Images
Query Request
Images
Get images
Retrieve Request
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Study Level keys for Query/Retrieve
Study Level keys for Query/Retrieve
Description Matching Type Tag
Query/Retrieve Level (“STUDY”)
(0008,0052)
Study Date R (0008,0020)
Study Time R (0008,0030)
Study ID R (0020,0010)
Patient's Name R (0010,0010)
Patient ID R (0010,0020)
Accession Number R (0008,0050)
Study Instance UID UNIQUE (0020,000D)
Modalities in Study O (0008,0061)
Referring Physician’s Name O (0008,0090)
Study Description O (0008,1030)
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Choosing the Appropriate KeyChoosing the Appropriate KeyDescription Matching Type Key
Query/Retrieve Level (“STUDY”)
N/A
Study Date R Poor
Study Time R Poor
Study ID R Good
Patient's Name R Good
Patient ID R Excellent
Accession Number R Excellent
Study Instance UID UNIQUE Excellent
Modalities in Study O Poor
Referring Physician’s Name O Poor
Study Description O Poor
Sample Query ScreenSample Query Screen
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Query by Name ExampleQuery by Name Example
Query by Accession NumberQuery by Accession Number
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Status Screen Example - ActiveStatus Screen Example - Active
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Status Screen Example - PendingStatus Screen Example - Pending
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Q/R Pending – Possible Reasons
Q/R Pending – Possible Reasons
• Images offline– Platter not online– Archived images, need to mount media
• Pending – Timeout– Media not mounted in a timely manner
• Images offline– Platter not online– Archived images, need to mount media
• Pending – Timeout– Media not mounted in a timely manner
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Q/R FailuresQ/R Failures
• Device not configured:– On Server (SCU_List.DIC)– On Client
• Study not found (images lost)•Duplicate Study Instance UID’s
• Device not configured:– On Server (SCU_List.DIC)– On Client
• Study not found (images lost)•Duplicate Study Instance UID’s
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DICOM Q/R SpecificsDICOM Q/R Specifics
• DICOM Objects Only• Supported SOP Classes Only• Study/Root Level Queries Only• Single Study at a time
• Does not support:– Patient Level Retrieval– Series Level Retrieval
• Must be configured on Server (GW) and Client
• DICOM Objects Only• Supported SOP Classes Only• Study/Root Level Queries Only• Single Study at a time
• Does not support:– Patient Level Retrieval– Series Level Retrieval
• Must be configured on Server (GW) and Client
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Moving studies in VistA Imaging Moving studies in VistA Imaging
• Manual Send from DICOM Gateway(Known as the “Manual PUSH” model)
• Clinical user request a Technical user to send study to DICOM destination
• Technical user enters the study into the DICOM Gateway
• The DICOM gateway pulls the DICOM objects from the server and builds a queue of DICOM files
• The DICOM Gateway sends the objects to the DICOM destination
• Technical user notifies Clinical user – study ready• Clinical user views study at DICOM destination
• Manual Send from DICOM Gateway(Known as the “Manual PUSH” model)
• Clinical user request a Technical user to send study to DICOM destination
• Technical user enters the study into the DICOM Gateway
• The DICOM gateway pulls the DICOM objects from the server and builds a queue of DICOM files
• The DICOM Gateway sends the objects to the DICOM destination
• Technical user notifies Clinical user – study ready• Clinical user views study at DICOM destination
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Moving studies in VistA Imaging Moving studies in VistA Imaging
• Routing Processor on the DICOM Gateway(Known as the “Automatic PUSH” model)– DICOM objects are received at the DICOM
gateway through normal daily operations– DICOM Gateway is configured to identify
qualifying studies required by other DICOM destinations
– DICOM Gateway automatically sends qualifying studies to qualified DICOM destination
• Routing Processor on the DICOM Gateway(Known as the “Automatic PUSH” model)– DICOM objects are received at the DICOM
gateway through normal daily operations– DICOM Gateway is configured to identify
qualifying studies required by other DICOM destinations
– DICOM Gateway automatically sends qualifying studies to qualified DICOM destination
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DICOM Query RetrieveDICOM Query Retrieve
Machine to machine interface
User control over Study selection
Real-time data retrieval
Study Level Retrieve Only
Machine to machine interface
User control over Study selection
Real-time data retrieval
Study Level Retrieve Only
DICOM Q/R Process
3D Reconstruction Workstation
Database
DICOM GatewayGet requested Info
Sending Images
Query Request
Images
Get images
Retrieve Request
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Key Functional DifferencesKey Functional Differences
– Manual Send Vs. Query/Retrieve• MS: Requires more than one person to
complete the process• Q/R: Only the Clinical user is needed to
complete the process
– Routing Process Vs. Query/Retrieve• RP: Generates significant network traffic• QR: Only generates necessary network traffic
• RP: Can only send when DICOM object is initially received
• Q/R: Can send DICOM objects anytime
– Manual Send Vs. Query/Retrieve• MS: Requires more than one person to
complete the process• Q/R: Only the Clinical user is needed to
complete the process
– Routing Process Vs. Query/Retrieve• RP: Generates significant network traffic• QR: Only generates necessary network traffic
• RP: Can only send when DICOM object is initially received
• Q/R: Can send DICOM objects anytime
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Q/R - SecurityQ/R - Security Query/Retrieve uses multiple levels of security
Standard Access and Verify code for communication with VistA
Secondary menu decides which users are allowed to use Query/Retrieve
Table with list of devices that may perform queriesTable with list of devices that may receive images
If the user (study requester) does not have valid Access/Verify codes, the application will shutdown. It will not listen for Query or Retrieve requests.
HIPAALog kept of connections receiving imagesVistA has no knowledge of who may view images
on receiving system or where they may travel. Thus, the VA requires agreement between sites
Query/Retrieve uses multiple levels of securityStandard Access and Verify code for
communication with VistASecondary menu decides which users are allowed
to use Query/RetrieveTable with list of devices that may perform queriesTable with list of devices that may receive images
If the user (study requester) does not have valid Access/Verify codes, the application will shutdown. It will not listen for Query or Retrieve requests.
HIPAALog kept of connections receiving imagesVistA has no knowledge of who may view images
on receiving system or where they may travel. Thus, the VA requires agreement between sites
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Query/Retrieve – Security Query/Retrieve – Security
• Patient Safety:– Must have Business Agreements– Must use VPN (outside VA firewall)– No Object Level encryption– Additional workflow protections for
sensitive patients
• Patient Safety:– Must have Business Agreements– Must use VPN (outside VA firewall)– No Object Level encryption– Additional workflow protections for
sensitive patients
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SummarySummary
• The DICOM Standard is a framework• The DICOM Standard is constantly
evolving and being updated• DICOM Q/R is part of the DICOM
Standard• For DICOM Q/R to work successfully,
both the SCP and the SCU must be DICOM compliant
• The DICOM Standard is a framework• The DICOM Standard is constantly
evolving and being updated• DICOM Q/R is part of the DICOM
Standard• For DICOM Q/R to work successfully,
both the SCP and the SCU must be DICOM compliant
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SummarySummary
• DICOM Q/R operates differently than a database SQL query
• DICOM Q/R uses 3 DICOM commands– C-FIND– C-MOVE– C-STORE
• DICOM Q/R performs at the Study level
• DICOM Q/R operates in real-time
• DICOM Q/R operates differently than a database SQL query
• DICOM Q/R uses 3 DICOM commands– C-FIND– C-MOVE– C-STORE
• DICOM Q/R performs at the Study level
• DICOM Q/R operates in real-time
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SummarySummary
• Devices using DICOM Q/R– Rad Techs – CT – 3D Reconstruction– Mammo Techs – MG – Digital Mammo
– Mini-PACS– Cardiologists/Dental
– cPACS – Sharing information between VistA Imaging and commercial PACS vendor
• Devices using DICOM Q/R– Rad Techs – CT – 3D Reconstruction– Mammo Techs – MG – Digital Mammo
– Mini-PACS– Cardiologists/Dental
– cPACS – Sharing information between VistA Imaging and commercial PACS vendor
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SummarySummary
• Users of DICOM Q/R– File room staff – CD-burning
– Rad Techs – CT 3D Reconstruction– Mammo Techs – Digital Mammo
– Specialists – Orthopedics/Cardiology
– PACS Administrators
• Users of DICOM Q/R– File room staff – CD-burning
– Rad Techs – CT 3D Reconstruction– Mammo Techs – Digital Mammo
– Specialists – Orthopedics/Cardiology
– PACS Administrators
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SummarySummary
• Query selection criteria are important– Study Instance UID– Patient ID– Accession Number
• Query selection criteria are important– Study Instance UID– Patient ID– Accession Number
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SummarySummary
• DICOM Q/R improves patient care:– Operates in real-time– Operates across geographical
boundaries– Provides the study data to the caregiver,
when they need it, where they need it
• DICOM Q/R improves patient care:– Operates in real-time– Operates across geographical
boundaries– Provides the study data to the caregiver,
when they need it, where they need it
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Upcoming Q/R EventsUpcoming Q/R Events
• Patch 66 – Release date• Patch 116 – In development
– Support for Patch 34• Q/R New SOP Classes
– Incorporate necessary security logging• Audit logging• Patient Safety logging
– Planned release date
• Patch 66 – Release date• Patch 116 – In development
– Support for Patch 34• Q/R New SOP Classes
– Incorporate necessary security logging• Audit logging• Patient Safety logging
– Planned release date
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QuestionsQuestions
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