1 rsna/ ihe 2003 dicom, a second generation image standard for mr, ct and x-ray angio: large data...
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RSNA/ IHE 2003RSNA/ IHE 2003
DICOM, a second generation image standard DICOM, a second generation image standard for MR, CT and X-Ray Angio: large data sets for MR, CT and X-Ray Angio: large data sets
and new applications.and new applications.
Tuesday, December 2nd, 200308:45-09:30
InfoRad / IHE Classroom
RSNA
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Agenda
• Enhanced MR and Enhanced CTEnhanced MR and Enhanced CT
• Enhanced XAEnhanced XA
• Implementation PlanImplementation Plan
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Advances in DICOM will Advances in DICOM will Enhance the clinical operation of Enhance the clinical operation of
MR and CTMR and CT
Kees Verduin, Philips Medical Systems
Chair DICOM WG16
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Presentation outlinePresentation outline
• The new MR StandardThe new MR Standard
• The clinical examples of its benefitsThe clinical examples of its benefits
• CT CT
• Roadmap for effective implementation Roadmap for effective implementation
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What is new ?What is new ?
Three new object definitionsThree new object definitions:
– Enhanced MR Image
– MR Spectroscopy
– Raw Data
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A new set of DICOM MR objectsA new set of DICOM MR objects
Not this time:Not this time:
the new Enhanced MR Image object serves the whole range of DICOM users: – from the modality specialist – to the user of a simple viewer in the same way.
So…. what is so exiting about it?So…. what is so exiting about it?
A new object, as such, is not great news.
8Multi-stack
Color
Spectroscopy
Dimensions
Multi-frame
Real World Values
Raw Data
A new MR Standard A new MR Standard (Supplement 49)(Supplement 49)
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The basics of Supplement 49The basics of Supplement 49
• Support of newest applications by New attributes• Less ambiguity through Stricter definitions and rules• Clear relationships through Reference mechanism• Header size reduction through Multi-frame technique• Context information from Image Type and Dimensions• File size flexibility through Concatenations• Functional images with Real World Values • Functional images with Palette Color LUT information
ALL these improve InteroperabilityALL these improve Interoperability
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What is really new ?What is really new ?
• Multi-Frame module with its Shared and Non-Shared header parts
• Dimensions and Dimension Organizations• Coded Object relationships
All these provide CONTEXT INFORMATION !
• Further: – Real World Values– Grayscale images with Color information
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The Multi-frame propertiesThe Multi-frame properties
• Whenever possible, all images of a scan-series shall become frames in one object.
• What is common to all frames, shall not be repeated: Elements that do not change vs. elements that change.
These have a different place in the object header.
• Related elements are defined in functional groups.
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From Single Image to Multi-frameFrom Single Image to Multi-frameN Objects, N Headers
Pixel data (not to scale)Non-Shared (per-frame) HeaderShared Header
N Frames, One Header
HEADER SIZE REDUCTION = less MB, faster transfer
KV
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From Single-frame to MultiFrameFrom Single-frame to MultiFrameN Objects, N Headers
N Frames, One Header
Pixel data (not to scale)Dimension data (not to scale)Per-frame headerFixed Header
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Multi-Frame not only for MR!Multi-Frame not only for MR!
The Enhanced MR Image and
MR Spectroscopy objects
have a multi- frame structure that is
also useful for adoption by other modalitiesalso useful for adoption by other modalities.
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DimensionsDimensionsMR images can have many attributes that change from MR images can have many attributes that change from
frame to frame.frame to frame.• When such a change in an attribute is fundamental
for the object, this data element can be structured by the creator as part of the Dimension ModuleDimension Module.
• It supplies the Context Information required for a specialized workstation.
• It also provides an explicit display ordering for the frames in the MR object, that can be used by viewing systems without specific MR application knowledge.
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Object RelationshipsObject Relationships
Image
PriorImage
Spectro-scopy
RawData
0 -n
0-n
Source ImageSequence for derivedimages
Ref. Image Sequencerequired if planned onprior images
0 - n0 - n
Ref. ImageSequencerequired if plannedon prior images
Ref. Raw DataSequence
Ref. Image SequenceOnly if image type isMETABOLITE MAP
0-n
Ref. Raw DataSequence
Source Image Sequencefor derived spectroscopydata
Ref. Image Sequencerequired if planned onprior spectroscopy data
0 - n PriorSpectro-
scopy
Ref. Image Sequence if planned onprior image
0-n
Referenced Image Sequence Source Image Sequence
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Clinical ExamplesClinical Examples
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Diffusion ImagingDiffusion Imaging
“Diffusion b-values” from 0 to 8000 and an ADC image
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Diffusion Tensor Imaging dataDiffusion Tensor Imaging data
Reconstructed Fiber Maps in the colors as seen by the creator
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MR Perfusion ImagingMR Perfusion Imagingtime
non perfused stroke area
Sig
nal
delayed perfusion
time-to-peak map
Real World Value Slope (0040,9225)
Real World Value Intercept
(0040,9224)
RW values
Sto
red
va
lues
Quantitative data with Real World Values
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Cardiac Cine LoopsCardiac Cine Loops
Enables automatic multi-slice / multi-phase display, even for standard workstations
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Total body ImagingTotal body Imaging
Display the correct image at the correct spot using Stacks and In-stack positions
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3
4
1 2 3 54
2
5
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Functional Brain ImagingFunctional Brain Imaging
• 10-60 slices• all slices measured
in one TR• repeated 100-1000
times to get sufficient signal
• leading to > 60,000 images in one object
Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module
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Relative NAA peak-height
Ratio ofCholine andCreatinine peaks
Spectroscopy ImagingSpectroscopy Imaging
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Spectroscopy RelationsSpectroscopy Relations
Relation:MR Image
Metabolite map
Ratio ofCholine andCreatinine peaks
Relative NAA peak-height
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Supplement 58 Enhanced CTSupplement 58 Enhanced CT
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Supplement 58 Enhanced CTSupplement 58 Enhanced CT
New applications such as – cardiac CT, cardiac CT, – gated studies, gated studies, – perfusion CT, perfusion CT, – CT fluoroscopy, CT fluoroscopy, – contrast tracking and contrast tracking and – post-processing post-processing (e.g. lung cancer screening, colonography);(e.g. lung cancer screening, colonography);
are not supported by the current standard. Not only are technique attributes insufficient, but also, the organization of
increasingly large datasets as single-frame objects is awkward, and limitations of the existing definitions of spatial and temporal attributes are apparent.
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DICOM Header InformationDICOM Header Information• Restrictive handling of parameters to ensure interoperability;• Detailed description of parameters needed, e.g.:
– meaning of table position, – image flavour and image type definition,– acquisition type– device information
• Exposure information and X ray details• Bolus application included• Synchronisation model, e.g. ECG, Respiratory• Precondition is Soft Copy Presentation• Handling of palette colour
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Geometry of CT Acquisition System Geometry of CT Acquisition System
Data Collection Diameter
Distance Source to Data Collection Center
Scan Field
Detector System
Scan Angle = 0 Positive in CW direction
Distance Source to Detector
+ -
Gantry Tilt
Reconstruction Target (width)
Reconstruction Target (height)
X-Ray Source
Data Collection Center
Reconstruction Target Center x y z
Reconstruction Diameter
Shaded area is image pixel data
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CT Multi-frameCT Multi-frame
• The CT Multi-frame solution addresses the same data-explosion issues as for MR.
• Multi-detector CTMulti-detector CT generates large volumes of images that need to be provided with sufficient and adequate context information.
• Multi-frame solutions may provide more interoperability for navigation and processing.
• But, 3D processing requires more than a Multi-frame structure.
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Multi-modality - Multi-frame
• Implementations for processing of the generated volumetric data will largely benefit from multi-modality implementations of the multi-frame concept.
• Common structures may lead to common architecture, which in turn will speed up the implementations.
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Implementation RoadmapImplementation Roadmap
Who should be the first ?Who should be the first ?
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The timing dilemma for the The timing dilemma for the Enhanced MR/CT objectsEnhanced MR/CT objects
• For the MR / CT vendorsFor the MR / CT vendors:– Why implement it, while nobody is ready to
use it?
• For the Workstation vendors:For the Workstation vendors:– Why implement it, when no one is creating it?
• For the PACS vendorsFor the PACS vendors:– Support it, but how to deal with the mix of
workstations that can yes/no receive it ?
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MR/CTMR/CT
ArchiveArchive
WorkstationWorkstation
NegotiateNegotiateNegotiateNegotiate
The negotiation scenarioThe negotiation scenarioDecide to Decide to
send New object send New object or send Old object or send Old object
(depending on hospital workflow)(depending on hospital workflow)
Negotiate Decide to Decide to send Old objectsend Old object
Decide to send old object (if available)
Or Cancel
Supports Enhanced SOP Class
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When will implementationWhen will implementation be required ? be required ?
• As soon as stability is proven.• As soon as the object definition is tested• As soon as resulting changes are implemented
in the standard.
• Or…..
So, pacing may be neededSo, pacing may be needed
As soon as possible!As soon as possible!
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NEMA Members are funding NEMA Members are funding a Demonstration & Test Toola Demonstration & Test Tool
PurposePurpose:• Prove that implementation is possible• Prove the multi-frame header construction• Prove the use of dimensions• Provide a test tool for vendors and other
implementers• Validate implemented objects
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NEMA Demonstration &Test-toolNEMA Demonstration &Test-tool
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Tool availabilityTool availability
• The tool is available to the funding participants
• It is currently under test
• The tool will become available in the public domain in 2003
But…No need to wait with implementation
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Collective support is neededCollective support is needed
The benefits of Supplements 49 and 58 as The benefits of Supplements 49 and 58 as described in this presentation will described in this presentation will onlyonly be be visible if and whenvisible if and when:: – MR scanners (creators)– DICOM workstations (receivers)– PACS systems (intermediaries)
will collectively support the newwill collectively support the new MR and CT DICOM objects MR and CT DICOM objects.
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• Vendors of Workstations / PACS need to prepare for implementation:
What should be done? What should be done?
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• Vendors of Workstations / PACS need to prepare for implementation:
– Prepare the color pipeline
What should be done? What should be done?
116
Functional Color on Anatomic Grayscale Images
....
Palette Color
Number of
entries
Range of Stored
Values to be mapped to grayscale
Range of Stored
Values to be mapped to
color
R G B
Largest Monochrome Pixel Value
ModalityLUT
Color Display
Mapped to gray level RGB values by display deviceVOI
LUTP-
LUT
+
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• Vendors of Workstations / PACS need to prepare for implementation:
– Prepare the color pipeline– Prepare your databases for large objects
What should be done? What should be done?
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Functional Color on Anatomic Grayscale Images
....
Palette Color
Number of
entries
Range of Stored
Values to be mapped to grayscale
Range of Stored
Values to be mapped to
color
R G B
Largest Monochrome Pixel Value
ModalityLUT
Color Display
Mapped to gray level RGB values by display deviceVOI
LUTP-
LUT
+
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Concatenations
• An object may be split up into two or more SOP Instances, using the same concatenation UID
Legend:
Pixel data (not on scale)
Dimension data (not on scale)
Per-frame header
Fixed Header
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• Vendors of Workstations / PACS need to prepare for implementation:
– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI
What should be done? What should be done?
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Functional Color on Anatomic Grayscale Images
....
Palette Color
Number of
entries
Range of Stored
Values to be mapped to grayscale
Range of Stored
Values to be mapped to
color
R G B
Largest Monochrome Pixel Value
ModalityLUT
Color Display
Mapped to gray level RGB values by display deviceVOI
LUTP-
LUT
+
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Concatenations
• An object may be split up into two or more SOP Instances, using the same concatenation UID
Legend:
Pixel data (not on scale)
Dimension data (not on scale)
Per-frame header
Fixed Header
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Real World Values
• Relates the pixel value to the actual value and unit it represents (e.g., velocity in mm/sec)
Value Unit
StoredValues
RealValueLUT
VOILUT
PLUT Display
Real worldvalue
Modality
LUT
MeasurementUnits CodeSequence
(0040,08EA)
Real WorldValue LUT
Data(0040,9212)
Real WorldValue Intercept
and Slopeattributes
or
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• Vendors of Workstations / PACS need to prepare for implementation:
– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI – Prepare for Dimensions
and Dimension Organizations
What should be done? What should be done?
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Real World Values
• Relates the pixel value to the actual value and unit it represents (e.g., velocity in mm/sec)
Value Unit
StoredValues
RealValueLUT
VOILUT
PLUT Display
Real worldvalue
Modality
LUT
MeasurementUnits CodeSequence
(0040,08EA)
Real WorldValue LUT
Data(0040,9212)
Real WorldValue Intercept
and Slopeattributes
or
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Functional Color on Anatomic Grayscale Images
....
Palette Color
Number of
entries
Range of Stored
Values to be mapped to grayscale
Range of Stored
Values to be mapped to
color
R G B
Largest Monochrome Pixel Value
ModalityLUT
Color Display
Mapped to gray level RGB values by display deviceVOI
LUTP-
LUT
+
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Concatenations
• An object may be split up into two or more SOP Instances, using the same concatenation UID
Legend:
Pixel data (not on scale)
Dimension data (not on scale)
Per-frame header
Fixed Header
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Multi Stack
Stack ID3
Frame Number1 - 5
Frame Number6-10
Frame Number11-15
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1In-Stack Position
Stack ID2
Stack ID1
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32
1In-Stack Position
54
32
1In-Stack Position
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• Vendors of Workstations / PACS need to prepare for implementation:
– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI– Prepare for Dimensions
and Dimension Organizations
What should be done? What should be done?
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Real World Values
• Relates the pixel value to the actual value and unit it represents (e.g., velocity in mm/sec)
Value Unit
StoredValues
RealValueLUT
VOILUT
PLUT Display
Real worldvalue
Modality
LUT
MeasurementUnits CodeSequence
(0040,08EA)
Real WorldValue LUT
Data(0040,9212)
Real WorldValue Intercept
and Slopeattributes
or
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Functional Color on Anatomic Grayscale Images
....
Palette Color
Number of
entries
Range of Stored
Values to be mapped to grayscale
Range of Stored
Values to be mapped to
color
R G B
Largest Monochrome Pixel Value
ModalityLUT
Color Display
Mapped to gray level RGB values by display deviceVOI
LUTP-
LUT
+
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Concatenations
• An object may be split up into two or more SOP Instances, using the same concatenation UID
Legend:
Pixel data (not on scale)
Dimension data (not on scale)
Per-frame header
Fixed Header
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Multi Stack
Stack ID3
Frame Number1 - 5
Frame Number6-10
Frame Number11-15
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1In-Stack Position
Stack ID2
Stack ID1
54
32
1In-Stack Position
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32
1In-Stack Position
BH
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SummarySummary
• The New DICOM MR and CT Objects:The New DICOM MR and CT Objects:
– will enhance interoperability
– will increase cross system functionality
– will reduce transfer time
• Success requires also action by Workstation Success requires also action by Workstation and PACS implementers.and PACS implementers.
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Further InformationFurther InformationMore in-depth discussions and presentations about:• Relationships between images • Concatenations• Dimension Organization• Real World Value mapping• Extended Image Type• Color Mappingcan be found at :http://medical.nema.org/dicom/presents.html
A new CT Standard
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Acknowledgement and copyrightAcknowledgement and copyright
• Images for this presentation were provided by:– GE Medical Systems
– Philips Medical Systems
– Siemens Medical Systems
• The slides of this presentation may be quoted if reference and credit to DICOM WG-16 is properly indicated
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Thank you for your attentionThank you for your attention
Now over to X-rays…..
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A Glimpse at the emerging A Glimpse at the emerging Enhanced XA/XRF ObjectEnhanced XA/XRF Object
(DICOM Supplement 83)(DICOM Supplement 83)
Heinz Blendinger, Siemens Medical Solutions
Chair DICOM WG-02
Presented by Rainer Thieme, Siemens Medical Solutions
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Presentation outlinePresentation outline
• The emerging XA/XRF StandardThe emerging XA/XRF Standard– Difference to other Enhanced IODsDifference to other Enhanced IODs– Clinical Benefit of Enhanced XAClinical Benefit of Enhanced XA
• Call for ParticipationCall for Participation
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The add-ons of Supplement 83The add-ons of Supplement 83• New Functional groups (not complete)
– Projection Pixel Calibration Macro
– Table Position Macro
– X-Ray Collimator Macro
– Reversed Modality LUT Macro
• Multi-frame Presentation Module
• Enhanced XA/XRF Image Module Attributes
ALL these improve Functionality & InteroperabilityALL these improve Functionality & Interoperability
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New functionality: an exampleNew functionality: an example
Dimension Module in enhanced XA images.Dimension Module in enhanced XA images.
• Rotational Angiography examination can include the cardiac cycle as structural information.
• Dimensions can be used to group multi-frame image frames taken at identical positions of a stepping table device.
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ECG
ECG-gated Cardiac Application
#Px
D
11 2
2
3
3
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New attributes
• Simple Filter Factor
• DSA Window Values
• Dedicated Reversed Modality DeLog LUT
• Dedicated Sequence to Reference other plane for Biplan
• Acquisition Context attributes
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Multi-Frame Presentation ModuleEdge Enhancement
Not the same, but “closer”
XA Object: private encodingReason: Hard to “standardize” Algorithms
Approximation XA enhanced:Attribute for “applied percentage”
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Dedicated Calibration Module
• Attributes to describe iso-centric geometry
• Include Table plane in geometric context
• Object plane relative to table
58UKK 2001
(TVP-1/2 TD)
°Rot
°Ang
#Px
D
D = # Px * Px * SOD / SID
SOD = ISO - (TVP - 1/2 TD) / cos°Rot * cos°Ang
Internal Calibration for Quantitative AssessmentsInternal Calibration for Quantitative Assessments
=> Practical solution based on user experience
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Supplement 83 RoadmapSupplement 83 Roadmap = Meeting of the WG-02 (green indicates the meetings already hold) = Meeting of the WG-06 (green indicates the meetings already hold)
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2002 2003 2004
Q1 Q2 Q3 Q4
2005
WG-02 writes the draft of the supplement « Enhanced XA ».
Re-activation of the WG-02. Identify list of requirements of the new XA
WG-06 reviews the draft
WG-02 updates the supplement
Public comments
WG-02 updates the supplement
Supplement Draft
Supplement issued for
public comments
Supplement In letter ballot
Supplement In final text
WG-06 includes the supplement in the standard
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Further workFurther work
• Differentiation on “processed” or “original” Differentiation on “processed” or “original” contents needed?contents needed?– Super SOP Class and SOP Classes for particular useSuper SOP Class and SOP Classes for particular use– ““For Processing” or “For Presentation” SOP ClassesFor Processing” or “For Presentation” SOP Classes
• ““Cut-line” between shared and non-shared Cut-line” between shared and non-shared contentscontents
• Further new attributes to support new Further new attributes to support new applications or procedures.applications or procedures.
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SummarySummary• The New DICOM The New DICOM enhancedenhanced XA/XRF Objects: XA/XRF Objects:
– will enhance interoperability – will increase cross system functionality– will create platform for new applications
• Success requires more clinical inputSuccess requires more clinical input
– Use CasesUse Cases– Requirements for new applications and Requirements for new applications and – ProceduresProcedures
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Further Information / ContactsFurther Information / Contacts
Please contact WG-02 chairman
Heinz.Blendinger@siemens.com
Supplement 83 Draft can be found at :
http://dclunie.com/dicom-status/status.html
Next meetings:December 9th and 10th, 2003 in BerlinFebruary 11th and 12th, 2004 at NEMAMay 4th and 5th, 2004 in Europe
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Thank you for your attentionThank you for your attention
Now over to …implementation..
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Introduction of the newIntroduction of the newDICOM MR and CT Enhanced DICOM MR and CT Enhanced
Multi-frame Image StandardMulti-frame Image Standard
Charles Parisot, GE Medical Systems
Chair NEMA DICOM Advancement Committee
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After 10+ years of effective DICOM After 10+ years of effective DICOM connectivity in MRI and CT introducing a connectivity in MRI and CT introducing a new Image Object poses three challenges:new Image Object poses three challenges:
A new CT Standard
–Avoid user confusionInform about the benefits of the enhanced multi-frame image Inform about the benefits of the enhanced multi-frame image standard and need to manage coexistence.standard and need to manage coexistence.
–Synch-up industryFacilitate availability of compatible PACS and Workstations Facilitate availability of compatible PACS and Workstations along with the release of the MRI and CT scanners.along with the release of the MRI and CT scanners.
–Reduce incompatibilitiesProvide to interested vendors testing tools and opportunities Provide to interested vendors testing tools and opportunities to quickly retire misinterpretations or bugs.to quickly retire misinterpretations or bugs.
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NEMA Advancement CommitteeNEMA Advancement Committee• Foster industry cooperation to facilitate the adoption Foster industry cooperation to facilitate the adoption
of new DICOM capabilitiesof new DICOM capabilities
• Members are Members are NEMA Medical Imaging InformaticsNEMA Medical Imaging Informatics Section members, plus other vendors & users.Section members, plus other vendors & users.
• Establish a voluntary plan and process to assist in Establish a voluntary plan and process to assist in introduction. Does not dictate product release.introduction. Does not dictate product release.
• Has done this successfully for 10 years.Has done this successfully for 10 years.
• Independent from the DICOM Standards Committee. Independent from the DICOM Standards Committee. Cooperation with COCIR in Europe and JIRA in Cooperation with COCIR in Europe and JIRA in Japan.Japan.
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What is the proposed plan ?What is the proposed plan ?Release test images and test viewer:Release test images and test viewer:
– Done in 2003 for Enhanced MR Image– To be planned for Enhanced CT: Oct 2004
A testing event followed by an education eventA testing event followed by an education event– Commitment by interested vendors 2Q 2004– Plan testing event for 2Q 2005 – Plan education and promotion event for 2Q 2005– Finalize education and promotion at RSNA 2005.
Reach Industry Agreement on plan Reach Industry Agreement on plan by 1Q 2004by 1Q 2004
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How can vendors get involved ?How can vendors get involved ?
To get involved in the proposed NEMA InitiativeTo get involved in the proposed NEMA Initiative
Contact Stephen VastaghContact Stephen Vastaghat NEMA: at NEMA: ste_vastagh@nema.org
Interested Users are WelcomeInterested Users are Welcome
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