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HL7 May 2001 Working Group Meeting
DICOM Tutorial
Introduction to DICOMIntroduction to DICOM
May 8, 2001, 9:00 – 10:30 a.m.
Fred M. Behlen, Ph.D.
Kurt Rossmann Laboratoriesfor Radiologic Image ResearchDepartment of Radiology
DICOM Standard• ACR-NEMA 1.0
– Published as NEMA PS3-1985
• ACR-NEMA 2.0– Published as NEMA PS-1988
• Digital Imaging and Communications in Medicine (DICOM) 3.0– Published as NEMA PS3-1993(94?), and
(almost) annual updates thereafter.PS3-2000 now available.
DiagnosticImaging
DICOM Scope
PatientBedside
Monitoring
Administrative HIS/RIS
. . .
Lab Data
. . .
Medical Informatics
Scope ofDICOM
Scope of standards
Information Repre- Transfer Signalingmodel sentation mech- method
syntax anism
DICOM X X XHL7 X X XXML XCORBA X XHTTP, FTP XTCP/IP, Ethernet X
DICOM Standard
“The DICOM Standard is structured as a multi‑part document using the guidelines established in the following document: — ISO/IEC Directives, 1989 Part 3: Drafting and Presentation of International Standards.”
DICOM StandardPS 3.1: Introduction and Overview
PS 3.2: ConformancePS 3.3: Information Object Definitions PS 3.4: Service Class Specifications PS 3.5: Data Structure and Encoding PS 3.6: Data Dictionary PS 3.7: Message Exchange PS 3.8: Network Communication Support for Message Exchange PS 3.9: Point‑to‑Point Communication Support for Message ExchangePS 3.10: Media Storage and File Format for Data InterchangePS 3.11: Media Storage Application ProfilesPS 3.12: Storage Functions and Media Formats for Data InterchangePS 3.13: Print Management Point-to-Point Communication SupportPS 3.14: Grayscale Standard Display FunctionPS 3.15: Security ProfilesPS 3.16: Content Mapping Resource (2001)
DICOM Supplements PS 3.1:
PS 3.2:PS 3.3:PS 3.4:PS 3.5:PS 3.6:PS 3.7:PS 3.8:PS 3.9:PS 3.10: PS 3.11: PS 3.12: PS 3.13: PS 3.14: PS 3.15:
Introduction
Part 1 changes
…
Part 3changes
…
Part 6 changes
…
…
Balloted Supplement Published Standard
M edical Im aging Application
D ICO M Application Entity
D ICO MUpper layer
protocolfor T CP/IP
DICO MSession/
Transport/Network
(STN)
O SI Association C ontro lService E lem ent (AC SE)
O SI Presentation Kernel
O SI Session Kernel
O SI Transport
O SI N etw ork
TCP
DICO MData Link
IP
LLC
Standard network physical layer(E thernet, FDDI, ISDN, et cetera)
D ICO MPhysical(50-pin)
O SI UpperLayerServiceboundary
Point-to-pointenvironm ent
Networked environm ent
N ote: The D ICO M STN supports a subset of the O SI upper layer serv ice
PS 3.1: Introduction and Overview
Part 7: Message Exchange
PS 3.3:Information
Object Definitions
PS 3.6:Data
Dictionary
PS 3.5: Data Structureand Semantics
PS 3.8: NetworkCommunication Supportfor Message Exchange
TCP/IP OSI
PS 3.9: Point toPoint Communication
Support forMessage Exchange
PS 3.4: Service Class Specifications
PS
3.2
: C
on
form
ance
Conformance
• DICOM Conformance Statement– Format and Content specified in Part 2
– Required for every claimed DICOM implementation
• “If there’s no Conformance Statement, it’s not DICOM.”
– Intended audience for Conformance Statement is engineer, not customer.
Vendor ASTANDARD
Customer
conformance
Vendor Bconformance
interoperation
contract
contractscope
Vendor ASTANDARD
Customer
conformance
Vendor Bconformance
interoperationcontract B
contract A
contract Ascope
contract Bscope
(voila!)
Key Sections
• PS 3.3: Information Object Definitions
• PS 3.4: Service Class Specifications
• PS 3.6: Data Dictionary
DIMSE Services
Composite Normalized
C-STORE N-EVENT-REPORT
C-GET N-GET
C-MOVE N-SET
C-FIND N-ACTION
C-ECHO N-CREATE
N-DELETE
DICOM Application EntityService Classes
- Study Mgt- Patient Image Mgt- Results Mgt
- Storage- Print- Query/Retrieve
Information ObjectsNormalized- Patient- Study- Visit
Composite- CT image- MR image- CR image
DICOM Message Service Element(DIMSE)
(DIMSE-C and DIMSE-N Operations and Notifications)
Upper LayerAssociationServices (1)
Upper Layer Presentation Data Service(see figure 6.1-1)
(1) This figure expands upon figure 6.1-1 by showing that the AssociationServices specified in Part 8 are formally part of the Application Entity.
Part 4
Part 3
Part 7
Part 8andPart 9
AssociationNegotiation
PS 3.3: Information Object Definitions
• Computed Radiography Image • Computed Tomography Image • Magnetic Resonance Image • Nuclear Medicine Image • Ultrasound Image • Ultrasound Multi-Frame Image • Secondary Capture Image • X-Ray Angiographic Image • X-Ray RF Image • Positron Emission Tomography Image • Hardcopy Grayscale Image • Hardcopy Color Image • Digital X-Ray Image • Digital Mammography X-Ray Image • Digital Intra-Oral X-Ray Image
PS 3.3: Information Object Definitions
• Visible Light Image – VL Endoscopic Image – VL Microscopic Image – VL Slide-Coordinates Microscopic Image – VL Photographic Image
• Standalone Overlay • Standalone Curve • Standalone Pet Curve • Stored Print • Standalone Modality Lut • Standalone VOI Lut • Grayscale Softcopy Presentation State • Basic Study Descriptor
PS 3.3: Information Object Definitions
• RT Image • RT Dose • RT Structure Set • RT Plan • RT Beams Treatment Record • RT Brachytherapy Treatment Record • RT Treatment Summary Record • Waveform
– Basic Voice Audio – 12-Lead Electrocardiogram – General Electrocardiogram – Ambulatory Electrocardiogram – Hemodynamic – Basic Cardiac Electrophysiology
• Structured Report Document – Basic Text SR – Enhanced SR– Comprehensive SR
PS 3.4: Service Class Specifications
• Verification• Storage• Query/Retrieve• Study Content Notification• Patient Management• Study Management• Results Management• Print Management• Media Storage• Storage Commitment• Basic Worklist Management• Queue Management• Grayscale Softcopy Presentation State Storage• Structured Reporting Storage
Service-Object Pairs (SOPs)
X X
X X X X X X X X X X
X
X X
X
X X
X
X X
X X
X
Ser
vice
sInformation Objects
STORE
PS 3.5: Data Structure and Encoding
• Presentation Context– Abstract Syntax
• Endianism– Big Endian– Little Endian
• Value Representation– Implicit VR– Explicit VR
– Transfer Syntax• Uncompressed• Compressed modes
Data Set and Data Elements
Data Set
Data Element
Tag Value Length Value Field
optional field - dependent on negotiated Transfer Syntax
VR
Data Elem. Data Elem.Data Elem. Data Elem.
order of transmission
PS 3.3 Annex A IOD ModulesCT IMAGE IOD MODULES
IE Module Reference Usage Patient Patient C.7.1.1 M Study General Study C.7.2.1 M Patient Study C.7.2.2 U Series General Series C.7.3.1 M Frame of Reference
Frame of Reference C.7.4.1 M
Equipment General Equipment C.7.5.1 M Image General Image C.7.6.1 M Image Plane C.7.6.2 M Image Pixel C.7.6.3 M Contrast/bolus C.7.6.4 C - Required if contrast media
was used in this image CT Image C.8.2.1 M Overlay Plane C.9.2 U VOI LUT C.11.2 U SOP Common C.12.1 M
PS 3.3 Annex C Patient ID
ModulePATIENT IDENTIFICATION MODULE ATTRIBUTES Attribute Name Tag Attribute Description Patient's Name (0010,0010) Patient's full name Patient ID (0010,0020) Primary hospital identification number or code
for the patient Issuer of Patient ID (0010,0021) Name of healthcare provider which issued the
Patient ID Other Patient IDs (0010,1000) Other identification numbers or codes used to
identify the patient Other Patient Names
(0010,1001) Other names used to identify the patient
Patient's Birth Name
(0010,1005) Patient's birth name
Patient's Mother's Birth Name
(0010,1060) Birth name of patient's mother
Medical Record Locator
(0010,1090) An identifier used to find the patient's existing medical record (e.g. film jacket)
PS 3.3 Annex C Pixel ModuleIMAGE PIXEL MODULE ATTRIBUTES
Attribute Name Tag Type Attribute Description Samples per Pixel (0028,0002) 1 Number of samples (planes) in this
image. See C.7.6.3.1.1 for further explanation.
Photometric Interpretation
(0028,0004) 1 Specifies the intended interpretation of the pixel data. See C.7.6.3.1.2 for further explanation.
Rows (0028,0010) 1 Number of rows in the image. Columns (0028,0011) 1 Number of columns in the image Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel
sample. Each sample shall have the same number of bits allocated. See PS 3.5 for further explanation.
Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See PS 3.5 for further explanation.
High Bit (0028,0102) 1 Most significant bit for pixel sample data. Each sample shall have the same high bit. See PS 3.5 for further explanation.
PS 3.3 Annex C Pixel ModuleIMAGE PIXEL MODULE ATTRIBUTES
Attribute Name Tag Type Attribute Description Pixel Representation (0028,0103) 1 Data representation of the pixel
samples. Each sample shall have the same pixel representation. Enumerated Values: 0000H = unsigned integer. 0001H = 2's complement
Pixel Data (7FE0,0010) 1 A data stream of the pixel samples which comprise the Image. See C.7.6.3.1.4 for further explanation.
Planar Configuration (0028,0006) 1C Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See C.7.6.3.1.3 for further explanation.
Pixel Aspect Ratio (0028,0034) 1C Ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. Required if the aspect ratio is not 1\1 and the Image Plane Module is not applicable to this Image. See C.7.6.3.1.7.
Pixel Encoding
Image Plane
Pixel i+1Pixel i
Pixel i+2
Example 1: CT Pixel Cell
Bits Allocated = 16Bits Stored = 12High Bit = 11
Example 2: Hypothetical Pixel Cell
Bits Allocated = 24Bits Stored = 18High Bit = 19
015 1112Pixel SamplePixel Sample
Pixel Sample21923 20 0
PS 3.6: Data Dictionary
• Tag Assignments– [xxxx,xxxx]
– Name (non-canonical)
– Value Representation
– Value Multiplicity
• DICOM-assigned UIDs
• Terminology Mapping Resource Registry
• Registry of Templates
Diagnostic Imaging in the
Patient Care Process• Patient arrives• Physician sees patient, writes order• Patient goes to Imaging Department• Patient is imaged• Radiologist interprets images, writes report• Physician looks at report (and often images)• Physician treats patient based on report• Patient discharged
Imag
ing
Dep
artm
ent
Diagnostic Imaging in the
Patient Care Process Hospital Enterprise
Radiology
Exam context
Results,Images
Exam Context
• Patient identification• Orders• Other clinical information• Scheduling (of some resources)• Financial authorizations
Imaging department obtains from the enterprise:
Patient
Visit
Study
Study ContentNotification
makes has
describes
includes
StudyComponents
Modality PerformedProcedure Steps
Comprisedof
Comprisedof
includes includes contains See Note
Results
contains
Report
LookupTable
StoredPrint
RadiotherapyObjects
1-n
1
0-n
1
1-n
1
1
1-n1
1
1-n
1-n
1-n
1 1 1
0-n
0-n0-n
1-n
0-n
1
0-1
0-n
Series
Frame ofReference
creates
SpatiallyDefines
Equipment
1-n 1-n 1-n
1-n
1-n
0-1
1
Curve
Overlay
0-n
Image
Ammendment
0-n
contains
1
Patient& visit
Study &acquisition
Storeddata
Patient IOD
Visit IOD
Study IOD
Basic StudyDescriptor IOD
references references
describes
references
Study ComponentIOD
Modality PerformedProc. Step IOD
Comprisedof
Comprisedof
references references references See Note
Results IOD
references
Interpretation IODImage IOD
Standalone CurveIOD
Standalone OverlayIOD
Standalone ModalityLUT IOD
Standalone VOI LUTIOD
Stored Print IODSee Figure 7.2b
Radiotherapy IODsSee Figure 7.2c
1-n
1
0-n
1
1-n
1
1
1-n1
1
1-n
1-n
1-n
1 1 1
0-n 0-n
0-n0-n0-n
1-n
0-n
1
0-10-n
Patient& visitIODs
Study &acquisitionIODs
StoreddataIODs
PatientIDdomain^PatientID
Placer OrderPlacer Order Number
Filler OrderFiller Order Number
Requested ProcedureRequested Procedure IDRP Study Instance UID
Performed Procedure StepPerformed Proc. Step UID
SeriesSeries UID
InstanceSOP Instance UID
Scheduled Procedure StepScheduled Proc. Step ID
I-PatientIDdomain^PatientID
I-StudyStudy Instance UID
11-n*
11-n*
10-n
0-n**
0-m**
1
1-n
0-n**
0-m**
1
0-n
11-n
1
1-n
1
0-n
* An Order Placer typically submit a single order (ORM), however, an Order Filler can expand that single order into multiple Requested Procedures. See IHE Y2TF Section 6 for more details.
** See Section 6 for a thorough description of the cardinality relationship options of Modality Performed Procedure Step.
*** The Performed Procedure Step UID is present as the Affected SOP Instance UID.
PatientIDdomain^PatientID
Placer OrderPlacer Order Number
Filler OrderFiller Order Number
Requested ProcedureRequested Procedure IDRP Study Instance UID
Performed Procedure StepPerformed Proc. Step UID
SeriesSeries UID
InstanceSOP Instance UID
Scheduled Procedure StepScheduled Proc. Step ID
I-PatientIDdomain^PatientID
I-StudyStudy Instance UID
11-n*
11-n*
10-n
0-n**
0-m**
1
1-n
0-n**
0-m**
1
0-n
11-n
1
1-n
1
0-n
SR InstanceSOP Instance UID
Results
• Reports
• Images
• Exam status
Imaging department delivers to the enterprise:
http://www.rsna.org/IHEhttp://www.himss.org/IHE
IHE Home Pages
http://medical.nema.org/dicom.html
Committee for the Advancement of DICOMDICOM Resources Pagehttp://www.merge.com/dicom/resources/
DICOM Home Pages
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