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THE DICOM 2013 INTERNATIONAL
CONFERENCE & SEMINAR March 14-16 Bangalore, India
Deploying DICOM Effectively:
Some Assembly Required
Kevin O’Donnell
Toshiba Medical Research Institute - USA, Inc. Sr. R&D Manager,
Pacifica, USA
Co-Chair, DICOM Standards Cmte
Member, WG6, WG10, WG21
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Deploying DICOM Effectively
Primary Topics:
• Planning
• Purchasing
• Installing
• Maintaining
• Troubleshooting
• Studying
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Planning
Hospitals are like children:
March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 3
But in many ways
they are much alike
… and so are clinics, imaging centers, etc.
Each one is unique
Photo by onejen@flickr
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Planning
Own your architecture
• Base it on standards
• Choose the pieces that meet your needs
• Understand the “Big Picture”
• Balance unique needs &
standard benefits
Identify the owner
• Staff, consultant, or long term vendor
• Ongoing initiative; not “One-and-Done”
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Doesn’t it Just Work?
Can I just ask for “DICOM”?
• Yes, if you don’t care what pieces you get
• Pieces can be implemented independently
• Depends on what the product needs to do
Won’t vendors just give me what I need?
• (We try to, but …) your input matters
• DICOM has it ≠ vendors use it (intelligently)
Know what is possible
Ask about your top priorities
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6
IHE Profiles as Models
IHE helps vendors implement & test
functions that span multiple systems
Profiles are implementation guides
• how to use existing standards
• to address a specific problem scenario
Connectathons are test events
• managed testing of Profile implementations
IHE helps users purchase & integrate
multi-system solutions
• list required IHE Profile support in RFPs
www.ihe.net -> User Handbooks
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7
images
stored
patient
information
RIS
examination orders
images
retrieved
HIS
PACS
procedure
scheduledPrefetch any relevant
prior studies
modality
worklist
report
report
Registration
Orders Placed
Orders Filled
Film
Film
Folder Image Manager
& Archive
Film
Lightbox
report Report
Repository
Diagnostic
Workstation
Modality
acquisition
in-progress
acquisition
completed
acquisition
completed
images
printed
Acquisition
Modality
IHE Scheduled Workflow
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IHE Profiles as Models
Other Profiles address:
- Radiation Exposure Monitoring (REM)
- Post-Acquisition Workflow (PAWF)
- Portable Data for Imaging (PDI)
- Cross-enterprise Image Sharing (XDS-I.b)
wiki.ihe.net -> Integration Profiles (Catalog)
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PACS is a Major Catalyst
• When buying a PACS system, you use
DICOM to integrate:
– Modalities (e.g. CT, MRI, X-ray, US, NM, etc.)
– Workstations (3D, CAD, Review, etc.)
– Radiology Information Systems (RIS)
– Printers (color and grayscale)
– Others………
Commonly known by most hospitals March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 9
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Key DICOM Features
• Basic DICOM features: – Send and receive images
– Query and Retrieve from an archive
– Download Patient information to modalities
– Print images
• Not so basic DICOM features: – Reliable storage of images
– Track image acquisition workflow
– Store images as viewed by clinician
– Generate and display reports
– Tag important images
– Others………..
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Only basics commonly known by most hospitals
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Translate Features into
DICOM Requirements
• This is a problem for hospitals that do
not know how to speak “DICOM”
– SOP Classes
– Information Objects
– Service Class User, Service Class Provider
– Storage Commitment
– Presentation State
– Etc.
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Integration Services
• Professional services offered by vendors and
consultants
• Vendors understand their products and can
typically tailor the integration better to their
systems
• Independent consultants typically understand
many products and can typically better employ
best of breed solutions and help with “finger
pointing”
Both types of consulting services can greatly
increase the probability of a successful outcome March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 12
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Mainstream IT
• DICOM uses standard network technology – this skill is very important
• Need to understand – TCP/IP, routers, hubs, switches, cables, subnets
• Archive technology important – RAIDs, Magnetic Tape, Cloud
– How much on-line storage do you need
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Purchasing
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Learn How to Speak “DICOM”
• “Translate” required hospital features into SOP Classes (or IHE Profiles)
Need
“I want my modalities to integrate patient information with my RIS”
Translation
“RIS shall support Modality Worklist Information Model – FIND SOP Class as an SCP”
“Modality shall support Modality Worklist Information Model – FIND SOP Class as an SCU”
OR
“RIS and Modality shall support IHE Scheduled Workflow”
Important education for PACS Administrators March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 15
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DICOM Conformance Statements
• Documents how product implemented DICOM
• Required, Public, often on Web sites
• Well-defined format
• Facilitates comparisons of products
• Detailed information aids a knowledgeable
DICOM person greatly
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DICOM Conformance Statements
• At a minimum, hospitals (PACS administrators) need
to read SOP Class Tables
Compare a product’s SCU table
with another’s SCP table
This Application Entity provides Standard Conformance to the following DICOM V3.0
SOP Classes as an SCU:
SOP Class Name (SCU) SOP Class UID
MR Image Storage 1.2.840.10008.5.1.4.1.1.4
Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7
Modality Worklist Management - FIND 1.2.840.10008.5.1.4.31
Modality Performed Procedure Step 1.2.840.10008.3.1.2.3.3
SOP Class
Name
SOP Classes
as a SCU Unique identifiers
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DICOM Conformance Statements
New DCS format Executive Overview
SOP Classes
User of Service (SCU)
Provider of Service (SCP)
Image Transfer
CT Image Storage
Yes
No
Query/Retrieve
Study Root Information Model
FIND
No
Yes
Study Root Information Model
Move
No
Yes
Workflow Management
Modality Worklist Information
Model - Find
Yes
No
….
Print Management
Basics Grayscale Print Mgt.
Yes
No
….
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Radiology Information System
(RIS)
Provide scheduled patient and exam info to
modalities
• Modality Work-list SCP
Receive and process updates from Modalities
• MPPS SCP
Required
Features
Optional
Features March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 19
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PACS
Receive and store acquired images
• Storage SCP
Respond to queries for patient studies/images
• Query/Retrieve SCP
• Storage SCU
Print images
• Print SCU
Provide conformation of storage
• Storage Commitment SCP
Required
Features
Optional
Features March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 20
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Modalities
Query for Patients and exams to be performed • Modality Work-list SCU
Send acquired images to PACS for storage • Storage SCU
Print acquired images • Print SCU
Query for prior exams • Query/Retrieve SCU
Confirm storage of images on PACS • Storage Commitment SCU
Update RIS on progress of exams • MPPS SCU
Send Radiation Dose information • Dose SR SCU
Required
Features
Optional
Features March 2013 DICOM International Conference & Seminar Deploying DICOM Effectively 21
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Workstations
• Quality Assurance Workstation
– Image Storage SOP Classes (Various) – SCU/SCP
– Study Root Query/Retrieve Information Model – Find – SCU
– Study Root Query/Retrieve Information Model – Move – SCU
– Basic Grayscale and/or Color Print Mgt Meta SOP Class –SCU
– Grayscale Softcopy Presentation State – SCU/SCP
– DICOM SRs (Various) – SCU/SCP
– Others
• Film Digitizer
– Secondary Capture Image Storage – SCU
– Modality Worklist Information Model – Find – SCU
– Storage Commitment Push Model SOP Class – SCU
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DICOM Storage Questions
DICOM Storage – “push” images
• Question for archives, workstations and modalities
PACS Vendors say “We support Storage”
• At a minimum it usually means, CT, X-ray, CR, MR, US,
Secondary Capture (for a PACS)
• But you need to ask, does it include MG (mammo), NM,
PET, Color US, Cardiac Echo (US multi-frame)?
Specific to the modality (e.g. a CT image is NOT a US image)
• Send CT Images – CT Image Storage SOP Class – SCU
• Receive CT Images – CT Image Storage SOP Class - SCP
Image Send
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Query/Retrieve and Print
Query/Retrieve – “pull” images from archive • Question for archives, workstations and some modalities
Many PACS don’t use DICOM with own workstations • Q/R is often only used with 3rd party workstations, such as 3D, NM
workstation, etc.
• Workstation asking query
• Study Root Query/Retrieve Information Model – Find – SCU
• Archive being queried
• Study Root Query/Retrieve Information Model – Find – SCP
Print – one simple question, Black/White (grayscale) and/or Color (RBG) • Modality or Workstation – Basic Grayscale Print Management Meta
SOP Class – SCU
• Printer - Basic Grayscale Print Management Meta SOP Class – SCP
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Storage Commit Questions
Guarantee secure storage of data on archive
Real feature is to manage disk space on modality
• Automatically delete images on modality?
• User interfaces makes deletion easy?
• Modalities do Storage Commitment but do nothing?
• Modality – Storage Commitment Push Model SOP Class – SCU
• Archive - Storage Commitment Push Model SOP Class – SCU
Image Send
Storage Committed
Storage Commit
Request
Archive
Scanner
Difficult for
hospitals to
understand
because they don’t
see the workflow
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IHE Resources
“I’m interested in IHE Profile X. Who does it?”
• Testing Database:
• IHE Connectathons – Comprehensive
• Lists Vendor Names
• http://connectathon-results.ihe.net
• Product Database
• IHE Integration Statements – Voluntary
• Specific Products / Versions
• http://product-registry.ihe.net
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Installing
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Configuration
• DICOM network configuration – AE Title, Port Numbers, IP Address
– Prone to human error; be diligent
• System Specific Details – Procedure Code Lists
– Acquisition Protocols
– User lists
– Etc.
• Be prepared to communicate these details to your vendor before installation
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Acceptance Testing
• Have a plan – Vendors will test some things
– Know what is important to test for you
• Be prepared to communicate these details to your vendor before installation
• There are public tools that can be helpful (See “Tools for DICOM”)
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Maintaining
• Display Calibration – DICOM Greyscale Display Function
• Configuration Evolution – New Procedure Codes
– New Acquisition Protocols
– New User lists
– Etc.
• Software Upgrades – Can be as involved as initial installation
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Troubleshooting
• There are public tools that can be very helpful (See “Tools for DICOM”) – Network sniffers
– DICOM object viewers
– Validators
– DVTK
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SIIM
• Society for Imaging Informatics in Medicine – http://www.siimweb.org/
– Growing set of “Need To Know ePubs”
– Imaging Informatics Professional (IIP)
• Training and Certification
– Practical Imaging Informatics: Foundations and Applications for PACs Professionals
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Author Contacts
Kevin O’Donnell, MASc.
• 706 N. Deerpath Drive,
Vernon Hills, IL 60061
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Thank you for your attention !