September 2017 Bjoern.Nolte@siemens.com

Current progress is shown below from the most recent meeting of the DICOM Base Standard (WG-06) and associated official telephone conferences.

WG-06 meets five times a year to do technical review and harmonization of the output from the 31 DICOM Working Groups.

These DICOM supplements add new "chapters" to the standard and the grouped DICOM change proposals, called CPacks or voting packages contain minor tweaks or bug fixes.

Supplement 201 Retire Dose from MPPS was voted final text. This supplement retires the Radiation Dose Module from the Modality Performed Procedure Step SOP Class. Retirement does not require any implementations to stop using them. It does mean DICOM will no longer maintain them.

Transform AIM/DICOM-SR

Sup 200 80% (Letter Ballot)

This Supplement defines patterns for transformation of measurement and annotation information for use-cases related to reporting of quantitative imaging results.

The Annotation and Image Markup (AIM) project defines a UML model and an XML schema for describing the observations that humans or machines make about specific semantic types of information in images: anatomic entities, imaging observations and their characteristics, quantitative imaging features of targets of interest, and other information about targets in images.

AIM information is captured using user-defined lexicons and/or well-defined medical lexicons such as RadLex, UMLS, SNOMED CT®, CPT, ICD-9/10, etc.

Image annotations in AIM have been used for cancer lesion measurements and ROIs for capturing quantitative imaging features, and it is desirable to harmonize this effort with similar capabilities that exist in DICOM, to allow AIM and DICOM systems to interoperate for these use cases.

DICOM PS3.16 defines various templates for different applications. The TID 1500 Measurement Report template describes a generic pattern that is similar to AIM and has been used for the same use cases.

This supplement defines a mapping between compatible components of the AIM model and the DICOM SR TID 1500 Measurement Report applicable to quantitative and categorical description of regions of interest in images.

A discussion produced an updated and improved scope and field section.

The focus of the meeting was the bi-directional mapping between AIM and the SR template.

The supplement was voted to go out for letter ballot voting.

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Multi Energy CT

Sup 188 60% (after Public Comment)

This Supplement extends the CT Image IOD and Enhanced CT Image IOD to support new types of images generated by Multi-energy (ME) CT scanners.

It describes various ME imaging techniques. While different vendors apply different techniques to achieve ME Images, there is large commonality in the generated diagnostic images. It adapts existing attributes of the CT / Enhanced CT IOD to fit ME techniques.

To detect the different X-Ray spectra, Multi-energy (ME) CT imaging uses combinations of different Source(s) and Detector(s) technologies such as current switching X-Ray tubes, spectral detectors, multi-layer detectors, multi-source and detector pairs.

Multi-energy CT data can be reconstructed and processed in different ways to serve a variety of purposes.

  • To differentiate materials that look similar on conventional CT images, e.g., to differentiate Iodine and Calcium in vascular structures or to differentiate vascular structures from adjacent bone.
  • To quantify base materials to accurately define tissues and organs. The intent is to quantify materials, and to extract regions and organs based on their composition.
  • To generate virtual non-contrast images from a contrast-enhanced image rather than having to scan the patient twice.
  • To reduce beam hardening artifacts.
  • To enhance the effect of contrast such as highlighting Iodine and soft tissue.

The multi energy macros have been factored out and put into a separate module (Multi-Energy CT Image).

Public Comments and the resulting revisions were reviewed.

The supplement editor recommended to keep image type value4 along with real world value mapping as value4 is heavily used in the field today. Working group 6 argued that real world value mapping shall be mandatory.

The further discussion concludes that rescale types may be better in part 17.

A walk through of the specific ME attributes took place.

The review will continue toward the goal of Letter Ballot.

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2GenRT C-Arm Treatment

Sup 175 60% (after Public Comment)

This Supplement specifies IODs for Radio Therapy Radiation and Radiation Sets in the areas of C-Arm techniques. A Radiation Set defines a Treatment Fraction as a collection of instances of RT Radiation IODs. Each RT Radiation IOD represent a different treatment modality. This supplement is uses the concepts and model found in supplement 147.

The new IODs supports all current treatment modalities and to be extensible for future modalities and new equipment.

Separate IODs defines specific treatment modalities, these include Tomotherapeutic treatments, C-Arm beams and Robotic beams.

Public Comments and the resulting revisions were reviewed.

The scope and field section is updated and the explanation of specific RT terminology is made clearer.

The concept of “Manufacturer’s device class” got positive feedback from working group 6. It was recommended to add this as a general concept to the equipment module. It will be of general use beyond RT scenarios.

The review will continue toward the goal of Letter Ballot.

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2GenNon C-Arm RT

Sup 176 40% (Public Comment)

This supplement introduces IODs for Radio Therapy non-C-Arm treatment devices. This supplement is uses the concepts and model found in supplement 147 and definitions in supplement 175.

The focus in the meeting was on the definitions of code values. The detailed discussion brought several improvements, which were incorporated right away.

The supplement was voted to go out for public comment.

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WebServices ReDoc

Sup 183 60% (after Public Comment)

This supplement re-documents (rewrites) Web Services in DICOM section PS3.18.

The goals of this rewrite are:

  • Bring the Standard into conformance with the latest Web Standards, especially [RFC7230 – 7234], and [RFC3986 – 3987].
  • Use the Augmented Backus-Naur Form (ABNF) defined in [RFC5234] and [RFC7405] to specify the syntax of request and response messages.
  • Use standard terminology throughout the standard.
  • Use a standard format for documenting services and transactions.
  • Clarify ambiguities and underspecified aspects of the Standard using the CP process.

The most important aspect of the re-documentation is to avoid changes in semantics. Errors, ambiguities, and underspecified aspects of the existing standard are out of scope and handled with change proposals to the current standard.

There was no presentation or discussion during the meeting. The time slots were used for "Thumbnails for Web" and other topics.

The review will continue toward the goal of Letter Ballot.

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Thumbnails for Web

Sup 203 40% (Public Comment)

This supplement affects Part 18 of the DICOM standard. It is based on the re-documentation in Supplement 183, especially section 11.4.

This supplement defines a Thumbnail resource on the WADO-RS study, series, and instance resources in the DICOM RESTful web services standard. This supplement provides a simple way to retrieve a representative image of a study, series, or instance.

This transaction returns an image for the parent resource that reflects the content of the resource. The primary use cases for this service are: 1) to provide Thumbnails to image viewers or 2) to provide Thumbnails to EMR/EHRs, e.g., as referenced from FHIR Imaging Study resources, in a simple and straightforward manner. An example Thumbnail resource would be: https://<DICOMweb endpoint>/studies/1.2.423432.1343223/thumbnail

The main part of the review was to discuss and walk through the closed and open issues section.

The supplement was voted to go out for public comment.

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TLS Security Profiles

Sup 204 40% (Public Comment)

Two new Secure Connection profiles are added to make DICOM consistent with the latest RFCs and best practices for TLS security. These are:

  • A Best Practices TLS Profile that requires compliance with the IETF BCP 195 Recommendations for Secure Use of Transport Layer Security (TLS) and Datagram Transport Layer Security (DTLS). This profile requires that TLS negotiation start with the strong security protection parameters, and allows progressive negotiation of weaker protection down to a minimum protection limit.
  • A Non Downgrading Best Practices TLS Profile that does not permit negotiation of weaker protections. This profile will refuse a connection that is not the initial strong level of protection.

Both the old Basic TLS Secure Transport Connection Profile and the old AES TLS Secure Transport Connection Profile are retired. The methods for breaking the old profiles are well known. The Internet Engineering Task Force (IETF) strongly recommends the updates introduced with this supplement.

The scope and field section was presented and improvements were incorporated during the discussion.

It was suggested to improve the general motivation and context around use cases for this supplement.

The supplement was voted to go out for public comment.

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Realtime Video

Sup 202 20% (First Read)

This Supplement describes a new DICOM Service for the transport of real-time video and associated medical data.

The Real-Time Video Service supports interoperable devices inside the Operating Room and beyond, enabling a better management of imaging information.

Professional video (e.g., TV studios) equipment providers and users have defined a new standardized approach for conveying video and associated information (audio, ancillary data, metadata…) enabling the deployment of equipment in a distributed way (vs. peer-to-peer).

This supplement defines an IP-based new DICOM Service for the transport of real-time video including quality compatible with the communication inside the operating room (OR).

The SMPTE ST 2110 suite, elaborated on the Technical Recommendation TR03 originated by the VSF (Video Services Forum) is the technical platform.

This supplement defines mechanisms to specify medical metadata to follow in the stream of the video signal.

The format of recording is out of the scope of the supplement, as well as the way of replaying the recorded videos. The supplement covers a method for feeding the recorder with the synchronized videos and associated metadata.

Among going through the new open issues a longer debate on the distinction between medical archives and video recording storage in general occurred.

To illustrate typical use of this supplement typical surgeon use cases were presented.

The meeting members discussed further specific important aspects:

  • Time Precision, especially sub micro seconds
  • Time alignment between real time video and caching of frames from xray CCDs
  • Precision Time Protocol

The specific art of linking the video stream into the DICOM object proved to be an interesting topic, especially the question of transporting the payload within or outside of the DICOM object. There was no concluding decision.

Around attribute details on patient, study, series and instance level necessary for real time video, it was suggested to work this out in more detail.

The review of the draft supplement will continue work up to public comment.

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3D Printing

Sup 205 20% (First Read)

This supplement adds a new DICOM IOD to encapsulate Stereolithography (STL) 3D model file formats.

This allows 3D manufacturing models to be exchanged between various types of equipment using DICOM messages. This adds the ability to store, query and retrieve 3D models as DICOM objects.

3D model files are a type of document that contains geometric instructions to create physical objects by a 3D printer or milling machine.

To exchange these 3D models in an efficient manner in an imaging environment, especially as part of patient care planning and the patient’s imaging record, it is useful to be able to “wrap” these model documents in a DICOM container.

This supplement only supports the binary encoding of STL for DICOM encapsulation.

This was a first reading of the Supplement.

With the help of the overview presentation slides the main use cases were illustrated. They were to create, review, update and print 3D manufacturing models in the form of encapsulated STL format.

Different options when using encapsulated MIME for this supplement were illustrated and discussed.

In a further discussion, working group 6 advised against supporting preview and real model distinctions. This would make the supplement unnecessary complex.

The review of the draft supplement will continue to work up to public comment.

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View overview »

CPack 92

WG-06 approved Final Text in September 2017

1629 Add Identical Documents Sequence to the Encapsulated Document Module 1633 Enhance Specification of Range Matching 1635 Add Isocenter Reference System to RDSR 1644 Correct conditions for Selected Segmental Ophthalmic Axial Length Sequence 1652 Update DICOM to reflect changes in IHTSDO SNOMED CT-DICOM Subset for JAN 2017 INT Release 1657 Consolidate Brachytherapy Applicator Geometry Definitions 1658 Dose Reference Beam Dose Verification 1660 Dose Measurement Type in RTSTRUCT 1664 Add Progress Parameters in UPS Progress Module 1675 Add Retain Institution Identity option to Basic Application Level Confidentiality Profile 1676 Remove duplicate anatomy information in irradiation event data in RDSR 1677 Do not include Modifying Device Manufacturer in Confidentiality Profile Attributes 1678 Use of JPEG Family Transfer Syntaxes rather than RLE for YBR_FULL 1679 Add compression pressure to mammography, breast tomosynthesis and projection objects 1680 Add teaching file export related codes 1681 Reference to real world value map used during segmentation 1682 Defined PET Units Defined terms by reference to UCUM used in Context Group 1685 Add session, authentication, authorization audit codes 1686 Add UDI code for use in templates 1687 Allow Segmented Color LUT in Color Palette IOD 1688 Correct Note of Table C.7.6.18-1 Cardiac Synchronization Module Attributes 1689 Correct codes and meanings 1690 Query Key for Anatomic Regions in Study 1691 Add more standard Body Part Examined Defined Terms 1692 Add more statistical multidimensional image component semantics 1693 Add study longitudinal temporal offset from event for clinical trials 1694 Match Segmentation Property Categories with specific Context Group 1695 Add laterality requirement information to anatomical concepts 1696 Clarify condition for Repetition Time (0018,0080) 1697 More structure of rather than entire SNOMED anatomical concepts

CPack 93

Current set for November 2017 Final Text.

CPack 94 candidates

Current candidates for final text in January 2018
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