MINUTES: DICOM STANDARDS COMMITTEE
PLACE OF MEETING: NEMA HEADQUARTERS
DATES AND TIMES: WEDNESDAY, JUNE 16, 1999
THURSDAY, JUNE 17, 1999
Krishna Anedath Konica Medical Imaging
David Best Eastman Kodak
David Clunie Quintiles Intelligent Imaging Technologies
Emmanuel Cordonnier ETIAM
Tim Cramer Picker International, Inc.
Bernard Hayes Canon Research Center America
David Heaney* ALI Technologies
Janet Keyes LORAD
Makoto Ogoda Fuji Medical Systems USA, Inc.
Charles Parisot GE Medical Systems
Hidenori Shinoda Toshiba
Dwight Simon Merge Technologies Inc.
Kees Smedema Philips Medical Systems
Csaba Titton (Proxy) DeJarnette Research
Nikolaus Wirsz Siemens Medical Systems
Dean Bidgood American College of Radiology
Joel Chabriais Societe Francaise de Radiologie
Brent Dove America Dental Association
Lloyd Hildebrand American Academy of Ophthalmology
Joseph Kvedar + American Academy of Dermatology
Alan Rowberg American College of Radiology
Robert Britain NEMA
Isao Ohbayashi JIRA
Edward Staabs NCI, NIH
Loren Zaremba+ Food and Drug Administration
Alvin Belden Shared Medical Systems Corp.#
Geert Clays AGFA
Keith Klassy Camtronics Medical Systems
Ed Schieffer Sterling Diagnostic Imaging#
Doug Sluis ATL, Inc.
Todd Treiber StorCOMM, Inc.#
John Vengroski Nikon#
Rainer Waedlich IFA Systems Group
Bill Yaeger Infimed, Inc.
# Do not count toward the quorum at meeting
Ulysses Balis College of American Pathologists
Michel Berg American Academy of Neurology
Steven Horii American College of Radiology
Louis Korman American Society for Gastrointestinal Endoscopy
Carolyn Lanham American College of Cardiology#
Johan HC Reiber European Society of Cardiology
Ruediger Simon European Society of Cardiology
#Do not count toward the quorum at meeting
Sun Kim Korean PACS Standard Committee
Laura Sato Canadian Institute for Health Informatics#
# Do not count toward a quorum at the meeting
Jay Gaeta (Speaker phone)+ Merge Technologies
Shun Kabata* Hitachi Medical Co.
Thomas Kennedy* Camtronics Medical Systems
Bisharah Libbus+ NIH
Eric Martin* Picker International
Kathleen Rattell Booze-Allen & Hamilton
Charles Showalter* ACR Staff
David Snavely NEMA Staff/DICOM Comte. Secretary
* Attended Wednesday only + Attended Thursday only
PRESIDING OFFICERS: DR. LLOYD HILDEBRAND AND
MR. DAVID BEST, CO-CHAIRMEN
1. APPROVAL OF PREVIOUS MINUTES
The minutes of the DICOM Standards Committee meeting held March 10 - 11, 1999 were
reviewed. Under Working Group 12, “ISUS” should be “ISIS.” Under Time and Place of Next Meeting,
the meeting in San Francisco should be “August 27, 1999” not “September 27, 1999.” The minutes were
then approved as amended. It should be noted that the meeting in Japan will be in conjunction with the
JMCP in Yokohama, Japan.
2. ELECTION OF NEW MEMBERS
There was one application for membership on the DICOM Standards Committee in the vendor
category. The application was from ETIAM, a vendor of cooperative medical imaging products. The
motion was made and passed to approve the membership of ETIAM on the DICOM Standards
3. REQUESTS TO BE ON WORKING GROUPS
There were four requests to be on working groups and have official voting status. The requests
were from Martin Kernberg, MD, University of California at San Francisco and Charles Thomas,
Heartlab to be on WG 1 and Eric Goodall, IBM Corporation, and Andrei Leontiev, IDX System
Corporation to be on WG 6. All four requests were approved.
4. REPORTS FROM THE WORKING GROUPS
WORKING GROUP 1 (CARDIAC AND VASCULAR INFORMATION)
Thomas Kennedy, Chairman of WG 1 submitted a written report (Exhibit A) which was e-mailed
to members before the meeting. The draft IVUS IOD is well along and Waveform is completed for
submission to WG 6 with the request to go to letter ballot. Work has started on DICOM „2000 which will
feature the Integrated Cardiac Record. WG 1 is developing SR requirements for the Cath Lab.
WG 1 submitted a Work Item for the development of the intravascular ultrasound (IVUS) IOD
and Application profile. Tom Kennedy reported that the review time for WG 6 should not be that much
and that WG 1 expects to submit the IVUS IOD to WG 6 at their September or October meeting. The
motion was made and approved to accept the Work Item with the addition of the dates for submittal to
WORKING GROUP 2 (DIGITAL X RAY)
Brent Dove, Chairman of WG 2, distributed a written report at the meeting (Exhibit B). He
reported that Supplement 32 is widely accepted. WG 2 is not working on anything at the present time.
WORKING GROUP 3 (NUCLEAR MEDICINE)
No written report was submitted. No report was present at the meeting.
WORKING GROUP 4 (COMPRESSION)
Alan Rowberg, Chairman of WG 4 submitted a written report (Exhibit C) which was e-mailed to
members before the meeting. He reported that WG 4 is working only by teleconference. David Clunie and
Kathleen Rattell are the WG 4 liaison to JPEG 2000. The JPEG Committee is doing the compression
evaluations on opaque paper but WG 4 is willing to coordinate the medical evaluations. The plan is to use
the flicker technique. The next meeting of the JPEG Committee is in Vancouver, BC, July 12 - 16, 1999.
WG 4 will also send to WG 6 a Change Proposal to include JPEG-LS in DICOM. The question
was raised whether some of the 16 forms of JPEG should be retired. Alan Rowberg agreed that WG 4
would review the 16 forms for retirement consideration.
WORKING GROUP 5 (EXCHANGE MEDIA)
David Clunie, Chairman of WG 5, prepared a written report (Exhibit D) which was e-mailed to
members before the meeting. He reported that Supplement 40 went out for public comment but no
comments were received. WG 5 believes it is not realistic to ballot Supplement 40 at this time. However,
there is interest in experimenting with the DVD media available (DVD-R and DVD-RAM). WG 5 will
present to WG 6 a proposal to freeze Supplement 40 with variable parameters and specify DVD-R and
DVD-RAM with UDF 1.5 for trial implementations. Tom Kennedy, Co-Chairman of WG 1 stated that
WG 1 would just as soon wait for WG 5 to make a recommendation.
WORKING GROUP 6 (BASE STANDARD)
Don Van Syckle, Chairman of WG 6, prepared a written report (Exhibit E) which was e-mailed to
members before the meeting. In the absence of the Chairman, Dwight Simon gave the report. He
reviewed the supplement status and reported that WG 6 members made presentations at the May 3 -5,
1999 IHE meeting. WG 6 discussed the decision by the DICOM Standards Committee that the DICOM
Standard be published every year with the new material included. WG 6 requested the DICOM Standards
Committee to reconsider that decision and to publish every two years. A straw poll of the Committee
indicated 21 in favor of yearly publication, 1 in favor of publication every two years, and one didn‟t care.
Consequently, the decision of the Committee for a yearly publication remains.
WG 6 proposed a work item for Interpretation Work List with an early draft in September.
Members then discussed the priority list for WG 6 that WG 10 developed. There were six levels with
Interpretation Worklist having the lowest priority. It was suggested that the priority of Interpretation
Worklist could be raised if an Ad Hoc Group was formed to work on it which didn‟t take resources away
from WG 6. Dwight Simon felt the Chairman of WG 6 would create an Ad Hoc Group. A motion was
made and passed to accept the priorities presented by WG 10 as the priority that WG 6 should be working
on. The priorities are as follows:
Presentation State (Almost completed)
Waveform (Almost completed)
Yearly publication of the Standard
Retirement of Sections
Revisiting of Sections (Parts 1 & 2)
MPEG for US
DICOM Mime type
Interpretation Worklist (Status could be raised by formation of an Ad Hoc Group)
The motion was made and passed to approve the work item on Interpretation Worklist.
WORKING GROUP 7 (RADIOTHERAPY)
David Murray, Chairman of WG 7, prepared a written report (Exhibit F) which was e-mailed to
members before the meeting. In the absence of the WG 7 Chairman, Charles Parisot provided a short
report There are presently two activities of WG 7, Change Proposals and Demonstrations. WG 7 is
lacking support on the professional side to try to publicize the Standard.
WORKING GROUP 8 (STRUCTURED REPORTING)
No written report was submitted. Dean Bidgood, Chairman of WG 8, reported that a draft of
Structured Reporting was discussed at the March 9 - 10, 1999 WG 10 meeting. On March 22, 1999 WG 6
spent a lot of time on SR and froze the draft. On April 8, 1999 WG 9 (Ophthalmology) meet to discuss
the use of SR. On April 13 - 14, 1999 WG 1 strongly endorsed SR and will feature SR in the ACC „2000
WORKING GROUP 9 (OPHTHALMOLOGY)
Lloyd Hildebrand, Chairman of WG 9, prepared a written report (Exhibit G) which was e-mailed
to members before the meeting. He reported that WG 9 meet April 9, 1999 in Seattle. They are working
with CAP with respect to the terminology that they need but it has been a problem. Interest has been
generated with respect to VL in the user community. WG 9 is working on a network demonstration.
WORKING GROUP 10 (STRATEGIC ADVISORY)
Kees Smedema, Co-Chairman of WG 10, presented the report on the WG 10 meeting held June
15 - 16, 1999 (Exhibit H). A proposal was made in the WG 10 meeting to request a DICOM MIME type
and a DICOM file extension. This proposal may be approved by WG 10 at the next WG 10 meeting. This
would not be a part of DICOM. Members also discussed the scope of DICOM and how DICOM needs to
evolve in a changing world.
A presentation was provided of what is happening for the IHE for both year 1 and year 2. IHE
will provide WG 6 with its wish list. Dean Bidgood provided a summary of the latest draft of SR. WG 10
recommended that WG 6 place a high priority on SR. The HL7 reply to the DICOM Standards
Committee letter asking for a joint working group and that the IMSIG be raised to the Technical
Committee level was discussed. HL7 replied that it was not necessary for the IMSIG to be given
Technical Committee status in order to achieve the objectives put forth by the DICOM Standards
Committee. In light of this, WG 10 recommended that a new working group be formed with HL7 with
co-chairs, one Co-Chair from the DICOM Standards Committee the other Co-Chair from HL7.
Priorities for WG 6 were recommended to the DICOM Standards Committee by WG 10. WG 10
will produce a draft on Workflow and also a draft Strategic Planning Document. WG 10 discussed the
issues on the rights and royalties of SNOMED and whether the medical part is still royalty free. WG 10
has asked David Clunie and Dean Bidgood to contact CAP to get the original proposal to NEMA. They
are to determine if the proposal is still in place and if implementers can use the terms royalty free as
described in the letter..
WORKING GROUP 11 (DISPLAY FUNCTION STANDARD)
No written report was submitted. In the absence of the Co-Chairmen, David Clunie gave a short
report. Letter ballot text was prepared for Supplement 33 - Soft Copy Presentation Storage for WG 6 to
review at their June meeting. There will be a demonstration of Soft Copy Presentation Storage for RSNA
„99 and it will include print vendors. WG 11 is working in a very early stage on Structured Display and
Advanced Presentation and is doing work with WG 17 on 3D.
WORKING GROUP 12 (ULTRASOUND)
David Heaney, Chairman of WG 12, prepared a written report (Exhibit I) which was e-mailed to
members before the meeting. He reviewed the work that WG 12 is doing. He was not aware that the 3D
Working Group is dealing with acquisition sets. He will report this to WG 12 members. WG 12 is only
working on multiframe not single frame. They are presently deciding between MPEG 1 and MPEG 2.
WORKING GROUP 13 (VISIBLE LIGHT)
Lloyd Hildebrand, Co-Chairman of WG 13 provided a written report (Exhibit J). He reported that
the working group is waiting for the results of the letter ballot of Supplement 15 - Visible Light (Single
Frame). The multiframe part was split out and made Supplement 47 Multiframe VL. It does not need a
work item since it was approved when it was part of the initial VL proposal. No work has started on
WORKING GROUP 14 (SECURITY)
Lawrence Tarbox, Chairman of WG 14 (Security), prepared a written report (Exhibit K). In the
absence of the Chairman, Dwight Simon reported that no progress has been made since the last DICOM
Standards Committee meeting. The Network Security Supplement is almost ready for ballot.
WORKING GROUP 15 (DIGITAL MAMMOGRAPHY)
David Clunie, Co-Chairman of WG 15, prepared a written report (Exhibit L) which was e-mailed
before the meeting. He reported that WG 15 has considered a proposal to develop an extension to
DICOM to standardize the reporting of Computer Assisted Detection (CAD) results for mammography.
WG 15 has no other work at the present time. A proposal for a Mammography CAD Work Item was
present to the DICOM Standards Committee for approval. The CAD work item was approved by motion.
WORKING GROUP 16 (MAGNETIC RESONANCE)
Matthias Drobnitzky, Chairman of WG 16, prepared a written report (Exhibit M) which was
distributed at the meeting. In the absence of the Chairman, Nikolaus Wirsz presented the report. He
summarized the previous activities of WG 16 and their planned schedule. He then presented a work item
for the development of a new MR Object supplement. The New MR Object work item was approved by
WORKING GROUP 17 (3D)
Doug Sluis, Chairman of WG 17, prepared a written report (Exhibit N) which was e-mailed
before the meeting. It was pointed out that the new Chairman of WG 17 was Doug Sluis.
5. PROPOSED NEW WORKING GROUPS
A. Working Group on Clinical Trials and Education
A proposal to form a new working group on Clinical Trials and Education was e-mailed to
members before the meeting (Exhibit O). The National Cancer Institute agreed to serve as Secretariat. The
motion was made and passed to approve the formation of a working group on Clinical Trials and
Education with the National Cancer Institute as Secretariat. David Clunie and Curtis Langlotz will
convene the first meeting. NEMA staff will send out a letter informing of the new working group and
inviting participation. This will be WG 18.
B. Working Group on Dermatologic Standards
A proposal to form a new working group on Dermatologic Standards was e-mailed to members
before the meeting (Exhibit P). Joseph Kvedar explained that their need for DICOM included the
cataloging of slides and to view remotely to give advice. They do not have a vendor community but use
off-the-self equipment. The motion was made and passed with one opposed to approve the formation of a
working group on Dermatology with the American Academy of Dermatology as Secretariat. NEMA staff
will send out a letter informing of the new working group and inviting participation. This will be WG 19.
C. Working Group on Integration of Imaging and Information Systems
WG 10 proposed a new working group on Integration of Imaging and Information Systems.
Members discussed the proposal and suggested changing bullet 6 to read: Meetings should be held in
conjunction with HL7, DICOM, and other related meetings. The estimated number of meeting days is 10
days per year. It was recommended that bullet 7 should be deleted and a new bullet added reading: The
Co-Chairs shall report to the DICOM Standards Committee and to the HL7 Technical Steering
Committee. Also added was that the DICOM members of the Working Group should be considered as
full HL7 members for this Working Group/SIG and vice versa and that the proposal will be sent to the
HL7 Board of Directors. The revised proposal is attached (Exhibit Q). The motion was made and passed
to approve the formation of the new working group on Integration of Imaging and Information Systems.
Since the formation of this working group was not on the agenda a thirty day ballot confirming the motion
will be sent to members of the DICOM Standards Committee. NEMA has agreed to serve as Secretariat
for the working group until another Secretariat is found. This will be WG 20.
6. REPORT ON EUROPEAN DICOM ACTIVITIES
Kees Smedema presented a report on current DICOM Activities in Europe (Exhibit R). He stated
that DICOM WG meetings in Europe have exceeded the number expected and the program to represent
DICOM as an International Standard is well under way. Europeans will not see the DICOM Standards
Committee as an American Committee. In addition they are working very hard to have IHE like activities
in Europe. There is no additional relationship between DICOM and CEN. The status quo seems
acceptable. The ISO TC215 Task Force was satisfied with the DICOM Standards Committee as a Class A
liaison with TC215.
7. REPORT ON JAPANESE DICOM ACTIVITIES
Hidenori Shinoda distributed a written report on current Japanese DICOM activities (Exhibit S).
He summarized the report through a series of slides.
8. STAFF REPORT
NEMA staff reported that Ballot 32 Supplement 15 - Visible Light passed with 24 ballots
received, 21 approval, 1 disapproval, and 2 abstentions. There were a number of comments received with
the ballots. Ballot 31 DICOM CP 5 expires June 22, 1999. At the present time 13 ballots have been
The NEMA server has been changed back to permit ftp but Vicki Schofield would prefer
members still use http.
9. UPDATE ON ISO TC215 ACTIVITIES
Charles Parisot reported that ISO TC215 met for the second time in Europe to organize TC215.
Work items were discussed but most were not approved. Joel Chabriais as Chairman of the Ad Hoc group
reported their recommendation that an imaging working group not be formed. The US delegation objected
to not forming an imaging working group on the basis that they felt the DICOM Standards Committee
was not open enough and did not communicate with other standards groups. Charles Parisot pointed out
the DICOM Standards Committee relationship with HL7, JIRA, and other standards groups and that the
DICOM Standards Committee was accepted as a category A liaison with TC215. The US delegation
agreed to proceed without an imaging working group. A TC 215 Ad Hoc group composed of Nick
Brown, Joel Chabriais, and Ed Hammond with Nick Brown as Chairman was formed to serve as the
TC215 liaison to the DICOM Standards Committee.
With regard to getting DICOM approved as an ISO Standard there are two approaches that could
be used. One is for the DICOM Standards Committee to become recognized as a peer standardization
group. As a peer group, DICOM could be proposed as an ISO standard with a vote up or down. The other
approach is to propose DICOM as an international standard to TC215 with one round of voting with
comments. The DICOM Standards Committee is open on how to proceed but does not want to reballot
Charles Parisot stressed to the DICOM Standards Committee members the need to build the
category A liaison with ISO. Charles Parisot was assigned to lead the DICOM liaison coordination. He
stressed that DICOM should have a liaison representative at every TC 215 meeting and give a 15 minute
10. IHE/DICOM WORKSHOP
Charles Parisot stated that he felt the workshop was useful. There was no DICOM representation
at the VA workshop which was held after the IHE/DICOM workshop. The VA did promote the second
day of the IHE/DICOM workshop.
11. DICOM LOGO
Lloyd Hildebrand made suggestions of what should be represented in the DICOM Logo. These
Want to bring out word DICOM
Want to give the global effect
Want to give the technical effect
Need a tag line
Need to give image of healthcare
With regard to the use of the word DICOM, the Committee has made the statement that
companies can use DICOM in product name as long as they don‟t trademark it.
12. REPORT FROM THE MII COMMITTEE FOR THE ADVANCEMENT OF DICOM
Jay Gaeta joined the DICOM Standards Committee meeting by speaker phone and provided a
written report (Exhibit T). He pointed out the procedures used by the Committee for the Advancement of
DICOM and what manufacturers get from demonstrations. This includes software and the visibility they
receive by having their name on a list of participants. He asked for suggestions to improve the process
from the DICOM Standards Committee. It was suggested that a point of contact was needed with fields
other than radiology. Specialty groups should identify a champion within who has good contact with
13. REPORT FROM THE DICOM FTP TASK FORCE
Lloyd Hildebrand reported that in talking to the appropriate people at the University of Oklahoma
he was told that they can not give away resources of the State. What was considered in the cost of setting
up a ftp site for DICOM was a public and private area and backup. The cost would be approximately
Bob Britain stated that NEMA has purchased a dedicated server for DICOM only. The NEMA IS
staff now thinks the problem with the down time of the server is a Microsoft problem. NEMA has a 24
hour monitoring service with Microsoft to hopefully find the problem and fix it.
Bob Britain also reported that he is making a report to the NEMA Board of Governors on the
placing of the draft DICOM Standard on the server. There have been 25,000 successful hits.
Members recommended to hold off on an alternate site for the ftp site and to put the University of
Oklahoma offer on hold. The motion was made and passed to dissolve the DICOM FTP Task Force. The
motion was made and passed to dissolve the Task Force On Publishing DICOM. It was suggested that in
the future the working group reports be put at the end of the agenda and that a one day meeting be
14. FINANCIAL SUPPORT FOR THE EUROPEAN DICOM SECRETARIAT
Bob Britain reported that NEMA will reimburse COCIR $10,000 for this year and $10,000 for the
year 2000. For the year 2001 there will probable be less money from COCIR and NEMA. The DICOM
Standards Committee will need to address this. Any increase in activity in Europe will require an increase
in dues or other means for funding. The need to consider reducing expenses was stressed.
15. ANSI ACCREDITATION OF THE DICOM STANDARDS COMMITTEE
The revised DICOM Operating Procedures approved in December 1998 were written for
acceptance by ANSI. The DICOM Executive Committee agreed that the application for accreditation
should be submitted. NEMA staff will target submittal by July 31, 1999.
16. APPOINTMENT OF NOMINATING COMMITTEE FOR VENDOR CO-CHAIR
A nominating committee was appointed for the vendor co-chair composed of Dave Best, Lloyd
Hildebrand, and Tim Cramer with Dave Best as Chairman. They will report a slate of candidates at the
August DICOM Standards Committee meeting.
17. NEW BUSINESS
Members identified three topics at this time for the August meeting. These were:
Additional DICOM Advancement Reports
DICOM Committee Logo
18. TIME AND PLACE OF NEXT MEETING
The next meeting of the DICOM Standards Committee is planned for Friday, August 27, 1999,
9:00 a.m. - 6:00 p.m. in San Francisco. Following meetings are planned for December 2, 1999, 9:00 a.m. -
5:00 p.m. in conjunction with the RSNA meeting in Chicago. Meetings in 2000 are planned in April in
Yokohama or Tokyo, Japan in conjunction with JMCP, in June in Baltimore, Maryland in conjunction
with SCAR, in September in Europe, and in December in Chicago in conjunction with the RSNA
The meeting was adjourned at 5:00 p.m. on Wednesday and at 12:15 p.m. on Thursday.
SECRETARY, DICOM STANDARDS COMTE.
Attachments: Exhibit A - Working Group 1 - Cardiac and Vascular Information
Exhibit B - Digital X-ray Working Group Report
Exhibit C - Working Group 4 (Compression) Report
Exhibit D - DICOM WG 5 Interchange Media Report
Exhibit E - DICOM WG 6 Status Report (Base Standard)
Exhibit F - DICOM WG 7 (Radiotherapy) Report
Exhibit G - WG 9 Report
Exhibit H - Report of Working Group 10 Meeting, June 17, 1999
Exhibit I - WG 12 Report for DICOM Committee
Exhibit J - WG 13 - Visible Light
Exhibit K - WG 14 Report
Exhibit L- DICOM WG 15 Digital Mammography Report
Exhibit M - Report from DICOM WG 16 (MR Enhancements) Activities
Exhibit N - WG 17 Status Report
Exhibit O - DICOM WG on Clinical Trials Report
Exhibit P - Proposal to Create a Working Group on Dermatologic Standards
Exhibit Q - New DICOM Working Group: Integration of Imaging and Information
Exhibit R - Report on European DICOM Activities
Exhibit S - Report on Japanese DICOM Activities
Exhibit T - MII Committee for the Advancement of DICOM Report to the DI
REVIEWED BY COUNSEL
To: DICOM Standards Committee
From: Working Group I – Cardiac and Vascular Information
Thomas Kennedy, Ph.D. Co-chair
Steven Nissen, M.D. Co-chair
Date: June 7, 1999
Re: WG1 Report
I. Work Item Authorization Request
WG1 requests work authorization to complete development of the intravascular ultrasound
(IVUS) IOD and Application profile. IVUS is a key imaging modality in the cardiac cath lab,
and in clinical practice, the IVUS images are closely linked to the cardiac x-ray angiographic
images for diagnosis of coronary artery disease and evaluation of intravascular therapy. IVUS
is a key component of the digital integrated record for the cardiac cath lab under development by
WG1 (incorporates waveforms – audio, and structured reporting – procedure log). Agreement
has been reached with WG12 (Ultrasound) that the IVUS modality is distinct from the
ultrasound or echocardiographic modalities that the IOD development should proceed under
WG1. Further, WG1 has essentially completed an IVUS clinical requirements specification,
and drafts of the IVUS IOD and Application Profile have been developed.
II. Supplement 30 – Waveform Interchange
WG1 has completed development of Supplement 30 and changes based on public
comments have completed. In particular, recommendations from WG 6 have been incorporated
into the supplement and will be reviewed at the June WG6 meeting.
III. Digital Integrated Cardiac Record
WG1, in collaboration with the American College of Cardiology (ACC) and the European
Society of Cardiology (ESC) developed a multi-media (CD-based) presentation of the
ACC/ESC/DICOM vision for the integrated cardiac patient record at the ACC scientific Session
in March, 1999. In the presentation, an actual patient was followed through an entire post-MI
cardiac workup. Multi-modality (x-ray angiography, IVUS, and nuclear medicine) images,
waveforms, and clinical reports were presented. The clinical and economic benefits of the
digital integrated record were also clearly described in the presentation. As part of the vision
statement, and to highlight the benefits of the digital record, conference attendees were given a
set of the traditional paper records for the same patient. The vision of the digital integrated
cardiac record and the role of standards, particularly DICOM, in enabling the vision were well
At the ACC Scientific Sessions in March, 1999, WG1 solicited increased support from the ACC
for development of the DICOM-based integrated cardiac record. Specifically a proposal was put
forth to the ACC Database Committee for expert physician input on clinical reporting
requirements (see attached). WG1 was particularly interested in harmonizing efforts between
WG1 and the Database Committee. Subsequent to the proposal, the ACC confirmed their
support for WG1‟s efforts, and the ACC Cath Committee will represent the ACC‟s interests.
IV. Structured Reporting
WG 1 is in the process of developing requirement specifications for key elements of the
cardiac catheterization lab procedure and clinical reports:
- Quantitative measurements (QCA, QVA, etc.)
- Hemodynamic measurements
- Laboratory reports
- ECG interpretation reports
- Outcomes core data – ACC National Cardiovascular Database Registry (NCDR)
- Patient history and physical report
- Clinical Summary reports
WG1 has developed a clinical informatics model to describe the cardiac catheterization
event, and the model is generalizable to other cardiology specializations. The clinical model has
been developed in close cooperation with Dean Bidgood, and the model will be used to develop
templates based on Supplement 23.
It is expected that a structured reporting demonstration for the cardiac cath lab will be
developed for the ACC 2000 Scientific Sessions.
From: Cardiac and Vascular Working Group 1, DICOM
Thomas Kennedy, Ph.D. Co-Chair
Martin E. Kernberg, MD (UCSF): SR DICOM Clinical
Harry Solomon: SR DICOM Standard
For: ACC Database Committee
Date: March 10, 1999
Subject: DICOM Integration of the ACC Database, Data Structure, And
Data Model for Interchange of Structured Reporting In The
Cardiac Catheterization Laboratory.
The interchange of cardiac x-ray angiographic data is supported
by specially developed extensions to the DICOM 3.1 (Digital
Image Communication in Medicine) standard; parallel support is
necessary for the interchange of textual information
(annotations, hemodynamics, electrocardiography, pathologic
findings, procedure log, complications, catheterization reports,
and clinical summaries) to provide complete data interchange for
diagnostic interpretation and interventional decisions.
Integration of the American College of Cardiology database
(National Cardiovascular Database Registry), data structure
(clinical organization of the NCDR), and data model (ACC Digital
Integrated Cardiac Record) for cardiac catheterization sets the
clinical requirements and specifications for the implementation
of DICOM structured reporting for cardiac catheterization.
Supplements 23 and 46 of the DICOM standard provide the
governing parameters for the implementation of and support for
the structured reporting interchange standard for the cardiac
catheterization laboratory. Content requirements and structure
follow the ACC standard development process.
The ACC/ESC/DICOM exchange standard was adopted in 1995 as a result of an initiative by
the American College of Cardiology to define a standard digital medium for the inter-facility exchange
of x-ray angiographic exams. The College recognized that a variety of clinically inferior media were
finding their way into practice as a replacement for cine-film in labs that had converted to filmless
operation. Use of analog recording media, with SVHS tape as an example, often resulted in patient re-
catheterization because of the diagnostic image quality of the replacement recording medium.
The American College of Cardiology (ACC) and the European Society of Cardiology (ESC), in
conjunction with representatives from the National Electrical Manufacturers Association (NEMA),
selected CD-R (Recordable Compact Disc) as the standard digital medium for exchange of
angiographic exams. This committee also developed a format for writing patient demographic
information and angiographic images to the digital medium. Similar standards were also developed for
the exchange of echocardiographic and cardiac nuclear medicine exams.
The media-based exchange standards are an extension of the basic DICOM (Digital Image
Communication in Medicine) standard. The DICOM standard was originally developed for exchange
of digital radiology images over a communication network. The standard specifies protocols and
services for the exchange of images and related patient information between interconnected devices
such as workstations, printers, and archive units. Today, the ACC/NEMA DICOM exchange standard
for x-ray angiographic images is well accepted and CD-R‟s are routinely used to exchange patient
exams between physicians and hospitals. Network-based cardiac archive and review systems based on
the DICOM x-ray angiography definitions have also been introduced.
The success of the ACC/NEMA DICOM exchange standard is a direct result of close
collaboration between the American College of Cardiology and the medical equipment manufacturers.
Expert physician input was essential for establishing the clinical requirements and performance
expectations for interchange. Engineers were able to incorporate these requirements into DICOM
extensions for cardiology. The rapid adoption of the exchange standard is also the result of a very
active education program supported by the ACC , ESC, and the DICOM cardiology working group –
particularly with demonstrations at the annual ACC and ESC Scientific Sessions.
III. The Next Step – The Integrated Cardiac Record
Angiographic image data represents only a fraction of the useful clinical information describing
a catheterization event in any individual patient. Intravascular ultrasound images (IVUS),
hemodynamic waveform data and measurements, the procedure log, and physician reports all combine
to provide the complete clinical perspective for a catheterization exam. Unfortunately, as with the
earlier problem of angiographic interchange, no standards exits for communication of these multiple
data types. According, the DICOM Standards Committee formed Working Group I in 1997 to address
the problem of cardiovascular information interchange for the catheterization exam. As the DICOM
standard moved beyond angiography, WG1 solicited additional physician and manufacturer expertise
to address each of the various cath lab data types.
IV. Current Status of WG I ICR Efforts
A. Creation of the Waveform Information Object
DICOM support for waveforms (hemodynamic and electrophysiologic) is nearly complete.
The DICOM waveform extension is general enough to describe any type of waveform; including multi-
channel ECG, hemodynamic, and audio signals. In addition, the Waveform Standard provides a
method to describe the acquisition context of the waveform. For example, the waveform standard not
only describes the temporal characteristics for the waveform, but also specific measurement locations
and derived parameters such as pressure gradients.
B. Creation of the IVUS Information Object
The IVUS modality represents a unique set of problems within the catheterization laboratory.
IVUS images cannot be properly interpreted without knowledge of the imaging catheter location in the
cardiac arterial structure. Fluoroscopic imaging must be utilized to document IVUS catheter
positioning. In today‟s IVUS equipment, an audio dictation track is recorded with the IVUS images to
provide some direction, but correlation to other data sources in the catheterization laboratory has been
limited. Like waveform data, IVUS image data requires a method within DICOM to describe the
acquisition context. Taxonomy for the native and grafted vessels must be created to provide an
adequate method of communicating acquisition context for IVUS images. This approach relies on the
evolving DICOM paradigm for structured reporting and will require expert clinical input.
C. Reporting and Procedure Log
DICOM Structured Reporting (SR) is a method for structuring and
encoding observations and findings associated with medical imaging
procedures. It also allows for the encoding of a variety of analytic
data, and provides a method for linking measurements and observations
to images or waveforms. Structured Reporting provides the framework
for describing and interchanging critical cath lab patient history
and physical reports, laboratory reports, procedure logs, and
quantitative measurements. Structured reporting also makes extensive
use of controlled vocabularies to facilitate universal
interchangeability. The vocabulary dictionaries are maintained in
databases by experts outside of DICOM (e.g., SNOMED), although
provisions exist for use of locally-developed dictionaries.
Importantly, the ACC database elements will provide a subset of these
vocabularies, and thus enabling their interchange for clinical
information, quality assurance, or research.
In large measure, Structured Reporting is the final, critical
element in the development of a DICOM-based integrated cardiac
catheterization record. SR will allow physicians to link
angiographic images, IVUS images, waveforms, and procedure notes for
a single cath exam. Objective measurements as well as physician
reports will be included in the electronic interchange (DICOM) file.
V. Information Model for Cardiac Catheterization
The DICOM Cardiac Catheterization Structured Report (or Object),
illustrated in the 1999 ACC CD-ROM demonstration of the Digital
Integrated Cardiac Record, contains the following sections
Entries in Bold Face: explicitly defined ACC National
Cardiovascular Database Registry (NCDR) database
Entries in Plain Text: delineated in the ACC DICR data model,
reflecting the database structure.
Entries in Underlined Text: DICOM standard in draft, frozen draft,
or completed form.
2. Clinical Indications
3. Clinical Presentation
3.1. History of Present Illness
3.2. Past Medical History
3.2.1. Cardiac Risk Factors
3.2.2. Other Past Medical History
3.3. Physical Examination
5. Pre-Procedure Protocol
5.2. Informed Consent
6.1. Diagnostic Procedure
6.2. PTCA Procedure
6.3. IVUS Procedure
6.4. Site Complications
6.5. In Lab Complications
6.6. In Lab Medications
6.7. Hemodynamic Data
7.1. Laboratory Data
7.2. Summary Coronary Anatomy
7.3. Lesion Description
7.4. Other Coronary Angiographic Findings
VI. DICOM SR SET FOR CARDIAC CATH
The Cardiac and Vascular Working Group 1, comprised of ACC and NEMA
representatives, will support the complete set of ACC lexicons,
databases, reporting standards, and clinical protocols within the
DICOM interchange standard. Each of the proposed DICOM reports and
corresponding sections (and subsections) will reflect the ACC
database, data structure, and data model, as the latter three evolve
under the direction of the associated ACC Committees, particularly
the Database Research and Development and Cardiac Catheterization
The proposed DICOM SR standard for cardiology fundamentally involves three types of data:
clinical information (current symptoms, historical data, and physical examination)
cardiology studies (diagnostic evaluation, monitoring, and imaging dependent on special
therapy (including medical management, interventional cardiology, and related cardiovascular
Applying this tripartite division to the cardiac catheterization
report yields the following set of sections (DICOM objects or
modules) requiring detailed templates for reporting:
1. Clinical Information
1.1. Clinical Presentation
1.1.1. Coronary Artery Disease
1.1.2. Acute Coronary Syndromes
1.2. History of Present Illness
1.3. Review of Systems (Cardiovascular)
1.4. Past Medical History
1.4.1. Cardiac Risk Factors
1.5. Past Imaging History
1.5.1. Nuclear Cardiology
1.5.2. Diagnostic Angiography
1.6. Past Interventional History
1.6.1. Cardiac Interventional Procedures
1.6.2. Peripheral Vascular Procedures
1.7. Past Cardiovascular Surgical History
1.9. Social History
1.10. Family History
1.11. Physical Examination
2. Diagnostic Studies
2.3. Cardiac Imaging
2.3.1. Nuclear Cardiology
2.3.2. Cardiovascular MR
2.4. Coronary Angiography
3.1. Cardiovascular Medications
3.2. Interventional Procedures
WG I Seeks the support of the American College of Cardiology and the Database Research
and Development Committee to provide the clinical expertise necessary to complete the proposed
DICOM Standard for Structured Reporting of the cardiac catheterization event. The collaborative
model established by the ACC and WG1 for development of the x-ray angiography, waveform, and
IVUS DICOM Exchange Standards must be continued to ensure success of the proposed Structured
Reporting extensions. WG1 also seeks the guidance of the ACC in securing the continued support
of the European Society of Cardiology and the Japanese College of Cardiology in development of
structured reporting for the cardiac catheterization environment. International participation has
been fundamental to the success of the DICOM exchange standard for cardiology.
DICOM Standards Committee
Digital X-ray Working Group Report
Submitted by S. Brent Dove, Chairman
June 16, 1999
Since the approval of the Digital X-ray Supplement to the DICOM
Standard in August 1998, there has been considerable acceptance of
the supplement. A large demonstration of the DX Supplement at the
American Dental Association annual meeting has established the DICOM
Standard as “the” imaging standard for all of dental imaging. I am
proud to inform you that virtually all vendors in the industry are
implementing the DICOM Standard in their new products. There has
also been significant acceptance of the DX Mammography extensions in
the field of general purpose mammography as well.
As chairman of the working group, I would like to thank each of the
members of Working Group 2 and all the members of the DICOM Standards
Committee for making this significant contribution to health care.
No new action items have been proposed. No meetings of this working
group have been scheduled. No action is requested of the committee
at this time.
Working Group 4 (Compression) Report
June 8, 1999
Alan Rowberg, Chair
Working Group 4 (Compression) held teleconferences on March 29 and
June 3, 1999.
David Clunie represented DICOM meeting of JPEG 2000 is in Seoul,
Korea during March 15-19. He reviewed the importance of compression
in medical imaging, and underscored the need to process medical
images with the proposed algorithms. During this meeting the
committee converged on a single Validation Model, and made progress
on the working draft. There is still a plan to have a Committee
Draft of the standard by December, but not later than March. He also
attended the parallel US national body meeting for NCITS May 17-21 in
Kathleen Rattell, the JPEG 2000 liaison to DICOM, also attended both
We are attempting to get the critical features, such as 16 bits per
pixel capability, in the baseline standard while not contributing to
feature creep in other areas, such as security.
During the June 3 teleconference, we reviewed the existing plan to
print original and compressed images onto high-resolution film, and
then make paper positive prints, for all of the JPEG 2000 test
images. Alan Chien of Kodak has said this will be done at the
levels of 0.25 bpp, 0.125 bpp, and 0.0625 bpp. We agreed that we
would like to have this done for the DICOM images also, but we will
also provide the images to the Kodak/Mallinckrodt/Henry Ford
consortium for evaluation using their flicker technique, as described
at RSNA (IDA9730 Demonstration of JPEG and JPEG 2000 Compression for
Medical Images by Slone, Foos, Young, Whiting, Muka, and Kohm). The
evaluation will be rank ordering but not observer preference or ROC
analysis. This evaluation will be done in St. Louis at no cost to
DICOM. .Compression will be requested at three compression levels,
different from the ones which will be used for the JPEG 2000 images.
The visible light images may be viewed on hardcopy, although the
flicker technique can also be used on color images. Because
ophthalmologists usually deal with 35mm slides rather
than reflective hardcopy, we will explore other output methods to
make it easier for experienced fundus photography readers to
evaluate the ophthalmic images.
David Clunie will also represent DICOM at the next JPEG 2000 meeting
July 12-16, 1999 in Vancouver, BC
The next meeting of WG 4 will be by teleconference July 30, 1999.
WG4 has also reviewed a CP to propose the inclusion of JPEG-LS (ISO
DICOM, now that it is officially an ISO and ITU standard. The CP will
be referred to WG6.
DICOM WG 5 Interchange Media Report (for June 1999 DICOM Committee Meeting)
The only current work item for WG 5 is to add DVD media to the standard.
Supplement 40 - DVD Media Using UDF has recently been through the public comment
phase. No comments were received. At its June meeting, the working group decided
not to aim for letter ballot in 1999 but rather to produce a "draft for trial
implementation" in order to allow implementors to experiment with the proposed
technology. The current intent (subject to WG 6's approval), is to define in the
draft supplement both those media types currently available (DVD-R and DVD-RAM)
for experiments with UDF 1.5 to begin. The modality specific groups (in particular
1 and 12)will be consulted as to whether or not they wish to use only one media
for the experiments for their profiles, or whether to experiment with both (as is
proposed for the general purpose profile).
This strategy has been suggested in order to proceed with experiments using what
technology is already available, while reducing the risk created by the
considerable confusion in the optical media industry over competing proposals for
writable and rewritable DVD formats.
No action by the committee is requested at this time.
David A. Clunie mailto:firstname.lastname@example.org
Director, Medical Imaging Technologies http://idt.net/~dclunie/
Quintiles Intelligent Imaging http://www.i2image.com/
521 Plymouth Rd #115 Work 610-238-0572 Fax -0578
Plymouth Meeting PA 19462 Home 570-897-7123 Fax –5117
DICOM WG 6 Status Report (Base Standard)
June 9, 1999
1.0 Scope of WG 6 - Base Standard Working Group
WG 6 is responsible for the overall consistency and maintenance of
the DICOM standard. WG 6 provides technical guidance to all DICOM
working groups and serves as the technical coordination point. It
also develops extensions (Supplements) to DICOM typically related to
overall systems enhancements. Some of responsibilities are as
Execute the DICOM Maintenance Process (Correction Proposals).
This process is used to make “corrections and minor changes”
to the current versions of the Standard. Any corrections made
are processed using the normal Letter Ballot procedures as
defined by NEMA.
Provide technical coordination and guidance for all WGs. This
includes review and official approval before the Public
Comment, Letter Ballot, and Final Text draft releases of all
Develop Supplements to the standard related to Print, Image
Coordinate joint development efforts with CEN, JIRA, and Medis
Coordination with NEMA for the publication of DICOM.
1.1 WG 6 Meetings Held
1.1 Specific Deliverables for 1999
DICOM Maintenance Process
Various Correction Proposals have been processed and CP Item
packet 5 was sent to the DICOM Committee for Letter Ballot.
Visit the NEMA web site for the Correction Proposal Log and
Supplements Currently Being Developed by WG 6
The DICOM committee has asked WG 6 to retire Part 9 of
DICOM. As part of this, WG 6 is looking at other portions
of the Standard and will make additional retirement
recommendations for the next DICOM committee.
The following process was defined by WG 6 for retiring Parts
and Sections from DICOM. The DICOM committee is invited to
review and comment.
1- Create work item for retirement which list WG 6 as the
responsible working group (WG 6 believes this has already
been accomplished as part of Part 9 retirement process).
2- Package retirement items providing the topic and
rationale for retirement prepared for Public Comment.
3- Comments will be analyzed by WG 6.
4- Retirement package containing the rationale for
retirement and the required editing of the Standard for each
item prepared by WG 6 with the help of other working groups
(Items will be listed separately so each may be voted on
5- Vote by WG 6 - Each member may pull any item and delay
action on the item by 9 months
6- What has not been pulled from the package goes to Letter
Ballot by the DICOM Standards Committee.
7- Pulled items resubmitted after 9 months for ballot will
be WG 6 with a two-thirds majority required for submittal
for ballot by the DICOM Standards Committee.
See the attach document for supplement status information.
Review and Approve Supplement from Other WGs (see individual
reports for details)
Supplement 15: VL (Single Frame) passed WG 6 approval and
was sent to the DICOM Committee for Letter Ballot.
Supplement 23 and Supplement 46 have been incorporated into
Supplement 23:Structured Reporting and no longer exists as a
separate supplement. Members made many comments.
Supplement 29: RT Treatment Record IOD passed DICOM Letter
Ballot by the DICOM Committee. Final Text was written with
technical changes, therefore, it has been resent to the
committee for further ballot.
Supplement 30: Waveform Interchange was discussed and many
comments were made to WG 1. The goal is to release this
supplement for Letter Ballot after the June WG 6 meeting.
See the attach document for supplement status information.
Please see other WG reports for details.
The Letter Ballot of many supplements from other WGs and WG
6 will account for much of the agenda in June. Please don’t
forget, if the documents are not formatted using the new
DICOM supplement template they will not be reviewed by WG 6
and a WG member must be present.
The need for a DICOM workshop related to Image Management
Services (Modality Worklist, Modality Performed Procedure
Step, and Storage Commitment) was discussed. It was
suggested that this effort should be coordinated with the
planned IHE and VA workshops. It occurred (May 3-5) and
members Charles Parisot and Don Van Syckle represented WG 6.
Miscellaneous technical discussions related to DICOM image
management and IHE occurred.
WG 6 was asked by the DICOM Committee to produce a new
version of the DICOM standard "DICOM 1999". This request
was discussed and members were about evenly divided related
to its support.
The supporters wish to go ahead as they feel it's important
to print new supplements and correction proposals in the
published standard as soon as possible. The non-supporters
feel that printing these updates so quickly makes it
difficult for customers of the standard (i.e. I just ordered
and paid an old copy?).
WG 6 wishes the DICOM committee re-discuss these pros and
cons and make the final decision for when the standard
should be published.
New Work Items
Members discussed models for the creation of a new work item
related to Interpretation Worklist. The scope of the
supplement will be determined by the basic questions that a
"physician using a workstation" will need to ask focussed
upon the goal of creating a diagnostic report. Such as:
What to do today, and what to do next? What information do I
need to do the task, and where is that information? How to
compile and structure the results of the tasks?
Ideas were discussed to define the "high-level" scope of the
work item. Member, Cor Loef, has written a new work item
for the DICOM Committee. (See work item).
Respectfully submitted by:
Donald E. Van Syckle
Chairman, DICOM WG 6
DICOM Supplement Status Overview - WG 6
March 25, 1999
The following table is a status overview of the various DICOM
supplements and is formatted as follows:
Column 1 - Supplement Number, Column 2 - Supplement Name,
Column 3 - Parts Affected
Column 4 - Status of the supplement
Preliminary (effort in progress, but no early
Released for Public Comment , Public Comment
Frozen for Purpose of Trial Implementations
Released for Letter Ballot, Passed Letter Ballot
Final Text Created (waiting for Publication)
DICOM (date) - DICOM Standard where Supplement has
been published. (Ex. DICOM 1996)
Column 5 - Comments
NEMA Server Address - ftp.nema.org , http://www.nema.org
The format of the supplement names are as follows:
NN is the supplement number
VV is the version number, ie:
01 for draft number 1
99 for draft number 99
pc for public comment
lb for letter ballot
fz for frozen draft for trial use
ft for final text
Donald E. Van Syckle
Chairman, DICOM Committee WG 6
Suppleme Supplement Name Parts Status Comments
nt # Affected
0 Print Management Point-to-Point 13 DICOM 1995
1 Media Storage and File Format 3,4,6,10 DICOM 1996
For Media Interchange
2 Media Storage Application 2,11 DICOM 1996
3 Media Format and Physical Media 12 DICOM 1996
4 X-Ray Angiographic Image 3,4,6,11 DICOM 1996
Objects and Media Storage
5 Ultrasound Application Profile 3,4,5,6, DICOM 1996
IOD and Transfer Syntax 11
6 X-Ray Fluoroscopic Image Object 3,4,6 DICOM 1996
7 Nuclear Medicine Image Object 3,4,6 DICOM 1996
8 Storage Commitment Service 3,4,6 DICOM 1996
9 Multi-byte Character Set 2,3,4,5, DICOM 1996
10 Basic Worklist Management 3,4,6 DICOM 1996
11 Radio Therapy IODs Phase 1 3,4,6 DICOM 1998
12 PET Image Object 3,4,6 DICOM 1998
13 Queue Management 3,4,6 DICOM 1998
(Print Queue SOP Class)
14 Unknown Value Representation 2,5 DICOM 1998
15 Visible Light Image (Single 3,4,6 Released Goal to be released for
Frame) for Letter Final Text July 1999
16 PostScript Print Management 3,4,6 Canceled
Suppleme Supplement Name Parts Status Comments
nt # Affected
17 Modality Performed Procedure 3,4,6 DICOM 1998
Step SOP Class
18 Media Storage Application 11 DICOM 1998
Profile for CT and MR Images
19 General Purpose CD-R 11 DICOM 1998
20 X-ray Cardiac (1024) Media 11 DICOM 1998
21 Nuclear Medicine Media 11 Canceled Will be solved by using the
Application Profile General Purpose CD-R
22 Presentation LUT (Print) 3,4,6 DICOM 1998
23 Structured Reporting 3,4,6 Frozen Continued to be frozen, see
Draft supplement 46 for future
24 Stored Print related SOP 3,4,6 DICOM 1998
25 Ultrasound Application Profile 11 DICOM 1998
26 Ultrasound Application Profile 3,4,6 Preliminary
27 Media Formats and Physical 12 DICOM 1998
Media for Data Interchange
28 Grayscale Standard Display 14 DICOM 1998
29 RT Treatment Record IOD 3,4,6 Final Text Waiting for Publication
upon upon approval of the DICOM
approval of committee.
30 Wave form Interchange 3,4,6 Public Goal to Release for Letter
Comment Ballot July 99.
Suppleme Supplement Name Parts Status Comments
nt # Affected
31 Security Enhancements One 2,3,8,15 Public Goal to Release for Letter
Comment Ballot mid 99.
32 Digital X-Ray 3,4,6 Final Text Waiting for Publication
33 Soft Copy Presentation Storage 3,4,6 Public Goal to Release for Letter
Comment Ballot mid/late 99.
34 Non-Preformatted Print Storage 3,4,6 Canceled Withdrawn by the champion
SOP Class and consensus was obtained
35 Retiring Referenced Print 3,4,6 Final Text Waiting for Publication
36 Codes and Controlled 3,4,6 Final Text Waiting for Publication
37 Printer Configuration SOP Class 3,4,6 Final Text Waiting for Publication
38 New Basic Image Overlay Box SOP 3,4,6 Final Text Waiting for Publication
39 Stored Print Media Storage 3,4,10 Final Text Waiting for Publication
40 DVD using UDF Media 10,11,12 Early Draft Public Comment in January
41 Security Enhancements Two Preliminary
42 MPEG Transfer Syntaxes and 5 Preliminary
43 3D (multi-dimensional) 3,4,6,10 Preliminary
Ultrasound IODs and SOP Classes
44 Part 9 Retirement 9 Initial Public Comment July 1999
45 Ultrasound Protocol Support 3, 6 Initial
46 Simplified Structured Reporting 3, 4, 6 Early Draft Public Comment July 1999
47 Multi-frame Visible Light Image 3,4,6 Late Draft
DICOM WG7 (Radiotherapy) Report
WG7 (radiotherapy) has been working primarily on Supplement 29
(RT Treatment Record Objects). This work has been undertaken using the WG7
newsgroup and teleconferences. Supplement 29 was presented to WG6 at the
March meeting, and was approved as final text subject to distribution of a
letter outlining some modifications made after letter ballot. This letter
was sent with no comments received during the two week period, and
Supplement 29 is now ready to become part of DICOM.
In addition, a number of Change Proposals (six) have been developed by WG7,
mostly clarifying interpretation of the standard following
Implementations of Supplement 11 objects. These CP's were reviewed by WG6
at the March meeting and will be reviewed again at the June meeting in
A number of important RT trade shows (e.g. AAPM, ASTRO, IFOMP) take place
in the coming months. Work is beginning to decide upon appropriate
DICOM RT demonstrations and/or workshops at these trade shows. It may be
possible to organize a WG7 at one of these shows to discuss future
directions for Dicom RT.
WG 9 - Ophthalmology Report:
The Working Group met in Seattle in association with the American
Society of Cataract and Refractive Surgery on April 9, 199. The following
issues and work items are being addressed:
1. Preparation for WG 9 presentation at the Joint AAO/PAAO meeting in
Orlando October 24-27 Vendors had positive feedback about the DICOM WG 9
presentation at the Technology center of the American Academy of
Ophthalmology in New Orleans and the participants of the New Orleans
presentation committed to participate in another DICOM presentation in
Orlando. Several possibilities will be considered including:
- Integration of more instruments
- Collaboration with other workgroups with the goal of adapting
- Creation of a project similar to IHE (Integrated Healthcare
Enterprise) for ophthalmology (IEE=Integrated Eyecare
2. A specific request for the AAO user community to develop reporting
templates for major ophthalmic conditions was requested. The existing PPP
structure (Preferred Practice Patterns) developed by the AAO will
be the platform for proposals of standard templates. The AAO has agreed
to produce templates beginning with these major clinical conditions:
- Diabetic retinopathy
- Refraction/Refractive Surgery
3. The Integrated Eyecare Enterprise An invitation will be extended to the
industry for to assist in creating an IEE project (Integrated Eyecare
Enterprise) similar to the IHE project.
4. Recruitment for New Working Groups The AAO will continue to recruit
participation from vendors within the field of perimetry, corneal
topography and ultrasound to participate within a dedicated subgroup of WG
9 for researching existing standards within DICOM and defining specific
needs for additional standard sets.
5. Next meetings The next meeting is planned in Europe. Alternatives are
the SOE in Stockholm or the DOG (Deutsche Ophthalmologische Gesellschaft)
in Berlin (as in 1998). The next WG 9 meeting in the US is planned in the
conjunction with the annual AAO meeting in Orlando (Friday, 22. October
Co-Chair, Working Group 9
Report Working Group 10 meeting, 16 June 1999
DICOM MIME Type
The Working Group agreed with the proposal of Emmanuel Cordonnier to request a DICOM MIME
type and a file extension.
DICOM Strategic Document
A discussion was held about the future of DICOM. Based on this
discussion, Eric Martin has offered to make a first version of
a strategic document.
Charles Parisot and Kees Smedema reported on the progress of
the IHE demonstration for year 1 and the preparations for year
2. The IHE will inform WG 6 before their next meeting about
the priorities from IHE’s point of view for completion of
certain parts of the DICOM standard. The IHE assumes that
supplements that do not go to letter ballot before March 2000
cannot be used in IHE year 2.
Dean Bidgood gave an update, reviewed Annex A and distributed the “Blue Book”. WG 10 thanked Dean
Bidgood for all the work he did and does for SR. WG 10 recommends to the DICOM Committee that WG 6
gives now a very high priority to the completion of SR.
Terminology and Codes
Some years ago DICOM got the agreement from CAP to use the terminology of SNOMED in DICOM SR.
However, SNOMED has evolved and the question is whether this agreement is still valid in the current
circumstances. The Working Group decides to ask Dave Clunie and Dean Bidgood to investigate the current
situation with the CAP as soon as possible and come up with an answer whether the codes are under any
royalties or not. This is required before SR goes to letter ballot.
Relation with HL7
It was proposed to go ahead with making IMSIG a full DICOM Working Group. It was suggested that merging
this new Working Group with WG 8 would probably be very beneficial. There should be 2 co-chairs, one from
DICOM and one from HL7. Meetings should not only be held in conjunction with HL7 meetings, but also with
relevant DICOM meetings.
Priorities for WG6
WG 10 recommends the following priorities for supplements etc:
1 Change Proposals
2 Presentation State
4 Retirement of Sections
4 Re-visiting Part 1 and Part 2
5 Security- Digital Signatures
5 Multiframe VL
5 US: MPEG, Intravascular, Stress Echo
5 DVD-UDF Media
5 DICOM MME type
6 Interprestation Worklist
It was suggested that if WG 6 would want to work on the Interpretaion
Worklist, a special Ad-hoc group should be set-up that would not delay
Report on Working Group 12, Ultrasound
June 7, 1999
SR 23 SOP CLASS PROPOSAL
WG 12 continues to follow the progress of the Structured Reporting
Ultrasound will adopt this Supplements for use in conveying
Ultrasound measurement and observation data. At this time plan on using
'generic' or 'general' SOP Classes rather than Ultrasound specific SOP
STRESS ECHO SUPPLEMENT
Progress continues in the development of the Stress Echo Supplement. We
hope to soon present it Working Group VI for review. Final discussions
involve mapping of Protocol Stages to the DICOM model. i.e. is each
Protocol Stage a Scheduled Procedure Step etc?
IVUS STANDARD REQUIREMENTS
The progress on the development of the IVUS Supplement by Working Goup I
continues to be followed. We have reviewed the initial Requirements and
hope to assist in it development.
The Work Group continues to compile and review list of measurements for
inclusion in LOINC.
Work has begun on creating a Supplement for adding MPEG compression for
Ultrasound cine images. This is planned to take the form of a new Transfer
Syntax and additional encoding rules for MPEG data in the existing pixel
DEVELOPMENT OF 3D STANDARD
The new 3D Group will be developing rules for encoding multi-dimensional
Data sets. They will not however address encoding issues for acquisition
sets which are used to derive the 3D data. For this reason Working Group 12
is reviewing the existing Ultrasound IODs to determine if any changes or
new IODs and SOP Classes are required.
DICOM DISK EXCHANGE
A decision will be made on whether to end the formal disk exchange tests
and create a final report for the ultrasound and DICOM communities.
WG 13 - Visible Light
WG 13 has not met since the last DICOM Standards Committee meeting. The
group is awaiting the final ballot results on the VL supplement 15
(Single Frame). Supplement 47 (Multi Frame) work item has not yet been
addressed since it has been segregated from the initial VL proposal.
Co-chair, WG 13
WG 14 Report -- 17 June 1999
WG 14 held two teleconferences since the last DICOM Committee Meeting. The
main effort was to send out, then evaluate responses to a Request
For Proposals (RFP) for a demonstration of DICOM Digital Signatures
at an upcoming conference. This RFP was coordinated through the
Committee for the Advancement of DICOM. The target conference for the
demonstration was RSNA 1999, with either SPIE 2000 as a fallback date. We
had one response to the RFP from OTech, which the Working Group deemed
acceptable. Based on that response, the WG submitted a proposal for a
booth at InfoRad.
About the same time, Vicki Schofield sent out requests to NEMA members for
voluntary contributions to support the RFP. Unfortunately, the
last report Vicki gave to the WG was that only two parties came forward
with a combined commitment of $6000, which falls far short of the $22,500
requested by the OTech/OFFIS development team. In light of this, Vicki
indicated that the RFP probably could not move forward.
Due to delays for which the Chair takes full responsibility, the WG 14
meeting originally scheduled for May was postponed to August in San
Francisco. The intention is to hold a full day meeting to address
finalization of Supplement 31, future steps for Supplement 41, the
potential support for a Digital Signature demonstration, and future issues
suggested by WG 10. Based on that last discussion, WG 14 could possibly
submit new work proposals to the DICOM committee.
DICOM WG 15 Digital Mammography Report (for June 1999 DICOM
WG 15 has considered a proposal to develop an extension to DICOM to
standardize the reporting of Computer Assisted Detection (CAD)
results for mammography. There is sufficient interest in this
subject by members of the working group (which includes several
CAD vendors) to support this development effort. This effort will
take advantage of the BIRADS standard from the ACR for mammography
WG 15 has no other work items on its agenda at the present time.
Action requested: Approval of the attached work item for a Mammography
CAD extension to DICOM.
-- end report --
-- begin proposal --
Proposal for Mammography CAD Work Item
The DICOM Mammography WG 15 has determined that it is necessary to
develop an extension to DICOM to standardize the reporting of
Computer Assisted Detection (CAD) results for mammography.
It is proposed that the DICOM Committee approve a Work Item
for the development of a Mammo CAD supplement, and
request the WG 6 staff to assign a supplement number.
Limitations of Current Standard.
The existing standard contains only overlay or curve objects that
may be used to indicate regions of interest on an image that may
pertain to CAD output. These convey no semantics and are not
sufficient to adequately represent the information CAD algorithms
may generate. At present, CAD results are used only in a
proprietary manner, without the opportunity to share results between
implementations or with general purpose (non-CAD specialized) workstations.
Description of Proposal.
It is therefore proposed that a Mammo CAD supplement be developed,
- makes use of the structure and framework defined by proposed Sup 23
structured reporting to encode CAD results
- makes use of terminology and structure defined in the ACR BIRADS
standard for mammographic reporting
Parts of Standard Affected.
Part 3 will require a new SR Mammo CAD IOD.
Part 4 will require a new SR Mammo CAD SOP Class.
Part 6 may require an extended data dictionary of Mammo CAD elements.
SNOMED will require the addition of terms for mapping BIRADS
It is not proposed to add new services, messaging or encoding.
The Mammo WG 15 consists of members from the general vendor, digital
mammography and CAD community, as well as clinical and research
radiologists, medical physicist and scientists, representatives of
regulatory authorities and research institutions, as well as ACR staff
involved in mammography.
The meetings do not consume significant bandwidth of other DICOM working
group members, apart from the involvement of some individuals concerned
with structured reporting. The secretariat is ACR and most of the meetings
have been in the USA. There is a high level of interest by many members,
particularly vendors, for the early adoption and implementation
Of a Mammo CAD reporting standard.
At the present time it is not expected that other CAD applications will
need to be considered in this supplement, since the state of the art in
mammography is further advanced, as is the commercialization of the
technology, hence the need for a standard.
It is anticipated that development of the supplement will take 12 months
and that meetings will be held on a three monthly basis, with much of the
work of document preparation and editing done by the exchange of email.
Many of the meetings will be held in conjunction with major scientific
meetings (such as SBI and AAPM).
Six hours of WG 6 meeting time on two occasions during early
and mid 2000 are expected to be consumed for the review and approval of
public comment and letter ballot text.
-- end proposal --
David A. Clunie mailto:email@example.com
Director, Medical Imaging Technologies http://idt.net/~dclunie/
Quintiles Intelligent Imaging http://www.i2image.com/
521 Plymouth Rd #115 Work 610-238-0572 Fax -0578
Plymouth Meeting PA 19462 Home 570-897-7123 Fax -5117
Report from DICOM WG 16 (MR enhancements) activities
List of previous meetings
september 16 and 17, 1998, during ESMRMB ’98 in Geneva
january 12 and 13, 1999, at NNI in Delft
april 15 and 16, 1999, at NEMA in Washington
List of future meetings
june 20 and 21, 1999, before CARS ’99 in Paris
september 14 and 15, 1999, before ESMRMB ’99 in Sevilla
december 13 and 14, 1999 at NEMA in Washington
List of action items defined through novel MR applications
work on multi-frame image module
work on novel descriptive attributes for pulse sequences
work on spectroscopy data representation
work on MR specific modality LUT, color in MR applications, calibration,
description of stimuli used in functional MR imaging, operations between images
(wrt. original and derived MR images)
discussion about MR rawdata representation
List of short-term goals
based on feedback of WG 6 on a draft of a new MR multiframe object members
are revisiting their ideas trying to reach a pragmatic solution
finding consensus on vendor-independent nomenclature of advanced pulse
sequence techniques and attributes
drafting of proposed work items for presentation to the DICOM comittee
have a joint meeting together with WG 17 (3D) to clarify common
interests/syngergies (before ESMRMB ’99 in Sevilla)
Action requested from the DICOM committee
consider a draft of a WG 16 scope for review by DICOM committee (was sent
Matthias Drobnitzky, WG 16
The scope of DICOM WG 16 – a proposal for the DICOM Committee
Proposal for New MR SOP Class Work Item
The DICOM MR WG 16 has determined that it is necessary to create a
new MR object to meet the needs of state of the art MR technology that
has evolved substantially since the existing MR object was standardized
It is proposed that the DICOM Committee approve a Work Item for the
development of a New MR Object supplement, and request the WG 6
staff to assign a supplement number.
Limitations of Current Standard:
It is not possible without the use of extensive collections of private
elements to describe modern MR pulse sequences using the current
standard, hence interoperability of annotation and advanced annotation
are hampered by the current standard.
Furthermore, new applications such as functional MR and MR
fluoroscopy, as well as the non-imaging application MR spectroscopy,
are not supported by the current standard. Not only are technique
attributes insufficient, but 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.
The MR WG believes that adding new optional elements to the existing
MR object would not be sufficient to meet the needs of modern MR
Description of Proposal:
It is therefore proposed that a new MR object be developed, that:
contains a more extensive set of descriptive attributes
makes use of the multiframe mechanisms and variants thereof (as
originally introduced by the nuclear medicine, ultrasound and x-ray
Parts of Standard Affected:
Part 3 will require a new MR IOD.
Part 4 will require a new MR Storage SOP Class.
Part 6 will require an extended data dictionary of MR elements.
It is not proposed to add new services, messaging or encoding.
The MR WG 16 has been meeting regularly since it was established in
1998, and its members are drawn mostly from the MR community. Until
now meetings do not consume significant bandwidth or other DICOM
working group members. The secretariat is now COCIR/NNI and most
of the meetings have been in Europe. This situation avoids the need for
NEMA staff to travel to staff all the meetings. The working group
includes members from the majority of MR equipment vendors as well
as interested users, mostly from the scientific community. The level of
interest by vendors bodes well for the early adoption and
implementation of a new MR object.
It is anticipated that development of the supplement will take 12-18
months and that meetings will be held on a three monthly basis, with
much of the work of document preparation and editing done by the
exchange of email. Many of the meetings are held in conjunction with
major MR scientific meetings (such as ESMRMB and ISMRM).
Six hours of WG 6 meeting time on two occasions during early and mid
2000 are expected to be consumed for the review and approval of public
comment and letter ballot text.
A close liaison with the DICOM 3D WG 17 is expected, since some
commonality in the form and description of spatially and temporally
varying multiframe acquisition objects is expected. Proposals have been
made to hold joint or overlapping 3D and MR WG meetings when
It is suggested that this commitment of time and resources is
considered to be well justified, considering that the exchange of MR
images is one of the oldest, highest volume and most mature
applications of DICOM, yet is one of the most rapidly evolving.
Matthias Drobnitzky, WG16
WG17 Status Report
WG17 convened its third meeting at NEMA May 18-19.
WG17 produced a draft set of requirements. A copy accompanies this report.
Concerned Working Groups should review this document at their next meetings
and provide feedback to WG17 regarding the adequacy, completeness, and any
other comments. Also attached to this report is a summary of WG17 mission
and activity intended for distribution to Working Groups or others that may
have interest in participating.
WG17 requests submissions that describe anticipated data types intended for
eventual support by the Standard. A directory on the NEMA ftp site holds
submitted white paper, minutes and other documentation.
There are two primary requirements classifications:
- reconstructed and modality native data; and
- annotation and presentation.
The former requirements are the current priority. WG17 will work with WG11
to refine the presentations related requirements. WG17 and WG11 will
interact to evolve the definition of these requirements and to partition
the responsibilities. As yet, there is no schedule for the effort.
WG17 is pursuing a *structured node* approach for the representation of
multi-dimensional data. The approach is a representation based on
hierarchical nodes. Primitive data types form the building blocks of
progressively more complex data types. The approach is extensible and
should meet all the requirements discussed thus far. Volunteers are
submitting use cases and white paper to develop and evaluate alternatives.
Volunteers are also evaluating how to leverage existing multi-dimensional
standards such as OpenGL, Fahrenheit, and SMIL.
The intent is to choose parameter definitions and terminology
consistent with that of these standards.
Requirements for N-Dimensional Data Sets
May 24, 1999
This draft is a summary of requirements gleaned from the first
two meetings and submitted white paper. The requirements are
separated into two categories:
requirements for data from acquisition through the
presentation data or the specifications by which to derive
Acquisition and Reconstruction
1. Data sets can be of any order of dimensionality: 1D, 2D, 3D,
… Dimensions may be space, time, physiological phase,
detector energy, or other acquisition defined dimensions.
2. Resampled, reconstructed data sets (such as a 3D voxel
arrays); sequences of lower dimension data types (such as
modality native 2D image frames) used to derive the
3. Sampling rates can vary along each dimension. That is, the
spacing in each dimension may differ. Voxels may be non-
cubic and pixels not square.
4. The sampling relationships between the data sets within a
particular dimension may be regular or irregular. Regular
relationships are the common case of pixels or voxels
equally spaced along an axis. An example of irregular
sampling is cine loops with missing frames or non-uniform
5. The sequence of data sets is not constrained. That is the
organization of the binary data portion of the data set (and
reflected in the organization of the nodes) is
unconstrained. For example a modality may export a four
dimensional data set with either space or time as the
highest order dimension. Similarly, a modality may
interleave the data sets of multiple sample components at
any level: pixel, frame or as separate volumes.
6. The data set relationships may be non-orthogonal and can
have arbitrary spatial relationships (both orientation and
translation). In this case, the relationship between the
data sets must include the direction cosines to define the
data set’s projection onto its child data sets. In this way
it is possible to describe the 3D spatial relationships of
frames acquired in any geometric acquisition protocol
including, for example, free hand ultrasound.
7. Data sets may have multiple components (or channels). For
example, ultrasound may have an echo component as well as
doppler components; MR may have T1, T2 and functional
8. Data sets of different components may have different
dimension sizes or sampling rates. For example, the data
sets of the power doppler component may be a sub-volume or
9. Data set components may have different dimension order
within the same root data set. For example, one dimensional
audio or physiological data sets may be correlated with two
10.Data sets have relationships describable in the Standard.
These are local (within the same root data set), or they can
be external, that is references to a reference coordinate
system defined externally. The relationships include
spatial, temporal, trigger delay relationships.
11.Data sets may have additional data to describe modality
specific acquisition data. This enables the modality to
specify any data useful to downstream clinical applications.
12.Data sets can be binary “shutter” volumes that define
volume masks. Data sets may have an enumeration of data
types. For example, an enumeration may encode segmented
tissue classifications such as: bone, muscle, fat, etc..
3D attributes that correspond to WG 11 Base Presentation
State. These are simple extensions of what is already
standardized in Base Presentation State.
New 3D attributes not handled via extension of Base Presentation State
These are not done in Base Presentation State, but items that
are sensible extensions.
Camera viewpoint, angle, path in time
types of rendering used
volume rendering (opacity based, MIP, etc)
surface renderings (marching cubes, isosurface, etc)
intent of rendering, i.e. clinical protocol (Circle of
Willis, CTA, etc)
multivalue (different colors for different types, etc)
leaf “structured nodes” used to generate the visualization
polygonal structures (external objects, like biospy gun,
radiation treatment beam, etc).
Complete description of Rendering State
This is to exactly specify (and thus) standardize the methods
used for the visualization.
Exact rendering method (volume, opacity, alpha blending, IW,
transparency, lighting, shading, etc).
Parameters to rendering method
STATUS REPORT OF ACTIVITY OF WORKING GROUP 17
MULTI-DIMENSIONAL DICOM WORK GROUP
This is a summary of DICOM Work Group 17 activities,
provided as information to other DICOM Work Groups concerned
with 3D imaging or other multi-dimensional data needs. The
mission, status and current activities are set forth.
Accelerating activity in 3D diagnostic imaging
applications has given rise to the need for representation of
3D diagnostic image data in DICOM. This need is relevant to
multiple modalities and DICOM Working Groups. To avoid
independent and divergent efforts in multiple Working Groups,
the DICOM Standards Committee commissioned WG 17 to develop a
common framework for multi-dimensional data sets, extensible
to any modality and clinical specialty.
The purpose of this paper is to inform other interested
Work Groups of WG 17’s direction, and to invite input and
collaboration toward the Standard’s development. The Work
Group convened its first meeting on Friday, December 4, 1998,
and has held subsequent meetings on February 25, 1999 and on
May 18-19, 1999. The next meeting will be held on September
15-16, 1999 in Seville, Spain. The morning of September 15
will be devoted to a joint meeting with Work Group 16 (MR).
At the first meeting, the WG set forth the mission. The
Standard must support dimensions of any type, including space,
time, spectral or other. WG 17 identified the following
general of requirements:
- Native modality objects
- Resampled objects such as 3D reconstructed volumes
- Derived presentation objects such as 2D images
renderied from 3D objects
- Annotation related requirements
Data types and characteristics of the data sets may
- Aggregate correlated data sets within multi-dimensional
-multiple signal types
- Relationships to external objects and frames of reference
- Binary or enumerated volumes such as shutter masks,
- Fiducials for data fusion, registration and synchronizing
WG17 identified examples of clinical applications the
Standard should support. Representative of these are:
-Diagnostic visualization: surface, volumetric, virtual
endoscopy, stereo projections
-Computer Aided Diagnosis
-Treatment planning and simulation
-Intra-operative: Image Guided Therapy
- Clinical specialties: cardiac; vascular; oncology;
obstetrics, dental; reconstructive surgery, pathology,
II. STATUS REPORT ON ACTIVITY
WG17 is giving priority to the problem of modality export vs.
presentation related issues. WG17 and WG11 will interact to
evolve the definition of these requirements and the
WG17 is pursuing a “structured node” approach. Primitive data
types form the building blocks of progressively more complex
data types. Volunteers are submitting use cases and white
paper to develop and evaluate alternatives. The following
items are now under investigation:
-Identifying and defining the fundamental node types
-Rules for constructing tree structures, dimension nesting,
and context inheritance
-Encoding recurring and non-recurring events
-Investigating what leverage, if any, is possible from
standards such as OpenGL, SMIL
III. NEXT STEPS FOR FURTHER ACTION
WG 17 is seeking from each affected modality and clinical
specialty, requirements statements, descriptions, or examples
of anticipated needs to ensure that the Standard will fully
meet the needs of the DICOM community. Thus far, WG17 has
received input from Ultrasound, Nuclear Medicine, and Working
Integrating the differing requirements of various modalities
is a daunting task. The members of WG 17 urge that your
Working Group incorporate multi-dimensional issues into its
agendas. We encourage your input into our development process.
Whenever possible feasible, WG17 will arrange joint meetings
with other work groups to deal with common issues. One such
meeting was held with WG12, the Ultrasound Working Group. A
joint meeting with WG 16 (MR) is another step consistent with
If you have further questions, please feel free to
contact Richard Eaton, Industry Manager at NEMA, by telephone
at (703) 841 - 3248, fax at (703) 841 - 3348 or e-mail at
DICOM WG on Clinical Trials Report (for June 1999 DICOM Committee
At the last DICOM Committee meeting in March in Vienna, a WG on Clinical
Trials was approved, pending acceptance of the Secretariat by the ACR.
In the interim, the NCI has been proposed as an alternative secretariat.
Discussions with the NCI representatives indicate a probable favorable
response, but this has not yet been formally confirmed.
Also, it has been suggested that the scope of the proposed WG might be
extended to include the use of DICOM in educational roles (e.g. the storage
of images for educational purposes), since there are many commonalties
(such as anonymization of patient identifying information).
The proposed WG has not yet met.
Action requested: That the committee approve NCI as the secretariat,
pending their acceptance.
Action requested: That the committee approve naming the proposed group
the Clinical Trials and Education WG, pending a formal charter and
scope to be developed by the group members, once convened.
David A. Clunie mailto:firstname.lastname@example.org
Director, Medical Imaging Technologies http://idt.net/~dclunie/
Quintiles Intelligent Imaging http://www.i2image.com/
521 Plymouth Rd #115 Work 610-238-0572 Fax -0578
Plymouth Meeting PA 19462 Home 570-897-7123 Fax –5117
PROPOSAL TO CREATE A WORKING GROUP ON DERMATOLOGIC STANDARDS
The American Academy of Dermatology convened an open organizational meeting for a new
Working Group on Dermatology Standards to focus on issues related to standards for
dermatologic imaging and digital communications. The Academy believes that the interests
and needs of industry, dermatologists and their patients are best served by establishing global
standards governing the communication of images and data. A digital imaging standard
permits users to communicate readily, no matter what specific technology they use. The
Digital Imaging and Communications in Medicine (DICOM) standard is recognized
throughout the world as the medical imaging standard. To date, however, there has been
little interface of dermatologists with this standard. The establishment of this Working
Group provides a formal mechanism for input into and creation of standards that are
responsive to the needs of industry, users and patients.
The group will be focusing on the standards development
activities related to digital imaging and terminology in
caring for diseases and conditions of the skin.
Accordingly, it is proposed that a new Working Group be
established to address this subject reporting, as appropriate,
to the Structured Reporting Working Group (Working Group 8)
and the Visible Light Working Group (Working Group 13)
Formation and Review:
The formation (and later disbandment) requires approval
by a majority vote of the DICOM and appropriate notice to
those who have interest in the activities of DICOM. The
scope and duties delegated, as a working group shall be
approved at the time it is formed. Subsequent changes in
scope or duties shall also require DICOM Committee
Like all DICOM Working Groups, membership and meetings would be open to all,
but it is likely members would include:
Members of the AAD interested in the application of DICOM
Major research institutions
Other industrial partners
Members and the Sponsoring Organizations of this working group will be appointed
A request for membership shall be addressed to the
Secretariat, and shall indicate:
a) The applicant’s direct and material interest in the
DICOM Committee’s work;
b) The applicant’s qualifications and willingness to
c) The interest category of the applicant (vendors, bio-
medical professional organizations, vendor associations,
standards developing organizations, government agencies);
d) The name of the representative (and alternate, if
Maintenance of Membership:
If any member or alternate of the working group is not
present for three consecutive meetings of the working
group, membership will cease. After the second
consecutive meeting not attended, the secretariat shall
notify the member that membership in the working group
will cease after the next meeting, if the member is not
present. Membership may be reinstated by action of
The secretariat shall maintain a current and accurate roster and shall distribute it to the
members at least annually, and otherwise on request. The roster shall include: the
name, chair, Sponsoring Organizations, and names and addresses of all members.
Individuals active in the formation of this Working Group
Joseph C. Kvedar, MD, Chair
Timothy Chartier, MD
Armand Cognetta, MD
Marta Petersen, MD
Robert Schosser, MD
William Stoecker, MD
Meetings will be held on a semi-annual basis, usually in conjunction with the semi-
annual meetings of the American Academy of Dermatology.
Calling of Meetings
Meetings may be held as decided upon by the members or
Meetings shall be open to all members and others having a
direct and material interest.
Prohibition of Commercial Topics:
No commercial topics shall be acted upon or even considered. To avoid the most
sensitive areas, there shall never be a discussion of the following at meetings:
current or future prices or components thereof, including discounts, rebates, and credit
terms; price lists or procedures for coordinating price changes; sales or production
quotas; allocation or division of territories of customers among manufacturers,
distributors or retailers; boycotting any party or denying any party access to markets,
products, product inputs, or information; identified individual company statistics,
market shares, inventories or merchandising methods; commercial practices,
warranties, guarantees, or the particular terms and conditions of sales, including
credit, shipping and transportation arrangements; or anything dealing with “arm-
twisting,”, trade abuses, or excluding or controlling competition.
Conduct of Meetings
All meetings shall be conducted in such a manner that all members are afforded an
adequate opportunity to present their views. All opinions shall be considered before
actions are voted upon. The chairperson(s) shall undertake this responsibility with the
assistance of the secretariat‟s staff.
Discussions shall be confined to technical, clinical, and
safety factors. Commercial considerations (warranties,
guarantees, etc.) are not proper factors and shall not be
considered. Since the DICOM Standard is voluntary, there
must be no agreement to adhere to it or any discussions
as to when members will begin to offer products
conforming to DICOM.
The secretariat shall ensure that minutes of all meetings
are clear, complete and accurate with regard to the
actions that were taken and the justification for those
There shall be no conversations off the record at the
meeting. If comments are not appropriate for recording,
they shall not be brought up at meetings.
Meetings shall be adjourned when it is over in all
respects and not simply in name. Informal rump sessions
are not part of meetings and should not be held.
The American Academy of Dermatology will act as secretariat performing
administrative functions, coordinating meetings and meeting the requirements of the
DICOM procedures for Working Groups.
Responsibilities of the Secretariat:
Work closely with NEMA (National Electrical
Manufacturers’ Association) for proper conduct and
documentation of subgroup activities, and coordinate with
other standard-setting bodies as appropriate;
Oversee the subgroup’s compliance with the procedures of
the DICOM Standards Committee;
Provide a secretary to perform administrative work including: meeting arrangements,
notices, agendas, minutes and other records;
Perform other administrative functions as required; and
Following the meeting procedures of the DICOM Standards
Proposed Work Items:
Create and maintain a SOP Class for dermatology
Develop definitive content specifically related to
dermatologic imaging and image-related information (such
as reports) applications in the DICOM standard;
The extension of the DICOM standard with respect to
dermatologic imaging applications of visible light,
ultrasound, and infrared imaging of the skin;
Assisting DICOM on technical, engineering, quality
assurance and safety issues related to imaging of the
skin as required;
Development of a standard terminology and interaction
with groups such as SNOMED; and
Demonstrations of the DICOM standards in dermatologic
imaging standards for visible light, ultrasound,
structured reporting and use of these standards in
Proposal to start a new Working Group
New DICOM Working Group: Integration of Imaging and Information Systems.
The scope of the working group is:
The development of DICOM and HL7 standards for image-related information for areas where the
consistent use of HL7 and DICOM is of prime concern.
The coordination and mutual education and understanding between the HL7 and the DICOM organizations
and their technical committees/working groups
All current members of IMSIG will be invited to become member.
The combination of WG 8 with this new working group may be explored in view of the substantial common
interests and the efficient organization of the DICOM work.
The NEMA has agreed to be the secretariat. This maybe taken over by a professional organization.
Meetings may be held in conjunction with HL7 meetings, DICOM Working Group meetings and other
related meetings. The estimated number of meeting days is 10 days per year.
The co-chairs shall report to the DICOM Standards Committee and to the HL7 Technical Steering
The DICOM members of the Working Group should be considered as full HL7 members for this Working
Group/SIG and vice versa.
This proposal will be sent to the HL7 Board of Directors.
Agreed in the DICOM Standards Committee Meeting of 17 June 1999
Report of the European DICOM secretariat
The European DICOM secretariat has been more successful than
was anticipated: more DICOM meetings were held in Europe than
we budgeted for.
The European DICOM secretariat is held by the Dutch Standards
Organization (NNI), under the auspices of the COCIR.
The following meetings were held or are planned for 1999:
Jan., 12-13 Working Group 16 Delft,
March, 9-10 Working Group 10 Vienna,
March, 10-11 DICOM Standards Committee
June, 21-22 Working group 16 Paris,
June. 23 COCIR IT Committee Paris, France (not
June, 28-July, 1 Working Group 6 Paris,
Aug. 30 Working Group 1 Barcelona, Spain
Sept. 14 Working group 16 Sevilla, Spain
Sept. 15-16 Working Groups 16, 17
The increasing number of meetings in Europe has certainly
enhanced the international image of DICOM. It has raised the
attendance from European companies, professional societies and
standards bodies to meetings held in Europe.
So far we have not been very successful in getting additional
membership from European professional societies, apart from
the French Society of Radiologists. We will continue our
efforts to increase membership in Europe.
The presentation state demonstration at the ECR in March in
Vienna was a success. Many people visited the demo in the
“Compurad”. The COCIR made an excellent brochure about DICOM
which was distributed at the ECR and beyond. There was also an
information booth about DICOM sponsored by the French Society
The COCIR is trying to raise awareness and funds to start an
IHE-like 1 demo in Europe. The initial plan was favorably
received by the European Union.
Report on Japanese DICOM Activities
JIRA and MEDIS-DC mainly perform DICOM related activities in
Japan. JIRA is an industrial association and has several
departments, one of which is for medical imaging systems.
MEDIS-DC is an organization supported by MITI, Ministry of
International Trade and Industry, and Ministry of Health and
Welfare. The department of JIRA is organized by people from
medical equipment manufacturers and has several committees
like DICOM Committee, ISO Committee, CRT Diagnosis Committee,
etc. under the department. JIRA’s DICOM committee is formed
with members from 30 companies and four advisors from
universities. The committee has meetings regularly and
sometimes forms a working group to discuss specific subjects.
The major mission of the committee is interpreting DICOM
standards, adapting the standards to Japanese circumstances,
and educating them to Japanese users. For example, we proposed
the multi-byte character set and using ISCL for the security.
Japanese committee currently focuses the interface between
HIS/RIS and PACS/modality, or worklist management and
performed procedure step. The information needed to operation
in the radiology department in Japan is slightly different
from that in the United States. For example, Japanese law
requires recording operating conditions like electric voltages
and currents to X-ray tubes in both cases of taking
fluoroscopy and radiography. We, therefore, have formed a
working group under JIRA’s DICOM committee and are extensively
discussing what kind of information or data should be
maintained for the practical operation. The working group is
lead by Dr. Kimura, professor of Hamamatsu University of
School of Medicine, and run by JIRA and JAHIS. JAHIS, Japanese
Industries Association of Healthcare Information Systems, is
another industrial association whose members are from
healthcare information systems manufacturers. After the
discussion has been completed, we will propose to correct the
supplement 10 and 17.
Education about DICOM to Japanese users is another area of
activities where the committee devotes. We have lectures on
DICOM at JMCP that is annual exhibition of radiological
equipment and systems and at academic conferences.
We have a regular meeting with JRS, Japan Radiological
Society, and JSRT, Japan Society of Radiological Technology.
They are the largest user groups of the standards in Japan. We
discuss issues on standards, operation in the radiology
department, regulations we all are interested in, etc.
Regarding biomedical imaging standard, which was discussed at
ISO/TC215, we formed a working group with JRS and JSRT.
We plan to demonstrate an integrating system of HIS, RIS,
PACS, and modalities at the next JMCP.
MEDIS-DC, Medical Information System Development Center, is
another standard discussing organization in healthcare
informatics. They have a committee, which is called IS&C
Committee and currently focuses to the discussion about
storage media and on-line security. A medium called IS&C,
Image Save and Carry, is now standardized as an archiving
medium for the medical image data. The standardization was
done after the discussion with DICOM Standards Committee. They
are now discussing the next generation media and
trying to find the way to harmonize DICOM standards. The
discussion is carried at working groups whose members are from
medical equipment and information systems manufactures and
academic societies. Another emphasized subject is on-line
security. The discussion is being shared with DICOM WG14.
The Ministry of Health and Welfare recently issued an official notice that said Japanese government would
approve healthcare facilities to archive any medical datum in electronic format. The facilities have been allowed
to archive only medical image data on IS&C media before the notice. Now they can archive any medical datum
in electronic format on certain media under proper operational rules and systems that would be defined by each
facility. JIRA, JAHIS, and MEDIS-DC are now discussing how we interpret the notice and what the proper systems
MII COMMITTEE FOR THE ADVANCEMENT OF DICOM REPORT TO THE DICOM
The Committee for the Advancement of DICOM utilizes an e-mail
Distribution list and telephone conferences, scheduled as needed, to
organize activities. It was established as an ad-hoc committee by the NEMA
Medical Imaging Informatics (MII) section, and meets infrequently,
typically once a year during the MII section meeting at RSNA. The chairman
of the Committee for the Advancement of DICOM has asked committee members
and MII section members on many occasions if they wish to have face-to-face
meetings or become more active. The consensus has always been that e-mail
and telephone conferences work well, and that there are too many DICOM-
related meetings anyhow.
The funding for activities supported by the Committee for the Advancement
of DICOM comes primarily from voluntary contributions from MII section
member companies, supplemented occasionally with money that has accumulated
from two public NEMA-organized DICOM workshops. The activities sponsored
by the Committee for the Advancement of DICOM have historically coincided
NEMA and the MII section have established and maintained a cordial
relationship with RSNA. NEMA has requested RSNA support for various
activities or demonstrations in the past. On some occasions RSNA
has requested support from the vendor community represented by the
MII section at NEMA (which typically exhibits products at RSNA). For
example, the MII section, at the request of RSNA was instrumental in
obtaining initial support from diagnostic imaging vendors for the RSNA-
HIMSS Integrating the Healthcare Environment (IHE) initiative. RSNA has
supported DICOM activities starting with the first DICOM demonstration in
1992. RSNA feels strongly that demonstrations need to be planned and
influenced by the vendor community that NEMA represents.
THE PROCESS TO SUPPORT DEMONSTRATIONS:
The Medical Imaging Informatics, Committee for the Advancement of DICOM was
asked at the DICOM Committee Meeting in Vienna, to solicit support for two
demonstrations for RSNA 1999:
1) Softcopy Display/ Hardcopy Output Consistency Demonstration
2) Security Demonstration (DICOM and Digital Signatures)
The process that was followed by the Committee for the Advancement of DICOM
in support of these requests is similar to what has been done in
the past and is described below as an illustration.
A telephone conference was scheduled by the Committee for the Advancement
of DICOM to discuss the two suggested demonstrations, and to discuss
various organizational issues with respect to the MII section, and the
Committee for the Advancement of DICOM. Minutes of the telephone meeting
are available from NEMA staff (Vicki Schofield).
RFPs to support the proposed demonstrations were generated by the
corresponding DICOM working groups and were distributed by NEMA
Staff, on behalf of the Committee for the Advancement of DICOM.
Solicitations for voluntary contributions to support the proposed
demonstrations were also distributed by NEMA staff. RSNA was informally
contacted to request support (assuming the necessary funding was obtained),
and a champion representing the corresponding working groups was
The proposals received to support the demonstrations were evaluated by the
Committee for the Advancement of DICOM (to make sure they met
NEMA open participation guidelines), and the respective DICOM working group
(for technical merit, and to determine if it met the RFP
requirements). This was done using a combination of e-mail messages and
telephone conferences, and working group meetings.
A timeline to gather the necessary information needed to obtain formal
support from RSNA was established. RSNA ECC meets each year in early June,
at which time such proposed projects are approved or disapproved;
from past experience, it is known that if that deadline is not met, it is
difficult or perhaps impossible to obtain RSNA support. Resource/ Budget/
and Space allocations are directly influenced as a result of the RSNA ECC
RSNA has expressed a strong interest in supporting the consistency
demonstration and will provide the space requested, provide educational
forums (theater access), etc.. Per the request of the Committee
for the Advancement of DICOM an RSNA ECC "champion" was identified to
help plan the demonstration and create educational and marketing materials.
The IHE demonstration planned for RSNA 1999 is proving to be very
costly for participating vendors. This makes it particularly challenging
to obtain voluntary contributions for additional demonstration at RSNA.
Unfortunately the security demonstration did not receive sufficient
funding, it will need to be postponed. Approximately 70% of the funding
for the consistency demonstration has been raised so far, therefore we will
continue to move forward with the plans, using contingency funds
accumulated from past DICOM workshops to fill in the gaps if necessary.
NEMA staff is issuing the contract to support the accepted consistency
The committee for the advancement of DICOM request assistance from DICOM
Committee members to obtain additional voluntary contributions to support
the consistency demonstration.
The committee also requests advice from the DICOM Committee with respect to
the security demonstration. Should a demonstration be planned for ECR 2000
(Austria), or JMCP (Japan), or perhaps some other venue?
The following individuals will coordinate additional activities
Associated with the consistency demonstration (probably using e-mail):
Jay Gaeta, chairman committee for the advancement of DICOM
Herman Oosterwick, consistency demonstration project manager
Brad Hemminger, WG 11 champion
David Channin M.D., RSNA ECC champion
Vicki Schofield, NEMA staff
Steve Drew, RSNA staff
There are a large number of educational and marketing activities that need to
be defined and planned between now and RSNA...
DICOM COMMITTEE INPUT:
The process followed to support RSNA demonstration is well understood by the
Committee for the Advancement of DICOM. It is usually similar to
what has been described above but always requires a fair amount of
flexibility depending on circumstances. The committee would welcome
suggestions from the DICOM Committee for improving "the process".
The DICOM Committee recently suggested that the committee for the
advancement of DICOM sponsor workshops to raise funds to support
international standardization activities (i.e. COCIR, JIRA). The
committee will explore this idea as long as such workshops are not in
conflict with activities that may be already provided commercially. Perhaps
workshops that concentrate on new DICOM aspects, or emerging trends that
require a workshop setting for investigation might be appropriate. The DICOM
Committee should suggest specific workshop ideas for investigation.
COMMITTEE FOR THE ADVANCEMENT SUGGESTIONS:
The chairman of the committee for the advancement of DICOM feels that it is
difficult to establish relationships similar to NEMA and RSNA
with other trade shows and scientific exhibits, particularly outside the
United States. It requires additional active involvement from other MII
section and committee members.
It has been suggested in the past that COCIR members, for example, take a more
active role to support European demonstration activities (i.e. ECR) and JIRA
members help coordinate activities in Japan (i.e. JMCP).
This is particularly important in establishing initial contacts and
defining "a process" that might be followed in future years.
Jay Gaeta <email@example.com> Tel: +1 (414) 475-4507
Chairman, Committee for the Advancement of DICOM
DICOM Standards Committee,
Diagnostic Imaging & Therapy
Systems Division (09)
305 June 16 - 17, 1999