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					                 MINUTES
        DICOM STANDARDS COMMITTEE
                             December 3, 2009
                                     Chicago, IL

  Members Present – Vendors                         Represented by
DatCard Systems                        Jere Darling
ETIAM                                  Emmanuel Cordonnier
Fujifilm Medical Systems               Takashi Nakashima
GE Healthcare                          Charles Parisot
Hologic                                Janet Keyes
^McKesson Medical Imaging              David Heaney
Group Healthcare North America
Merge                                  Ronald Cowan
Philips Healthcare                     Dana Spinks
RadPharm                               David Clunie
Toshiba Medical Research Institute     Kevin O‟Donnell
USA
    Members Present – Users                         Represented by
American College of Radiology          John Carrino
American College of Radiology          Steve Horii
American College of Radiology          Charles Kahn
American College of Radiology          Alan Rowberg
American College of Veterinary         Dennis Balance
Radiology
American Dental Association            Allan Farman
Deutsche Roentgengesellschaft          Peter Mildenberger
Societe Francaise de Radiologie        Joel Chabriais

   Members Present – General                       Represented by
JAHIS      Interest                    Takashi Nakashima
JIRA                                   Makoto Suzuki
                                        656                 ________________________
                                                            DICOM Standards Committee
                                                                     December 3, 2009
Medical Imaging & Technology        Howard Clark
Alliance
         Others Present                           Associated with
Yutaka Ando                         National Institute of Radiological Sciences
                                    and IHE-Japan
Fred Behlen                         American College of Radiology
Cynthia Fenerty                     American College of Radiology
Jay Gaeta                           American College of Radiology
William Hornof                      American College of Veterinary Radiology
Koji Imokawa                        JIRA
M. Elliot Lord                      Laurel Bridge Software
Paul Morgan                         Fujifilm Medical Systems USA
Oleg Pianykh                        Harvard Medical School
Evgeny Salnikov                     Microsoft, HSG
Harry Solomon                       GE Healthcare
Lawrence Tarbox                     Mallinckrodt Institute of Radiology
Alexis Tzannes                      Aware


       Members Absent – Vendors                      Represented by
*Agfa HealthCare                            Geert Claeys
*Boston Scientific                          Tat-Jin Teo
*Carestream Health                          Jonathan Belanger
*Carl Zeiss Meditec                         Ulrich Sauer
*Corista                                    Eric Wirch
*DeJarnette Research Systems                Charles Stockham
Genetix                                     Julian Burke
*Konica Minolta Medical & Graphic           Ugo Joe Piasevoli
*Medis Medical Imaging                      Robert Goedhart
Panasonic Shikoku Electronics               Masayuki Takahashi
*^Sectra                                    Krister Valtonen
Siemens Healthcare                          Nikolaus Wirsz
Sony                                        Yuji Kohga
*Stryker                                    Staffan Lindstrom
SuperSonic Imagine                          Jacques Souquet
Ziosoft                                     Katsumasa Makino

       Members Absent – Users                       Represented by
*American Academy of Ophthalmology          Lloyd Hildebrand
*American College of Cardiology             Thomas Gerber
                                 657                     ________________________
                                                        DICOM Standards Committee
                                                                  December 3, 2009
         *College of American Pathologists                  Kirsten Haake
         *European Society of Cardiology                    Nico Bruining
         *European Society of Radiology                     Jan Stormer
         *Healthcare Information Management &               Audrey Dickerson
         Systems Soc.
         Medical Image Standards Assn. of Taiwan            Jenn-Lung Su
         Radiological Society of North America              Chris Carr
         *Society for Imaging Informatics in                Paul Nagy
         Medicine

            Members Absent – General Interest                       Associated with
         *Canada Health Infoway                             Margaret Kennedy
         *Center for Devices and Radiological               Kish Chakrabarti
         Health
         *CIMICS                                            Jianming Qu
         *India Centre for Development of Adv.              J. S. Bhatia
         Computing
         *Korean PACS Standards Committee                   Hee-Joung Kim
         *National Cancer Institute                         C. Carl Jaffe
         *Web3D Consortium                                  Alan Hudson
                          * = Does not count toward a quorum at this meeting.
                          ^ = Has not submitted Patent Agreement.


Presiding Officers:                                                Emmanuel Cordonnier, Co-chair
                                                                   Charles Kahn, Co-chair

1. Preliminary Events
Participants identified themselves and their employers. Members accepted version 1 of the agenda,
which had been posted to the Committee‟s private FTP site. Minutes of the September 11, 2009
meeting in Athens, Greece were approved as presented.
The secretary reported that the Committee includes 50 organizational members with a total of 53
official representatives. However, 24 of these representatives were absent from at least the last two
meetings, so they do not count toward a quorum. Therefore, 26 representatives do count toward the
quorum, and 14 must be physically present (or represented by a proxy) to constitute a quorum. At
this meeting, since 21 representatives were present, the quorum requirements were met.

2. Rotation of Vendor Co-chair
Emmanuel Cordonnier‟s second term as vendor co-chair of the DICOM Standards Committee
expired at this meeting. The nominating committee recommended two candidates for consideration
by the membership – Kevin O‟Donnell and Nikolaus Wirsz. A ballot was issued with a closing
                                             658                ________________________
                                                                DICOM Standards Committee
                                                                           December 3, 2009
date of November 27. The secretary announced that Kevin O‟Donnell received a majority of the
votes cast.

3. Election of New Members
No requests to join the DICOM Standards Committee were ready for consideration at this meeting.

4. Requests to Join Working Groups
One nomination had been received for the appointment of a member to an existing DICOM
working group. However, the required Patent Disclosure Agreement has not been submitted, so
action was deferred.

5. Staff Report
The secretary entered the following report on the:

                        STATUS OF RECENT SUPPLEMENTS

Sup.                    Title                                    Approved   Due                    Outcome or
 No.                                                                 for                            Comments
74   Utilization of Worklist in Radiotherapy                     Trial Use Oct. „08            Rev. for LB/Mar. „10
     Treatment Delivery
78   Pediatric, Fetal and Congenital Cardiac                     Ltr. Bal.      Aug. „09 Rev. for FT/Jan. „10
     Ultrasound Reports
95   Audit Trail Messages                                        Trial Use      Jan. „05       Rev. for LB/Mar. „10
96   Unified Worklist and Procedure Step                         Trial Use      Aug. „08       Rev. for LB/Mar. „10
118 Application Hosting                                          Trial Use      Apr. „09       Rev. for LB/Nov. „09
120 Extended Presentation States                                 Ltr. Bal.      Dec. „09       Rev. for FT/Mar. „10
129 Electrophysiology SR                                         Pub. Cmt.      Aug. „07       Rev. for LB/TBD
131 Implant Templates                                            Pub. Cmt.      Aug. „09       Rev. for LB/Jan. „10
134 Implementation Plan SR IOD                                   Pub. Cmt.      Sep. „09       Rev. for LB/Jan. „10
135 SR/CDA Mapping                                               Pub. Cmt.      Apr. „08       Rev. for LB/Tcon
139 Enhanced XA/XRF IOD Informative                              Ltr. Bal.      Aug. „09       Rev. for FT/Jan. „10
     Annex
140 XA/XRF Grayscale Softcopy                                    Final Text                    Approved Oct. „09
     Presentation State Storage SOP Class
144 Ophthalmic Axial Measurements                                Pub. Cmt.      Aug. „09 Rev. for LB/Nov. „09
     Storage SOP Class
146 Ophthalmic Visual Field – Static Peri-                       Pub. Cmt.      Dec. „09       Rev. for LB/Jan. „10
     metry Measurements Storage SOP Class
   CB = Confirmation Ballot; FT = Final Text; FZ = Frozen Text for Trial Use; LB = Letter Ballot; TBD = To Be Determined


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6. XML Encoding of the DICOM Standard
David Clunie reported that he plans to conduct a search for a service organization that could handle
automatic transformation of text to XML format. However, this is not likely to be completed in the
near future. Therefore, he expects to issue a “2009 compilation” early in 2010. Nearly all of the
figures are finished.

7. Proposed Work Items
Members considered a Work Item Proposal from WG-02 (Projection Radiography and
Angiography) aimed at defining a Structured Report Template to convey patient radiation dose
information in the domains of Computed Radiography (CR) and Digital Radiography (DR). This
proposal generated considerable discussion concerning such topics as:
     The need for a communication protocol between detector and generator
     Profiling
     Adequacy of the gap analysis
     Potential input from the “Image Gently” community
     Participation of the affected vendors on WG-02
     Whether to split into two separate topics
In the end, members voted (with two abstentions and no disapprovals) to defer the proposal for
future consideration after a more thorough gap analysis has been completed.

8. Patent Agreement for Faculty Members
The secretary noted that while universities are unwilling or unable to sign DICOM‟s current
Patent Disclosure Agreement, faculty members (who are employees of a university) often are
willing to sign the agreement promising to inform the DSC of any relevant patents or
applications of which they may be aware. However, these faculty members do not have sufficient
authority to commit their employers to make such patents available for licensing, as the current
policy requires.
Staff suggested preparing a new agreement, which would apply specifically to university faculty
members who wish to participate in DICOM Working Groups. Signers of this document would
agree to inform the DSC of any relevant patents or patent applications of which he or she may be
aware that would be required to practice the DICOM Standard or proposed additions to it. Also,
if those patents or applications are owned by the university, the faculty member would agree to
submit a non-binding request to the university inquiring whether it would be willing to license
those patents either at no cost or on reasonable and non-discriminatory terms to those who need
the technology to practice the DICOM Standard. Additionally, the faculty member would agree
to license any patents that he or she may own either at no cost or on reasonable and non-
discriminatory terms.
If implemented, this policy would:

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                                                                              December 3, 2009
      Fill a critical gap (a long-needed agreement for university employees).
      Help prevent the DSC from approving supplements that include technology that requires
       a license.
      Eliminate the awkward situation where university faculty members are asked to sign an
       agreement making commitments that cannot be honored.
Members agreed that such a document was both needed and appropriate. They encouraged staff
to prepare a formal draft proposal for inclusion in the Committee‟s Procedures. Additionally,
they noted that some governments have patent policies every bit as restrictive as universities and
suggested that individuals from both kinds of organizations should be covered. The secretary
noted that he had recently encountered an example where such a policy prevented a very
enthusiastic government employee from seeking to participate in DICOM activities.

9. DICOM-Related Activities around the World
On behalf of both JIRA and JAHIS, Makoto Suzuki presented a PowerPoint show summarizing
DICOM-related activities sponsored by these groups in Japan. Details were provided on each of the
following topics:
        Connectathon-J Oct. 26-30, 2009
        Standards Translation
        PACS Specialist
        JAHIS Standardization
A copy of Mr. Suzuki‟s presentation may be found in the Minutes Folder for this meeting.
Committee members from other parts of the world exchanged information on activities of which
they were aware. It was noted that:
     In Europe medical facilities, now, have the ability to access medical records for EU citizens
       regardless of where they travel domestically. However, this does not currently include
       medical images.
     Europe is launching a large initiative in telemedicine with the objective of enabling transfer
       of information between unrelated institutions.
     REM Profiles in IHE were tested successfully at the most recent European connect-a-thon.
     RSNA‟s Radiology Reporting Initiative is progressing smoothly.
     What some people called Healthcare Reform looks to others like financial reform aimed at
       ensuring that the government does not pay too much for medical services.
     MITA/NEMA, which represents major imaging vendors from around the world, is trying to
       get the U.S. Government to fund the development of testing tools for Health IT
       Applications.

10. International Standards Organizations
The Committee‟s liaisons to the following standards-writing organizations reported on recent
developments of potential interest to members of the DSC:
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                                                                     DICOM Standards Committee
                                                                              December 3, 2009
      HL7 – See written report on WG-20 included in the Reports Folder for this meeting.
      IHE Radiology – Kevin O‟Donnell reported progress on three specific Radiology fronts:
           o Management of distributed objects (This work is being done in collaboration with
               the DICOM WG-06 Whitepaper work.)
           o Regional repositories (This work is clarifying how Regional Repositories, such as
               those used in Canadian Provinces and elsewhere, fit into the IHE Scheduled
               Workflow and XDS-I Profiles.)
           o Chest CAD and Chest CAD Presentation
       In the course of this discussion, one member expressed a desire for greater coordination
       between IHE Radiology and DICOM – especially around the XDS-I profile.
      IHE Cardiology – Harry Solomon identified five new work items in Cardiology:
           o CDA Templates for Cardiology Structured Reports
           o ECG Workflow
           o Image Enabled Office, which has applications far beyond Cardiology
           o Electrophysiology with application to implanted cardio devices
           o Workflow issues associated with Sup43 (3D Ultrasound)
      ISO/TC 215 – No recent activities. However, WG2 of ISO‟s TC215 is scheduled to hold a
       joint meeting with DICOM‟s WG-10 during HL7‟s January-2010 meeting in Phoenix.
       Also, one member noted that ISO is thinking about trying some PROJECT-A-THONS for
       large integration projects like those of Canada Health Infoway.

11. Committee for the Advancement of DICOM
The Committee has no projects or initiatives underway at this time.

12. DICOM Conference
Dr. Lawrence Tarbox, General Chair of the Conference, presented a comprehensive PowerPoint
Presentation summarizing the status of planning for this event. A copy of his presentation appears
in the Reports Section of the Minutes Folder for this meeting.

13. Reports from the Working Groups
Working group chairs presented written or oral reports on the activities of their respective groups.
Copies of the written reports and PowerPoint presentations may be found in the Reports Section of
the Minutes Folder for this meeting. Two groups were discussed in more detail than the others –
WG-06 and WG-10.
Some members believe that WG-06 is overwhelmed by the sheer volume of supplements that are
under development at this time. (Twenty-nine supplement titles appear in the minutes of its last
meeting.) Others add that far too much time is spent “fixing” poor quality supplements brought to
it for review. Members of WG-06 who were present listed some of the steps that have been taken
recently in an effort to streamline its process. For example, a teleconference is held about one week
before each meeting to review as many non-controversial CPs as possible (e.g., correcting typos).
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                                                                       DICOM Standards Committee
                                                                                    December 3, 2009
Also, a scheme has been established to assure that those supplements which are nearest to
completion receive priority in planning the agendas for subsequent meetings. Developers of new
supplements are invited to come and present an early version of their work for a “First Reading” to
ensure that it starts off in an appropriate direction to avoid subsequent re-direction after a large
amount of work already has been completed. Many Tcons are being scheduled to complete
“editorial” reviews and, thereby, free up meeting time for structural reviews.
Finally, WG-06 has discussed possible ways to improve the quality supplements brought for
review. For example, WG-06 might:
     Ask the WG sponsoring a supplement to complete a line-by-line review before it is sent
        to WG-06
     Identify mentors to guide "first-time authors."
With regard to WG-10, several members thought that DICOM SR is disconnected from IHE on the
topic of Radiology Reporting. They noted that RADLEX was engaged with CDA and thought that
DICOM needs to produce CDA templates.

14. DICOM Strategic Document
The secretary noted that a new version of the Strategy had been posted to the FTP site for this
meeting just one day before the meeting, but that several updates had arrived subsequent to that.
He offered to incorporate these additions and produce a year-end version for distribution to the
Committee‟s voting members and alternates. Two weeks would be allowed for review and
response. If no changes were suggested, the document would be assumed satisfactory and posted to
the Public Web Page. If some controversial changes were suggested, a Tcon of the Executive
Committee would be arranged to resolve the issues.

15. Promoting DICOM
Members were invited to give a short reports on their personal or organizational activities aimed at
educating and informing potential users of the DICOM Standard. It was noted that:
    A special session had been arranged by ACR to follow the DSC meeting on the best way to
       handle the issue of unreadable CDs.
    The U.S. National Cancer Institute's "caBIG" (Cancer Biomedical Informatics Grid)
       initiative has developed a pilot DICOM Ontology, which has been on display as a scientific
       exhibit at this year's RSNA meeting.
    The French Society of Radiology prepared two documents aimed at showing users how to
       buy DICOM-compliant products.
    A course on Application Hosting by Lawrence Tarbox at RSNA drew 170 students at
       RSNA.
    Some 56 presentations at RSNA included the word “DICOM” in their title.
    Dennis Ballance presented a lecture on DICOM to the Assoc. for Veterinary Informatics.


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      David Clunie briefed members on the goals and objectives of a new NEMA Section
       concerned with Digital Imaging and Communication for Security (DICOS), which is built
       directly on the foundation of DICOM. They just happen to have patients that look a lot like
       suitcases.

16. New Business and Agenda Items for the April Meeting
No new business came before the Committee.

17. Time and Place of Future Meetings
Members confirmed the following meeting dates and locations:
   April 13, 2010 – Bordeaux, France in conjunction with the IHE Europe Connect-a-thon
   October 12, 2010 – Rio de Janeiro in conjunction with the DICOM Conference
   December 2, 2010; RSNA; Chicago, IL
   Spring 2011 – Korea???

18. Adjournment
The meeting was adjourned at 2:35 p.m.

Reported by:                                                Howard E. Clark, Secretary
                                                            December 28, 2009

Reviewed by Counsel:                                        January 6, 2010




                                               664                 ________________________
                                                                   DICOM Standards Committee
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