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                        DICOM Working Group Ten
                                  (Strategic Advisory)
                                      April 6, 2004
                                     Kamakura, Japan

WG-10 Members Present:                                 Represented by:
Eastman Kodak                                          Lance Van Nostrand
ETIAM                                                  Emmanuel Cordonnier
GE Medical Systems                                     Charles Parisot
JIRA                                                   Isao Ohbayashi
Merge eFilm                                            Dwight Simon
Philips Medical Systems                                Cor Loef
RadPharm                                               David Clunie
Siemens Medical Solutions                              Lawrence Tarbox
Societe Francaise de Radiologie                        Joel Chabriais
Toshiba                                                Hidenori Shinoda

WG-10 Members Absent:                                  Voting Representative:
*Agfa Healthcare Imaging                               Geert Claeys
*American College of Radiology                         Steven Horii
American College of Radiology                          Alan Rowberg
IBM Life Sciences                                      Eric Goodall
*IDX Systems                                           Alexey Ulanov
*McKesson Information Solutions                        David Heaney
      (* Does not count toward quorum.)

                                           96          Working Group 10 (Strategic Advisory)
                                                         of the DICOM Standards Committee
                                                                               April 6, 2004
Others Present:                                            Associated with:
Peter Mildenberger                                         Deutsche Roentgengesselschaft
Nobuo Okazaki                                              Secretariat, IHE Japan
Hans Roehrig                                               Univ. of Arizona
Takaya Sakusabe                                            Shizuoka Univ.
Juergen Thiem                                              Sony Europe
Hitoshi Yoshimura                                          Konica-Minolta Medical and Graphic
Howard Clark                                               NEMA Staff

Presiding Officers:                                        Cor Loef, Co-Chair and
                                                           Joel Chabriais, Co-Chair

1. Preliminary Events
Participants identified themselves and their employers. A quorum was present.
Members dropped the discussion of Item No. 6 (CT PET) from this agenda. Working Group No. 3
is planning to address this issue.
Minutes of the January 24, 2004 meeting were approved as submitted.

2.     Strategic Document
Howard Clark reviewed the current status of the Strategic Document (dated December 30, 2003)
indicating that it represents the version approved at the December 3, 2003 meeting of the DICOM
Standards Committee – including all changes that were recommended at that meeting.
Members agreed that it would be useful to include a short section near the front of the document
that gives a brief explanation of the process for developing and maintaining the Standard. This
will also explain that the complete and current version of the standard includes both the last
published version plus all supplements and corrections proposals that have been approved since
the published version was issued. Additionally, it should include information on where and how
these documents may be obtained (ordered or downloaded). Dwight Simon agreed to prepare a
draft for members’ consideration via E-mail. It may be desirable to include such information as
boilerplate in each new supplement.
WG-10 Co-chair Cor Loef reported that he had identified a number of items in the “front end’ of
the document as well as some specific Working Group sections that need to be updated. He will
prepare a new draft of the document that addresses each of these components. Mr. Loef will
forward the revised draft to members of WG-10 and the chairs of affected working groups for all
to review and comment via E-mail.

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                                                                                  April 6, 2004
3. DICOM’s Relation to Other Standards-Writing Bodies and Related Groups
Members reported as follows on DICOM’s relationship to, and recent meetings with, other
standards-writing bodies and related groups (excluding DICOM WG-20/HL7 that is addressed
separately in Item 7):
      ANSI X12N – Charles Parisot reminded members that this group is working to define a
       second generation of attachments resulting from HIPAA. The main concern of the DICOM
       Community is to ensure that any specifications on handling images do not conflict with the
       DICOM Standard.
      ASTM E07.11 – Howard Clark noted that Mr. Chris Voelker, the last known chair of this
       committee, has changed his employer and may no longer be the chair of this committee. Nor
       has he been heard from in over a year. Members asked Dr. Clark to contact ASTM,
       determine who is the current chair of that group and invite that individual to provide an
       update on its recent activities.
      HL7 – Charles Parisot reported that HL7’s group on Electronic Health Records has
       significantly changed the direction of its recent work efforts. Rather than prepare a set of
       1600 detailed requirements on how to prepare and maintain such records, it will, instead,
       prepare a 250-item list of requirements identifying the functions that the EHR should
      IEEE Vital Signs 1073 Group – No report at this meeting.
      IHE – Charles Parisot presented a brief report on current IHE activities. He noted that:
             In the radiology domain, IHE is setting up a profile concerned with the portability of
              interchange media – i.e., how compact disks will replace film.
             Progress on “Instance Availability Notification” is drawing heavily on recent
              accomplishments of DICOM’s WG-06.
             A nuclear medicine profile is being developed.
             IHE is preparing an overview of departmental workflow.
             Consistent with its expansion into domains outside of radiology, IHE will hold a
              single connect-a-thon early in 2005 that covers Radiology, Cardiology, Laboratory
              Services and IT Infrastructure. A similar event involving some 50 vendors was held
              in Europe during the last week of March.
             Two new IHE profiles (Cath Lab and Ultrasound Echolab) will draw heavily upon
              previous DICOM efforts.
             Four initiatives relate to IT Infrastructure:
                     Patient Demographic Query.
                     Expansion of audit trail and node identification.

                                                  98          Working Group 10 (Strategic Advisory)
                                                                of the DICOM Standards Committee
                                                                                      April 6, 2004
                      A white-pages personal directory to provide detailed information that can be
                       used in many departments.
                      Cross-enterprise clinical document sharing.
      ISO TC 215 – Hidenori Shinoda, one of the DICOM Standards Committee’s official liaisons
       to this Committee, gave a PowerPoint Presentation on the status of the WADO Standard that
       was developed by a joint task force of the two organizations. A copy of that report appears in
       the minutes folder for this meeting at:

      ISO/IEC/ITU WSC (World Standards Cooperation) High Level Workshop on Medical
       Technologies – Peter Mildenberger attended this February 2004 event in Geneva and gave a
       presentation on DICOM’s approach to standards development. Copies of the program and all
       presentations may be found at:

      ITU – Cor Loef reported that he expects to participate in the Med E-Tel conference.
      JPEG – Howard Clark noted that a report on recent JPEG activities relative to the DICOM
       community may be found in the minutes of the WG-04 meeting of February 18, 2004. Lev
       Weisfeiler, DICOM’s official delegate to JPEG 2000, prepared this report. See:

4. DICOM/ISO Relationship
At the January meeting of WG-10, Howard Clark was asked to prepare a draft agreement between
DICOM and ISO regarding the detailed process by which DICOM could submit its standard to
ISO for review, approval and dissemination. Members noted that this topic has been under
consideration for over six years, and the healthcare community has evolved substantially.
Accordingly, they focused their immediate attention on evaluating the current validity of the
original objectives that stimulated this effort. They noted that the relationship between DICOM
and ISO had been significantly strengthened over those years. DICOM now has an effective “Type
A” liaison with ISO’s TC 215. DICOM’s WG-10 (Strategic Advisory) holds a joint meeting each
year with TC 215’s WG2 (Messaging and Communication). A joint, ad hoc working group of the
two organizations recently completed the development of a draft international standard (WADO)
that is relevant to the interests of both groups.
After considerable discussion, members determined that, instead of focusing on the mechanics of
ISO approval and publication of a document that is already complete and available everywhere in
the world for free, it would be better to devote the limited resources of both organizations to
working with ISO TC215 on the exchange of current, technical information and (if appropriate) on
the development of new standards (like WADO) that would be of mutual interest to both parties.
Members voted to make such a recommendation to the DICOM Standards Committee at its
meeting on April 7, 2004. To facilitate these interactions, members agreed that joint annual
meetings between DICOM’s WG-10 and TC 215’s WG2 should be continued and that identifying
                                                       99            Working Group 10 (Strategic Advisory)
                                                                       of the DICOM Standards Committee
                                                                                             April 6, 2004
a U.S.-based liaison to TC 215 (to complement the existing liaisons from Europe and Asia) must
be given a high priority.

5. DICOM Plug-ins
Lawrence Tarbox presented an updated version of his white paper on DICOM "Plug-ins." A copy
of that document may be found at:

Members conducted a high-level evaluation of this proposal and concluded that the work does,
indeed, fall within the scope of the DICOM Standard. However, they suggested that the term
“Application Programming Interface (API)” would be more appropriate than “Plug-in.” The
process for moving forward is as follows:
      Dr. Tarbox will update the existing white paper and post it to the group’s private ftp site.
      Members will review and forward their comments to Dr. Tarbox by May 7.
      A WebEx teleconference will be held at 9 AM EDT (3 PM in Europe and 10 PM in Japan)
       on May 28, 2004.

6. CT-Pet
Deferred since Working Group #3 is planning to take up this issue.

7. Collaboration between the Referring Clinician and the Radiologist
Emmanuel Cordonnier presented the first draft of a white paper and gave a PowerPoint
presentation on the “Collaboration between the Referring Clinician and the Radiologist.” A copy of
these documents may be found at:

This paper stimulated considerable discussion on the traditional differences that exist between one
country and another. There was also considerable discussion on the extent to which one is likely
to see applications of Structured Reporting or Clinical Document Architecture. At the conclusion
of this discussion, members with comments or suggestions were encouraged to contact Herman
Oosterwijk ( who will be leading the WG-06 effort to encapsulate PDF
files in a DICOM wrapper.

8. Progress in Reporting with CDA
Cor Loef presented a written report prepared by Fred Behlen summarizing developments in this
area. A copy of Dr. Behlen’s report maybe obtained at:

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                                                                                               April 6, 2004
9. DICOM and EHR
Charles Parisot covered this topic in his report on HL7 that appears in Item No. 3 above.

10. New Business
No new business was brought before the group at this time.

11. Agenda and Assignments for the Next Meeting
Names shown in bold throughout these minutes signal action items for future discussion.

12. Next Meeting
The next meeting of WG-10 is scheduled for September 2, 2004 at Munich, Germany in conjunction
with ESC meeting.

13. Adjournment
The meeting was adjourned at 5:20 PM.

Submitted by:                                                Howard E. Clark, Secretary
                                                             April 20, 2004

Reviewed by Legal Counsel:                                   April 21, 2004

                                                101          Working Group 10 (Strategic Advisory)
                                                               of the DICOM Standards Committee
                                                                                     April 6, 2004

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