Docstoc

WG Min DICOM Home

Document Sample
WG Min DICOM Home Powered By Docstoc
					                                     MINUTES
                                DICOM Working Group Seven
                                              (Radiation Therapy)

                                              December 8 – 11, 2009
                                                Clearwater Beach, FL


         Members Present                            Represented by             T W T F
AAPM; Rhode Island Hospital                 Bruce Curran                       X X     X   X
BrainLab                                    Christof Schadt                    X X     X   X
Calypso Medical Technologies                Andrea Morgan                              X
Elekta/CMS Software                         Bill Bennett                       X   X   X   X
Nucletron                                   Harold Beunk                       X   X   X   X
Optivus Proton Therapy                      Michael Baumann                    X   X   X   X
Philips Healthcare                          Mark Pepelea                       X   X   X   X
Siemens Healthcare                          Johannes Stahl                     X   X   X   X
TomoTherapy Incorporated                    Dave Murray                        X   X   X   X
Varian Medical Systems                      Uli Busch                          X   X   X   X

      Members Absent                                Represented by
ITC-ATC, Wash. Univ. St. Louis              Walter Bosch

           Others Present                           Associated with
 (Observers or alternate representatives)
Mike Courtney                               Philips Healthcare                 X X     X   X
Nghia Van Ho                                Massachusetts General Hospital       X     X   X
Paul Jacobs                                 MIMVista                           X X     X   X
Anders Liander                              RaySearch Laboratories             X X     X   X
Anders Malmberg                             Elekta                             X X     X   X
Scott Mark                                  Third Way Software                 X X     X   X
Chris Pauer                                 TomoTherapy                        X X     X   X
Veerendra Shetty                            Siemens Healthcare                 X X     X   X
Colin Sims                                  Accuray                            X X     X
Mark Sinclair                               Vision RT                          X X     X

                                                          1                     WG-07 (Radiation Therapy) of
                                                                             the DICOM Standards Committee
                                                                                     December 8 – 11, 2009
Howard Clark                          MITA                                  X X      X X

Presiding Officer:                                           Dave Murray, Chair

1. Preliminary Events
Members identified themselves and their employers. The secretary reported that a quorum was present.
Members reviewed and approved the agenda for this meeting. Slight changes in the sequence of events
were made to accommodate travel requirements of the participants. For example, Patient Positioning,
Dose, Prescription, Robotic IOD, and Ions were discussed in the first three days when the interested
parties were present.
Members approved the minutes for the meeting of March 17-20, 2009 at MITA HQ.
The group agreed to start at 8:30 a.m. for the rest of the meeting and finish between 5:30 and 6:00 to
provide 75-90 minutes for lunch.

2. Change Proposals
Of the following CPs, seven were introduced to WG-06 by Bruce Curran at their August meeting. The
last two were not. They were discussed and dispatched as noted:

  cp1007_02.doc        Beam Record Type.             Originally presented at August 19 WG6 T-con. WG7
                                                     reviewed again at this meeting and considers ready for
                                                     voting packet, and will indicate this at January WG6
                                                     meeting.
  cp1008_02.doc        Image Orientation in          Originally presented at August 19 WG6 T-con. WG7
                       Coordinate calculation on     reviewed again at this meeting and considers ready for
                       Deformable registrations      voting packet, and will indicate this at January WG6
                                                     meeting.
  cp1009_02.doc        Plans that are composed of    Originally presented at August 19 WG6 T-con. WG7
                       more than one component       reviewed again at this meeting and considers ready for
                       RT Plan.                      voting packet, and will indicate this at January WG6
                                                     meeting.
  cp1010_02.doc        RT Applicator                 Originally presented at August 19 WG6 T-con. WG7
                       Enhancements                  reviewed again at this meeting and considers ready for
                                                     voting packet, and will indicate this at January WG6
                                                     meeting. There is demand for this CP to be standardized
                                                     as soon as possible.
  cp1011_02.doc        RT Beams Recording            Originally presented at August 19 WG6 T-con. WG7
                       Clarifications                reviewed again at this meeting and considers ready for
                                                     voting packet, and will indicate this at January WG6
                                                     meeting.
  cp1012_02.doc        Exposure Tag Availability     Originally presented at August 19 WG6 T-con. WG7
                       for PORTAL image type.        reviewed again at this meeting and considers ready for
                                                     voting packet, and will indicate this at January WG6
                                                     meeting.



                                                     2                      WG-07 (Radiation Therapy) of
                                                                         the DICOM Standards Committee
                                                                                 December 8 – 11, 2009
  cp1013_02.doc         RT Ion Beams Recording        Uli and Michael reviewed wording for discussion on
                        Clarifications                Thursday. Discussed Thursday, Uli reworded for further
                                                      discussion in Friday. Reworded again, considered ready
                                                      for voting packet, and will indicate this at January WG6
                                                      meeting.
  BC_CP_RTIntegrat      Integrated RT Image           Originally presented at August 19 WG6 T-con. WG7
  edRTImage_05.doc      Parameters                    reviewed again at this meeting and Uli added dynamic
                                                      table motion for discussion on Thursday. Bruce will
                                                      introduce this CP at January 2010 WG6 meeting.
  BC_CP_RTIonBea        RT Ion Beams Beam             Reviewed again at this meeting. Bruce will introduce
  msBLDCorrection_      Limiting Device               this CP at January 2010 WG6 Meeting.
  _02.doc               Corrections

New CPs
None were introduced at this meeting.

3. IHE-RO Update
Bruce Curran reported on IHE-RO activities, including the connect-a-thon. The press release from the
connect-a-thon should be available shortly. IHE has introduced a new worldwide system – IHE-RO data
will recoded in this new format for recent years. The IHE web site will also have Integration Statements.
RT vendors are encouraged to submit these.
IHE-RO domain pre-testing and connect-a-thon for 2010 will consist of Dose Compositing (will be
distributed for review shortly), repeat testing of Workflow Connectivity, and possible retesting of
advanced objects at the connect-a-thon. Test tool work will be required for Dose Compositing.
Work is also underway to separate the Workflow connectivity profile into a pure delivery workflow, and a
positioning and delivery workflow. It is possible that the delivery only profile will be tested instead of the
existing Workflow Connectivity profile in 2010 if the profile review process advances at the required rate.
Bruce also reported on an IHE international board meeting during RSNA:
      Deployment committees have been formed for China and Japan
      A new domain, IHE-Surgery is being formed for surgical planning, and another for dentistry.
      A testing framework, Gazelle, is available as a management system for tool execution. The MESA
       tests will be ported to this Gazelle. The goal is to be complete by January 2011.
      Connectathon managers now need to be trained (training course in Paris). Bruce is hoping that he
       will be accepted as a trainer without this training, based upon his experience.

4. Supplement 74 – Workflow in RT
WG-07 discussed the future of Supplement 74, which has currently been in Frozen Draft status for some
time. WG-07 considers that the UPS workflow-related parts of Supplement 74 have been well
demonstrated in conjunction with Supplement 96, and are ready to become part of the standard. However,
the Machine Verification service classes have not been trialed, and original sponsors of these sections
have not been active in submitting further comments, despite repeated requests [last meeting minutes
contained the statement “Scot Hogan will review Supplement 74 and report back with a suggested strategy
for moving the status of this supplement forward (specifically the verification modules), taking into

                                                      3                       WG-07 (Radiation Therapy) of
                                                                           the DICOM Standards Committee
                                                                                   December 8 – 11, 2009
account Supplement 147”]. During further discussion WG-07 members present considered that this part
of the supplement is not as important as it once was, and there is a risk of it being either unused or used by
only one vendor. It was moved that:
        “These sections shall be removed from Supplement 74 prior to submittal to WG6 for
        inclusion in the final standard, unless one or more interested parties make reasoned
        submittals to the contrary prior to the March 2010 WG7 meeting, for discussion and
        resolution at that meeting. Any removed parts can be reintroduced later if desired.”
        Moved by Bruce Curran; seconded by Uli Busch. 6 in favor, 1 abstention (Elekta), 0
        against. Motion carried.

5. Second-Generation Radiotherapy (Supplement 147)
Note: Current status of documents pertaining to Supplement 147 can be found in Annex A.
TUESDAY
An initial review of the current status of Supplement 147 was undertaken.
Items discussed:
Concept of a “course” (page 11), specified as occurring over a certain time frame (e.g. a month or two).
Generally, a single „course‟ will be used to represent different primary sites being treated at the same time.
Presence of RT Patient Setup in Supplement 147 was discussed. It was decided that an RT Patient Setup
module with at least the same functionality as in current first-generation objects should be modeled. If the
other related patient positioning material is ready in the required timeframe, it could be added also.
The concept of a series in RT was reviewed. Overall, it was decided to adhere to existing PACS series
requirements, with the implication that there will be a proliferation of series. Addition of a „RT Course‟
entity was discussed, but considered too have a huge disadvantage in terms of breaking the current
DICOM model supported by PACS systems.
C-Arm Radiotherapy Procedure Technique Identifiers changed to „General Procedure Technique
Identifiers‟ to allow re-use by other device types.
Uli presented his work on Delivery Session Records, with extensive re-use of the modules present in the
Radiation IODs. There was a long discussion whether or not to have a different IOD for each Radiation
type, or to have a single Record IOD with conditional modules depending upon the original Radiation
IOD. It was decided to have a separate Record IOD corresponding to each Radiation IOD. Dave updated
Supplement 147 to reflect this.
WEDNESDAY
Scheduling for presentation of supplement 147 was discussed. The goal is to finalize Supplement 147 at
the March 2010 meeting, present it to WG6 at their meeting the following week, and start a public
comment period that will terminate just prior to the next WG7 meeting in July (Philadelphia). The
revisions could then be presented to WG6 at their August meeting.
Christof introduced discussion on the Patient Positioning module. A key discussion concerned division of
the data that will be stored in the Radiation IOD from that which will be associated with the patient
positioning classes being developed separately. It was decided that a Radiation IOD shall contain the
patient position (“HFS” etc), and a reference to a “Setup UID” that defines a „conceptual setup‟. This


                                                      4                      WG-07 (Radiation Therapy) of
                                                                          the DICOM Standards Committee
                                                                                  December 8 – 11, 2009
setup is realized by a specific RT Patient Setup IOD, communicated with worklist or described in RT
Course. If the setup changes in a significant way, the „Setup UID” would change.
The RT Patient Position IOD was then discussed line-by-line.
Uli will propose enhancements to the Radiation Common to indicate the use of otherwise of motion
compensation.
The Gamma Knife proposal was reviewed (presented by Anders). It was decided to name it “Multiple
Fixed Source”. Dave undertook to ensure that it is possible to model a meterset in seconds combined with
a nominal dose rate, and integrate the gamma knife modules into sup 147.
Dose IODs were discussed as a sub-group. Conclusions:
    IODs and modules renamed to not be RT-specific.
    Restriction to parallel planes has been relaxed. Should we re-impose this requirement? Yes, draft
       modified to disallow non-coplanar images.
    Determine if extra attributes for image orientation are required in new „enhanced‟ paradigm. Yes,
       keep them, no further changes required.
    Respiratory Synchronization: no additional concerns at this stage.
    Start and Stop Meterset has been added for partials.
Patient Positioning was discussed as a subgroup, including a review of recent changes in the subgroup,
and how to encode sequential positioning steps. The schedule for the release was discussed – Christof felt
that with the current state and rate of progress, patient positioning should be introduced as a second
supplement (after 147), with just the patient setup module included in Supplement 147. In this case, a
new Supplement number could be requested at the WG-06 meeting in March 2010.
THURSDAY
Uli proposed that the Patient Support Position Macro be reworked to use code sequences, to allow
representation of arbitrary axis and translations of devices. Dave reworked Supplement 147 in this way.
Uli, Mark, and Christof reviewed the current status of patient positioning work.
A proposal to include the transformation components of the 4x4 matrix separately (e.g. pitch, roll, x-axis
move) as well as the complete 4x4 matrix was discussed and rejected. It was also noted that the actual
machine parameters can be encoded using the newly developed Patient Support and Delivery Machine
parameter macros if desired, but that these values do not represent the equivalent of the transform but
rather the specific machine settings.
Christof repeated an earlier call for contributions from vendors of ultrasound positioning devices, to
complete the Patient Position Verification Equipment macro. Bruce will contact NOMOS/Best directly.
Christof lead a review of the Registration Instruction.
A review of all remaining open issues in Supp 147 was started.
Conclusions from this discussion:
    Intended use of Acquisition Context Module 7.6.14: Walter was unsure, but it was decided to
      leave as mandatory (can be empty if necessary).
    Hierarchical macro replaced by instance macro (and sometime series instance macro), since full
      references to objects are found in mandatory Common Instance Reference Module.
    „Beam‟ replaced with „Beam Set‟ for Multiple Fixed Source Beam Module.

                                                      5                     WG-07 (Radiation Therapy) of
                                                                         the DICOM Standards Committee
                                                                                 December 8 – 11, 2009
       Discussed shear again: Will still allow, but not arbitrarily-oriented planes.
       Dose Grid Geometry: Walter advocated providing this.
       Added note to RT Series explanation regarding same Referenced Performed Procedure Step
        Sequence contents for all instances in series.
       Removed C.8.A.2.11 and 12 (machine setting macro and equipment status macro), and sent to
        Christof for inclusion in second supplement.
FRIDAY
Evolution Strategy: The mechanisms for encouraging implementation of the new objects were discussed.
The following ideas were noted:
    Encourage IHE-RO to define a prescription profile involving the new Treatment Intent IOD. This
       is a relatively simple way to begin introduction of the new objects, and represents a solution to a
       real-world clinical problem. Bruce and Dave can present the importance of this at the IHE-RO TC
       Meeting in January.
    Vendors of „new‟ technologies may be more able to introduce new objects, since their
       technologies cannot easily be represented using the existing standard.
    Implementation by TMS vendors will be key to widespread introduction.
    Other IHE profiles could require new object support (as well as existing objects) to encourage
       migration.
    Generation of a few sets of new objects and a simple PACS capable of handling them would be a
       huge aid to implementers.
    A white paper could be written by WG-07 members to explain how to convert from existing to
       new objects (where possible).
RT Course Scope Indicator: The group discussed the utility of the PARTIAL/GLOBAL course concept
proposed by Uli, and updated Supplement 147 accordingly.
RT Course Instance References: The group discussed the role of this module. It was made optional, but a
role/purpose code sequence added as mandatory in the cases.
Session Record modules: Review of these modules was started.

6. New Business
No new business was introduced at this meeting.

7. OPEN ACTION ITEMS FROM LAST TWO MEETINGS:
   Walter: Investigate clinical trial submittal workflow instruction.
   Christof: Update isocenter white paper and communicate with Bruce.
   Christof: Integrate workflow instructions and patient positioning in Supplement147 follow-on.
   Uli: Check location/definition of “Equivalent Anatomies.”

8. NEXT WG-07 MEETINGS
   Tues-Fri March 16-19, 2010, at MITA. Starting 9:00 a.m. Tuesday, finishing 12:00 Friday. The
    positioning group may possibly meet just prior to that meeting.
   Tentative scheduling for 22-24 July, Philadelphia PA (after AAPM, finish noon on 24th).

                                                    6                      WG-07 (Radiation Therapy) of
                                                                        the DICOM Standards Committee
                                                                                December 8 – 11, 2009
9. NEXT WG-06 MEETINGS
   January 25-29, 2010, MITA.
   March 22-26, 2010, MITA (time will be reserved for reading of Supplement 147 at this meeting)
   June 21-25, 2010, Barcelona
   August 23-27, 2010, MITA
   November 1-5, 2010, MITA

10. Adjournment
The meeting was adjourned at 12:26 on Friday, 11 December 2009.


Reported by:                                              David Murray, Chair
                                                          Howard Clark, Secretary
                                                          December 17, 2009

Reviewed by counsel:                                      December 18, 2009




                                                   7                     WG-07 (Radiation Therapy) of
                                                                      the DICOM Standards Committee
                                                                              December 8 – 11, 2009
                                                                                                                                                   8
                     DICOM WG7 (RT) Task Assignments for Supplement 147 (Second Generation Radiotherapy)
                                        Last Update: 11 December 2009 (D Murray)
Doc Name                  Content                 Sub-       Reviewers/co       Last update   Status
                                                  editor     workers
sup147_10.doc             All currently           David      -                  2009/12/11    Updated following WG7 and WG6 in D.C,
                          integrated              Murray                                      WG7 in Newport Beach, and WG7 in
                          supplement 147                                                      Clearwater Beach. Goal is to ready
                          content                                                             document for WG6 during March 2010
                                                                                              WG7 meeting.
supRTPatientSetup_1.doc   Patient Setup           Christof   -                  2009/12/08    Split from Sup 147 v9. Dave to re-integrate
                          modules from Supp       Schadt                                      into V11.
                          147
supXXX_RTPatPosAndW       Content after Supp      Christof   All                2009/12/10    Reviewed in Clearwater Beach. Includes
kInsts_03.doc             147, esp patient        Schadt                                      positioning IODs and registration Workflow
                          positioning and                                                     Inst.
                          workflow instructions
supRT2SegmentationInstr   Segmentation            -          Bennett/Hogan,     2007/08/20    Reviewed in LV. Stable. REVIEW, ROLL
uction_05.doc             Instruction IOD                    Bosch, Beunk                     INTO SECOND SUPPLEMENT (Christof)
-                         Change proposal for     -          -                  -             Not addressed in this Supplement (will be
                          RT Image IOD to                                                     done once Supplement 147 is finalized, or
                          reference new RT                                                    potentially a new object will be developed).
                          objects; Examination
                          of Blending Softcopy
                          Presentation State
                          as a replacement for
                          the obsolete Curve
                          module.
SUPPORTING DOCUMENTS
supRT2a_CombiningAnat     High-level clinical     Bruce      Moyers             2009/03/17    Currently in WG07 March 2009 meeting
omyUseCases_01.doc        use cases               Curran?                                     inbox
supRT2a_IMRT_UseCas       High-level clinical     Bruce      Moyers             2009/03/17    Currently in WG07 March 2009 meeting
es_01.doc                 use cases               Curran?                                     inbox
supRT2aERDiagram_01.      Overall Entity-         Bill       Busch, Beunk       2007/12/14    In supporting docs directory
pdf                       Relationship Model      Bennett



                                                                            8                                            WG-07 (Radiation Therapy) of
                                                                                                                      the DICOM Standards Committee
                                                                                                                              December 8 – 11, 2009
                                                                                                                                                             9
Doc Name                   Content               Sub-         Reviewers/co       Last update   Status
                                                 editor       workers
supRT2aERDiagram_01.       Overall Entity-       Bill         Busch, Beunk       2007/12/14    In supporting docs directory
pdf                        Relationship Model    Bennett
PatPosDeviceCoordsWhit     Patient Positioning   Mark         -                  2009/12/010   In supporting docs directory
ePaper                     Coordinate Systems    Sinclair
WhitePaperIsocenter.pdf    Description of        Christof     Bruce Curran       2009/08/07    In supporting docs directory
                           different isocenter   Schadt
                           concepts
Beam_Scanning_Beige_P      Description of        Nghia        -                  2009/12/11    In supporting docs directory
aper__V2.pdf               Proton beam           Ho
                           scanning concepts


Email Addresses (non-exhaustive list)
Dave Murray     dmurray@tomotherapy.com           Uli Busch        Ulrich.busch@varian.com               Johannes Stahl johannes.stahl@siemens.com

Bill Bennett    bbennett@cmsrtp.com               Stuart Swerdloff sswerdloff@impac.com                  Colin Sims        csims@accuray.com

Harold Beunk    harold.beunk@nl.nucletron.com     Michael Moyers mfmoyers@roadrunner.com                 Bob Pekarek       bpekarek@tomotherapy.com

Mark Sinclair   msinclair@visionrt.com            Walter Bosch     bosch@wustl.edu                       Ulrich Beifuß     ulrich.beifuss@brainlab.com

Christof Schadt christof.schadt@brainlab.com      Bruce Curran     bcurran1@lifespan.org                 Jaap Pijpelink    jaap.pijpelink@nl.nucletron.com

Andrea Morgan amorgan@calypsomedical.com          Scot Hogan       shogan@impac.com                      Michael Baumann          baumann@optivus.com

John Weston     jweston@impac.com                 Tony Apicella    aapicella@viewray.com                 Michael Hofer     Michael.mh.hofer@siemens.com




                                                                             9                                               WG-07 (Radiation Therapy) of
                                                                                                                          the DICOM Standards Committee
                                                                                                                                  December 8 – 11, 2009

				
DOCUMENT INFO