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Introduction to DICOM

• Introduction
• The DICOM Interface
• History
• Information Objects
• Roles
• Service Classes
• Conformance
• Parts of the Standard
• Other DICOM Terms

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Traditional
Traditionalimaging workflow
imaging workflow

Image Clinical
Acquisition Interpretation

Film
Management
and
Library
Result Distribution
Image Output to
on Film Referring Physician
Introduction-
Evolving from a hospital need
In the 1980’s, it became clear
that the tremendous growth
in image acquisition systems,
display workstations, archiving
systems and Hospital Infor-
mation Systems made it
vital to have a good
connectivity and
interoperability between all
kinds of (medical) equipment.

There was a strong need to:


• Share diagnostic information
in different departments
• Combine all medical
information on a patient for
better diagnostic results
• Complete the patient folder
with results from all medical
Course Name Toshiba America International Training Academy studies performed
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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Why do we need a (DICOM) standard ?

Without a standard, custom


interfaces are needed for each
Without a standard: imaging device.
CT
Currently, in a typical multi-
vendor imaging department,
there is little compatibility of
equipment, so custom
interfaces are developed or
purchased in order to
interconnect the equipment.

Custom When Dicom is built into a


Interface medical imaging device, it can
be directly connected to other
equipment via a standard
Print network.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The hospital benefits of the Dicom
standard
The benefits are:
• enables the hospital to select
the best equipment per
diagnostic application
• improves the level of
interactive communication
among medical professionals
• provides a wider access to
images and associated
information
• creates new opportunities for
handling diagnostic images in
more cost effective ways.

• Increase diagnostic quality


• Cost effective

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM – The Standard in communicating medicine

DICOM is the industry standard


for transferal of medical
images, patient demographics
and related information.

DICOM enables digital


communication between
diagnostic equipment, printers,
picture archives etc. from
various manufacturers
(vendors)

DICOM is the first


• Multi-modality standard multi-modality standard
( US, CT, MRI etc. )
• Multi-vendor standard

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Introduction - What DICOM stands for

In order to simplify and improve


equipment connectivity,
medical professionals joined
forces with manufacturers in an
international effort to develop
DICOM.

DICOM stands for:


D = Digital
I = Imaging and
CO = Communications in
M = Medicine

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
History
DICOM is the result of an
alliance of potential users of
the standard ( Members of the
American College of Radiology
ACR NEMA - ACR ) with the companies
(Users) (Manufacturers) that manufacture medical
equipment ( Members of the
National Electrical
Manufacturers Association -
NEMA ) that began in 1984.

DICOM DICOM has also been


standard embraced by other worldwide
standards organizations and
other healthcare disciplines
outside of radiology.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
History
DICOM, the expanding standard Through development over the
course of more than the past
decade, DICOM continues to
grow and evolve to meet the
2000 needs of the imaging
community.
1999 DIC
OM •ACR/NEMA 1.0 (Ó1985)
1998 DIC
•ACR/NEMA 2.0 (Ó1988)
OM •DICOM 3.0 (1993) current
1997 3.0
evolving standard
DIC
1996 OM
3.0 Work continues on many useful
1995 supplements to DICOM which
extends its usefulness to other
medical disciplines, such as
Endoscopy, Radiation Therapy
Planning, Pathology and
More than 40 supplements during the past years Diagnostic Reporting

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Image transfer via networks
Image Acquisition CT DICOM uses computer industry
standards to provide a network
connection with other devices.
This allows easy connection of
DICOM imaging equipment to
existing hospital networks.
Archive
Intra-hospital connections,
communication with remote
Standard hospital network clinics and tele-radiology
applications are supported.

Distribution
Printer

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The DICOM interface
A manufacturer uses the
standard to design and build a
product. The Dicom standard
describes all of the detailed
functional specifications which
Image Acquisition a device with a communication-
DICOM interface (allowing one
computer to ‘talk’ to another
Interface
e.g. Ultrasound Inside medical
computer) must employ to meet
equipment the standard.
The standard provides a
common reference for all
developers of medical
equipment.
DICOM image
The interface uses a set of
computer software which
executes the DICOM protocol.
The software also formats the
data for transmission.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM concepts
Information Objects:
Information Objects standardize
the content of a wide range of
image types (e.g. CT, MRI,
DICOM NM, US, Xray)
concept
Service Classes:
Service classes define what to do
with those Objects (e.g. store,
move, print) across the
network.
Information Role Service
Role Definition:
Objects Definition Classes In the Role Definition is defined
which equipment is the
transmitter of information
Three concepts specified and which equipment is the
receiver of information.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Information Objects
The Information Objects consist
Information of two parts:
Objects •Object Attributes
•Image Object

Object Attributes Image Object Object Attributes:


•patient information e.g. CT pixel matrix This is the so called header
•acquisition parameters
information of an image
•modality etc
containing Patient information,
modality information etc.
Example: CT Object
Patient module : Name, birthday, sex etc Image Object:
• Study module : Study date, time, ID etc The Image Object contains the
• Series module : Modality, series etc Attributes
• Image plan module : Slice orientation, slice thickness pixel data of the medical image,
• Etc. like the pixel data of a CT-
image.
Image

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Information Objects

• Information Objects are not only


images and graphics but also
studies, reports, lists, etc.

• An information Object has:


– Modules
– Attributes

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Data elements
In all the modules there are standard data elements
that can be :
M : Mandatory.
C : Conditional.
U : User options.
M* : Mandatory with special conditions.
U* : User option with special conditions.

All the defined data elements start with an even


number (like in ACR-NEMA).

Private data elements have an odd number and may


contain data that is not defined in the standard data
elements.

example :Relative Couch position : 0019 110B


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Service Classes
A Service Class defines the
service or operation that can
Storage Service Class take place ( e.g. printing, storing
etc.) now that the objects have
Query and Retrieve Service Class been defined.

Print Service Class

Modality Work list Management Service Class

Modality Performed Procedure Step Service Class

Media Storage Service Class

Storage Commitment Service Class

Structured Reporting Service Class

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Roles –storage class user, provider

To setup communication, two


I am a User of the I am Providing the roles have to be specified:
Archive Services Archive Services
Service Class User
•The device that sends information
or an image on the network is a
Service Class User Service Class Provider Service Class User ( SCU ).
(SCU) (SCP) The SCU uses the network service.
( e.g. A CT scanner uses a network-
workstation to display the CT
Image images)
Archive
acquisition
Service Class Provider
•The device that receives
information or an image from the
network is a Service Class Provider
Network ( SCP ).
The SCP provides the service to the
network ( e.g. a network-archive
provides the archiving service )

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Roles –Print class user provider

I am a User of the I am Providing the


Print Services Print Services
A CT scanner uses the Print
Services of a printer which is
Service Class User Service Class Provider connected to the network.
(SCU) (SCP)
Printer
A Printer provides the Print
Image Services to the network
acquisition
A SCU always needs a SCP
and visa versa.

Network

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Successful communication
If two devices want to have a
The DICOM functionality is defined as follows:
successful communication, we
Functionality = must consider the following:

Information Role Service


Objects
+ Definition
+ Classes
• What functionality is
supported?
• Communication Rules.
E.g. : XRAY image + SCU + Storage
To make a successful communication between Systems
we must consider the following communication Rules:

• They must support identical Information Objects


• They must support identical Service Classes
• A SCU needs a SCP ( a User needs a Provider )

Communication examples are:


CT Storage SCU and CT Storage SCP : OK
XRAY Print SCU and US Print SCP : No good

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Association request
If two devices want to have a
1. I need to STORE US successful communication,
2. Yes, I can STORE US
images, do you support they first must negotiate
images in my archive
this? supported functions and rules.

Storage Service Storage Service This is accomplished by an


Class User Class Provider association request or
“handshake.”

Image
Archive
acquisition

1 2
Network

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Verification Service classes
The verification Class is used to test
DICOM connections over the
network. It uses the DICOM
echo command to another
DICOM compatible
workstation to verify the
Verification (SCU) Verification (SCP) connection.
Most systems have the verification
class user and provider function
to be able to test connections.
Provider means that when you
receive a DICOM echo
Echo
command that you will respond
SCU SCP to this (you provide this service
to the users on the network).
User means that you can send a
DICOM echo command to
another system. (you use the
service from a provider on the
network).

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Storage Service Class
•The storage class describes
I can send US-images I can store US-images the storage of digital images in
to a Storage device in my archive via a network.

•In the Storage Service


Storage Service Storage Service Classes, two Roles can be
Class User Class Provider defined: User and Provider

•If you are Storage Class User,


Image
Archive
it means that you can send data
acquisition to a Storage Class Provider.

•If you are Storage Class


Provider, it means that you can
receive data from a Storage
Network
Class User, provided that both
systems do support the same
Image-object. E.g. an US-image
object.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Query and Retrieve Service Class

•The Query and Retrieve Service


1. Please send me a 2. Here you have the Class supports basic operations to
list of studies of list access and move images based on
patient X search criteria, such as retrieving an
image of a particular study of a
patient X
4. Here you
•If you are Query and Retrieve User
3. Please send me have image you can ask for a list from a Query
images no. 4 no. 4 and Retrieve provider on the
network and pull any desired image
Archive from this provider to your local
Viewing system.
station server
Query •An additional condition is that both
systems support the same DICOM
Image Object ( e.g. US-Object )

•If you are Query-and-retrieve-


Provider you accept a request for a
list from a Query-and-retrieve-User
over the network and send the
desired data images to this user.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Modality Worklist Management Service Class

The worklist management service


class is intended to transfer patient
information between the hospital
server (HIS=Hospital Information
System, RIS=Radiology Information
New patient System) and the imaging
equipment.
All clinical appointments in a
hospital are normally made on a
central HIS/RIS server. With
Patient Worklist management class it is
schedule list possible to send the patient
information from the central desk to
TOSHIBA HIS/RIS- all imaging equipment. The

User Server advantage is that the operator at the


Ultrasound system doesn't need to
Provider type in all the patient information
(with the risks of typing mistakes).
Even a bigger advantage is that
traceability of patient images in the
archive can be better guaranteed.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM Data Exchange Walkthrough

SCP
SCU
Image

DICOM
Application DICOM DICOM Protocol

Transfer TCP
Communication TCP TCP Protocol
Protocol
IP
Network IP IP Protocol
(Internet Protocol)

Ethernet
Link Ethernet card Ethernet card Protocol
(DICOM I/F PWB)

Course Name
Network
Toshiba America International Training Academy
Page 25
Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Data transfer
• When the system starts the communication, it will
send a package to the other system (provider) with
– The other party's IP address
– The other party's Port Number.
– The other party's AE title (Application Entity)
– The systems IP address for return handshake
• In the other system this packet will be passed
upwards and because of the port number, the TCP
layer knows to which application this package must
be passed. The DICOM provider will now check the
AE Title and respond to the source IP number with
the source port number.
• The packages that are sent are called datagrams.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
OSI model
• Application
• Presentation • Application
• Presentation
• Session • Session
• Transport
• Transport • Network
• Datalink
• Network • Physical
• Datalink • Application

• Physical

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Image transfer via networks

• OSI model
DICOM Application Entity

DICOM "Added
Value"
OSI Assocationa DICOM
OSI Upper Layer Control (ACSE)
Service Boundary Upper Layer
OSI Presentation protocol for
OSI Session TCP/IP
OSI Transport TCP
OSI Network
IP
OSI LLC Standard
Networking

Ethernet, ATM, FDDI, ISDN, etc.

Course Name Toshiba America International Training Academy


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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM Terminology
• Application Entity
Application Entity
• Image Object Definition The label or name of a
DICOM application
• Service Class
Image Object Definition
• Association (IOD)
The standardized format for
• DIMSE Services data based on the modality of
the image. CT images have
a different IOD than do US
images.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM Terminology
• Application Entity Service Class

• Image Object Definition associates one or more


Information Objects with one
or more Commands to be
• Service Class performed upon these
objects. Service Class
• Association Specifications state
requirements for Command
• DIMSE Services Elements and how resulting
Commands are applied to
Information Objects. Service
Class Specifications state
requirements for both Users
(SCU’s) and Providers
(SCP’s) of communications
services.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM Terminology
Association
The initial ‘handshake’
• Application Entity between Application Entities
(AE’s) that represents an
• Image Object Definition agreement the SCP will
support the requested
• Service Class services of an SCU.

• Association DIMSE Service


Generic services which act
• DIMSE Services upon instances of an
information object. The
specific messages that AE’s
use to

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
DICOM data format
• Since there are 2 different data Most DICOM programs accept
both forms and convert it
formats commonly used you must automatically to their desired
format (depending on the CPU
specify what format you use in and Operating System.
your DICOM conformance The default setting is Little
statement: Endian.

– Little Endian: If byte order 68A4 is


received it will be converted to A468.

– Big Endian: If byte order 68A4 is


received it is not converted.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Conformance Statement
Anyone claiming that their
equipment or software conforms to
the DICOM standard, must be able
DICOM Standard to provide a so called Conformance
Statement that describes exactly
System A how that device or software
Connectivity conforms to the standard.

System B A question that is frequently asked


about the DICOM standard is :
If DICOM is a standard, why is a
Conformance Statement required?
Isn’t it sufficient to simply state that
equipment conforms?
As has already been explained,
DICOM can support many different
Information Objects, Service
Classes etc.
Because of the wide multi-modality
scope of the DICOM standard, a full
implementation of the DICOM
standard is seldom targeted in a
medical product development plan.

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Conformance Statement
The Conformance Statement of a
Example of a Toshiba Conformance Statement: DICOM interface (defining a part of
the DICOM standard), contains the
following items:
•Which Information Objects are
TOSHIBA No.2A260-669E supported
•Which Service Classes are
supported
DICOM •Which role ( SCU or SCP ) is
CONFORMANCE STATEMENT supported
FOR
TOSHIBA WHOLE BODY X-RAY CT SCANNER A user or manufacturer trying to
X-SERIES determine if two DICOM devices will
communicate to suit a particular
application, can compare the
conformance statements side by
side.

This process does not guarantee


that the two devices will
communicate properly, but obvious
problems, such as one device not
supporting the service needed by
the other, can be caught.
Course Name Toshiba America International Training Academy
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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Toshiba Conformance Statements

• Most are available from TAMS Web Site


at http://www.toshiba.com/tams

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Introduction and Overview
Part 1 Introduction and Overview • Overview of the DICOM
Part 2 Conformance standard. It describes the
Part 3 Information Objects Definition history, scope, goals, and
structure of the standard.
Part 4 Service Class Specifications
Conformance
Part 5 Data Structure and Encoding
• Defines principles that
Part 6 Data dictionary
implementations
Part 7 Message exchange (DIMSE) claiming conformance to
Part 8 Network Communications Support for message exchange it are required to follow.
(TCP/IP)
• Defines DICOM
Part 9 Network communication support for message exchange (50 pin) Conformance Statement,
minimum general
Part 10 Media storage and file format conformance
Part 11 Media storage application profiles requirements, etc.
Part 12 Media formats and physical media
Part 13 Print management
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Information Object Definitions
Part 1 Introduction and Overview • Specifies all the Information
Part 2 Conformance Object Definitions (i.e.
images, overlays, print
Part 3 Information Objects Definition
objects, etc.)
Part 4 Service Class Specifications
Service Class Specifications
Part 5 Data Structure and Encoding
• Defines all the Services Class
Part 6 Data dictionary and more important SOP
Part 7 Message exchange (DIMSE) classes (i.e. Store, Query,
Part 8 Network Communications Support for message exchange Retrieve, Print, etc.)
(TCP/IP) Data Structure and Encoding
Part 9 Network communication support for message exchange (50 pin) • Defines the structure and
encoding rules of the Data Set
Part 10 Media storage and file format (encoding, transfer syntax,
Part 11 Media storage application profiles etc.)
Part 12 Media formats and physical media
Part 13 Print management
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Data Dictionary
Part 1 Introduction and Overview • Registry of all DICOM data
Part 2 Conformance
elements and unique
identifiers (UIDs).
Part 3 Information Objects Definition
Message Exchange
Part 4 Service Class Specifications • Defines the DICOM
Part 5 Data Structure and Encoding Message Service Element
(DIMSE). It specifies the
Part 6 Data dictionary
protocol to send commands
Part 7 Message exchange (DIMSE) such as Store, Find, Move,
Part 8 Network Communications Support for message exchange Get, Create, Action, Event,
(TCP/IP) Set, and Delete.
Part 9 Network communication support for message exchange (50 pin) Network Communication
Support for Message
Exchange
Part 10 Media storage and file format
• Defines the services and
Part 11 Media storage application profiles upper layer network
Part 12 Media formats and physical media protocols (i.e. association
negotiation, support for
Part 13 Print management
TCP/IP, OSI, etc.)
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Network Communication
Part 1 Introduction and Overview Support for Message
Part 2 Conformance Exchange
Part 3 Information Objects Definition • Define the 50-pin protocol.
This portion of the standard
Part 4 Service Class Specifications
is no longer significant in an
Part 5 Data Structure and Encoding actual networking clinical
Part 6 Data dictionary environment.
Part 7 Message exchange (DIMSE) Media Storage and File Format
Part 8 Network Communications Support for message exchange • Specifies the general model
(TCP/IP) for media interchange (i.e.
Part 9 Network communication support for message exchange (50 DICOM File Format,
pin) Directory, etc.)
Part 10 Media storage and file format
Part 11 Media storage application profiles
Part 12 Media formats and physical media
Part 13 Print management
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Media Storage Application
Part 1 Introduction and Overview Profiles
Part 2 Conformance • Specifies a selection of
choices which are applicable
Part 3 Information Objects Definition to a specific need or context
Part 4 Service Class Specifications in which media interchange
Part 5 Data Structure and Encoding
is to be performed (i.e. X-
ray Cardiovascular, etc.)
Part 6 Data dictionary
Media Formats and Physical
Part 7 Message exchange (DIMSE) Media
Part 8 Network Communications Support for message exchange • Specifies a set of physical
(TCP/IP) media and formats (i.e. CD-
Part 9 Network communication support for message exchange (50 pin)
R, 3" MOD, etc and DOS,
ISO 9660, etc.)
Print Management
Part 10 Media storage and file format
• Point-to-point
Part 11 Media storage application profiles Communication Support
Part 12 Media formats and physical media • Defines a point-to-point
Part 13 Print management print protocol replacing the
network.
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
The Standard
Section Grayscale Standard Display
Part 1 Introduction and Overview Function
Part 2 Conformance • Specifies the display
Part 3 Information Objects Definition standard used to obtain
visual consistency in how
Part 4 Service Class Specifications
a given digital image
Part 5 Data Structure and Encoding appears whether viewed
Part 6 Data dictionary on separate display
Part 7 Message exchange (DIMSE) monitors or light boxes.
Part 8 Network Communications Support for message exchange
(TCP/IP)
Part 9 Network communication support for message exchange (50 pin)

Part 10 Media storage and file format


Part 11 Media storage application profiles
Part 12 Media formats and physical media
Part 13 Print management
Part 14 Grayscale standard display functions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.
Questions

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Module #: Lesson # Title  2003, Toshiba America Medical Systems, All rights reserved.