a working group of our own (dicom wg-26)
DESCRIPTION
A Working Group of Our Own (DICOM WG-26). Bruce Beckwith, MD Department of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts. Current State. Future State. Outline. DICOM overview DICOM pathology support Use in Pathology Issues to address. - PowerPoint PPT PresentationTRANSCRIPT
A Working Group of Our Own A Working Group of Our Own (DICOM WG-26)(DICOM WG-26)
Bruce Beckwith, MDBruce Beckwith, MDDepartment of PathologyDepartment of Pathology
Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center Harvard Medical SchoolHarvard Medical SchoolBoston, MassachusettsBoston, Massachusetts
Current StateCurrent State
Future StateFuture State
OutlineOutline
DICOM overviewDICOM overview
DICOM pathology supportDICOM pathology support
Use in PathologyUse in Pathology
Issues to addressIssues to address
DICOMDICOM
DDigital igital IImaging and maging and CoCommunications in mmunications in MMedicineedicine
Initially drafted as jointly sponsored effort of the Initially drafted as jointly sponsored effort of the American College of Radiology and the National American College of Radiology and the National Electrical Manufacturers Association (ACR-NEMA), Electrical Manufacturers Association (ACR-NEMA), which became the DICOM committee in 1998which became the DICOM committee in 1998Ver. 1 released 1985Ver. 1 released 1985– Physical 50 pin hardware abstraction layer standardPhysical 50 pin hardware abstraction layer standard– Never implementedNever implemented
Ver. 2 released 1988Ver. 2 released 1988– Initial interest from radiological manufacturing community onlyInitial interest from radiological manufacturing community only
DICOM V3.0 released 1992DICOM V3.0 released 1992Visible light supplement 1999 (endoscopy/microscopy)Visible light supplement 1999 (endoscopy/microscopy)
DICOM GovernanceDICOM Governance
Voluntary standards groupVoluntary standards groupHoused at NEMA in VirginiaHoused at NEMA in VirginiaCurrently 2Currently 266 working working ggroupsroupsParticipantsParticipants– IndustryIndustry– Professional and trade groupsProfessional and trade groups– Standards developing bodies and government Standards developing bodies and government
agenciesagencies– Anyone who has a material interestAnyone who has a material interest
Pathology in DICOMPathology in DICOM
Visible Light working group was initial Visible Light working group was initial homehome
Created Supp. 15 Created Supp. 15
Minimal pathology activity since thenMinimal pathology activity since then
Dec 2005, created a new group for Dec 2005, created a new group for Pathology (WG-26)Pathology (WG-26)
Working Group 26Working Group 26
Open to all interested partiesOpen to all interested parties
3-4 meetings per year3-4 meetings per year
70+ subscribers to the mailing list70+ subscribers to the mailing list35+ organizations35+ organizations
9 countries9 countries
Working with IHE (Japan and France) and Working with IHE (Japan and France) and HL7 Pathology groupsHL7 Pathology groups
DICOM Supplement 15DICOM Supplement 15
Support forSupport for– gross imagesgross images– microscopic imagesmicroscopic images– accession numbersaccession numbers– case historycase history– SNOMEDSNOMEDTMTM nomenclature and others nomenclature and others– ssome imaging system specificationsome imaging system specifications– compatible with all DICOM database systemscompatible with all DICOM database systems
How DICOM is UsedHow DICOM is Used
To communicate between image sources To communicate between image sources (radiographic instruments) and PACS(radiographic instruments) and PACS
To communicate between PACS and display To communicate between PACS and display workstationsworkstations
To communicate between RIS and PACSTo communicate between RIS and PACS
To communicate between image sources and To communicate between image sources and enterprise image archiveenterprise image archive
Image ExchangeImage Exchange
DICOM standard is for communication DICOM standard is for communication related to digital imagesrelated to digital imagesUses externally defined file formats to Uses externally defined file formats to encode the image dataencode the image dataIncludes metadata with the image dataIncludes metadata with the image dataUses an object oriented data modelUses an object oriented data model16-part standard document16-part standard document– http://medical.nema.org/dicom/2006/http://medical.nema.org/dicom/2006/
Typical VL Message ComponentsTypical VL Message Components
Header Constructs•Patient demographics•Study capture parameters•Equipment parameters•Pixel/voxel dimensions•Diagnostic data
Image Data•Primary image plane data•Overlay data•Arbitrary waveform data•ROI data•Diagnostic ROI-localized modifier data•Access/authentication/watermark dataSer
vice
Cla
ss W
rap
per
Optional Components
Structured Reporting Data•Self-referential XML schemata•Clinical Data•Specimen Data•Tissue Array Data•Research Access data•Clinical Trial Data•Chain of custody data•………………….•Ancillary Schemata/DTD definitions•Ancillary XML
Picture Archiving & Picture Archiving & Communication SystemsCommunication Systems
Store images acquired by multiple Store images acquired by multiple instrumentsinstruments
Serves images to various workstationsServes images to various workstations
Uses DICOM for messagingUses DICOM for messaging
Typically only utilized for radiology imagesTypically only utilized for radiology images
May have workflow limitationsMay have workflow limitations
Enterprise Image ArchiveEnterprise Image Archive
Centralized storage for medical imagesCentralized storage for medical images
Share across many departmentsShare across many departments
Not limited to radiology or even DICOMNot limited to radiology or even DICOM
Not tightly coupled to any workflowNot tightly coupled to any workflow
Can be write once – read many (no Can be write once – read many (no deletion)deletion)
Imaging ComparisonImaging Comparison
RadiologyRadiology– digital acquisitiondigital acquisition– automatic image captureautomatic image capture– clinician interpretableclinician interpretable– many patient requestsmany patient requests– large storage needslarge storage needs– digital images save moneydigital images save money– large budgetslarge budgets– strong standards for strong standards for
storage and transferstorage and transfer
PathologyPathology– analog primary dataanalog primary data– manual image capturemanual image capture– hard to interpret for non-hard to interpret for non-
pathologistspathologists– few patient requestsfew patient requests– extreme storage needsextreme storage needs– digital imaging costs moredigital imaging costs more– modest budgetsmodest budgets– limited pathology specificlimited pathology specific
standards standards
Current State in PathologyCurrent State in Pathology
Many PACS vendors are compliant with Visible Many PACS vendors are compliant with Visible Light images for pathology, endoscopy, etc.Light images for pathology, endoscopy, etc.
Growing number of imaging products targeted at Growing number of imaging products targeted at pathology are DICOM compliantpathology are DICOM compliant
Anatomic pathology laboratory information Anatomic pathology laboratory information systems offer limited image managementsystems offer limited image managementVeteran’s Administration:Veteran’s Administration:
Pathology imaging vendors must be DICOM compliant and Pathology imaging vendors must be DICOM compliant and store images in VISTA PACSstore images in VISTA PACS
Small, but growing adoption of DICOMSmall, but growing adoption of DICOM
Barriers to Adoption of Barriers to Adoption of Current ProductsCurrent Products
TurfTurf– PACS systems have traditionally been the domain of RadiologyPACS systems have traditionally been the domain of Radiology– Movement toward storing all medical images in a central location Movement toward storing all medical images in a central location
with a single viewing mechanism still in infancywith a single viewing mechanism still in infancy
WorkflowWorkflow– May need to manually annotate files with image description, May need to manually annotate files with image description,
accession number, etc.accession number, etc.– If sending to PACS, need to order study firstIf sending to PACS, need to order study first
CostCost– Image acquisition and annotation takes time – no extra Image acquisition and annotation takes time – no extra
reimbursement currentlyreimbursement currently– Slide scanners and storage are costlySlide scanners and storage are costly
Path PACSPath PACS
Humin Tec (Korea)Humin Tec (Korea)– PACS system for pathology departmentsPACS system for pathology departments– 21 installations, all in Korea21 installations, all in Korea– Communicates with standard radiology PACSCommunicates with standard radiology PACS– Also offers station for specimen photographyAlso offers station for specimen photography
Apollo Telemedicine (USA)Apollo Telemedicine (USA)– PACS system allows acquisition and storage of imagesPACS system allows acquisition and storage of images– Installed at Milwaukee Veterans Administration Installed at Milwaukee Veterans Administration
HospitalsHospitals– Images can be stored in VISTA imaging systemImages can be stored in VISTA imaging system
Academic Center EffortsAcademic Center Efforts
UnivUniv. . of Pittsburghof Pittsburgh– AP LIS is image awareAP LIS is image aware– Gross specimen photos and single field microscopic Gross specimen photos and single field microscopic
images savedimages saved– Transmitted to Enterprise Image ArchiveTransmitted to Enterprise Image Archive– Clinicians can see only selected images on completed Clinicians can see only selected images on completed
casescases– Main clinician interest is specimen photosMain clinician interest is specimen photos– Main pathologist use is conferencesMain pathologist use is conferences
Issues to AddressIssues to Address
TechnicalTechnical– Need for additional data elements (block, slide, slide status, Need for additional data elements (block, slide, slide status,
more detailed imaging system description, etc.)more detailed imaging system description, etc.)– Support for whole-slide microscopic imagesSupport for whole-slide microscopic images
DICOM is limited to 64k x 64k pixel images currentlyDICOM is limited to 64k x 64k pixel images currently
– Support for multi-resolution (pyramidal) formats Support for multi-resolution (pyramidal) formats – Support for navigating and selecting a region of interest from Support for navigating and selecting a region of interest from
within entire slide imagewithin entire slide image– Support for multispectral and hyperspectral modality imagesSupport for multispectral and hyperspectral modality images
Non-technical Non-technical – Suggested workflow and use examples (IHE)Suggested workflow and use examples (IHE)– Support for DICOM from LIS vendorsSupport for DICOM from LIS vendors
ResourcesResources
DICOM web site: DICOM web site: medical.nema.orgmedical.nema.org
RSNA DICOM Intro RSNA DICOM Intro www.rsna.org/Technology/DICOM/intro/index.cfmwww.rsna.org/Technology/DICOM/intro/index.cfm
Medical Imaging FAQ: Medical Imaging FAQ: www.dclunie.com/medical-image-faq/htmlwww.dclunie.com/medical-image-faq/html