DICOM Educational Conference Brisbane, Australia

DICOM Educational Conference Bangkok, Thailand OCTOBER 3-4, 2019 TRENDS AND FUTURE DIRECTIONS IN DICOM KEVIN ODONNELL CANON MEDICAL RESEARCH USA CO-CHAIR DICOM WG-10 (STRATEGY) PAST-CHAIR DICOM STANDARDS COMMITTEE The Future Making predictions is hard, especially about the future Yogi Berra The Future The best way to predict the future is to invent it Alan Kay Working Groups Modality, clinical domain, or function specific teams, assigned to develop Supplements

or Change WG-01: Cardiac and Vascular WG-17: 3D Information Proposals WG-02: Projection Radiography/Angiography WG-03: Nuclear Medicine WG-04: Compression WG-05: WG-06: WG-07: WG-08: WG-09: WG-10: WG-11: WG-12: Exchange Media Base Standard Radiotherapy Structured Reporting Ophthalmology Strategic Advisory

Display Function Standard Ultrasound WG-18: Clinical Trials and Education WG-19: Dermatology WG-20: Integration of Imaging and Info Systems WG-21: Computed Tomography WG-22: Dentistry WG-23: Application Hosting WG-24: Surgery WG-25: Veterinary Medicine WG-26: Pathology WG-27: Web Technology for DICOM WG-28: Physics WG-29: Education, Communication & The Common Thread DICOM Mission Create & maintain an international standard for the communication of biomedical, diagnostic, and therapeutic information in medical disciplines that use digital images and associated data. DICOM Strengths Sustainable standard (stable & evolving) we dont break it;

its a safe investment Semantic interoperability with stable information model Mature development and maintenance process DICOM Trends (Themes of Recent Work) Theme: Modalities As vendors continue developing digital modalities, the data must be stored Multi-Energy CT Sup 188 MR Tractography Sup 181 Wide Field Ophthalmic Photography Sup 173 Ophthalmic OCT Angiography Sup 197

Whole Slide Imaging (recent uptake) Sup 145 Neurophysiology Waveforms Sup 217 Dermoscopy Sup TBA * Further reinforced by trend toward Enterprise Imaging solutions Multi-Energy CT Multi Energy Imaging 4 families Standar d CT Image many flavors

Objective Image Family Virtual Monoenergetic Image (VMI) Effective Atomic Number (Z) Image Electron Density Image Material Quantification Family MaterialSpecific IodineImage Map; Bone Density MaterialRemoved Image Virt. Non Contrast;

Virt. Non-Ca; Proportional Map Image * Courtesy WG21 Material Labeling Family Discrete Labeling Image Probabilit y Map Image Value-based Map Image Gout crystals Material Visualization Family

CT IOD Other IOD MaterialModified Image Color Overlay Image Highlighted; PartiallySuppressed Color Blending Image Color Map Image Theme: DICOMweb RESTful services for modern architectures and programmers STOW-RS (Store) Sup 163

QIDO-RS (Query) Sup 166 WADO-RS (Retrieve) Sup 161 RESTful Rendering Sup 174 UPS-RS (Worklists) Sup 171 Server Options (Capabilities) Sup 170 Thumbnail Service Sup 203 Non-Patient Instances Sup 194 Web Services Re-documentation

Sup 183 (dicomstandard.org/current Part 18) * DIMSE & RESTful service symmetry -> Bi-directional Proxies DICOMweb example http://encountermanager.here.org/workitems?AdmissionID=987654 &ScheduledProcedureStepSequence.ScheduledStationAETitle=DermTab1 Encounter Manager Get Imaging Context [ { PatientName: {"vr": "PN", "Value": [{"Alphabetic": "SMITH^JOHN"}]}, PatientID: {"vr": "LO", "Value": ["66437748"]}, IssuerOfPatientID: {"vr": "LO", "Value": ["MyHospital"]}, PatientBirthDate: {"vr": "DT", "Value": ["19670701"]},

PatientSex: {"vr": "CS", "Value": ["M"]}, InstitutionName: {"vr": "LO", "Value": ["Metrocity General Hospital"]}, InstitutionalDepartmentName: {"vr": LO", "Value": [Dermatology"]}, http://mypacs.here.org/studies Content-Type: application/dicom+json Store Images Image Manager/ Archive [ { PatientName: PatientID: IssuerOfPatientID: PatientBirthDate: BodyPartExamined: Laterality: {"vr": "PN", "Value": [{"Alphabetic": "SMITH^JOHN"}]}, {"vr": "LO", "Value": ["66437748"]},

{"vr": "LO", "Value": ["MyHospital"]}, {"vr": "DT", "Value": ["19670701"]}, {"vr": "CS", "Value": [CALF"]}, {"vr": "CS", "Value": [R"]}, Content-Type: image/jpeg Theme: Quality Assurance Managing and monitoring Imaging Procedures CT Radiation Dose SR Sup 127 Radiopharmaceutical Administration SR Sup 159 Patient Dose SR Sup 191 Contrast Agent Administration SR Sup 164 Cone-beam CT Radiation Dose SR Sup 214

CT Protocol Storage Protocol Approval Sup 121 Sup 192 XA Protocol StorageSup 212 MR Protocol Storage Sup TBA fMRI Acquisition Paradigms Sup 210 Protocol Storage SOURCES Defined Protocol Device=Scanomatic Series Pat. Pos. : Feet First / Supine Pat. Instruct : Single Breath Hold / Full Inspiration kVp : 80~140 Slice Thickness : 1.0~2.5mm

Recon. Kernel : Std. Prior Scan Modality Protocol Library APPLICATIONS Semi-auto Semi-auto Scan Scan Setup Setup Prior Prior Comparability Comparability Patient Patient Positioning Positioning Vendor

Sharing Sharing Best Best Practice Practice Clinical Trial Protocol or Clinical Trial Performed Protocol Local Standard Hospital Best Practice ACR / RSNA AAPM Device=Scanomatic Delta Version=3.0.4 Pat. Pos=Feet First / Supine Pat. Instruct=Given

kVp=120 Slice Thickness=1.0mm Recon. Kernel=FC12 Protocol Protocol Backups Backups Acquisition Acquisition Validation Validation Scan Scan QA QA // Troubleshooting Troubleshooting Contrast Administration SR Performed Administration Contains

1 Programmed at injector device Programme d Plan 1-n Steps 1-n Phases Phases 1 Actually delivered by injector device Delivered Plan 1-n Steps Pressure

Pressure Vs. Vs. Time Time Graphs Graphs Flow Flow Rate Rate Vs. Vs. Time Time Graphs Graphs 1-n Phases Phases * Courtesy WG-6 Theme: Radiotherapy (2nd Generation) Prescribing, planning, verifying, and delivering radiotherapy treatments RT Prescription & Segment Annotation Sup 147

RT C-Arm Radiations Sup 175 RT New Radiations Sup 176 RT Patient Positioning and Workflow RT Dose Objects RT Course Sup 160 Sup 177 Sup 178 RT Radiation Records Sup 199 RT Ion Radiation Objects Sup 215 RT Brachytherapy Objects

Sup 216 Theme: Conformance Increasing formalization of conformance assessment and communication (WG-31) Revised DICOM Conformance Statement Sup 209 Address needs identified in user survey Consider Machine-readable for inter-system distribution and analysis Conformity Assessment Sup 207 Define hierarchy of conformance clauses and assessment procedures A Few Other Topics Security Providing and maintaining security mechanisms used within the protocol TLS Security Profiles

Sup 204 Extended BCP195 TLS Profile Sup 206 * Variety of features added circa 1999-2001 3D Manufacturing Manage 3D files together with the imaging study used to generate them STL Encapsulation for 3D Manufacturing Sup 205 OBJ Encapsulation for AR/VR/3D Manufacturing Sup 208 Video Increasing use of video; stored and streaming HEVC/H.265 Transfer Syntax Real-Time Video Sup 195 4 Sup 202 (New!)

2 Compression ratio to MPEG-2 1 MPEG-2 AVC HEVC DICOM Standard in HTML / XML dicomstandard.org/current AI / Machine Intelligence Enormous interest in applying AI to medical imaging Transform NCI AIM & DICOM SR Measures Sup 200 Simplified SR in JSON for AI Sup 219 WG-23 Artificial Intelligence / Application Hosting AI Results: Display Primitives, AI Ready

AI Operational Workflow: Image Generation, Processing, Display, Reporting AI Development Workflow: Data Annotation, Management, Research, Algorithm Training, Distribution WG-08 Structured Reporting and Common Data Elements (CDE) Radelement.org Prostate SR The Future You tell us seek out new modalities & new technology find new applications & new efficiencies boldly solve problems we have never solved before. Participate ! DICOM invites new members & contributors Application process Patent disclosure policy dicomstandard.org [email protected] Great opportunity to learn

Great opportunity to contribute Presenters contact information Kevin ODonnell, MASc. [email protected] Pacifica, California, USA https://global.medical.canon/ Thank you For Your Attention!

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