DICOM Basics

Connectivity – Part 1
Overview

DICOM Overview

Rev. 1
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 Goal
Goal and
and Content
Content
Goal:
Understand at a high level how main DICOM Services are working and
what they are used for.

Content:
• Introduction to DICOM
• Presentation of DICOM Services used in GE products:
– Verification
– Storage
– Query/Retrieve
– Modality Worklist
– Performed Procedure Step
– Storage Commitment
– Printing
– Media Interchange and Application Profiles
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 DICOM
DICOM
(Digital
(Digital Imaging
Imaging and
and COmmunication
COmmunication in
in Medicine)
Medicine)
History:
• 1985-1988 :
Joint effort between Radiologist and Manufacturers to specify
ACR-NEMA 1.0 and 2.0
ACR : American College of Radiology
NEMA : National Electrical Manufacturer Association

• 1993 :
9 parts of DICOM (3.0)

• 2007 :
18 parts of DICOM - 126 Supplements

DICOM is continuously growing

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 DICOM
DICOM Members
Members
DICOM is developed under joint efforts of
ACR (American College of Radiology)
NEMA (National Electrical Manufacturers Assoc.)
ESC (European Society of Cardiology)
ACC (American College of Cardiology)
SFR (Société Française de Radiology)
DRG (Deutschen Röntgengesellschaft)
AAO (American Academy of Ophthalmology)
AAD (American Academy of Dermatology)
CAP (College of American Pathology)
JIRA (Japaneese Radiology Vendors Association)
COCIR (European Radiology Vendors Association)
…
And also more than 25 vendors…

DICOM: a GLOBAL STANDARD of Communication

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DICOM Information
In order to communicate information about:
List of exams to be performed, Images, Waveforms,
measurements, reports, etc,
several services are defined:
>Storage (e.g. of images)
>Storage Commitment
>Query (e.g. of images, of worklist)
>Retrieve (e.g. of images)
>Printing of images
>Storage on Media for interchange
>...

BUT… no forcing mechanism to select what services

to implement on which product
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DICOM Conformance Statements
A formal Document to know what DICOM functionalities /
options have been implemented in the product
• Every implementation SHALL be provided with a CONFORMANCE
STATEMENT:

• Stating explicitly the subset of the standard implemented

• Identifying any options selected

• Users and system integrators will have the means to assess if two
conformant implementations will interoperate.

A critical document available for the customer

For GEHC products, available at: http://www.ge.com/
dicom
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 The 4 dimensions of DICOM
DICOM for
Image Management DICOM for
DICOM for Network Printing
Network Image Transfer

IMAGE IMAGE INFORMATION OBJECTS

IMAGING
MANAGEMENT QUERY HARD COPY
RETRIEVE PRINTING

STORAGE

Networking Support, e.g.. TCP/IP

and ... DICOM for Media Interchange

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Dimension #1

DICOM for
Image Transfer

IMAGE IMAGE INFORMATION OBJECTS

QUERY
RETRIEVE

STORAGE

Networking Support, e.g.. TCP/IP

Understanding Image transfer with DICOM ...

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DICOM Service Class User/Provider (SCU/SCP)

“ I want you to store this image “

User Provider

SCU SCP
Service Class User Service Class Provider
role role

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 DICOM Verification
• Allows any system to send a test message to another
system to verify the network connection
•A successful response means that the remote node configuration
is correct and the remote DICOM application is responding
• Verification SCP mandatory on all systems able to
respond to a DICOM Association
My Request:
System A “Is your DICOM application Verification Request System B
able to talk with me?” (DICOM “ping”)

Response:
Verification Response Status = SUCCESS
“Yes, it is”
(“ping” success rsp)
Verification Verification
Service Class User (SCU) Service Class Provider (SCP)
Available since DICOM day one
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 DICOM Storage
• Allows a system to send object data to a remote node.
• Object data may be Images (e.g. CT images), Waveforms,
SRs or SR based objects (e.g. Mammo CAD), etc.

Modality Remote Node

Image 1.2.840.15.1
Image Send

Response:
Status = SUCCESS
Store Response
Storage (SCU) Storage (SCP)

Available since DICOM day one,

but more and more object types defined every year
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 DICOM Query/Retrieve
• Allows a system to query another system for a list of
available images (query)
My Query Request:
• Patient Name:
• Patient ID: PACS, Archive
• Study UID:
Workstation • Study ID: or Short Term
Query Request
• ... Storage Device

Response 1:
• Patient
Response Name:Doe^John
2:
• Patient
• Patient ID:Name:Smith^Joe
Response PatID26
n:
• Study
• Patient UID:
• Patient 1.2.34526.2
ID:Name:Smith^Joe
PatID45
• Study
• Study ID: 5
UID:
• Patient ID:1.2.78945.4
PatID45
• ...
Query (SCU) Query Response(s) •• Study
• Study
...
ID:UID:
40 1.2.78945.63
• Study ID: 48
• ... Query (SCP)

Final Response:
Status = SUCCESS

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 DICOM Query/Retrieve
• Filtering is possible to get only relevant response(s)

My filtered Query Request:

• Patient Name: Smith^Joe
• Patient ID:
• Study UID: PACS, Archive
Workstation • Study ID:
Filtered or Short Term
• ... Query Request
Storage Device

Response 1:
• Patient Name:Smith^Joe
Response n-1:
• Patient ID: PatID45
• Patient Name:Smith^Joe
• Study UID:
• Patient ID:1.2.78945.4
PatID45
• Study ID:UID:
• Study 40 1.2.78945.63
Query (SCU) Less • ...
• Study ID: 48
Query Response(s) • ...
Query (SCP)

Final Response:
Status = SUCCESS

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 DICOM Query/Retrieve
• Allows a system to request another system to send
images (retrieve)
My Retrieve Request:
Send me the following images:
• Image 1.2.840.12.1
•… PACS, Archive
Workstation
• Image 1.2.840.12.N Retrieve Request or Short Term
Storage Device
Image Send Image 1.2.840.12.1

Response:
Status = SUCCESS Store Response
…
Image Send Image 1.2.840.12.N

Retrieve (SCU) Response:

Status = SUCCESS Store Response Retrieve (SCP)

Final Final Response:

Status = SUCCESS
Retrieve Response
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Dimensions #2

DICOM for
Imaging management

IMAGING
MANAGEMENT

Networking Support, e.g.. TCP/IP

Understanding Information Management with DICOM ...

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 DICOM Storage Commitment
Enables an image source to obtain the commitment
that images have been stored for safekeeping
Image 1.2.840.1.1 Image Send
Image 1.2.840.1.N
… Store Response
PACS, Archive
Modality or Short Term
My STC Request:
Archive the following images: Storage Commitment Storage Device
Im. 1.2.840.1.1,… , im. 1.2.840.1.N (STC) Request
STC Response STC Resp: Status = SUCCESS
=> I accept processing your request
(Ack. to process Rq.)

STC Result STC Result Notification Request:

Storage Commitment Notification Request Successfully archived these images:
(the expected Resp.) Im. 1.2.840.1.1,… , im. 1.2.840.1.N
(SCU) Storage Commitment
STC Result Notification Resp: STC Result (SCP)
Status = SUCCESS
Notification Response

First Products available since 1999

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 DICOM Modality Worklist
• Provides integration of modalities with Radiology Information Systems
• Automatic download of patient info, study identifiers, scheduling,
procedure description, increasing operator productivity and avoiding
typing errors
My Worklist Request:
• Patient Name: Doe^John
• Patient ID:
• Study Descr.:
• Sched. System:
Modality
Worklist Request
Modality • ... RIS
Response 1:
• Patient Name:
Response Doe^John
n-1:
• Patient ID:Name:
• Patient PatID26
Doe^John
• Study Descr.:
• Patient CT Head
ID: PatID26
• Sched.
• StudySystem:
Descr.: CTMy Lung
CT1
Modality • ...
• Sched. System: My CT2
Worklist Response(s) • ...
Modality Worklist Modality Worklist
(SCU) (SCP)
Final Response:
Status = SUCCESS

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DICOM Modality Performed Procedure Step
• Allows Modalities to Upload Acquisition Administrative Data in
RIS/PACS:
• Examination Started/Complete
• Description/Codes about what was actually performed
• List of Images
• Materials to bill
• Doses Performed Procedure
Step Started
Modality
PPS Started Rsp RIS
(PPS Update)
(PPS Update Rsp)
PACS
PPS Ended
Performed Procedure
PPS Ended Rsp Performed Procedure
Step (SCU)
Step (SCP)
Standard Approved early 1998
Available on some products since 1999
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 4 DICOM Service Classes for Integration
Worklist
Modality Worklist
RIS
Modality Performed
Procedure Step Started
MPPS
PACS &
Store Images
Archive
Storage
Commitment Storage Commitment
List of Images

Modality Performed Step:

Performed Status = Completed
Procedure Performed CT Head A Closed Loop
Step
Patient Name, Patient ID,
Accession Nb, Study UID
for a seamless integration
List of Images, Doses 20 /
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Dimensions #3
DICOM for
Network Printing

HARD COPY
PRINTING

Networking Support, e.g.. TCP/IP

Understanding Film Printing with DICOM ...

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 DICOM Print Management

A Standard Interface
New Printer to Share Printers
DICOM DICOM
Old Printer
Spooler

• DICOM print (Grayscale and/or color) links Printers with

Modalities and Workstations on a standard network

• A lot of flexibility to support all features available on various

vendor’s printers
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Dimension #4
DICOM for
Media Interchange

ALL DICOM
INFORMATION OBJECTS

DICOM File Format

DICOM Media

Understanding Media Interchange with DICOM…

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 DICOM for Media Interchange

The DICOM
Directory
(a.k.a. DICOMDIR)
facilitates media The same image objects as
browsing MEDICAL ALL DICOM defined for Network
DIRECTORY INFORMATION OBJECTS exchange are usable on
physical media
DICOM File Format
FS

F 60
l 1 60
16

UD 96
S
ve 96

DO
DO
T

O
FA

Le O

IS
IS

USB CD-ROM 130 mm 90 mm MOD DVD-ROM

Media CD-R MOD (128, 230, -R/+R/
(650 MB, 540, 640 MB, -RW/+RW
1.2, 2.3, 4.1GB) 1.3, 2.3 GB)

DICOM Relies on Broadly Available Media Storage Technology

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 DICOM Application Profile

Application Profile

Object / Image
specificity(ies)

Application Profile X
Selection of: (FSC)
- Objects to be stored
(images, …)
Check
DICOM
Selection of: Conformance
Application Profile X
- Interchange Media(s) Statement
(FSR)

FSC: File Set Creator

FSR: File Set Reader
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 DICOM Application Profiles

> Basic Cardiac X-ray Angiographic Application Profile

> 1024 X-ray Angiographic Application Profile
> Ultrasound Application Profiles
> General Purpose CD-R and DVD (RAM) Interchange Profiles
> CT and MR Image Application Profiles
> General Purpose MIME Interchange Profile
> General Purpose DVD with Compression Interchange Profiles
> DVD MPEG2 Interchange Profiles
> General Purpose USB and Flash Memory with Compression Interchange Profiles
> Dental Application Profile
> ZIP File over Email Interchange Profiles

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 As a summary: DICOM Communication
SCU / SCP and FSC / FSR

Service Class User Service Class Provider

(SCU) (SCP)
Network
SOP Class Y SOP Class Y

Application Profile X Application Profile X

File Set Creator File Set Reader

(FSC) (FSR)

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