1. Mpeg-21 and Medical data A strategy for Tomorrow ’ s EMR

2. Introduction to Health care Standards $ DICOM $ ACR-NEMA $ Current version3 $ HL-7 $ User consortia  V2.4 (v3 – next step)

3. DICOM- Digital Imaging and Communication in Medicine $ Set of services and protocols to allow communication between imaging devices, whatever they are. $ The DICOM file format is not only an image file format, it also contains patient, study and acquisition related information.

4. The Parts of the DICOM Standard $ Part 1 - Introduction and Overview $ Part 2 - Conformance $ Part 3 - Information Object Definitions $ Part 4 - Service Class Definitions $ Part 5 - Data Structures & Semantics $ Part 6 - Data Element Listing and Typing $ Part 7 - Message Exchange Protocol $ Part 8 - Network Support for Message Exchange $ Part 9 - Point-to-Point Support

5. The Parts of the DICOM Standard $ Part 10 - Media Storage and File Format $ Part 11 - Media Storage Application Profiles $ Part 12 - Media Formats and Physical Media $ Part 13 - Print Management Point-to- Point

6. DICOM Application Domain MAGN ETOM Information Management System Storage, Query/Retrieve, Study Component Query/Retrieve, Patient & Study Management Query/Retrieve Results Management Print Management Media Exchange LiteBox

7. Network Protocol

8. Summary of DICOM Features $ NETWORK PROTOCOL $ DICOM incorporates negotiation to permit nodes to agree on the functions to be performed $ MESSAGE ENCODING $ DICOM defines 24 data types (V2.0 had 4) $ DICOM message encoding includes JPEG compression (17 variants) $ DICOM includes encapsulated image and multi-frame syntaxes

9. Summary of DICOM Features $ OBJECT DATA MODEL $ DICOM is based on a completely specified data model $ DICOM includes a robust UID mechanism $ SERVICE CLASSES $ DICOM defines classes of service for specific applications (e.g. image management, printing) and conformance levels $ Off-Line Media Support $ DICOM defines a directory structure and media profiles $ CONFORMANCE $ DICOM requires conformance statements and contains detailed conformance requirements.

10. DICOM Terminology $ DICOM Message Service Element (DIMSE) - The set of DICOM Application Layer communication services. $ DIMSE Service Group (DSG) - A subset of the full DIMSE services which is applicable to a specific IOD. $ Information Object Definition (IOD) - A data abstraction of a class of real-world objects. A collection of related attributes (data elements).

11. DICOM Terminology $ Service Class - A set of functionality relating to a single type or real-world activity. Composed of a set of SOP Classes plus rules and associated semantics. $ Service-Object-Pair Class (SOP) - The atomic unit of DICOM functionality. Composed of an IOD and a DIMSE Service Group plus restrictions or extensions of the IOD. (Equivalent to an Object Class)

12. Service-Object Pair Class SOP Data Dictionary Real-World Object Information Object DIMSE Service Group

13. Example $ Verb : store  – Service (DIMSE) $ Noun : CT image  – Information Object Definition (IOD) $ Generic sentence : store a CT image  – SOP class $ Specific sentence : store this CT image  – SOP instance

14. DICOM Service Classes $ Composite (flow of image data ) $ Verification $ Storage $ Query/Retrieve $ Study Content Notification $ Normalized (management related) $ Patient Management $ Study Management $ Results Management $ Basic Print Management

15. DICOM and Mpeg-21 $ Parties are Either Service Class Provider (server) or Server Class User (client) $ MPEG-21 -> Parties are categorized equally as USERS. $ Processing in DICOM is more on a 1-1 basis.

16. DICOM and Mpeg-21 $ Both need to have the same SOP Classes $ SOP classes identify the capabilities of the specific distributed processing for a certain service Class $ SOP Instance MPEG-21 Digital Item

17. DICOM and Mpeg-21 $ DICOM the context is with medical Images. $ Mpeg-21 ideally is for all multimedia data.

18. MPEG-21 Frame work

19. DI aware app/browser DICOM AE data Dcm=> DI creator DI(med) Strategy1

20. DI aware app/browserl DICOM AE m1.dcm Translator DI ( m1.dcm) Strategy2

21. Health Level Seven  14-year-old, not-for-profit organization $ ANSI-accredited standards developer since 1994 $ International affiliates in 17 countries $ Version 2.x Standards are widely used in US and being rapidly adopted world-wide

22. HL-7 In healthcare systems it enables electronics communication of text based information between all Institutions and their different departments.

23. HL-7 mission To Provide standards for the exchange,management and integration of data that support clinical patient care and the management, delivery and evaluation of healthcare services.

24. HL-7 versions $ v2.x features $ Messaging standard $ Event triggered $ V3 $ Reference Information Model $ ALL communications (by default) uses XML

25. HL-7 and MPEG-21 Clinical Document Architecture(CDA) $ Similar to DI description Model Clinical documents ¥1 MPEG-21 DI ’ s

26. Electronic Health Record(EHR) $ A collection of individual records that reside in a variety of information systems and locations and on multiple types of media. $ A new way of structuring, storing and managing patient data so that it can shared and exchanged between different healthcare providers in safe and secure manner.

27. Electronic Medical Record(EMR) Electronic Patient Record(EPR) Electronic Health Record(EHR) MPEG – 21 DI ’ s ???

28. References $ ACR-NEMA committee http://medical.nema.org/dicom/  Penn state DICOM resources page http://www.xray.hmc.psu.edu/dicom/