DICOM Conformance Statement (DCS) A Proven Power within DICOM Dwight A. Simon, Medical Standards Director & Senior Integration Specialist Merge eFilm

A 10 year Proven track record of Power It is Required It is a Public document It describes the DICOM Features / Functions implemented in a Product It allows connectivity comparisons It defines the information that is required to perform specific functions

Content of DCS Using 2003 Publication of Std A brief introduction that is specified in general terms A simple data flow diagram and description The functional definition of each DICOM feature More detail on specifics later How this product communicates to another product

Content of DCS Using 2003 Std continued Specification of any enhancements or changes to standard DICOM features A list of configurable parameters A list of character sets that are supported (i.e., Japanese or French) Any codes and controlled terminology A specification of all DICOM security features

Functional Definitions … more detail Specification of each feature/function within the application Utilizes specific terminology of DICOM Benefit - defined in an unambiguous way Disadvantage - must understand the terminology in order to get all the information one needs to: Understand the products DICOM features Compare this DICOM product with another

The common format is a huge benefit Almost Everyone follows the Templates from the Standard for writing a DCS The common format is a huge benefit Easy to find information, because always in same place Easy to compare one DICOM product with another

Who has ability to use this information with a high degree of understanding? Those that have taken DICOM training Those that have read and understood the DICOM Standard Unfortunately, the common healthcare user who does not have this background can probably only understand less than 40% of the information in the DCS

Presentation Context Tables Association Initiation Presentation Context Table - Proposed Abstract Syntax Transfer Syntax Role Expanded Name UID Name List UID List Negotiation X-ray RF Image 1.2.840.10008. 5.1.4.1.1.12.2 Implicit VR LE 1.2.840.10008.1.2 SCU None Storage JPEG-14 1.2.840.10008. 1.2.4.70 Lossless (70) Secondary 1.2.840.10008. 5.1.4.1.1.7 Implicit VR LE 1.2.840.10008.1.2 SCU None Capture Image Explicit VR BE 1.2.840.10008.1.2.2 Storage Association Acceptance Presentation Context Table - Accepted Abstract Syntax Transfer Syntax Role Expanded Name UID Name List UID List Negotiation Study Root Query/Retrieve - FIND 1.2.840.10008.5.1.4.1. 2.2.1 Implicit VR LE 1.2.840.10008.1.2 SCP None Query/Retrieve - MOVE 2.2.2 Verification 1.2.840.10008.1.1

Other Likely Unknown Terms AE Specification Application Entity Title Application Profile SOP Class SOP Instance Standard Extended SOP Class Unique Identifier (UID)

After 10 years DICOM Conformance Statement has become even more Powerful It includes an enhanced template It has a wider range of examples that deal with the majority of possible DICOM features It has grown from 50 pages to over 330 pages

Enhancement is called Supplement 64 Already balloted and approved to become part of the DICOM Standard Minor corrections and editing still to be done by Working Group 6 prior to making it a final document

Supplement 64 Enhancements (Sup64) Will benefit the non-DICOM literate user directly Will enable the DICOM literate user to more easily find and compare DICOM features Will be additive to most of what is in the current 2003 publication

Sup64 – New Additions DICOM Conformance Statement Overview Includes a description of the implementation in "layman's terms“ Requires that the tables for both Networking and Media Storage List all used DICOM features (SOP Classes) List be organized and grouped by categories

Sup64 – New Additions … continued Requires a Table of Contents (some vendors already do this) New "Introduction" section The "Definitions, Terms and Abbreviations" item will be one key addition for the non-DICOM literate If vendors do a good job with this item, then these users should be able to have an 80% or higher understanding of the DCS

Sup64 – New Additions … continued Enhancements to "Sequencing of Real-World Activities" Defines interactions between this product’s various DICOM connections and other products It is strongly recommended to incorporate UML Sequence Diagrams Sequence diagrams emphasize the sequence of the DICOM messages between two products Even without a formal understanding of the Unified Modeling Language (UML) the average user should be able to interpret the diagrams

UML Sequencing Diagram Storage Application Image / Info Manager 1. Open Association 2. C-STORE (CT Image) [1 to N images to be sent] 3. C-STORE (GSPS) [1 to N grayscale image consistency information sets to be sent] 4. N-ACTION (Storage Commitment Request for Images & GSPS) [Are they reliably stored] 5. N-EVENT-REPORT (Storage Commitment Response) [Each are or are not reliably stored] 6. Close Association

Sup64 – New Additions … continued The "Configuration" section has also been enhanced. Requires a much more definitive description of the configurable parameters that the application will utilize when it is running The parameters refer to application name(s), networking relationships, remote application connectivity, node level security, etc. There is a recommended set of operational parameters that are required to be represented

Sup64 – New Additions … continued The powerful "Annexes" section helps define some of the operational aspects of the product Within the Annexes one must describe the data that is created, put in the DICOM message and sent to another product.

Sup64 – New Additions … continued Within the Annexes" each piece of information (called an attribute) must be specified by name and DICOM identifier (called attribute tag), range of values that might be present type of value person name date time floating point double precision number integer number

Sup64 – New Additions … continued Within the Annexes each attribute must be defined whether it will or will not exist within a DICOM message and under what conditions it will exist If its value is present, then from where will it come from user input be generated automatically come from functional information like a work list be a configurable parameter.

Sup64 – New Additions … continued other important items within "Annexes" specification of attributes that are required mapping of attributes between different information sets HL7 mapped into a DICOM work list DICOM work list mapped into a CT image specify whether key attributes are allowed to be modified patient name patient identifier study instance UID

Sup64 – New Additions … continued A data dictionary of all private attributes The support of coded terminology and/or templates, if utilized The support for "Grayscale Image Consistency", if applicable A definition of any enhancements or changes to standard DICOM features that have been implemented, including feature specialization or new private features All private encoding of information that is support, if applicable

Sup64 – New Additions … continued Many informative sections in PS3.2 specifically to give examples of DICOM Conformance Statements for various types of products a huge benefit to both the vendors and the users for the vendors, they are used as a guideline for interpreting the DCS template for a specific kind of product for the user, it will insure that multiple vendors with similar products will have DCSes that look alike.

DCS Examples available in Sup64 A DICOM modality that has connectivity to an archive, a workflow manager and a print server, along with have the capability to create a DICOM generic CD-Rs A product that interfaces to a Radiology Information System via DICOM A DICOM image viewer that can handle a wide range of modality images, including radiation therapy planning information. It also can query and retrieve information from a remote application and can read both DICOM generic CD-R and DVD-RAM A DICOM print server A DICOM query/retrieve server

DICOM would truly only have Half the Power it currently has without the DICOM Conformance Statement!

With the Enhanced DICOM Conformance Statement ability to better understand how products connect to each other via DICOM what information they communicate and under what conditions what information must be received for the application to function properly how parameters must be configured to make the application function in specific ways a formal way to describe the sequencing of messages between DICOM applications