DICOM News

TLS
Security
Profiles

Two new Secure Connection profiles are added to make DICOM consistent with the latest RFCs and best practices for TLS security.

• A BCP195 TLS Profile that requires compliance with the IETF BCP 195 Recommendations for Secure Use of Transport Layer Security (TLS) and Datagram Transport Layer Security (DTLS). This profile requires that TLS negotiation start with the strong security protection parameters, and allows progressive negotiation of weaker protection down to a minimum protection limit.
• A Non-Downgrading BCP195 TLS Profile that does not permit negotiation of weaker protections.

The old Basic TLS Secure Transport Connection Profile is retired.

Voted to go into the standard as final text.

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DICOM Encapsulation of
STL Models
for 3D Manufacturing

This supplement adds a new DICOM IOD to encapsulate Stereolithography (STL) 3D model file formats. The new IOD allows 3D manufacturing models to be exchanged between various types of equipment using DICOM.

This adds the ability to store, query and retrieve 3D models as DICOM objects.

Updates are addressed by storing new instances, with reference back to earlier instances.

Line by line review performed. The working group will do a cleanup of the final comments and send the result to the base standard group.

Voted to go into the standard as final text.

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2^ndGen RT Objects
Prescription and Segment
annotation

This supplement addresses the need for a new generation of IODs and processes required for use in radiotherapy. This new generation model centers around the following concepts:

• Different representations of data are encoded in different IODs.
• Follows the "enhanced multi-frame" paradigm.
• Support legacy and full-featured, modern equipment.
• The concept of workflow management using Unified Procedure Step has been fully integrated into the new IODs.

New techniques in oncology: The existence of new treatment techniques (such as robotic therapy and tomotherapy) have been taken into account, along with new treatment strategies (such as image-guided therapy and adaptive therapy). Further supplements of RT Second Generation objects include:

• Supplement 175 C-Arm RT Treatment Modalities
• Supplement 176 Additional RT Treatment Modalities
• Supplement 177 RT Dose Objects
• Supplement 178 RT Course

A line by line review to reach final text was started. It was suggested to align all modules with the current DICOM standard. Further optimizations, factoring out of common parts, is to be done with change proposals later.

The supplement will be presented again in a base standard meeting before being ready for final text voting.

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Contrast
Agent
Administration

This supplement introduces IODs that describe the administration of imaging agents. The supplement applies to all modalities in which imaging agents are introduced into a subject's circulatory system in a controlled fashion (e.g., CT, MR, XA).

The new SOP Classes describe administration events, flows, pressure, timings, physio-chemical attributes and pharmacological attributes of the agent administration and also consumables related to the administration.

• The Planned Imaging Agent Administration SR Storage SOP Class represents patient specific plans to deliver the imaging agent. The plan is tuned to the characteristics of a patient and needs of that procedure.
• The Performed Imaging Agent Administration SR Storage SOP Class is for reporting the actual administration delivered during a medical imaging study. The operator may program a delivery system with an intended delivery. This program is captured in this object. The delivery system or a user may deviate from the programmed plan based on a variety of factors. The actual delivery is also captured in this object.

These SOP classes do not describe administration of radiopharmaceuticals, which is addressed by R-RDSR.

The supplement will be presented again in a base standard meeting before being ready for final text voting.

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Thumbnail Service
over
DICOMweb

This supplement defines thumbnail handling in conjunction with web services (supplement 183).

The supplement will stay in "draft final text" as it depends on the finalization of supplement 183.

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2^Gen RT
C-Arm
Treatment

This Supplement introduces RT Radiation IODs and RT Radiation Set IODs. A Radiation Set IOD defines a Radiotherapy Treatment Fraction as a collection of instances of RT Radiation IODs. RT Radiation IODs represent different treatment modalities.

This Supplement introduces the representation of the C-Arm techniques. The complex coding of patient and device positioning and the sequence of instructions and commands to put them into position was presented and discussed in detail.

The supplement will be presented again in a base standard meeting before being ready for letter ballot voting.

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Web Services
Redocumentation

This supplement affects Part 18 of the DICOM standard; however, it is based on the re-documentation in Supplement 183. The reader should be familiar with Supplement 183, Section 11.4.

This supplement defines Thumbnail resources on the WADO-RS Study, Series, Instance, and Frame resources in the DICOM RESTful web services standard. These resources provide representative images that reflect the content of the parent resources. The origin server determines the pixel content of the Thumbnail.

The primary use cases are Thumbnails for:

• image viewers, or
• EMR/EHRs, e.g., as referenced from HL7 FHIR Imaging Study resources.

This resource allows a web client to retrieve a representative image without having to retrieve a full study structure.

The granularity of which an implementer can choose to implement services shall be made more explicit in chapter 6 or 7.

The supplement will be presented again in a base standard meeting before being ready for letter ballot voting.

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Multi Energy
CT

This Supplement extends the CT Image IOD and Enhanced CT Image IOD to support new types of images generated by Multi-energy (ME) CT scanners.

It describes various ME imaging techniques. While different vendors apply different techniques to achieve ME Images, there is large commonality in the generated diagnostic images. It adapts existing attributes of the CT / Enhanced CT IOD to fit ME techniques.

To detect the different X-Ray spectra, Multi-energy (ME) CT imaging uses combinations of different Source(s) and Detector(s) technologies such as current switching X-Ray tubes, spectral detectors, multi-layer detectors, multi-source and detector pairs.

Multi-energy CT data can be reconstructed and processed in different ways to serve a variety of purposes.

• To differentiate materials that look similar on conventional CT images, e.g., to differentiate Iodine and Calcium in vascular structures or to differentiate vascular structures from adjacent bone.
• To quantify materials and to extract regions and organs based on their composition.
• To generate virtual non-contrast images from a contrast-enhanced image rather than having to scan the patient twice.
• To enhance the effect of contrast such as highlighting Iodine and soft tissue or to reduce artifacts.

The overview slides where presented. The base standard suggested to avoid lookup tables for materials but to use different bit planes per material for discrete labelling.

Further, the base standard proposed to use the standalone segmentation object or a simpler suitable new general table map object instead of inline table maps within the CT image. The idea is to have a general "value representation" object to say what values for each voxel means, in the CT case for material labelling.

The supplement will be presented again in a base standard meeting before being ready for letter ballot voting.

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Realtime
Video

This Supplement describes new DICOM IODs and associated transfer syntaxes for the transport of real-time video and/or audio and associated medical data. These are referred to collectively DICOM Real-Time Video (DICOM-RTV). The supplement defines an IP-based new DICOM Service for the broadcasting of real-time video to subscribers with a quality of service which is compatible with the communication inside the operating room (OR).

The new Real-Time Video Service supports interoperable devices inside the OR and beyond, enabling a better management of imaging information, impacting directly the quality of care.

Professional video (e.g., TV studios) equipment providers and users have defined in SMPTE (ST 2110 family of standards) a new standardized approach for conveying video and associated information.

SMPTE ST 2110 suite, elaborated on the basis of Technical Recommendation TR03 originated by the VSF (Video Services Forum) is used as a platform.

The format of recording is not defined in the supplement, nor the way of replaying the recorded videos. Only the method for feeding the recorder with the synchronized videos and associated metadata is specified by the present supplement.

The meaning between flow and essence needs to be made more specific. The real time video is planned to include endoscopic, microscopic, photographic, audio and rendition objects.

A discussion took place on which meta data to duplicate from the video stream into the DICOM header.

The transportation of the video stream should be unchanged. This will avoid having the sender to convert.

The supplement is voted approved for public comment.

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DICOM
3D Printing
Additional Models

This supplement adds a new DICOM IOD to encapsulate additional 3D files to facilitate 3D manufacturing. The supplement will address the encapsulation of 4 different 3D modalities:

• Extensible 3D Graphics (X3D) and The Virtual Reality Modeling Language (VRML) 3D model file formats.

All the following formats support color information.

• X3D/VRML have distinct differences to the STL file format. The information is either coded to a vertex or face of a polygon or as a texture map that is wrapped around the 3D model. X3D is the successor of the VRML format from the Web3D consortium.
• Object Files (OBJ) and Material Library Files (MTL)
• 3D Manufacturing File (3MF)

The 3MF file format is the newest common-use 3D file format with growing widespread adoption. The file format was designed specifically for 3D printing (X3D and OBJ were originally designed for 3D visualization).

These IODs add the ability to store, query and retrieve 3D models as DICOM objects. Updates are addressed by storing new instances, with reference back to earlier instances similar to the IOD for STL encapsulation (supplement 205).

The pros and cons between a zip format container and multi part mime to transport many smaller files were discussed. Zip is seen as more convenient.

The supplement will be presented again in a base standard meeting before being ready for public comment voting.

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