Working Group 13 (Visible Light) Emmanuel Cordonnier ETIAM, (Interim) co-chair Juergen Thiem SONY, (Interim) co-chair Emmanuel Cordonnier ETIAM, (Interim)

Working Group 13(Visible Light)

Working Group 13(Visible Light)

Emmanuel CordonnierETIAM, (Interim) co-chair

Juergen ThiemSONY, (Interim) co-chair

Emmanuel CordonnierETIAM, (Interim) co-chair

Juergen ThiemSONY, (Interim) co-chair

Berlin, September 15th, 2006Berlin, September 15th, 2006

Update in Orange

[email protected] DICOM WG13 (Visible Light) Berlin, Sept. 15th, 2006 page 2

AgendaAgenda• Introduce participants (10 people from ESC, Uni. Liepzig,

Olympus, Philips, Sony, Stryker, Tribvn, Etiam)• WG-13 objectives and activities• Participation of users from medical societies• End-user feedback on video acquisition in xx-scopy• Need for acquisition context information in Endoscopy• Feedback on DICOM MPEG-2 implementation• Examples of DICOM video sequences• Perspectives of high definition video (HDTV)• Cooperation with WG-24, WG-26, IHE-J-Endoscope• Work item proposal, if required• Other business


WG-13 objectives and activities (1)WG-13 objectives and activities (1)

• Scope:– To accompany the adoption of DICOM standards for still and

motion Visible Light color images, produced by endoscopes, microscopes, or photographic cameras, and propose new DICOM standards if required, on both sides, creation and use.

• Roadmap:– To contribute to accelerate the adoption of the DICOM MPEG2

Sup. 42 & 47.– To enlarge (number of modalities) and enrich (quantity of

information) the DICOM VL standard.– To see if other topics must be specifically addressed around the

existing standards, like, for example, streaming video, and/or, automation of workflow based on simple acquisition modalities ("unscheduled" and/or "one button" operation based).

– To accompany/anticipate the adoption of HD video by the medical arena.


WG-13 objectives and activities (2)WG-13 objectives and activities (2)• Short Term Goals:

– To develop and populate DICOM video sequence MPEG2 examples.– To propose a way for selecting sub-sequences using existing Key

Object Selection. Postponed.– To refine acquisition context for Visible Light images (equipment and

anatomy). Extended to other “touchy” attributes.– To accompany adoption of MPEG2 Transfer syntax for Ultra Sound.

No real demand for the moment.– To accompany adoption of DICOM for VL images in Pathology.

Responsibility transferred to the newly formed WG26.• Current Status:

– WG-13 has been "reactivated" for the successful development and the adoption of DICOM ML@MP MPEG2 (Sup. 42 and Sup. 47). It is actually focusing of its real use by the actors of the domain.

• Future Work Items:– TBD on HDTV to be prepared for the next WG13 meeting


WG-13 objectives and activities (3)WG-13 objectives and activities (3)

• Risks:– Not enough participation from the key players of the domain

(users and vendors), based in America, Asia and Europe.– No acceptance of the DICOM video objects by PACS vendors and

administrators.• Challenges and Opportunities:

– The use of VL images is rapidly growing (non/less invasive surgery, advanced diagnosis, surgery monitoring…). All equipment is migrating from analog to digital technology, thanks to consumer multimedia technologies. Targeted modalities are Gastroenterology, Laparoscopy, Orthopedics, Ophthalmology, Ear Nose Throat, Gynecology, Bronchoscopes.

– The manufacturers and users are facing to the necessary integration with other equipment and information system, for quality, safety and efficiency objectives.


Participation of users from medical societies

Participation of users from medical societies

• Challenge: How to enroll users and vendors from the different medical specialties using Visible Light imaging systems?– Organize WG13 at dedicated medical

conferences, such as EAES OK for vendors but not possible to meet users, yet. Probably in Gastroenterology user are more advanced. Next meeting in this domain and in North-America.

– Cooperate with parallel initiatives (WG24, WG26, IHE-J-Endoscope…). Makes senses.


End-user feedback on video acquisition in xx-scopy

End-user feedback on video acquisition in xx-scopy

• The video acquisition has different origin:– Image guided diagnosis– Image guided surgery– Surgical operation recording– Monitoring (vital signs…): in video only for display?

• Record the video aims to:– Facilitate the workflow from admission to reporting– Enrich the Electronic Healthcare Record (EHR)– Contribute to research and education– Create audit trails only few demand for the moment


Image source / Interest for storingImage source / Interest for storing

diagnosis surgery operation monitoring

workflow +++ +++ + +

EHR ++ +++ + +

research education

++ + ++ +

audit + ++ +++ +++


IODsModules

SC SC MF TC

VL EN

VL MC

VL SL

VL PH

VideoVL EN

VideoVL MC

VideoVL PH

Patient M M M M M M M M M

Specimen Identification M M C M C

Clinical Trial Subject U U U U U U U U U

General Study M M M M M M M M M

Patient Study U U U U U U U U U

Clinical Trial Study U U U U U U U U U

General Series M M M M M M M M M

Clinical Trial Series U U U U U U U U U

Frame Of Reference M

General Equipment U U M M M M M M M

SC Equipment M M

General Image M M M M M M M M M

Image Pixel M M M M M M M M M

Cine C M M M

Multi-frame M M M M

Frame Pointers U

SC Image M U

SC Multi-frame Image M

SC Multi-frame Vector C

VL Image M M M M M M M

Slide Coordinates M

Overlay Plane U U U U U

Modality LUT U

VOI LUT U

Acquisition Context M M M M M M M

SOP Common M M M M M M M M M

IODs ModulesIODs Modules to be studied by implementers

To be sure the PACS is accepting the object, many xx-scopy vendorsAre exporting SC only.But to add additional attributes, they are ready to export VL objects.


Typical « touchy » AttributesTypical « touchy » Attributes

• General Image / Image Type (ORIGINAL\PRIMARY)

• SC Equipment / Secondary Capture Device Manufacturer vs. SOP Common / Manufacturer

• General Series / Performing Physician’s Name vs. General Study / Referring Physician’s Name

• General Study / Study Description vs. Acquisition Context Module / Acquisition Context Description

• VL Image / Anatomic Region Sequence• Acquisition Context

to be studied by implementers


Anatomic Region Sequence 1CAnatomic Region Sequence 1C

Anatomic Region Sequence

(0008,2218) 1C Sequence that identifies the anatomic region of interest in this image (i.e. external anatomy, surface anatomy, or general region of the body).

Only a single Item shall be permitted in this sequence.

Required if Number of Frames (0028,0008) is present and Specimen Accession Number (0040,050A) is absent. May be present otherwise. ???



Anatomic Region Codes for VL « ES »Anatomic Region Codes for VL « ES »

Value Meaning

T-D4000 Abdomen

T-59490 Anus, rectum and sigmoid colon

T-60610 Bile duct

T-74000 Bladder

T-DD123 Bladder and urethra

T-26000 Bronchus

T-83200 Cervix

T-D3000 Chest

T-DD163 Esophagus, stomach and duodenum

T-AB200 External auditory canal

T-63000 Gall bladder

T-D7000 Inguinal region

T-15001 Joint

T-71000 Kidney

T-D9200 Knee

T-59000 Large intestine

T-24100 Larynx

T-40230 Lumen of blood vessel

T-D3300 Mediastinum

T-2300C Naso pharynx

T-22000 Paranasal sinus

T-55002 Pharynx

T-20101 Pharynx and larynx

T-59600 Rectum

T-D2220 Shoulder

T-59470 Sigmoid colon

T-11500 Spine

T-DD006 Trachea and bronchus

T-70010 Upper urinary tract

T-73800 Ureter

T-88920 Uterus and fallopian tubes



Acquisition Context for EndoscopyAcquisition Context for EndoscopyAttribute Name Tag Type Attribute Description

Acquisition Context Sequence (0040,0555) 2 A sequence of Items that describes the conditions.

>Value Type ((0040,A040) 3 TEXT, NUMERIC, CODE, DATE, TIME, PNAME

>Concept Name Code Sequence (0040,A043) 1 A concept that constrains the meaning of (i.e. defines the role of).

>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context is defined.

>Referenced Frame Numbers (0040,A136) 1C References one or more frames in a Multi-frame SOP Instance.

>Numeric Value (0040,A30A) 1C This is the Value component of a Name/Value pair when numeric.

>Measurement Units Code Sequence (0040,08EA) 1C Units of measurement. Only a single Item.

>>Include ‘Code Sequence Macro’ Table 8.8-1 Baseline Context ID is 82.

>Date (0040,A121) 1C This is the Value component of a Name/Value pair when date.

>Time (0040,A122) 1C This is the Value component of a Name/Value pair when time.

>Person Name (0040,A123) 1C This is the Value component of a Name/Value pair when Person.

>Text Value (0040,A160) 1C This is the Value component of a Name/Value pair when Text.

>Concept Code Sequence (0040,A168) 1C This is the Value component of a Name/Value pair when Code.

>>Include ‘Code Sequence Macro’ Table 8.8-1 No Baseline Context is defined.

Acquisition Context Description (0040,0556) 3 Free-text description of the image-acquisition context.



Examples of DICOM video sequencesExamples of DICOM video sequences

• Availability of such sequences? Some are ready to provide such sequence

• Objective of such a repository? To improve the interoperability (“touchy” attributes…)

• Qualification of examples? Decided by the vendor but shall be a “real” object, “not patched”

• Interest to share them between vendors? Yes• Management of the repository? NEMA• Level of access (public / DSC members…)? only

contributing DICOM DSC “vendor” members


Perspectives of high definition videoPerspectives of high definition video

• Use case(s): the general demand for highest accessible quality. Some medical cases where HD is required could emerge

• Limitations of the present DICOM MPEG2 for such use cases: too early to say

• Possibilities afforded by HDTV (demonstration): three vendors shown it

• Standards used (MPEG2 HD, MPEG4…): MPEG2 MP@HL seems to be the best candidate, up to 1080p, typically 1080i or 722p, OK for the MPEG2 HD decoders

• Link with media storage (DVD…): could be the different DVD HD format supported by the HD DVD readers, but too early to say


WG-24, WG-26, IHE-J-EndoscopeWG-24, WG-26, IHE-J-Endoscope

• WG-24 (Surgery): use case definition, analysis of the workflow in surgery, depending of the domains: needs for analysis of the workflow at a more global (but simple) level (unscheduled…)

• WG-26 (Pathology): analysis of the DICOM object model to fit with pathology context (specimen, blocks, slides…); whole slide images (WSI) and object format. Interesting but quite different approach than for endoscopy where the diagnosis is done by the physician during the act

• IHE-J-Endoscope: workflow in diagnosis endoscopy and related acquisition context. Even in surgical endoscopy, need for link with the pathology.

Maintain the “link” with the three groups


ADT

OrderPlacer

OrderFiller

AcquisitionModality

PPSManager

ImageManager

ImageArchive

ImageCreator

ImageDisplay

B/W: HL7 MessagesGreen: DICOM Messages

Pt.Registration Pt.Registration

Filler Order Management

Modality Worklist Provided

Procedure Scheduled

Modality PPS

PPS

PPS

Modality Image Stored

Storage Commitment

Creator PPSStorage Commitment

Creator Image Stored

Query Images

IHE-J Diagnosis Endoscopy WorkflowIHE-J Diagnosis Endoscopy Workflow

Placer Order Management

Pt.Update Pt.Update

Pt.UpdateImage Availability Query

Retrieve Images

ReportManager

ReportCreator

ReportReader

ReportRepository

OrderRequester

StatusManager

Pathology OrderPlacer

Pathology OrderFiller

IHE Pathology

1 not yet come2 arrival3 start premedication4 completed premedication5 start exam6 completed exam7 start recovery8 completed recoveryAnd so on

Key issue :Tight relation between the Endoscopy and pathology

① ②

③

Biopsy #

Will be communicated to the WG26


Feedback on DICOM MPEG-2 implementation

Feedback on DICOM MPEG-2 implementation

• Difficulty to implement on the source side? No, on the standard point of view (interoperability works)

• Ability to retrieve video from other file formats? Yes, DVDs, DV, AVI, MPEG4, HDTV…

• Average length of DICOM MPEG2 video? 10s to xxx, very dependant of the user and the context. Very often limited by the system to avoid trouble

• Acceptable image quality? Comparable to source• Compatibility with PACS servers? THE MAIN ISSUE• Compatibility with DICOM viewers? The second one• Ability to edit object? (sub-sequences…) no clear demand

for the moment, especially in routine (no time to spend).• Use of DVD for patient and doctor to doctor (education)


Work Item proposalWork Item proposal

• If required

• To be prepared by mail interchange for being discussed and reviewed at the next meeting: extension of the VL video to HDTV. To be checked if interest in other domains (cardiology, ophthalmology…). The time frame anticipated for users demand is 3 years. So it is time to start now.


ConclusionConclusion

• Other business

• Next WG13 meeting (date, place): to take place at the next Digest of Disease Week (May-2007? in the US)

Documents

Working Group 13 (Visible Light) Emmanuel Cordonnier ETIAM, (Interim) co-chair Juergen Thiem SONY, (Interim) co-chair Emmanuel Cordonnier ETIAM, (Interim)