1 DICOM Conference 2010 Sunday, October 10th, 2010 09:20 - 09:40 Riocentro Rio de Janeiro.

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Why is the implementation of Enhanced DICOM delayed ?

Kees Verduin Chair DICOM WG16

www.kees-verduin.nl

Presentation outline

Reasons for Delayed ImplementationsBenefits of Enhanced SOP ClassesThe clinical examples of its benefits for

MRI

Problem areas

Suggestions for Solution

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Delayed ?Facts:

Enhanced MR SOP class in DICOM standard since 2002

Demonstrations by Modality Vendors in 2004 and 2005

Expectations:Implementations by 2006 with MR and CT

modalitiesMassive support by PACS and WorkstationsSubstantial support through IHE profiles

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All these are Delayed !

What happened till today?Two modality vendors actually implemented

the creation of Enhanced MR objects.Many PACS vendors support the Storage

only.A few PACS/Workstation vendors do support

DISPLAY of more than just the pixelsLate support by IHE (till 2009), however,

these IHE profiles are still under debate because of interpretation/implementation differences

New attributes are also added to the classic IODs.

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Reason …DICOM is non-committal.

When approving a supplement, nobody in the industry commits itself for implementation.

Therefore good idea’s may lay around for years and vendor debates may go on for years.

Users can only address the vendors individually. 6

Why is there still a debate ?The Enhanced DICOM standard for MR and CT

supports many FEATURES, without ONE OVERWHELMING BENEFIT.

There is no direct competitive advantage thus:No Business Priority

During implementation vendors found that the architecture of their systems does not simply allow the support by their own workstations and PACS systems and therefore delayed the implementation.

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But vendors in DICOM agreed?The DICOM standard has become too diverse

to simply implement everything.

The DICOM representatives are NOT responsible for implementation and prioritization.

Prioritization: “the art of choosing what NOT to do”,where one choice is : “do nothing and await what happens”.

DICOM Standards Committee does not look at implementation speed.

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But there were such successful demos at SCAR and RSNA ?

Yes, these were stimulated AND executed by development staff from several vendors.

However, only those who were also responsible for product policy, could steer towards implementation.

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What are these Benefits ?Its NEW, supporting State of the Art imaging

It solves existing problems with Private Attributes

It is compact, through a Multi-Frame headerIt adds Real World ValuesIts adds Color (also in full RGB)It also supports storage of SpectroscopyIt also supports storage of Raw Data

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A new MR Standard (Supplement 49)

11Multi-stack

Color

Spectroscopy

DimensionsMulti-frame

Real World ValuesRaw Data

Diffusion Imaging

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“Diffusion b-values” sorted (and an ADC image) (courtesy: Philips)

Perfusion Imaging

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time

non perfused stroke area

Sig

nal

delayed perfusion

time-to-peak map

Real World Value Slope (0040,9225)

Real World Value Intercept

(0040,9224)

RW values

Stored

values

Quantitative data with Real World Values(courtesy: Siemens)

Functional Brain Imaging10-60 slicesall slices

measured in one TR

repeated 100-1000 times to get sufficient signal

leading to > 60,000 images in one object

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Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module

Spectroscopy and its Imaging

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Relative NAA peak-height

Ratio ofCholine andCreatinine peaks

Problems ….There was a timing dilemma foreseen for

changing from “classic” MR and CT to Enhanced DICOM

This dilemma is still an actual problem

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The timing dilemma for the Enhanced MR object

For the MR vendors:Why implement it, while nobody is ready

to use it?

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For the Workstation vendors:Why implement it, when no one is

creating it?For the PACS vendors:Support STORAGE, but how to deal with

the mix of workstations that can yes/no receive it ?

The timing dilemma for the Enhanced MR object

If nobody is asking for it , nobody will solve the chicken and egg problem

Only the PACS/Workstation vendors can solve this.

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Problems and adversaries

Current discussions in WG16 are about (potential) implementation choices by different vendors like:

ConcatenationsDimension OrganizationObject selectionSeries definition

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How can this delay be addressed ?More buy-in from modality vendors:

better cooperation in the interest of the end-users

More involvement by end-users/organizations:more clinical focus/influence for IHE Profiles

More involvement of Workstation/PACS vendors: to solve the chicken and egg problem

All stakeholders should be represented in/by the Committee for the Advancement of DICOM

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What should be done now ?Power to the users:

Join IHE user groups,Demand improvements from your vendors,Require up-to-date DICOM implementation,Join DICOM working groups.

More Power to the DICOM Standards Committee:Demand timely implementation, Reduce non-committal approval of new

supplements.27

Thank you for your attention

Muito Obrigado

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Acknowledgement and copyright

The slides of this presentation (including the hidden slides) may be quoted with reference to the author :

www.kees-verduin.nl

email:[email protected]

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