DICOM Progress

An overview of the yearly progress of the DICOM standard for the last five years


2nd Gen. C-Arm RT Treatment

This Supplement introduces the RT Radiation Set and representation of the C-Arm techniques.

An RT Radiation Set IOD defines a Radiotherapy Treatment Fraction as a collection of instances of RT Radiation IODs.

Further this supplement adds support for C-Arm Photon-Electron Radiation instances.

RT Radiation IODs represent different treatment modalities.

This supplement was voted as Final Text and will be part of the next edition of the standard.

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Webservices Redocumentation

This supplement re-documents PS3.18 Web Services. The goals of this re-documentation are:

  • Factor out text that is common to multiple services and in doing so 1) ensure uniformity and 2) make clearer and concise for readers.
  • Use a uniform format and style for documenting DICOM web services, making it easier to navigate and more efficient for readers implementing multiple services
  • Bring the Standard into conformance with current Web Standards, especially [RFC7230 - 7234], and [RFC3986 - 3987].
  • Use the Augmented Backus-Naur Form (ABNF) defined in [RFC5234] and [RFC7405] to specify the syntax of request and response messages.
  • Use consistent terminology throughout the Standard.
  • Use a consistent format for documenting services and transactions.
The most important aspect of the re-documentation is that technical requirements of PS3.18 should not be changed. Errors, ambiguities, and underspecified aspects of the current PS3.18 have been corrected through the CP process prior to the finalization of this supplement.

This supplement was voted as Final Text and will be part of the next edition of the standard.

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Thumbnail Service over DICOMweb

This supplement adds thumbnail handling to web services in part 18 of the DICOM standard.

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.

This supplement was voted as Final Text. It will be part of the next edition of the standard.

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2G RT Objects Prescription and Segment Annotation

This supplement lays the foundation for a new generation of RT objects. It adds Prescription and Segmentation Annotation objects.

This new generation model centers around the following concepts:

  • Spezialised objects in separate different IODs.
  • Follows the enhanced multi-frame paradigm.
  • Support legacy and full-featured, modern equipment, e.g. robotic therapy and tomotherapy) and modern treatment strategies, e.g. image-guided therapy and adaptive therapy.
  • Workflow management using Unified Procedure Steps.

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Contrast Agent Administration

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 and XA) involving both automated and manual administration. It covers planned and records performed administration.

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

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Multi Energy CT Images

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 Multi-energy images, there is large commonality in the generated diagnostic images. It adapts existing attributes of the CT / Enhanced CT IOD to fit ME techniques.

Multi-energy CT acquires pixel information, which correlates to different X-Ray spectra to enable differentiation, quantification and classification of different types of tissues.

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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.

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DICOM Encapsulation of STL Models for 3D Manufacturing

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.

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Security: EXTENDED BCP195 TLS Profile

Adds a new Secure Connection profile to make DICOM consistent with the latest recommendations from the Japanese CRYPTREC committee by recommending support for all the ciphersuites included in the CRYPTREC recommendation.

The Extended BCP195 TLS Profile requires compliance with the IETF BCP195 Recommendations for Secure Use of Transport Layer Security (TLS) and Datagram Transport Layer Security (DTLS) plus support for the additional cypher suites specified by the CRYPTREC committee.

This profile requires that TLS negotiation start with the strong security protection parameters, and allows progressive negotiation of weaker protection down to a specified minimum protection limit.

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Advanced Blending Presentation State

Adds support to blend color sources such as parametric maps together with other images with a consistent color presentation.

Parametric Maps can be used to store the quantification of a specific measurement.

The Advanced Blending Presentation State defines the blending of the content of different Parametric Maps with an optional anatomical image as underlay, showing the measurements (e.g., BOLD fMRI, Diffusion maps, CT/MRI Perfusion maps, FDG PET map) in relation to the anatomical structure.

Blending can be performed on any combination of Images.

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Presentation State Volume Rendering

Extends the family of Volumetric Presentation States by adding three additional SOP Classes to represent Volume Rendering Volumetric Presentation States:

  • One restricted to a single input volume and excluding segmentation cropping.
  • One restricted to a single input volume with one or more segmented each with separate classification maps.
  • One allowing multiple input volumes.

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Patient Radiation Dose Structured Reports

Adds support for creating a structured report to contain the information concerning the recording of the estimated radiation dose to a patient.

This includes radiation dose from CT, projection X-Ray, and radiopharmaceutical administration (diagnostic and therapeutic). Occupational radiation exposures and dose from external beam therapy, ion beam therapy, or brachytherapy is out of scope.

This SR dose object allows the data flow and data management of patient estimated radiation dose reports to be disentangled from the data flow and data management of images.

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Instance Approval

Adds support to record and convey approval (or disapproval) of DICOM Defined Procedure Protocol instances.

The nature, basis and scope of the approval depends on the semantics of the codes used in the assertion. Specific codes and examples are provided for assertions about CT Protocols.

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RESTful NonPatient

Adds support for Restful Services (RS) for retrieving, storing, and searching for non-patient-related IODs such as hanging protocols, color palettes, procedure protocols.

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Ophthalmic tomography

Adds support for "en face" images acquired using ophthalmic optical coherence computed tomography (OCT) technology.

En Face angiography images are derived from images obtained using OCT technology (i.e., structural OCT volume images plus angiographic flow volume information).

With special image acquisition sequences and post hoc image processing algorithms, OCT angiography detects the motion of the blood cells in the vessels to produce images of blood flow in the retina and choroid with capillary-level resolution.

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Retire WADO Web Services

Retires the WADO-WS Web Service from the Standard. The functionality provided by WADO-WS is now included in and enhanced by DICOMweb. WADO-URI and WADO-RS remain part of the Standard.

Retirement does not imply that these features cannot be used. However, the DICOM Standards Committee will not maintain the documentation of retired features. The reader is referred to earlier editions of the Standard.

The use of the retired features is discouraged for new implementations, in favor of those alternatives remaining in the standard.

The DICOM Standard will not reuse Data Element tags and UIDs that would conflict with retired services.

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transform AIM/DICOM SR

Adds support for transforming cancer lesion evaluation from the AIM model to DICOM SR TID 1500 and back.

It focuses on the transformation of measurement and annotation lightrmation for use-cases related to reporting of quantitative imaging results.

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Retire Dose from MPPS

RDSR, not MPPS, is used in the IHE Radiation Exposure Monitoring (REM) profile and is the preferred mechanism for submission to registries.

The Radiation Dose Structured Report (RDSR) mechanism has long since replaced MPPS as the mechanism for interchange of radiation dose information for all X-Ray modalities, such as CT, XA/XRF and projection radiography, including mammography.

This supplement retires the Radiation Dose Module from the Modality Performed Procedure Step SOP Class.

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Distribution of CT protocols

Adds support for describing and distributing defined CT protocols and to record performed CT protocols. It also defines a Query and Retrieve service and the corresponding C-FIND behavior.

This address details including:

  • Patient preparation and positioning
  • Equipment characteristics
  • Acquisition technique
  • Reconstruction technique
  • Preliminary image handling such as filtering, enhancement
  • Results data storage (auto-sending)

The primary goal is to set up the scanner.

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Standardized Adult Echo Measurements

Adds support for a simplified SR template for Adult Echocardiography Measurements.

It provides similar content to that of TID 5200 "Echocardiography Procedure Report" while addressing details that were the source of interoperability issues.

In particular it provides, with varying degrees and patterns of pre- and post-coordination, multiple codes for the same concept and numerous optional descriptive modifiers.

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Content Assessment
Results Reporting

Adds support for content assessment by a person or device.

It stems from the development of the Quality Assurance with Plan Veto profile in IHE-RO. While the profile originated from use cases to assess RT Plan, the IOD is generalized to allow for reporting of assessment results of any DICOM SOP Instance.

This Supplement specifies a new IOD to encode the results of an assessment by a person or device of the content of a DICOM SOP Instance. An assessment might be performed when the content of the SOP Instance could cause serious delays in clinical workflow, or outright harm to a patient, if the values are not consistent and safe.

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HEVC.H265 4:2:0

Adds support for two new Transfer Syntaxes to embed High Efficiency Video Coding (HEVC) / H.265 Main Profile / Level 5.1 and Main 10 Profile / Level 5.1 encoded pixel data in DICOM.

These 4:2:0 compression models support better color handling and higher precision than previous compression technologies.

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Templates for Procedure Reports in CDA

This part of the DICOM Standard specifies templates for the encoding of imaging reports using the HL7 Clinical Document Architecture Release 2 (CDA R2, or simply CDA) Standard.

Within this scope are clinical procedure reports for specialties that use imaging for screening, diagnostic, or therapeutic purposes.

This Part constitutes an implementation guide for CDA, and is harmonized with the approach to standardized templates for CDA implementation guides developed by HL7.

It also provides Business Names for data elements that link data in user terminology, e.g., collected by a report authoring application, to specific CDA encoded elements.

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MPR Presentation State

Adds support for a Planar MPR Volumetric Presentation State, allowing Multi Planar Reconstruction (MPR) rendering of 3D volumes or temporal sequences of 3D volumes (a.k.a., 4D).

The Volumetric Source Information, the underlying images for the VPS can for example be XA-3D, enhanced MR and enhanced CT images.

In the case of multiple sources blending pipelines and image fusion are used.

Volumetric Presentation State creators may also create Secondary Captures or other derived images to convey basic presentation information to systems without these capabilities.

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XR 3D Informative Annex

Delivers explanatory information on the usage of DICOM attributes for X-Ray 3D Angiographic Image IOD:

Detailed additional information like scenarios, examples and drawings beyond the definitions in PS 3.3;

Identify scenarios where the X-Ray 3D Angiographic Image is applied;

Indicate restrictions on the applicable scenarios; encourage the usage of Type 3 attributes under particular scenarios;

Assess the applicability for some conditional attributes under particular scenarios;

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Ophthalmic Photography

Ophthalmic photographic imaging devices have been generating DICOM OP images (using a narrow field) for many years.

New technology enables devices to generate OP images using a wide field. But since the back of the eye is approximately a concave sphere, it introduces large errors when making anatomic measurements (such as a lesion in the eye).

This supplement specifies two new SOP Classes that solve this problem as they enable anatomically correct measurements on wide field ophthalmic photography images.

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RESTful Rendering

Adds support for rendering functionality for Restful Services that is largely equivalent to the functionality in the URI and WS services.

It defines Retrieve Rendered and Retrieve Rendered Presentation State transactions for Restful Services. These transactions allow a user agent to retrieve rendered images and other instances in non-DICOM media types from an origin server.

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MPEG-4 AVC/H.264

Adds support for three new Transfer Syntaxes to embed MPEG-4 Advanced Video Coding (AVC) / H.264 High Profile / Level 4.2 (HiP@Level4.2) and H.264 Stereo High Profile /Level 4.2 encoded pixel data in DICOM.

This additional support enables the following use cases:

  • Storage of video files with a resolution of 1920x1080 at 50Hz/60Hz.
  • Transmitting stereoscopic 3D content with frame packing formats.
  • storage of video files where higher compression can be achieved due to inter-view prediction. An example of the use would be in binocular operational microscopy.

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Tractography Results

Adds support for storing magnetic resonance diffusion tractography (MR DT) results.

An MR diffusion acquisition sequence (e.g. EPI, HARDI, etc.) collects data reflecting the diffusivity of water and the directionality of its movement. Based upon a model of diffusion in tissue (e.g. simple tensor, multiple-tensor, etc.) this information can be used by tracking algorithms to estimate the pathways followed by the white matter fiber tracts.

Examples of tractography applications include:

  • Visualization of white matter tracks to aid in resection planning or to support image guided (neuro) surgery.
  • Determination of proximity and/or displacement versus infiltration of white matter by tumor processes.

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RT Brachytherapy

Adds support for worklist handling within brachytherapy treatment management and treatment delivery systems, similar to supplement 74 for first generation RT.

Adds the RT Brachy Application Setup Delivery Instruction Storage Composite IOD.

It contains the data necessary to instruct a treatment delivery device on what is to be delivered.

The key element of the IOD is the RT Brachy Delivery Instruction Module, which contains information on the RT Plan to be used, the channels within the plan that will actually be delivered or omitted.

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Extensible Structured Report Storage

Adds support for a new extensible IOD and SOP Class that allows new Content Item types to be used as they are added to the standard.

There is an increasing need for new Content Item types (such as SCOORD3D) and these are being added as needed to application-specific IODs and SOP Classes (such as the Colon CAD Supplement 126).

There is a need for a generic IOD and SOP Class to allow new applications to make use of these in a general way, yet this conflicts with the requirement to be able to render all content.

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Preclinical Imaging of Small Animals

Adds support for storage of information related to acquisition of small animal images during preclinical research. This includes defining use cases and adding templates.

The Acquisition Context SR instances, a "description of the conditions present during data acquisition", will usually be in the same Study as the acquired images.

This supplement defines a new DICOM SR root template and supporting templates, as well as an IOD and SOP Class specific to that template to facilitate interoperability.

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