DICOM News

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Structural Heart SR Template

This supplement introduces SR templates for Structural Heart Procedures.

These procedures involve interventions aimed at addressing various conditions or abnormalities affecting the structures of the heart, excluding the coronary arteries.

Unlike open-heart surgery, these interventions are characterized by their minimally invasive nature or catheter-based approach.

Periprocedural imaging follows a consistent pattern of three phases: pre-operative assessment, intraprocedural assessment, and follow-up.

Throughout all three phases, echocardiography emerges as the primary imaging modality.

X-ray angiography is predominantly utilized for intraprocedural guidance.

CT may also find application in the pre-operative assessment and follow-up.

The templates proposed in the supplement are based the Simplified Adult Echocardiography Templates (root TID 5300), modified to support multimodality image acquisition.

Structural Heart Procedures include:

• TAVI: Transcatheter Aortic Valve implantation
• TAVR: Transcatheter Aortic Valve Replacement
• TTVP: Transcatheter Tricuspid Valve Procedure
• TTVR: Transcatheter Tricuspid Valve Repair
• TEER: Transcatheter Edge-to-Edge Repair
• TMVR/TMVr Transcatheter Mitral Valve Replacement
• LAAC: Left Atrial Appendage Closure

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Patient Model Gender Enhancements

This supplement adds a comprehensive gender logical model for sex and gender representation in DICOM.

This facilitates communication between DICOM and the various HL7 systems.

The goal is to make the distinction between phenotypical sex and the patient's social context gender clear.

The approach is to add new optional sequences to the Patient Study Module.

The DICOM model extensions are consistent with the work in HL7 and FHIR:

- The HL7 Gender Harmony Project created a logical model to describe the information needed in an electronic record to support proper care for gender and sex diverse patients.

- The HL7 model includes both clinical information and social information.

This supplement also updates Patient Sex (0010,0040) description and some CIDs to match the HL-7 updated definition.

This supplement was voted ready for Final Text and to be incorporated into the next publication of the standard (2025b).

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Eyecare measurements templates

This Supplement proposes to add templates, context groups, and coded vocabulary for eyecare measurements to the Standard.

These templates may be used in either SR documents, or for structured content in an Encapsulated PDF object.

The focus of this Supplement is the set of “key” measurements clinically important for patient care. These are not intended to be a comprehensive set of ophthalmic measurements, although the extensible context groups and templates allow additional measurements beyond the specified key measurements to be included in SOP Instances.

There is tension in clinical documentation between the needs for structured discrete data and human-readable content. In DICOM, discrete data is generally sent using Structured Reporting, and ready for display rendered data may be sent in an Encapsulated PDF.

A given set of measurements may be sent in objects in both formats, with cross-reference to the other object using the Referenced Instance Sequence (0008,114A); note that the cross-reference is to an instance as a whole, not to individual measurements. Alternatively, discrete measurements may be included in an Encapsulated PDF object in the SR-like Content Sequence (0040,A730).

The Templates defined in this Supplement may be used in either object type.

The DICOM Standard does not recommend the use of any particular approach to meeting the clinical documentation needs of the users.

Such recommendation may be made by a professional society or a standards profiling effort. For example, the American Academy of Ophthalmology and the IHE Eyecare domain, considering the need to integrate legacy PDF-based systems, have in the past recommended use of Encapsulated PDF with the included SR-like Content Sequence for basic interoperability, but those recommendations may not meet all use cases in the evolving interoperable healthcare IT environment.

This supplement was voted ready to go out for Letter Ballot.

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DICOMWeb Modality Workflow Services

The DICOMweb Modality Workflow Services extends the existing DICOMweb services, mimicking the Modality Worklist (MWL) and Modality Performed Procedure Step (MPPS) services that are already available in DIMSE with a RESTful web-interface.

It has been designed with the intention of facilitating proxies from/to DIMSE to/from DICOMweb Modality Workflow Services.

This supplement was voted ready to go out for Public Comments.

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RDSR Informative Annex

This Supplement provides explanatory information on the creation and usage of RDSR (traditional and enhanced) within Angiography, Mammography, Radiography, CT, Dentistry modalities etc.

This supplement excludes Radiopharmaceutical and Patient Radiation Dose SR.

Given the modality-specific content definition of the RDSR, and the many different types of system configurations existing in the field, it becomes challenging for the manufacturers to have a clear understanding of the precise requirements for each type of device.

The purpose of this supplement can be summarized as follows:

- Give more information beyond the definitions in PS 3.16: describe real-world scenarios of typical equipment configurations, provide examples and encoding guidelines;

- Indicate restrictions on the applicable scenarios (defined terms recommended, values ranges, recommended presence of Content Items);

- Promote usage of optional Content Items under particular scenarios;

- Assess the applicability for some conditional Content Items under particular scenarios;

The scope of the proposed Supplement includes:

- An overview of the landscape of different modalities and types of equipment configuration, from simple legacy CR to modern integrated Angio equipment.

- Guidance on how to use the different TIDs and Content Items depending on the modality, equipment types and configurations.

This supplement will be further presented and discussed in the base standard group before going out for Public Comments.