DICOM

Digital Imaging Communications

in Medicine

Communication Protocols:
Key to Connectivity
Layered Model, each layer performs a specific function
Set of Services and Protocols
Connectivity requires sharing of a complete protocol
Communication requires a shared Semantic Context

ISO Reference Model

APPLICATION

Upper Layers
(DICOM)

PRESENTATION
SESSION

Lower Layers

File Transfer, E-mail, HTTP

Data Formatting, Compression,Encryption
Synchronization,Comm. Management

TRANSPORT

End-to-End communication

NETWORK

Internetworking

DATA LINK

LLC
MAC

PHYSICAL

Ethernet, FDDI, etc.

Fiber, Coax, UTP, Wave

Communication Standards
Protocols are defined by standards
A Standard is an agreement which may be
voluntary, Government mandated, or International
Law
Protocols may also be proprietary

Who Defines
Communication Standards?
User Consortia (e.g., HL7)
Organizations (e.g., NEMA, IEEE)
US Government Agencies (e.g., ANSI, NIST)
Foreign Government Agencies (e.g., CEN)
United Nations (e.g., ISO, CCITT)

ACR-NEMA
1982 - ACR and NEMA form a joint committee
1985 - Publication of Version 1.0
1988 - Compression and Mag Tape Standards
1988 - Publication of Version 2.0
1989 - Began work on Network Version with HIS/RIS

DICOM
The name was changed to separate the standard
from the originating body
1991 - Release of Parts 1 and 8 of DICOM
1992 - RSNA demonstration, Part 8
1993 - DICOM Parts 1-9 approved,
RSNA demonstration of ALL parts
1994 - Part 10: Media Storage and File Format
1995 - Parts 11,12, and 13 plus Supplements

The Parts of the DICOM Standard

Part 1 - Introduction and Overview
Part 2 - Conformance
Part 3 - Information Object Definitions
Part 4 - Service Class Definitions
Part 5 - Data Structures & Semantics
Part 6 - Data Element Listing and Typing
Part 7 - Message Exchange Protocol
Part 8 - Network Support for Message Exchange
Part 9 - Point-to-Point Support

The Parts of the DICOM Standard

Part 10 - Media Storage and File Format
Part 11 - Media Storage Application Profiles
Part 12 - Media Formats and Physical Media
Part 13 - Print Management Point-to-Point

DICOM Application Domain

Storage, Query/Retrieve,
Study Component

LiteBox

MAGN
ETOM

Print Management

Query/Retrieve
Results Management
Media Exchange
Query/Retrieve, Patient & Study Management
Information Management System

Summary of DICOM Features

NETWORK PROTOCOL
DICOM incorporates negotiation to permit nodes to agree on
the functions to be performed

MESSAGE ENCODING
DICOM defines 24 data types (V2.0 had 4)
DICOM message encoding includes JPEG compression (17
varients)
DICOM includes encapsulated image and multi-frame syntaxes
DICOM supports multiple character repertoires

Summary of DICOM Features

OBJECT DATA MODEL
DICOM is based on a completely specified data model
DICOM includes a robust UID mechanism

DATA DICTIONARY
DICOM includes a large number of new data elements

SERVICE CLASSES
DICOM defines classes of service for specific applications (e.g.
image management, printing) and conformance levels

Summary of DICOM Features

Off-Line Media Support
DICOM defines a directory structure and media profiles

CONFORMANCE
DICOM requires conformance statements and contains detailed
conformance requirements

DICOM Terminology
DICOM Message Service Element (DIMSE) - The set of
DICOM Application Layer communication services.
DIMSE Service Group (DSG) - A subset of the full DIMSE
services which is applicable to a specific IOD.
Information Object Definition (IOD) - A data abstraction of
a class of real-world objects. A collection of related
attributes (data elements).

DICOM Terminology
Service Class - A set of functionality relating to a
single type or real-world activity. Composed of a
set of SOP Classes plus rules and associated
semantics.
Service-Object-Pair Class (SOP) - The atomic unit
of DICOM functionality. Composed of an IOD and
a DIMSE Service Group plus restrictions or
extensions of the IOD. (Equivalent to an Object
Class)

Service-Object Pair Class

Data Dictionary
Information Object

DIMSE Service Group

SOP
Real-World Object

DICOM Service Classes

Composite
Verification
Storage
Query/Retrieve
Study Content Notification

Normalized
Patient Management
Study Management
Results Management
Basic Print Management

Conformance
DICOM Part 2 specifies the structure of a
conformance statement

DICOM does not specify a test suite or a

compliance verification mechanism
All DICOM implementations must be supported by
a properly constructed conformance statement

DICOM Conformance Statement

Implementation Model which describes the Application
Entities in the implementation
Detailed specification of each Application Entity
SOP Classes supported
policies for initiation and acceptance of associations
Presentation Contexts
SOP options
Supported communications protocols
Specializations
Configuration

Purpose of a Conformance
Statement
Allow a user to determine which optional
components of the DICOM Standard are
supported by a particular implementation, and
what extensions or specializations an
implementation adds.
By comparing the Conformance Statements from
two implementations, a knowledgeable user
should be able to determine whether or not
interoperability is possible.

DICOM Conformance Testing

No Formal Mechanism is Defined in the Standard
Committee for the Advancement of DICOM
Define initial test plan and cross-connect matrix
Future RFP for organization to monitor the process
Problem: How to Map DICOM Conformance
Statements into Test Plans

The DICOM Explosion

Joint CEN-DICOM development
Medicom = DICOM
MIPS 95 work is underway with JIRA
IS&C Harmonization is also in progress
HL7 Harmonization continuing interest
New DICOM organization
Companies: NEMA and non-NEMA
ACR, ACC, CAP, ...
individuals

Summary
Networking is a critical component of all medical
imaging systems
Support for Open Communication Standards is a
MUST
DICOM is here, NOW
DICOM products exist on the market
DICOM is emerging as THE common protocol for
medical image communication - WORLD WIDE!