DE32-DCM DentalEye 3.2. DICOM conformance statement

Transcription

1 DentalEye 3.2

2 Table of contents 1. INTRODUCTION DentalEye Enterprise Application About this Document Integration and Validation Future Evolution Sources for this Document IMPLEMENTATION MODEL Application Data Flow Diagram Receive Images Query to/from Other Devices Retrieve Images from Other Devices Transmit Images Storage Commitment Print to Other Devices Query Modality Worklist Functional Definitions of AEs DentalEye Enterprise Sequencing of Real-World Activities AE SPECIFICATIONS DentalEye Enterprise Specifications Association Establishment Policies Association Initiated by Real-World Activity Association Acceptance Policy COMMUNICATIONS PROFILES Supported Communication Stacks TCP/IP Stack Physical Media Support EXTENSIONS / SPECIALIZATIONS / PRIVATIZATIONS Media Interchange Implementation Model Application Data Flow Diagram Functional Definitions of AEs Sequencing of Real World Activities File Meta Information Options AE Specifications DentalEye Enterprise AE Augmented and Private Application Profiles Augmented Application Profiles Private Application Profiles Extensions, Specializations and Privatizations of SOP Classes and Transfer Syntaxes Media Configuration Character Sets Codes and Controlled Terminology CONFIGURATION SUPPORT FOR EXTENDED CHARACTER SETS CODES AND CONTROLLED TERMINOLOGY SECURITY (40)

3 10.1. ASSOCIATION LEVEL SECURITY APPLICATION LEVEL SECURITY ACRONYMS AND ABBREVIATIONS (40)

4 Labelling and symbols DentalEye 3.2 is a medical device, CE-marked according to the directive 93/42/EEC. Manufacturer: DentalEye AB Kavallerivägen 30 SE SUNDBYBERG SVERIGE Tel: +46 (0) Fax: +46 (0) info@dentaleye.com The date of manufacture is shown in the software. Read all instructions before use! The catalog number is DentalEye 3.2. Current product version is shown in the software (DentalEye 3.2.x). This version of the installation instructions is valid for product versions from DentalEye (40)

5 1. INTRODUCTION 1.1. DentalEye Enterprise Application DentalEye Enterprise is a multi-functional application for dental practice and digital radiography. It can be configured to be an acquisition/modality station where it can capture images directly from digital sensors or phosphorus plate scanners. The application also has the support for importing JPEG, TIFF, BMP and other common raster formats plus capturing images from video capture devices and scanned films or images from TWAIN devices. It can create a DICOM dataset from the captured images by associating patient identification information passed to it, either via user input or a patient management system through different interfaces it exposes or a user querying a Modality Worklist server and selecting a scheduled procedure. The type of IOD class it uses to create DICOM is configurable and is based on the selected template. The application can also be configured to store a series of images to multiple DICOM servers using DICOM C-STORE services for this process. It can also be configured as a diagnostic/review station where users can query and retrieve images from DICOM storage servers or print selected images or a series of images to DICOM Print Servers. DentalEye Enterprise can also import images from DICOM Media or stand-alone DICOM files and can export selected images or a series of images of a patient as DICOM Part 10 Media format. The DentalEye Enterprise communication is based on the DICOM v3.0 standard in order to communicate with any DICOM v3.0 compliant products, e.g. a DICOM Storage server or a DICOM Print Server. DentalEye Enterprise functions generally as a DICOM service class user, but other stations can store DICOM storage instances/images to it via the C-STORE service. The communication protocol uses TCP/IP as the transport layer About this Document This document is a standard DICOM Conformance Statement for the DentalEye Enterprise application, and its purpose is to outline its conformance to different DICOM services. It is assumed that the reader of this document is familiar with the DICOM v3.0 standards and with the terminology and concepts used in those standards. DentalEye Enterprise is a SCP (Service Class Provider) and a SCU (Service Class User) for services relating to DICOM data storage and retrieval. This DICOM Conformance Statement is intended for: Customers or potential customers System integrators of dental equipment Software designers implementing DICOM interfaces 1.3. Integration and Validation The use of this Conformance Statement, in conjunction with the DICOM v3.0 standard, is intended to facilitate communication with DentalEye Enterprise. The integration of any device into a system of interconnected devices goes beyond the scope of the DICOM v3.0 standard when interoperability is desired. The user needs to proceed with caution and be aware of some issues: 4 (40)

6 It is the user s responsibility to analyze the application requirements and to design a solution that integrates DentalEye Enterprise properly with the network. Testing the complete range of possible interactions between the DentalEye Enterprise and other devices should not be overlooked by the user Future Evolution DICOM v3.0 standard evolves over time in order to meet user requirements and in order to add new technologies and features. To keep up with these changes, DentalEye AB will follow the evolution of the standard. This evolution may require modifications to any device that has implemented DICOM v3.0 standard. In the same time the user should ensure that any other provider that DentalEye Enterprise connects to follows this evolution Sources for this Document American College of Radiology-National Electrical Manufacturers Association (ACR-NEMA) Digital Imaging and Communications V2.0, ACR-NEMA Digital Imaging and Communications in Medicine (DICOM) V IMPLEMENTATION MODEL DentalEye Enterprise is a Microsoft Windows based application for capturing images from dental hardware and creating DICOM files to store to any DICOM Storage Server. It can query a Clinical Information System for scheduled worklist and patient information using the DICOM Modality Worklist Find service. It can also query and retrieve images from a PACS using DICOM query retrieve service and C-MOVE service. DentalEye Enterprise is a DICOM image store and query/retrieve Service Class User (SCU) and also Service Class Provider (SCP) to DICOM Storage Service Application Data Flow Diagram DentalEye Enterprise normally has only one single application entity, which is configurable by the system administrator. It uses the preconfigured single application entity (AE) for providing all DICOM services that are required to support the send, query, retrieve, print, and verification services. When DentalEye Enterprise is installed on Citrix terminal server to run as a thin client application, it can be set up to use a different application entity and port (SCP listen port) for each user that logs into the application. Figure 2.1 shows all of the Application Entities and the application data flow in the implementation. 5 (40)

7 Figure 2.1 Application Data Flow Diagram The DentalEye Enterprise Application Entity (AE) is the only AE which handles all DICOM protocol communications. All remote DICOM devices that are to be used by DentalEye Enterprise must be manually configured via a graphical user interface, and the system administrator handles this during installation. There are six local real-world activities that occur in DentalEye Enterprise - Image Send, Image Print, Get Modality Worklist, Image Query, Image Retrieve and Connection Verification. Get Modality Worklist, Image Send, Image Print and Image Retrieves are done in manual mode. Image query is automated when DentalEye Enterprise is launched from a CIS/patient management application that passes the patient identifying parameters to DentalEye via exposed interfaces. If the patient management integration is not configured, the user can manually query the remote SCP for patient images. DentalEye Enterprise AE as a SCU uses the remote SCP Query/Retrieve Service Class functionality to query for remote images. When the user manually selects a series to retrieve, DentalEye Enterprise AE as a SCU uses the remote SCP Query/Retrieve Service Class functionality to retrieve remote images (C-MOVE Service). The user can also query the DICOM Modality Worklist Service of a CIS/Patient Management System for a scheduled worklist from DentalEye Enterprise. DentalEye Enterprise also supports the DICOM standard Storage Service class as a SCP so that the requesting SCP can store images to the DentalEye Enterprise database. 6 (40)

8 DentalEye Enterprise can be configured to automatically transfer images to a remote Storage SCP as soon as a series is validated to be a DICOM file. A user can also manually push a series to a remote Storage SCP. DentalEye Enterprise AE as an SCU uses the remote SCP Storage Service Class functionality to store local images on a remote database. DentalEye Enterprise AE as a SCU uses the remote Print Management Service Class to print local, user selected images and to verify the printer status. DentalEye Enterprise uses the Verification service as a SCU to test the basic communication checks between DentalEye Enterprise and other network devices or connections for remote AEs. Remote AEs as SCUs can also test the connection to DentalEye Enterprise via the standard DICOM Verification service Receive Images DentalEye Enterprise stores any received image, in its entirety, to its internal local data store. Also, DentalEye Enterprise extracts the query information and stores the patient, study, series, and image data in its internal database Query to/from Other Devices DentalEye Enterprise will query any pre-configured SCP with patient demographic information passed to it from a Patient Management system (if so configured) or allow users to enter patient identifying parameters for a query. DentalEye Enterprise will display all the matches in the local and remote SCP to the user basing its decisions on the records stored in the local database and the query response from the remote SCP(s) Retrieve Images from Other Devices DentalEye Enterprise sends C-MOVE commands to a remote SCP in order to retrieve images to its local database and displays them to the user. It uses the information it retrieves from the previous query response from the SCP for the C-MOVE operation Transmit Images DentalEye Enterprise will transmit images to other compatible devices as a SCU of the C-STORE service Storage Commitment This functionality is not yet implemented in DentalEye Enterprise Print to Other Devices DentalEye Enterprise will print images to other compatible devices as SCU of Print Management Service Class. The DentalEye Enterprise AE as a SCU uses the remote Print Management Service Class for the printing of user-selected images and to request the printer status Query Modality Worklist DentalEye Enterprise will query a preconfigured Modality Worklist SCP for scheduled procedures as a SCU. The user initiates a modality worklist query to the remote worklist SCP with a given set of query parameters entered by the user. The remote worklist SCP returns responses which match the query parameters. Items from the returned worklist responses are presented to the user as a list of scheduled 7 (40)

9 procedure for selection option. The user select a scheduled procedure from the list and a subset of the returned worklist responses are included in acquired DICOM images Functional Definitions of AEs DentalEye Enterprise The DentalEye Enterprise AE is the one and only application entity within the DentalEye Enterprise application. It includes the following service classes: Verification Service Class The DentalEye Enterprise AE can perform the Verification service as a SCP and a SCU. DentalEye Enterprise AE as a SCU can initiate an association with a remote SCP for the Verification SOP class. After receiving acceptance, it will send a verification request (C-ECHO) and expect a response. After a successful response, it will send a release request to close the connection. A remote SCU shall request an association with the DentalEye Enterprise AE for the Verification SOP class. After accepting the association, the DentalEye Enterprise AE shall receive and respond to the Verification request and release the association when requested. Storage Service Class The DentalEye Enterprise AE can perform the Storage service as a SCP and a SCU. A remote SCU shall request an association with the DentalEye Enterprise AE for the Storage SOP classes. After accepting the association, the DentalEye Enterprise AE shall receive the Storage requests, store the data in the local database, send the applicable Storage responses, and release the association when requested. This could be the result of a user sending a request from the DentalEye Enterprise application to a remote storage server. The DentalEye Enterprise AE as a SCU shall request an association with a preconfigured or user selected remote Storage SCP for all applicable Storage SOP classes. When the association is accepted, the DentalEye Enterprise AE shall send the Storage requests, receive the Storage responses and act accordingly, and release the association. Query/Retrieve Service Class The DentalEye Enterprise AE can perform the Query/Retrieve service as a SCU. The DentalEye Enterprise AE shall request an association with the selected remote SCP for the applicable Query/Retrieve SOP class. When the association is accepted, the DentalEye Enterprise AE shall send the Query/Retrieve requests, receive the Query/Retrieve responses and act accordingly, and finally release the association. The DentalEye Enterprise AE as SCU will initiate an association for retrieving images from a remote server. It shall send a C-MOVE request to the remote SCP to retrieve images to its local database. After receiving a C-MOVE response, DentalEye Enterprise AE shall send a release request and will release the connection. The DentalEye Enterprise AE fully supports the Cancel functionality as a SCU for the Query/Retrieve service. 8 (40)

10 Print Management Service Class The DentalEye Enterprise AE can perform the Print service as a SCU. The DentalEye Enterprise AE shall request an association with the selected remote DICOM Print SCP for all applicable SOP classes of the applicable Print Management Meta SOP class. When the association is accepted, the DentalEye Enterprise AE shall send the Print requests, receive the Print responses and act accordingly, and finally release the association. The remote Service Class Provider of the Basic Print Management Meta SOP Class can send N-EVENT-REPORT to DentalEye Enterprise to report execution status changes of a print request in an asynchronous way. The DentalEye Enterprise AE can perform the Printer service, as a SCU. The DentalEye Enterprise AE shall request an association with the selected remote Print SCP for the Printer SOP class. When the association is accepted, the DentalEye Enterprise AE shall send the N-GET request, receive the Printer responses (Event Report) and act accordingly, and finally release the association. Modality Worklist Service Class The DentalEye Enterprise AE conforms to the Modality Worklist SOP Class as a SCU. When the user initiates a modality worklist query, the DentalEye Enterprise AE shall request an association with preconfigured remote Modality Worklist SCP for the Modality Worklist Information Model FIND SOP class. When the association is accepted, the DentalEye Enterprise AE shall send the C-FIND command with user entered query parameters. When the remote worklist SCP returns responses, which match the query parameters, the DentalEye Enterprise AE acts accordingly and finally releases the association. Items from the returned worklist responses are presented to the user as a list of scheduled procedures for selection. The user selects a scheduled procedure from the list and a subset of the returned worklist responses is included in the acquired DICOM image object Sequencing of Real-World Activities The DentalEye Enterprise AE supports the following functions: Manually or automatically initiates a DICOM association to send images Manually initiates a DICOM association for Modality Worklist query Manually or automatically initiates a DICOM association to query retrieve images Manually initiates a DICOM association to print images Automatically initiates a DICOM association for Printer Status Manually initiates a DICOM verification to assist in network diagnostics Automatically processes Association request as a SCP from remote AEs for the Storage Service. Automatically processes Association request as a SCP from remote AEs for the verification service Automatically processes Association request from remote AEs for notification event processing. Responds to DICOM verification requests from other remote AE(s). 9 (40)

11 The following diagram describes the real world sequencing for the image printing process. Figure 2.2 Sequencing For Image Printing and Print Status 3. AE SPECIFICATIONS 3.1. DentalEye Enterprise Specifications DentalEye Enterprise supports the following transfer syntaxes to communicate with DICOM peer AEs: Table 3.1 Standard Transfer Syntax Transfer Syntax Name Transfer Syntax UID Implicit VR Little Endian (DICOM Default) Explicit VR Little Endian Explicit VR Big Endian Table 3.2 Extended Transfer Syntaxes for Storage Service Transfer Syntax Name Transfer Syntax UID Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian JPEG Baseline, Lossy (Process 1) JPEG Lossy (Process 4) (12 bit) JPEG Lossless, Non-Hierarchical (Process 14) JPEG Lossless, Non-Hierarchical, First-Order Prediction (Process 14 [Selection Value 1]) JPEG 2000 Image Compression (Lossless Only) JPEG 2000 Image Compression RLE Lossless (Pack Bits) (40)

12 DentalEye Enterprise provides Standard Conformance to the following DICOM V3.0 SOP Classes as SCP and SCU: Table 3.3 Verification SOP Class SOP Class SOP Class UID Verification DentalEye Enterprise provides Standard Conformance to the following DICOM V3.0 Storage SOP Classes as SCP and SCU: Table 3.4 SOP Classes for Storage Services SOP Class Name SOP Class UID Hardcopy Grayscale Image Storage Class Hardcopy Color Image Storage Class Computed Radiography Image Storage Computed Tomography Image Storage Secondary Capture Multi-frame Grayscale Byte Image Storage Secondary Capture Multi-frame Grayscale Word Image Storage Magnetic Resonance Image Storage Secondary Capture Multi-Frame True Color Image Storage Secondary Capture Image Storage Digital X-Ray Image Storage - For Presentation Digital X-Ray Image Storage - For Processing Grayscale Softcopy Presentation State Digital Intra-oral X-Ray Image Storage - For Presentation Digital Intra-oral X-Ray Image Storage - For Processing Visible Light Image Storage (Retired) Visible Light Multiframe Image Storage (Retired) Visible Light Endoscopic Image Storage Class Visible Light Microscopic Image Storage Class Visible Light Slide-Coordinates Microscopic Image Storage Class Visible Light Photographic Image Storage Class DentalEye Enterprise provides Standard Conformance to the following DICOM V3.0 SOP Classes as a SCU: Table 3.5 SOP Classes for Query Retrieve and Print Services SOP Class Name SOP Class UID Patient Root Query/Retrieve Information Model FIND Patient Root Query/Retrieve Information Model MOVE Study Root Query/Retrieve Information Model FIND Study Root Query/Retrieve Information Model MOVE Presentation LUT (40)

13 SOP Class Name SOP Class UID Basic Grayscale Print Management (Meta) > Basic Grayscale Image Box Basic Color Print Management (Meta) > Basic Color Image Box > Basic Film Session > Basic Film Box > Printer Modality Worklist Information Model FIND Association Establishment Policies General The Maximum Length PDU negotiation is included in all association establishments requests. The maximum length PDU for an association initiated by DentalEye Enterprise is The DICOM standard Application Context Name proposed and recognized by DentalEye Enterprise is: Application Context: Note that the Max PDU length is not configurable. The SOP Class Extended Negotiation is supported for Query/Retrieve services. Note that the same Abstract Syntax may be offered multiple times with different Transfer Syntaxes. The user information Items sent by the DentalEye Enterprise AE are: Maximum PDU Length: Implementation UID: Implementation Version Name: DentalE3.2.x (where x is the current version revision) Number of Associations The DentalEye Enterprise AE will initiate only one DICOM association at a time to perform an image Store, Query, Retrieve, Print or Verify. The DentalEye Enterprise AE will accept up to ten DICOM associations at a time from remote AEs to perform an image Verify, Store, Printer Asynchronous Nature DentalEye Enterprise will only allow a single outstanding operation on an association. Therefore, DentalEye Enterprise will not perform asynchronous operations negotiation other than the default specified by the DICOM standard Implementation Identifying Information DentalEye Enterprise requests and responds with the following implementation identifying parameters: Implementation Class UID: Implementation Version Name: DentalE3.2.x (where x is the current version revision) 12 (40)

14 Called/Calling Titles Calling AE title is configurable in DentalEye Enterprise and any user with administrative rights can configure the AE and listening port settings. Also DentalEye Enterprise validates the Called Title and IP address of the requesting SCU during association negotiation, providing a first pass level of security Association Initiated by Real-World Activity Real-World Activity Verification Associated Real-World Activity Verification DentalEye Enterprise will commit Verification requests as a response to the user mediated requests via GUI, in order to test the validity of the current DICOM connection Proposed Presentation Contexts Table 3.6 Proposed Presentation Contexts Abstract Syntax Name Abstract Syntax UID Transfer Syntax Role Extended Negotiation Verification SOP Class All from Table 3.1 SCU None SOP Specific Conformance Verification DentalEye Enterprise provides standard conformance to the Verification Service Class from DICOM v3.0 as a SCU Real-World Activity Storage Associated Real-World Activity Storage DentalEye Enterprise can be configured to automatically transfer images to a remote Storage SCP as soon as a series is validated to be stored as DICOM. A user can also manually push a DICOM series to a remote Storage SCP. Although there are two different ways for the operator to initiate an image transmission, the DICOM initiation and transfer process are identical. When a user validates a series or manually selects a series to store to a remote DICOM Storage Server, DentalEye Enterprise AE initiates an association to a preconfigured remote Storage Server AE and uses it to send C-STORE requests and receive the associated C-STORE responses. The association is released when all selected images in the series have been transmitted. By default, DentalEye Enterprise sends an IOD using the transfer syntax that was used when the image was originally created or imported. DentalEye Enterprise can be configured to offer the original transfer syntax in the stored DICOM dataset and Implicit Little Endian (DICOM default) transfer syntax per presentation context to remote SCP. If the SCP accepts Implicit Little Endian transfer syntax, DentalEye Enterprise will convert the IOD from the original transfer syntax to Implicit Little Endian. The DentalEye Enterprise AE will stop the transfer of the images and release the association as soon as it receives an unsuccessful store response status. 13 (40)

15 Presentation Context Table Storage Table 3.7 Presentation Contexts for Storage SOP Class Transfer Syntax Role Extended Negotiation All from Table 3.4 All from Table 3.2 SCU None SOP Specific Conformance Storage DentalEye Enterprise as a SCU conforms to the DICOM Storage Service Class. Use of optional, private, and retired attributes The following Private tags are used for encoding proprietary annotation information: Table 3.8 Tags Used for Encoding Proprietary Annotation Information Attribute Name Tag Value Private Identification Code 0051,0010 LEAD_ANNOTATION_0013 LEADTOOLS Annotation Data 0051,1000 DentalEye Enterprise may transmit Storage SOP instances with all the optional elements specified in the DICOM standard, depending on the source of the images. The transmitted Storage SOP instances may contain Retired and Private data elements, depending on the source of the images. DentalEye Enterprise may store and transmit proprietary annotation information in Storage SOP instances as private elements. Table 3.9 DICOM C-STORE Response Handling Behavior Service Status Further Meaning Status Code Success Storage is complete 0000 Refused Out of Resources A7XX Dataset does not match SOP Class A9XX Error Cannot understand CXXX Coercion of Data Elements B000 Warning Data Set does not match SOP Class B006 Elements Discarded B007 Behavior Continues with next store until completed and thereafter association is released User notified and/or reason is logged. Store job fails and connection closed User notified and/or reason is logged. Store job fails and connection closed User notified and/or reason is logged. Store job fails and connection closed Continues with next store until completed and thereafter association is released Continues with next store until completed and thereafter association is released. Continues with next store until completed and thereafter association is released. 14 (40)

16 Association Acceptance Policy Real-World Activity Verification Associated Real-World Activity Verification DentalEye Enterprise shall accept associations only from known remote AEs that wish to verify application level communication. DentalEye Enterprise performs the Verification Service Class by responding with C-ECHO RSP, in order to provide a SCU the state of being able to receive DICOM requests Associated Acceptance Policy DentalEye Enterprise shall reject association requests from unknown AEs, i.e. AEs that offer calling AE titles that are not preconfigured in DentalEye Enterprise. Also, DentalEye Enterprise shall reject association requests from applications that do not use the proper called AE title which is also preconfigured in DentalEye Enterprise Presentation Context Table Verification Table 3.10 Acceptable Presentation Contexts Abstract Syntax Name Abstract Syntax UID Transfer Syntax Role Extended Negotiation Verification SOP Class Any from Table 3.1 SCP None SOP Specific Conformance Verification DentalEye Enterprise provides standard conformance to the DICOM V3.0 Verification Service Class as a SCP for the Verification SOP Class, UID= Presentation Context Acceptance Criterion Verification DentalEye Enterprise will accept any Presentation Context from Table Transfer Syntax Selection Policies DentalEye Enterprise shall support only the default DICOM Transfer Syntax for the Verification command Real-World Activity Storage (Import Images) A remote system requests image storage to DentalEye Enterprise using the C-STORE command Associated Real-World Activity Storage The Real-World Activity associated with the C-STORE operation is the storage of the image in the DentalEye Enterprise s local database. DentalEye Enterprise will issue a failure status if it is unable to store the image in its local database. 15 (40)

17 Association Acceptance Policy DentalEye Enterprise shall reject association requests from unknown AEs, i.e. AEs that offer calling AE titles that are not preconfigured in DentalEye Enterprise. Also, DentalEye Enterprise shall reject association requests from applications that do not use the proper called AE title which is also preconfigured in DentalEye Enterprise Accepted Presentation Contexts- Storage DentalEye Enterprise AE shall be able to accept the presentation contexts as specified in the following table. Table 3.11 Acceptable Presentation Contexts Abstract Syntax Transfer Syntax Role Extended Negotiation Any from Table 3.4 Any from Table 3.2 SCP FULL SCP DentalEye Enterprise provides standard conformance to the DICOM V3.0 Storage Service Class as a SCP for any of the SOP Classes from table SOP Specific Conformance Storage DentalEye Enterprise conforms to the FULL DICOM Storage Service Class (Level 2). No elements are discarded. Also DentalEye Enterprise conforms to the DICOM File Management Roles and Services as a FSC and FSR, as defined in Part 10 of the DICOM v3.0 specifications. DentalEye Enterprise stores all DICOM images along with the File Meta Information Header. The response status behavior of DentalEye Enterprise is as described in the following table. Table 3.12 DICOM C-STORE Response Handling Behavior Service Status Further Meaning Status Code Success Storage is complete 0000 Refused Out of Resources A700 Error Warning Dataset does not match SOP Class Cannot understand A900 C000 Behavior Coercion of Data Elements B000 N/A Data Set does not match SOP Class B006 N/A Elements Discarded B007 N/A The image (s) shall be stored in DentalEye Enterprises local database Database is full. Response with this status sent to AE and condition logged SOP Class of the image does not match the abstract syntax. Connection notified and reason is logged Error in parsing dataset. Connection notified and reason is logged Presentation Context Acceptance Criterion - Storage DentalEye Enterprise will accept any number of Storage Presentation Contexts per association request. 16 (40)

18 Transfer Syntax Selection Policies Storage DentalEye Enterprise has no preference on Transfer Syntax encoding. If offered a choice of Transfer Syntax's in a Presentation Context, it will pick the first Transfer Syntax it encounters from Table 3.2 in a Presentation Context Real-World Activity Find (Query Remote Images) Associated Real-World Activity Find There are two different real world activities, automated and manual, that could cause DentalEye Enterprise AE to initiate the association to query remote SCP to find matching images. Automated mode is when the patient management integration is enabled in DentalEye Enterprise. In this scenario, DentalEye Enterprise is launched from a patient management application that passes the patient identifying parameters to it via different interfaces exposed by DentalEye Enterprise. DentalEye Enterprise AE automatically initiates the association with pre-configured selected peer entity and uses it and patient identifying parameters (passed to it from Patient Management application) to send Query (C- FIND) requests. The association is released when the execution of the query completes. The manual process is when the patient management integration is not configured and the user uses a GUI query dialog to query a remote SCP for patient images. In this scenario, DentalEye Enterprise AE initiates the association with selected peer entities when a user clicks on the Find button in the query dialog and uses it and user entered patient identifying parameters to send Query (C-FIND) requests. DentalEye Enterprise shall send a C-FIND-Cancel request if the user selects Cancel option in GUI any time before execution of the query completes. The association is released when the execution of the query completes. In case of Refused, Failed or Cancel status response from SCP, DentalEye Enterprise will proceed to close the connection by sending a release request to the SCP and shall act accordingly after a response from the SCP Presentation Context Table Find DentalEye Enterprise will propose any of the Presentation Contexts listed in Table 3.13 for Query. Table 3.13 Proposed Presentation Contexts Abstract Syntax Name Abstract Syntax UID Transfer Syntax Role Patient Root Query/Retrieve FIND Study Root Query/Retrieve FIND Any from Table Any from Table 3.1 SCU SCP Extended Negotiation None None DentalEye Enterprise AE initiates associate request with an extended negotiation stub for C-Find Extended Negotiation to use relational queries. If it receives an associate acceptance with an extended negotiation stub for relational queries, it will issue a C-FIND request following the DICOM relational queries rule. Otherwise it shall be capable of generating query requests, which meet the requirements of C-FIND baseline Hierarchical Search. Associate request will have the following information for appropriate presentation context: 17 (40)

19 Table 3.14 Find extended negotiation Field Name Value Description Field Relational-queries 1 Relational queries are supported SOP Specific Conformance Find DentalEye Enterprise provides standard conformance to the DICOM V3.0 Query/Retrieve Service Class as a SCU for the SOP Class listed in Table 3.12 via the DIMSE C-FIND. The DentalEye Enterprise AE will generate queries containing zero length optional keys. The DentalEye Enterprise AE does not assume the SCP will process an Optional Key in the same manner as a Required Key. The DentalEye Enterprise AE prefers Relational Search Method, when the SCP accepts extended negotiation for appropriate Abstract Syntax. Otherwise, it will generate baseline queries based on Hierarchical Search Method. In the following table the supported query keys for each query level are described. Universal matching shall be supported as default. DentalEye Enterprise supports all the four levels of query using the respective keys. DentalEye Enterprise transmits the following attributes of the Patient Root Query/Retrieve Information Model-FIND SOP Class: Table 3.15 Patient Level Attributes Attribute Type of Matching Tag Type Patient's Name Wild Card (0010,0010) Required Patient ID Wild Card (0010,0020) Unique Patient's Birth Date - (0010,0030) Optional Patient's Birth Time - (0010,0032) Optional Patient's Sex - (0010,0040) Optional Other Patient Ids - (0010,1000) Optional Other Patient Names - (0010,1001) Optional Ethnic Group - (0010,2160) Optional Patient Comments - (0010,4000) Optional Number of Patient Related Studies - (0020,1200) Optional Number of Patient Related Series - (0020,1202) Optional Number of Patient Related Instances - (0020,1204) Optional Table 3.16 Study Level Attributes Attribute Type of Matching Tag Type Study Date Date Range / Single Value (0008,0020) Required Study Time - (0008,0030) Required Accession Number Wild Card (0008,0050) Required Study ID Wild Card (0020,0010) Required Study Instance UID Single Value (0020,000D) Unique Modalities in Study - (0008,0061) Optional Referring Physician's Name - (0008,0090) Optional Study Description Wild Card (0008,1030) Optional Name of Physician(s) Reading Study Wild Card (0008,1060) Optional 18 (40)

20 Attribute Type of Matching Tag Type Admitting Diagnoses Description - (0008,1080) Optional Patient's Age - (0010,1010) Optional Patient's Size - (0010,1020) Optional Patient's Weight - (0010,1030) Optional Occupation - (0010,2180) Optional Additional Patient History - (0010,21B0) Optional Number of Study Related Series - (0020,1206) Optional Number of Study Related Instances - (0020,1208) Optional DentalEye Enterprise transmits the attributes listed in the following table for Series Level Study Root Query/Retrieve Information Model FIND request: Table 3.17 Series Level Attributes Attribute Query Keys Return Tag Type Modality Single Value (0008,0060) Required Series Number - (0020,0011) Required Series Instance UID Single Value (0020,000E) Unique Number of Series Related Instances - (0020,1209) Optional DentalEye Enterprise transmits the attributes listed in the following table for Image Level Study Root Query/Retrieve Information Model FIND request. Table 3.18 Composite Object Instance Level Attributes Attribute Query Keys Return Tag Type Instance Number - (0020,0013) Required SOP Instance UID Single Value (0008,0018) Unique DentalEye Enterprise transmits the following attributes of the Study Root Query/Retrieve Information Model FIND SOP Class: Table 3.19 Study Level Attributes for Study Root- FIND Attribute Name Type of Matching Tag Type Study Date Date Range (0008,0020) Required Study Time - (0008,0030) Required Accession Number - (0008,0050) Required Query/Retrieve Level Enumerated value: STUDY (0008,0052) Required Modalities in Study - (0008,0061) Optional Referring Physician s Name - (0008,0090) Optional Study Description - (0008,1030) Optional Patient s Name Wild Card (0010,0010) Required Patient ID Wild Card (0010,0020) Required Patient s Birth Date Single Value (0010,0030) Optional Patient s Sex Single Value (0010,0040) Optional Study Instance UID - (0020,000D) Unique Study ID - (0020,0010) Optional 19 (40)

21 Attribute Name Type of Matching Tag Type Number of Patient Related Studies - (0020,1200) Optional Number of Patient Related Series - (0020,1202) Optional Number of Patient Related Instances - (0020,1204) Optional Number of Study Related Series - (0020,1206) Optional Number of Study Related Instances - (0020,1208) Optional The following are the status codes that are more specifically processed when receiving messages from a C-FIND SCP: Table 3.20 DICOM C-FIND Response Handling Behavior Service Status Further Meaning Status Code Behavior Success Matching is complete 0000 Find results are displayed Refused Out of Resources A700 Failed Cancel Pending Identifier Does not match SOP Class Unable to process Matching terminated due to user cancel request Matches are continuing Current Match is supplied and any Optional Keys were supported in the same manner as Required Keys. Matches are continuing Warning that one or more Optional Keys were not supported for existence and/or matching for this identifier A900 CXXX Fe00 FF00 FF01 User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed Find command continues Find command continues Real-World Activity Move Associated Real-World Activity Move The Real-World Activity Retrieve Images involves the retrieve of images on a remote system by moving matching images from the remote database to DentalEye Enterprise s database. When a user opens a patient s folder or queries for images of a patient, DentalEye Enterprise queries all user selected AE(s) down to image level to present the user with a combined list of available images (instances) in series level view. In this process it also collects the information (Retrieves AE Title) about AEs that have the actual instances. The user is able to select a series of image(s) in a patient folder from a remote database to the local database in the following two ways: When DentalEye Enterprise is not configured with a Patient Management system, a user can retrieve images by means of selecting a series and double clicking on the series or clicking on retrieve button from the query dialog in DentalEye Enterprise. 20 (40)

22 A user can also retrieve images from a remote DICOM Server whether the Patient Management system is enabled or not by clicking on a series list (Series View) in a patient folder. When a user triggers the image retrieval in any of the above mentioned processes, DentalEye Enterprise will initiate association with the remote AE and uses it to send a retrieve (C-MOVE) request. It specifies its own AE Title as the destination AE during C-MOVE command for retrieval. DentalEye Enterprise sends a series level C-MOVE request to retrieve all images/instances under the series with one request. The association is released after the final Retrieve (C-MOVE) response from the remote AE Proposed Presentation Context Table Move DentalEye Enterprise will use Presentation Contexts listed in Table 3.21 for retrieval. Table 3.21 Proposed Presentation Contexts Abstract Syntax Name Abstract Syntax UID Transfer Syntax Role Extended Negotiation Patient Root Query/Retrieve MOVE All from Table 3.1 SCU None Study Root Query/Retrieve MOVE All from Table 3.1 SCU None DentalEye Enterprise prefers relational queries and will send an associate request with an extended negotiation stub. If the accepting SCP supports extended negotiations for abstract syntax listed in Table 3.21, DentalEye Enterprise shall send C-MOVE request using Relational-Retrieve option, otherwise it will conform to baseline SCU behavior. DentalEye Enterprise will send an associate request with extended negotiation stub with the following information: Table 3.22 Move extended negotiation Field Name Value Description Field Relational-queries 1 Relational queries are supported SOP Specific Conformance Move DentalEye Enterprise provides both the baseline and extended behavior of the C-MOVE SCU. The extended behavior of Relational-Retrieve is used only if properly associated with SCP. Study Root Information Model MOVE SOP Class: DentalEye Enterprise transmits the following attributes of the Study Root Information Model MOVE SOP Class. It uses only the Series Level move. Table 3.23 Attributes for Move Study Root Information Model - MOVE Attribute Value Tag Type Study Instance UID Single Value 0020,000D Unique Series Instance UID Single Value 0020,000E Unique Query/Retrieve Level SERIES 0008,0052 Required 21 (40)

23 Patient Root Information Model MOVE SOP Class: DentalEye Enterprise transmits the following attributes of the Patient Root Information Model MOVE SOP Class. It uses only the Series Level move. Table 3.24 Attributes for Move Patient Root Information Model MOVE Attribute Value Tag Type Patient ID Single Value 0010,0010 Required Study Instance UID Single Value 0020,000D Unique Series Instance UID Single Value 0020,000E Unique Query/Retrieve Level SERIES 0008,0052 Required The following are the details regarding response behavior of different status code. Table 3.25 C-MOVE status Service Status Further Meaning Status Code Success Sub-operations Complete No Failures 0000 Refused Failed Warning Cancel Out of Resources Unable to calculate number of matches Out of Resources Unable to perform suboperations Move Destination unknown Identifier Does not match SOP Class Unable to process Sub-operations Complete One or more Failures A701 A702 A801 A900 CXXX B000 Matching terminated due to user cancel request FE00 Pending Sub-operations are continuing FF00 Behavior Retrieved images are displayed. Association is released User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, Retrieved images are displayed. Association is released User notified, reason is logged and connection closed User notified, Move command continues Real-World Activity Query Modality Worklist Associated Real-World Activity Modality Worklist The Real-World Activity Query Modality Worklist involves the retrieval of scheduled procedures on a remote system by querying for matching scheduled procedures from the remote database to DentalEye Enterprise s database. When user selects the Modality Worklist Query option from the menu or clicks on the Modality Worklist button in DentalEye Enterprise, the user is presented with a dialog box to enter query parameters listed in Table 3.26 and Table 3.27 and a Query button to initiate the query. When user clicks the query button, DentalEye Enterprise initiates an association with a preconfigured Modality Worklist SCP for the 22 (40)

24 Modality Worklist service. Once the association is accepted by the SCP for the appropriate SOP class, DentalEye Enterprise sends the C-FIND command with the query parameters entered by the user. The remote worklist SCP returns responses, which match the query parameters. Once the matching is complete, DentalEye Enterprise closes the association. Matching items from the returned worklist responses are presented to the user as list of scheduled procedures for the user to select. The user can select a scheduled procedure item from the list to capture image(s) for the selected procedure. DentalEye Enterprise shall create appropriate SOP instances using the corresponding IOD class matching the modality specified in the scheduled procedure and auto populating the dataset using information from the selected scheduled procedure item. Table 3.26 Matching Key Attributes for Patient-based Query Matching Key Attributes Tag Patient s Name (0010,0010) Patient ID (0010,0020) Accession Number (0008,0050) Requested Procedure ID (0040,1001) Table 3.27 Matching Key Attributes for Broad Query Matching Key Attributes Tag Scheduled Station AE Title (0040,0001) Scheduled Procedure Step Start Date (0040,0002) Modality (0008,0060) Proposed Presentation Context Table Query Modality Worklist DentalEye Enterprise will use Presentation Contexts listed in Table 3.28 for Modality worklist query. Table 3.28 Proposed Presentation Contexts Abstract Syntax Name Abstract Syntax UID Transfer Syntax Role Modality Worklist Information Model FIND All from Table 3.1 SCU Extended Negotiation None SOP Specific Conformance Modality Worklist Information Model FIND DentalEye Enterprise provides both the baseline and extended behavior of the Modality Worklist Information Model FIND. Table 3.29 Attributes for Modality Worklist Information Model FIND Attribute Tag Match Return Patient Identification Module Patient ID 0010,0020 Single Value 1 Patient's Name 0010,0010 Wild Card 1 Other Patient IDs 0010, Other Patient Names 0010, Patient Demographic Module 23 (40)

25 Attribute Tag Match Return Patient's Birth Date 0010, Patient's Sex 0010, Patient's Weight 0010, Patient's Address 0010, Patient Comments 0010, Confidentiality Constraint on Patient Data Description 0040, Patient Medical Module Medical Alerts 0010, Contrast Allergies 0010, Additional Patient History 0010,21B0 2 Pregnancy Status 0010,21C0 2 Special Needs 0038, Patient State 0038, Visit Relationship Module Referenced Patient Sequence 0008,1120 Sequence Matching 2 > Referenced SOP Class UID 0008,1150 1c > Referenced SOP Instance UID 0008,1155 1c Visit Identification Module Institution Name 0008, Institution Address 0008, Admission ID Visit Status Module Current Patient Location 0038, Visit Admission Referring Physician's Name 0008, Scheduled Procedure Step Module Scheduled Procedure Step Sequence 0040,0100 Sequence Matching 1 >Comments on the Scheduled Procedure Step 0040, >Modality 0008,0060 Single Value 1 >Pre-Medication 0040,0012 2c >Requested Contrast Agent 0031,1070 2c >Scheduled Performing Physician's Name >Scheduled Procedure Step Description 0040,0007 1c >Scheduled Procedure Step ID 0040, >Scheduled Procedure Step Location 0040, >Scheduled Procedure Step Start Date 0040,0002 Date Range 1 >Scheduled Procedure Step Start Time 0040, >Scheduled Procedure Step Status 0040, >Scheduled Protocol Code Sequence 0040,0008 Sequence Matching 1c >Scheduled Station AE Title 0040,0001 Single Value 1 >Scheduled Station Name 0040, (40)

26 Attribute Tag Match Return Requested Procedure Module Study Instance UID 0020,000D 1 Requested Procedure Description 0032,1060 1C Requested Procedure Code Sequence 0032,1064 Sequence Matching 1C Requested Procedure ID 0040,1001 Single Value 1 Reason for the Requested Procedure 0040, Requested Procedure Priority 0040, Names of Intended Recipients of Results 0040, Requested Procedure Comments 3 Referenced Study Sequence 0008,1110 Sequence Matching 2 Imaging Service Request Module Accession Number 0008,0050 Single Value 2 Referring Physician's Name 0008, Requesting Physician 0032, Requesting Service 0032, Reason for the Imaging Service Request 0040, Placer Order Number / Imaging Service Request 0040, Filler Order Number / Imaging Service Request 0040, Imaging Service Request Comments 0040, SOP Common Module Specific Character Set 0008,0005 1C In the following table are the details regarding response behavior of different status codes: Table 3.30 Modality Worklist FIND status Service Status Success Further Meaning Matching is complete- no final identifier is supplied Status Code 0000 Refused Out of Resources A700 Cancel Matching terminated due to user cancel request FE00 Failed Identifier Does not match SOP Class Unable to process A900 CXXX Behavior Matching scheduled responses are displayed. Association is released User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed User notified, reason is logged and connection closed 25 (40)