3 Where Do You Get DICOM from? DICOM vs. Digital DICOM, DICOM-Compatible, DICOM-Ready? In the Middle of Nowhere...

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1 XIII Part I: Introduction to DICOM 1 What Is DICOM? How Does DICOM Work? Where Do You Get DICOM from? DICOM vs. Digital DICOM, DICOM-Compatible, DICOM-Ready? In the Middle of Nowhere A Brief History of DICOM How Did This All Get Started? Part II: DICOM and Clinical Data 5 Parlez-Vous DICOM? IT Boot Camp Text vs. Binary DICOM Grammar: Value Representations VR Length Characters: Foreign and Wild Text VRs: CS, SH, LO, ST, LT, UT Dates and Times: DA, TM, DT, AS Numbers in Text Format: IS, DS Numbers in Binary Format: SS, US, SL, UL, FL, FD, OB, OW, OF, AT PN: Storing Person s Names AE: Naming Application Entities UIDs: Unique Identifiers SQ: Sequencing Data Sets UN: Representing Unknown Values DICOM Data Dictionary Standard DICOM Data Dictionary... 42

2 XIV Private DICOM Data Dictionaries Standard DICOM Command Dictionary DICOM Objects Encoding Data Elements Encoding Data Groups Example: Element and Group Lengths Encoding DICOM Data Objects SQ: Encoding DICOM Object Sequences Required and Optional Data Elements Storing Image Data Unique Identifiers DICOM Information Hierarchy Problems with Patient ID Problems with Study, Series, and Image UIDs Hierarchical and Relational Data Modules, IODs, and Information Entities Macro Attributes: Making it Easier Information Modules: Basic Data Blocks Information Entities DICOM Information Objects IODs and Their Instances Learning More Medical Images in DICOM DICOM BMPs Image Compression Lossless Compression Lossy Compression Streaming Compression Choosing the Right Compression Technique Working with Digital Medical Images Image Interpolation Image Reconstructions Grayscale Depth Waveforms Part III: DICOM Communications 7 DICOM SOPs: Basic Identifying Units on the DICOM Network Services and Data DIMSE Services Simple DIMSE Example: C-Echo Service-Object Pairs

3 XV The Verification SOP Storage C-Store IOD C-Store DIMSE Query: Find A Few Words on Data Matching in DICOM C-Find IOD C-Find DIMSE C-Cancel Modality Worklist The MWL IOD The MWL DIMSE Basic DICOM Retrieval: C-Get The C-Get IOD C-Get DIMSE Advanced DICOM Retrieval: C-Move The C-Move IOD The C-Move DIMSE C-Move vs. C-Get DICOM Ping, Push, and Pull Gentleman s Toolkit Matching Application Roles DICOM SOPs: Beyond Basic Storage Commitment Secondary Capture Structured Reports Encapsulated PDFs Hardcopy Printing DICOM Associations Association Establishment Basics Association Establishment Abstract Syntax Transfer Syntax Application Context Presentation Context User information Protocol Data Unit A-Associate-RQ A-Associate-AC A-Associate-RJ A-Abort A-Release-RQ and A-Release-RP P-Data-TF

4 XVI How Associations Terminate What Do I Do When it Fails? Point-to-Point Spell Networking: Standard and Beyond Part IV: DICOM Media and Security 10 DICOM Media: Files, Folders, and DICOMDIRs DICOM File Format Preamble and DICM Prefix Group 0002: DICOM File Meta Information Data Object DICOM File IDs and Names Special DICOM File Formats DICOMDIR Secure DICOM File Format DICOM File Services DICOM File Set File Management Roles and Services Grains of Salt DICOMDIR Media Storage Please, Send Us Some Film! Export and Import Storing DICOM Data in PACS File-Based PACS Storage Database-Based PACS Storage Mixed PACS Storage Models Choice of Internal File Format DICOM Security DICOM Hacking Securing the Workflow Securing the Data Anonymization Encryption How it All Works Encrypting the Data Verifying Data Integrity Validating Data Origin Concluding Remarks on Security Incompatibility of Compatible DICOM Conformance

5 XVII 12.2 Testing, Testing, and Yes, More Testing Who Wants DICOM? DICOM from a Black Box Home-Made DICOMs Open-Source DICOM Part V: Advanced Topics 13 DICOM and Teleradiology Can I See the Image? You ve Got Mail Teleradiology DICOM and the DICOM From PACS to PDAs? Starting Your Teleradiology Project Conclusion Standards and System Integration in Digital Medicine HL7: HIS and RIS Integration Problems Data Integration Application Integration IHE: Integration Profiles Disaster PACS Planning and Management What it Takes to Kill a PACS Extreme PACS Digging in the Dirt Confidentiality and Security Archiving Disaster-Proof PACS Design DICOM Software Development Developing DICOM from Scratch The I just need to open this DICOM file Project Implementing DICOM Learning from Others DICOM Implementation Plans Imaging Center Teleradiology Center Hospital Image-Processing Laboratory

6 XVIII 18 DICOM FAQs Frequent Problems I Want to Go Digital. How Do I Start? How Do I Distinguish DICOM Files from Others? I Am Trying to Open a File in My DICOM Program, and it Does Not Open What Is DICOMDIR? I Send a Study to My DICOM Device, but it Never Gets There I Send a Study to My PACS Archive: it Arrives There, but Becomes Merged with Another Study (Patient) I Need to Send This Study to a Remote Facility I Open a DICOM Image in My Software, and it Looks Wrong I Do Some Image Editing on My PACS, but When I Send it to Another System, the Editing Is Missing Can I Break My DICOM Device if I DICOM-Connect it to Another? Naive Questions that Physicians Like to Ask and Salesmen Like to Brag About Do I Get the Original Image Resolution if I Buy Your PACS? Is Your System Web-Based? Can You Connect to My CT Scanner (MR, Ultrasound, Positron Emission Tomography, and so on)? Do You Have 3D Imaging (Perfusion, Diffusion, Volume Measurements, and so on)? Does Your System Support Multitasking (e.g., Multithreading, 64-bit Processors)? Can I Use Your System for Teleradiology? How Fast Can You Transfer the Images? How Much Data Can I Store in Your PACS? Is Your DICOM Software Secure? Do You Have Full-Fidelity DICOM? Appendix A.1 DICOM Transfer Syntaxes A.2 DICOM SOPs A.3 C-Find Bytes References Subject Index

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