Working Group 13 (Visible Light)

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Working Group 13(Visible Light)
Berlin, September 15th, 2006

• Emmanuel Cordonnier
• ETIAM, (Interim) co-chair
• Juergen Thiem
• SONY, (Interim) co-chair

Update in Orange
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Agenda

• Introduce participants (10 people from ESC, Uni.
  Liepzig, Olympus, Philips, Sony, Stryker, Tribvn,
  Etiam)
• WG-13 objectives and activities
• Participation of users from medical societies
• End-user feedback on video acquisition in
  xx-scopy
• Need for acquisition context information in
  Endoscopy
• Feedback on DICOM MPEG-2 implementation
• Examples of DICOM video sequences
• Perspectives of high definition video (HDTV)
• Cooperation with WG-24, WG-26, IHE-J-Endoscope
• Work item proposal, if required
• Other business

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WG-13 objectives and activities (1)

• Scope
• To accompany the adoption of DICOM standards for
  still and motion Visible Light color images,
  produced by endoscopes, microscopes, or
  photographic cameras, and propose new DICOM
  standards if required, on both sides, creation
  and use.
• Roadmap
• To contribute to accelerate the adoption of the
  DICOM MPEG2 Sup. 42 47.
• To enlarge (number of modalities) and enrich
  (quantity of information) the DICOM VL standard.
• To see if other topics must be specifically
  addressed around the existing standards, like,
  for example, streaming video, and/or, automation
  of workflow based on simple acquisition
  modalities ("unscheduled" and/or "one button"
  operation based).
• To accompany/anticipate the adoption of HD video
  by the medical arena.

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WG-13 objectives and activities (2)

• Short Term Goals
• To develop and populate DICOM video sequence
  MPEG2 examples.
• To propose a way for selecting sub-sequences
  using existing Key Object Selection. Postponed.
• To refine acquisition context for Visible Light
  images (equipment and anatomy). Extended to other
  touchy attributes.
• To accompany adoption of MPEG2 Transfer syntax
  for Ultra Sound. No real demand for the moment.
• To accompany adoption of DICOM for VL images in
  Pathology. Responsibility transferred to the
  newly formed WG26.
• Current Status
• WG-13 has been "reactivated" for the successful
  development and the adoption of DICOM ML_at_MP MPEG2
  (Sup. 42 and Sup. 47). It is actually focusing of
  its real use by the actors of the domain.
• Future Work Items
• TBD on HDTV to be prepared for the next WG13
  meeting

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WG-13 objectives and activities (3)

• Risks
• Not enough participation from the key players of
  the domain (users and vendors), based in America,
  Asia and Europe.
• No acceptance of the DICOM video objects by PACS
  vendors and administrators.
• Challenges and Opportunities
• The use of VL images is rapidly growing (non/less
  invasive surgery, advanced diagnosis, surgery
  monitoring). All equipment is migrating from
  analog to digital technology, thanks to consumer
  multimedia technologies. Targeted modalities are
  Gastroenterology, Laparoscopy, Orthopedics,
  Ophthalmology, Ear Nose Throat, Gynecology,
  Bronchoscopes.
• The manufacturers and users are facing to the
  necessary integration with other equipment and
  information system, for quality, safety and
  efficiency objectives.

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Participation of users from medical societies

• Challenge How to enroll users and vendors from
  the different medical specialties using Visible
  Light imaging systems?
• Organize WG13 at dedicated medical conferences,
  such as EAES OK for vendors but not possible to
  meet users, yet. Probably in Gastroenterology
  user are more advanced. Next meeting in this
  domain and in North-America.
• Cooperate with parallel initiatives (WG24, WG26,
  IHE-J-Endoscope). Makes senses.

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End-user feedback on video acquisition in xx-scopy

• The video acquisition has different origin
• Image guided diagnosis
• Image guided surgery
• Surgical operation recording
• Monitoring (vital signs) in video only for
  display?
• Record the video aims to
• Facilitate the workflow from admission to
  reporting
• Enrich the Electronic Healthcare Record (EHR)
• Contribute to research and education
• Create audit trails only few demand for the moment

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Image source / Interest for storing
diagnosis surgery operation monitoring
workflow
EHR
research education
audit
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IODs Modules
to be studied by implementers
IODs Modules SC SC MF TC VL EN VL MC VL SL VL PH VideoVL EN VideoVL MC VideoVL PH
Patient M M M M M M M M M
Specimen Identification M M C M C
Clinical Trial Subject U U U U U U U U U
General Study M M M M M M M M M
Patient Study U U U U U U U U U
Clinical Trial Study U U U U U U U U U
General Series M M M M M M M M M
Clinical Trial Series U U U U U U U U U
Frame Of Reference M
General Equipment U U M M M M M M M
SC Equipment M M
General Image M M M M M M M M M
Image Pixel M M M M M M M M M
Cine C M M M
Multi-frame M M M M
Frame Pointers U
SC Image M U
SC Multi-frame Image M
SC Multi-frame Vector C
VL Image M M M M M M M
Slide Coordinates M
Overlay Plane U U U U U
Modality LUT U
VOI LUT U
Acquisition Context M M M M M M M
SOP Common M M M M M M M M M
To be sure the PACS is accepting the object, many
xx-scopy vendors Are exporting SC only. But to
add additional attributes, they are ready to
export VL objects.
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Typical  touchy  Attributes
to be studied by implementers

• General Image / Image Type (ORIGINAL\PRIMARY)
• SC Equipment / Secondary Capture Device
  Manufacturer vs. SOP Common / Manufacturer
• General Series / Performing Physicians Name vs.
  General Study / Referring Physicians Name
• General Study / Study Description vs. Acquisition
  Context Module / Acquisition Context Description
• VL Image / Anatomic Region Sequence
• Acquisition Context

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Anatomic Region Sequence 1C
Anatomic Region Sequence (0008,2218) 1C Sequence that identifies the anatomic region of interest in this image (i.e. external anatomy, surface anatomy, or general region of the body). Only a single Item shall be permitted in this sequence. Required if Number of Frames (0028,0008) is present and Specimen Accession Number (0040,050A) is absent. May be present otherwise. ???
to be studied by implementers
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Anatomic Region Codes for VL  ES 
to be studied by implementers
Value Meaning
T-D4000 Abdomen
T-59490 Anus, rectum and sigmoid colon
T-60610 Bile duct
T-74000 Bladder
T-DD123 Bladder and urethra
T-26000 Bronchus
T-83200 Cervix
T-D3000 Chest
T-DD163 Esophagus, stomach and duodenum
T-AB200 External auditory canal
T-63000 Gall bladder
T-D7000 Inguinal region
T-15001 Joint
T-71000 Kidney
T-D9200 Knee
T-59000 Large intestine
T-24100 Larynx
T-40230 Lumen of blood vessel
T-D3300 Mediastinum
T-2300C Naso pharynx
T-22000 Paranasal sinus
T-55002 Pharynx
T-20101 Pharynx and larynx
T-59600 Rectum
T-D2220 Shoulder
T-59470 Sigmoid colon
T-11500 Spine
T-DD006 Trachea and bronchus
T-70010 Upper urinary tract
T-73800 Ureter
T-88920 Uterus and fallopian tubes
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Acquisition Context for Endoscopy
to be studied by implementers
Attribute Name Tag Type Attribute Description
Acquisition Context Sequence (0040,0555) 2 A sequence of Items that describes the conditions.
gtValue Type ((0040,A040) 3 TEXT, NUMERIC, CODE, DATE, TIME, PNAME
gtConcept Name Code Sequence (0040,A043) 1 A concept that constrains the meaning of (i.e. defines the role of).
gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 No Baseline Context is defined.
gtReferenced Frame Numbers (0040,A136) 1C References one or more frames in a Multi-frame SOP Instance.
gtNumeric Value (0040,A30A) 1C This is the Value component of a Name/Value pair when numeric.
gtMeasurement Units Code Sequence (0040,08EA) 1C Units of measurement. Only a single Item.
gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 Baseline Context ID is 82.
gtDate (0040,A121) 1C This is the Value component of a Name/Value pair when date.
gtTime (0040,A122) 1C This is the Value component of a Name/Value pair when time.
gtPerson Name (0040,A123) 1C This is the Value component of a Name/Value pair when Person.
gtText Value (0040,A160) 1C This is the Value component of a Name/Value pair when Text.
gtConcept Code Sequence (0040,A168) 1C This is the Value component of a Name/Value pair when Code.
gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 gtgtInclude Code Sequence Macro Table 8.8-1 No Baseline Context is defined.
Acquisition Context Description (0040,0556) 3 Free-text description of the image-acquisition context.
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Examples of DICOM video sequences

• Availability of such sequences? Some are ready to
  provide such sequence
• Objective of such a repository? To improve the
  interoperability (touchy attributes)
• Qualification of examples? Decided by the vendor
  but shall be a real object, not patched
• Interest to share them between vendors? Yes
• Management of the repository? NEMA
• Level of access (public / DSC members)? only
  contributing DICOM DSC vendor members

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Perspectives of high definition video

• Use case(s) the general demand for highest
  accessible quality. Some medical cases where HD
  is required could emerge
• Limitations of the present DICOM MPEG2 for such
  use cases too early to say
• Possibilities afforded by HDTV (demonstration)
  three vendors shown it
• Standards used (MPEG2 HD, MPEG4) MPEG2 MP_at_HL
  seems to be the best candidate, up to 1080p,
  typically 1080i or 722p, OK for the MPEG2 HD
  decoders
• Link with media storage (DVD) could be the
  different DVD HD format supported by the HD DVD
  readers, but too early to say

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WG-24, WG-26, IHE-J-Endoscope
Maintain the link with the three groups

• WG-24 (Surgery) use case definition, analysis of
  the workflow in surgery, depending of the
  domains needs for analysis of the workflow at a
  more global (but simple) level (unscheduled)
• WG-26 (Pathology) analysis of the DICOM object
  model to fit with pathology context (specimen,
  blocks, slides) whole slide images (WSI) and
  object format. Interesting but quite different
  approach than for endoscopy where the diagnosis
  is done by the physician during the act
• IHE-J-Endoscope workflow in diagnosis endoscopy
  and related acquisition context. Even in surgical
  endoscopy, need for link with the pathology.

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IHE-J Diagnosis Endoscopy Workflow
1 not yet come 2 arrival 3 start premedication 4
completed premedication 5 start exam 6 completed
exam 7 start recovery 8 completed recovery And so
on
ADT
Status Manager
Pt.Registration
Pt.Registration
Pt.Update
Pt.Update
Placer Order Management
Order Placer
Order Filler
Filler Order Management
Procedure Scheduled
Image Availability Query
Pt.Update
B/W HL7 Messages Green DICOM Messages
Image Creator
Creator PPS
Storage Commitment
Creator Image Stored
PPS
Image Display
Query Images
PPS Manager
Image Manager
Image Archive
Retrieve Images
Key issue Tight relation between the Endoscopy
and pathology
PPS
Modality Image Stored
Storage Commitment
Modality PPS
Acquisition Modality
Modality Worklist Provided
Report Manager
Biopsy
Report Creator
Order Requester
Will be communicated to the WG26
?
Report Repository
IHE Pathology
Pathology Order Placer
Pathology Order Filler
?
Report Reader
?
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Feedback on DICOM MPEG-2 implementation

• Difficulty to implement on the source side? No,
  on the standard point of view (interoperability
  works)
• Ability to retrieve video from other file
  formats? Yes, DVDs, DV, AVI, MPEG4, HDTV
• Average length of DICOM MPEG2 video? 10s to xxx,
  very dependant of the user and the context. Very
  often limited by the system to avoid trouble
• Acceptable image quality? Comparable to source
• Compatibility with PACS servers? THE MAIN ISSUE
• Compatibility with DICOM viewers? The second one
• Ability to edit object? (sub-sequences) no clear
  demand for the moment, especially in routine (no
  time to spend).
• Use of DVD for patient and doctor to doctor
  (education)

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Work Item proposal

• If required
• To be prepared by mail interchange for being
  discussed and reviewed at the next meeting
  extension of the VL video to HDTV. To be checked
  if interest in other domains (cardiology,
  ophthalmology). The time frame anticipated for
  users demand is 3 years. So it is time to start
  now.

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Conclusion

• Other business
• Next WG13 meeting (date, place) to take place at
  the next Digest of Disease Week (May-2007? in the
  US)