DICOM Detailed Specification for Diagnostic Labs and Radiology Center Connectivity Authored by Global Engineering Team, Health Gorilla April 10, 2014
Table of Contents About Health Gorilla s Online Healthcare Marketplace...3 Overview... 4 DICOM Standard History...4 Data Format... 5 Use of DCM4CHE Open...5 SOP Classes Defined Information Object Definitions (IOD)...6 Integration with Health Gorilla s Online Healthcare Marketplace...7 Trademark Acknowledgements...8 2
About Health Gorilla s Online Healthcare Marketplace Health Gorilla is the first online healthcare marketplace to connect all doctors and clinicians with over 9,000+ diagnostic labs and 38,000+ radiology centers. Doctors and their teams can instantly place orders, get results, and completely eliminate paper faxes. Uniquely, our HIPAA compliant and ONC modular certified MU2 solution is available immediately at absolutely no charge for doctors and clinicians. 3
Overview Digital Imaging and Communications in Medicine (DICOM) is a standard for information management in medical imaging. DICOM includes both a file format definition and a network communications protocol. The communication protocol is TCP/IP based for system to system communication. DICOM files can be exchanged between any two systems that are capable of receiving image and/or patient data in DICOM format. The standard is copyrighted today by the National Electrical Manufacturers Association (NEMA). The DICOM Standards Committee also has some members from NEMA. There are other standards which include the DICOM specification. DICOM is also known as NEMA standard PS3. There is also an ISO standard for DICOM called ISO standard 12052:2006 Health informatics -- Digital imaging and communication in medicine (DICOM) including workflow and data management. DICOM enables the integration of many different devices to include network components, scanners, servers, printers and workstations. Picture archiving and communication system (PACS) can then be assembled from different manufacturers components into one integrated system. Each device comes with a DICOM conformance statements which clearly states the DICOM classes supported and other important information. Today, DICOM has been broadly adopted by hospitals and is growing in doctor s offices to support initiatives such as Meaningful Use and online order and receipt of radiological tests. DICOM Standard History The DICOM standard was developed by the American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). Starting in the 1980 s computerized tomography and magnetic resonance imaging machines came into broad use. X-ray computed tomography (CT scan) uses computer-processed x-rays to produce tomographic images which are virtual slices of specific areas of the scanned object. Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to observe the anatomy and function of the body in both health and disease. MRI scanners use strong magnetic fields and radio waves to form images. The technique is used in hospitals for medical diagnosis without exposure to ionizing radiation. Initially CT and MRI devices produced detailed images in complex and proprietary formats. It was very difficult for anyone other than manufacturers of computed tomography or magnetic resonance imaging devices to decode and view the images that the machines generated. In order to resolve these issues ACR and NEMA joined forces and formed a standard committee in 1983. Their first standard to address these problems, ACR/ NEMA 300, was released in 1985. 4
In 1988 the second version was released. This version gained more acceptance among the vendor community. The image transmission, at that time, was specified to use a dedicated 2 pair cable (EIA-485). Commercial equipment supporting ACR/NEMA 2.0 was presented at the annual meeting of the Radiological Society of North America (RSNA) in 1990. The second version also needed improvement. The first large-scale deployment of ACR/NEMA technology was made in 1992 by the US Army and Air Force. This program was called the Medical Diagnostic Imaging Support system (MDIS). The Veterans Administration and the Navy also purchased systems off this contract. In 1993 the third version of the standard was released. Its name was then changed to DICOM so as to improve the possibility of international acceptance as a standard. New service classes were defined, network support added and the Conformance Statement was introduced. Officially, the latest version of the standard is still 3.0 but each year it has been constantly updated and extended. Beyond DICOM and HL7, RSNA s Integrating the Healthcare Enterprise (IHE) initiative layered on top of DICOM (and HL-7) can then enable useful clinical application workflow. Data Format DICOM groups information into data sets. That means that a file of a chest x-ray image, for example, actually contains the patient ID within the file, so that the image can never be separated from this information by mistake. A DICOM data object consists of a number of attributes, including items such as name, ID, etc., and also one special attribute containing the image pixel data. A single DICOM object can have only one attribute containing pixel data. This may often be one single image. The attribute may also contain multi-frame data. In many cases, three- or four-dimensional data can be encapsulated in a single DICOM object. Pixel data can be compressed using a variety of standards, including JPEG, JPEG Lossless, JPEG 2000, and Run-length encoding (RLE). Rarely LZW (zip) compression can be used for the whole data set not just the pixel data. Use of DCM4CHE Open HG uses DCM4CHE open source SDK. Scheduled Workflow Dcm4che/archive is a system that provides services for safe storage and retrieve of DICOM evidence object such Images, Key Image Notes, Presentation States, Structured Reports and others. Our Service Object Pairs (SOP Classes) follow in this document. 5
SOP Classes Defined Information Object Definitions (IOD) SOP Class Name SOP Class UID SCU SCP Verification SOP Class 1.2.840.10008.1.1 Yes Yes Storage Commitment Push Model SOP Class 1.2.840.10008.1.20.1 No Yes Hardcopy Grayscale Image Storage SOP Class 1.2.840.10008.5.1.1.29 No Yes Hardcopy Color Image Storage SOP Class 1.2.840.10008.5.1.1.30 No Yes Computed Radiography Image Storage 1.2.840.10008.5.1.4.1.1.1 No Yes Digital X-Ray Image Storage - For Presentation 1.2.840.10008.5.1.4.1.1.1.1 No Ye s Digital X-Ray Image Storage - For Processing 1.2.840.10008.5.1.4.1.1.1.1.1 No Ye s Digital Mammography X-Ray Image Storage - For Presentation 1.2.840.10008.5.1.4.1.1.1.2 No Ye s Digital Mammography X-Ray Image Storage - For Processing 1.2.840.10008.5.1.4.1.1.1.2.1 No Ye s Digital Intra-oral X-Ray Image Storage - For Presentation 1.2.840.10008.5.1.4.1.1.1.3 No Ye s Digital Intra-oral X-Ray Image Storage - For Processing 1.2.840.10008.5.1.4.1.1.1.3.1 No Ye s CT Image Storage 1.2.840.10008.5.1.4.1.1.2 No Ye s Ultrasound Multi-frame Image Storage 1.2.840.10008.5.1.4.1.1.3.1 No Ye s MR Image Storage 1.2.840.10008.5.1.4.1.1.4 No Ye s Enhanced MR Image Storage 1.2.840.10008.5.1.4.1.1.4.1 No Ye s Ultrasound Image Storage 1.2.840.10008.5.1.4.1.1.6.1 No Ye s Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1. No Yes Multi-frame Grayscale Byte Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7.2 No Ye s Multi-frame Grayscale Word Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7.3 No Ye s Multi-frame Color Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7.4 No Ye s X-Ray Angiographic Image Storage 1.2.840.10008.5.1.4.1.1.12.1 No Ye s X-Ray Radio fluoroscopic Image Storage 1.2.840.10008.5.1.4.1.1.12.2 No Ye s Nuclear Medicine Image Storage 1.2.840.10008.5.1.4.1.1.20 No Ye s Raw Data Storage 1.2.840.10008.5.1.4.1.1.66 No Ye s VL Endoscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.1 No Ye s VL Microscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.2 No Ye s VL Slide-Coordinates Microscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.3 No Ye s VL Photographic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.4 No Ye s Positron Emission Tomography Image Storage 1.2.840.10008.5.1.4.1.1.128 No Ye s RT Image Storage 1.2.840.10008.5.1.4.1.1.481.1 No Ye s Grayscale Softcopy Presentation State Storage SOP Class 1.2.840.10008.5.1.4.1.1.11.1 No Ye s Basic Text SR 1.2.840.10008.5.1.4.1.1.88.11 No Ye s Enhanced SR 1.2.840.10008.5.1.4.1.1.88.22 No Ye s Comprehensive SR 1.2.840.10008.5.1.4.1.1.88.33 No Ye s Key Object Selection Document 1.2.840.10008.5.1.4.1.1.88.59 No Ye s 6
Integration with Health Gorilla s Online Healthcare Marketplace This specification is designed to provide information to diagnostic labs and radiology center partners sufficient to assist in the development of an interface between their lab information systems and Health Gorilla s (HG) online healthcare marketplace. This document explains the technical details of our DICOM data standard support. Interface development between HG and our vendors is approved by our business development team, then scheduled and managed by our engineering and development organization. We work in conjunction with our vendor partners to spend time analyzing and planning our interface to ensure that both parties are using the same optional features. Our interfaces support the transmission of HL7 data and HL7 encapsulated.pdf s as well as DICOM IOD s and DICOM encapsulated.pdf. 7
Trademark Acknowledgements HL7 and Health Level Seven are registered trademarks of Health Level Seven International. DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information. Health Gorilla is a trademark of Health Gorilla, Inc. Copyright 2014 Health Gorilla. Health Gorilla 256 Gibraltar Dr. #101 Sunnyvale, CA 94089 1.844.446.7455 (1.844.HGORILLA) www.healthgorilla.com 8
www.healthgorilla.com Copyright 2014 Health Gorilla, Inc. All rights reserved. Health Gorilla is a trademark of Health Gorilla, Inc.