The DICOM extensions for

radiotherapy

Michael Neumann
Nucletron B.V., Germany
 Contents

§ History of development of RT extension

§ The Real World Model

§ The RT Objects
§ Details for the individual RT Objects

§ Patient Coordinate System(s)

§ DICOM in ‘Real Life’

§ Tools

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Interoperability

This Standard facilitates interoperability of systems claiming

conformance in a multi-vendor environment, but does not, not by
itself, guarantee interoperability.

DICOM PS 3.1 - “Goals of the DICOM Standard”

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The RT Extension

" (...) support the transfer of

radiotherapy-related data
between devices found within
and outside a radiotherapy
department."

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 DICOM WG7

§ Founded 1994/95 as
“DICOM RT ad-hoc Working Group“
§ Cooperation with IEC since 1995
§ Currently 34 members
§ All major vendors represented
§ CMS, Elekta, GE, IMPAC, Nomos, Nucletron, Philips,
Siemens, TomoTherapy, Varian
§ 2 to 3 meetings a year

http://groups.yahoo.com/group/dicomrt

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The DICOM Real World Model

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The DICOM Information Model

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The RT Extension

Patient

Study

Image
Image

Sup. 29
Sup. 11

RT Image RT Dose RT Structure Set RT Plan RT Treatment

RT Treatment
RT Treatment
Record
Record
Record

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The RT Extension

§ RT Image IOD
DRR, Portal Imaging, Simulator
§ RT Dose IOD
Dose Matrix, Dose Points, Isodoses, DVH
§ RT Structure Set IOD
VOIs, Dose Reference Points,
Observations/Characterizations
§ RT Plan IOD
External&Brachy Plan, Tolerance Table, Fractionation
Scheme, Patient Setup
§ RT Treatment Record IODs
Beam&Brachy Session/Summary Recording Information

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The RT Extension

§ Extends:

§ Part 3: Information Objects Definitions

§ Part 4: Service Class Specifications
§ Part 6: Data Dictionary

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 No Information Management

... due to the absence of a consistent process model for a

radiotherapy department, especially in an international
context.

DICOM Supplement 11 - “Radiotherapy Objects”

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 The RT Objects Module Tables

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 New IOD Modules

General Series RT Series

Modality Modality
Series Instance UID Series Instance UID
Series Number Series Number
Laterality
Series Date
Series Time
Performing Physician's Name
Performing Physician Identification Sq.
Protocol Name
Series Description Series Description
Operator's Name
Operator Identification Sq.
Referenced Performed Procedure Step Sq. Ref. Performed Proc. Step Sq.
>Ref. SOP Class UID >Ref. SOP Class UID
>Ref. SOP Closs Instance UID >Ref. SOP Closs Instance UID
Body Part Examined
Patient Position
Smallest Pixel Value in Series
Largest Pixel Value in Series
Requested Attributes Sq. Requested Attributes Sq.
>Requested Procedure ID >Requested Procedure ID
>Scheduled Procedure Step ID >Scheduled Procedure Step ID
>Scheduled Procedure Step Description >Scheduled Procedure Step Description
>Scheduled Procedure Step Code Sq. >Scheduled Procedure Step Code Sq.
Performed Procedure Step ID Performed Procedure Step ID
Performed Procedure Step Start Date Performed Procedure Step Start Date
Performed Procedure Step Start Time Performed Procedure Step Start Time
Performed Procedure Step Description Performed Procedure Step Description
Performed Protocol Code Sequence Performed Protocol Sequence
Comments on the Performed Procedure Step

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Approval Module

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 New IOD Modules

RT RT RT RT RT RT RT
Image Dose Stct.
Stct. Set Plan BmsTR BrchTR TrmtSR

Structure RT Gen. RT Gen. RT Gen. RT Gen.

RT Image RT Dose
Set Plan Trmt.
Trmt. Rec. Trmt.
Trmt. Rec. Trmt.
Trmt. Rec.
RT ROI RT RT Pat. RT Pat. RT
DVH Contour Prescr.
Prescr. Setup Setup TrmtSm

Structure RT ROI RT Toler. RT Trmt.

Trmt. RT Trmt.
Trmt.
Set Observat.
Observat. Table Machine Machine
ROI RT Pat. Meas. Meas.
Contour Setup DoseRef DoseRef

RT Dose RT Fract.
Fract. Calcul.
Calcul. Calcul.
Calcul.
ROI Scheme DoseRef DoseRef
RT RT RT
Beams BmsSR BrchSR

RT RT RT
BAS TrmtSm TrmtSm

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Image

§ Conical Imaging Geometry

§ Radiographs
§ Digital Reconstructed
Radiographs (DRR)
§ Simulator Images
§ Portal Images
§ Pixel Spacing on the image
plane
§ Exposure Sequence
§ Multiple Exposure Images
§ Cine Images
§ Information on image generation
§ Gantry Angle
§ Field shape (Block, MLC)
not stored as Overlay!

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Image Module

Image Description
Radiation Machine Description
Ref. RT Plan Sq.
Sq.
Ref. Plan
Ref. Beam Number
Exposure Sq.
Exposure Description
Beam Limiting Device Sq.
Beam Limiting Device Description
Applicator Sq.
Electron Applicator Description
Block Sq.
Block Description

Gantry/Beam Lim. Dev. Angle, Table Pos.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Image Implementations

Vendor SCP SCU

Elekta Oncology Systems iView PrecisePlan

GE Medical Systems AdvantageSIM AdvantageSIM

IMPAC Medical Systems ViewStation QwikSIM

Merge Technologies MergeARK MergeARK

NOMOS CORVUS BAT

Plato, O‘IMCON, TPP, Plato,

Plato, O‘IMCON,
O‘IMCON, O‘VISIR
O‘VISIR,,
Nucletron
O‘DA TPP, O‘DA
Pinnacle,
Pinnacle, AcQSim,
AcQSim, Pinnacle,
Pinnacle, AcQSim,
AcQSim,
Philips
AcQPlan AcQPlan
Siemens Medical LANTIS, BeamView,
BeamView, BeamView,
BeamView, Imaging
Systems Imaging Platform Platform Implemented
WIP
Varian Medical Systems VARiS/Vision
VARiS/Vision G6 VARiS/Vision
VARiS/Vision G6 Future Release

Data from Hans Sethi, Elekta Oncology Systems

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Dose

§ 0D, 1D, 2D, and 3D

§ Dose Distribution
§ Specification for Dose
Calculations (?)
§ Grid-based 2D plane(s)
§ Values in Image Pixel
Module (DICOM)
§ Planes identified through
Grid Frame Offset Vector
§ Different summation types
Plan / Fraction / Beam /
Brachy

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Dose

§ Isodoses § Dose Volume Histograms

§ Description of Isodose § Cumulative, Integral,
Lines Natural
§ Referencing related ROI § Differential or Cumulative
§ Dose Units DVH
§ Dose Value § Reference to according
ROIs
§ ROI Contribution Type
INCLUDED, EXCLUDED

ROI A ROI B

ROI C
Volume = U (VINCLUDED) - U (VEXCLUDED)

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Dose Module

Dose Units, Type, Comment

Normalization Point
Summation Type

Ref. RT Plan Sq.

Ref. Plan
Ref. Fraction Group Sq.
Ref. Fraction Group Number
Ref. Beam Sq.
Ref. Beam Number
Ref. Brachy Application Setup Sq.
Ref. Brachy AS No.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT DVH Module

Ref. Structure Set Sq.

Ref. Structure Set UID
DVH Normalization Point, Value
DVH Sq.

DVH Ref. ROI Sq.

Ref. ROI Number, Contribution

DVH Type
Dose Units, Type
Dose Scaling
Volume Units
DVH Data
DVH Min, Max, Mean Dose

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Dose Implementations

Vendor SCP SCU

Elekta Oncology Systems PrecisePlan

IMPAC Medical Systems Future Release

Merge Technologies MergeARK MergeARK

NOMOS CORVUS,
CORVUS, BAT
HelaxTMS,
HelaxTMS, O‘DM, TPP,
Nucletron O‘DM, TPP, O‘DA
O‘DA
Pinnacle,
Pinnacle, AcQSim,
AcQSim, Pinnacle,
Pinnacle, AcQSim,
AcQSim,
Philips
AcQPlan AcQPlan

TomoTherapy Inc. Future Release

Implemented
WIP
Varian Medical Systems VARiS/Vision
VARiS/Vision G6 VARiS/Vision
VARiS/Vision G6 Future Release

Data from Hans Sethi, Elekta Oncology Systems

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Structure Set

§ Regions and Volumes of

Interest (ROI, VOI)
§ Points of Interest (e.g. Dose
Points)
§ 3D Objects (e.g. Bolus,
Brachytherapy Applicator)
§ Associated with 0-N images
§ Frame of Reference
Relationship
§ ROIs referencing images
§ ROI Generation algorithm
AUTOMATIC,
SEMIAUTOMATIC,
MANUAL

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Structure Set

§ Contours § ROI Obervations

§ Contour Data for ROI § Identification,
§ Contours not necessarily Interpretation
in one plane § Specification of Coding
§ Associated with 0-N Scheme
images (SDM, NLM TeRMS)
§ Geometric Type § ROI Interpreted Type
POINT, § ROI Material ID
OPEN_PLANAR, § ROI Physical Property
OPEN_NONPLANAR,
CLOSED_PLANAR
§ Contour Slab

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Structure Set Module

Structure Set Description

Ref. FoR Sq.
Ref. FoR UID
FoR Relationship Sq.
Related FoR UID
Transformation Type, Matrix

RT Ref. Study Sq.

Ref. Study UID
RT Ref. Series Sq.
Ref. Series UID
RT Ref. Image Sq.
SOP Class/Instance UID

ROI Sq.
ROI Number, Description

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT ROI Contour Module

ROI Contour Sq.

Ref. ROI Number
Contour Sq.
RT Ref. Image Sq.
SOP Class/Instance UID
Ref. Frame Number

Contour Geometric Type

Contour Data

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Dose ROI Module

RT Dose ROI Sq.

Ref. ROI Number
Dose Units
Dose Value

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT ROI Observations Module

RT ROI Observations Sq.

Observation Number
Ref. ROI Number, Label, Description
RT Related ROI Sq.
Ref. ROI Number
RT ROI Relationship

RT ROI Identification Code Sq.

Code Value, Scheme, Meaning
Related RT ROI Observations Sq.
Observation Number

ROI Interpreted Type, Interpreter

Material ID
ROI Physical Properties Sq.
ROI Physical Property, Value

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Structure Set Implementations

Vendor SCP SCU

CMS XiO FocalSIM
Elekta Oncology Systems PrecisePlan, iView PrecisePlan

GE Medical Systems AdvantageSIM AdvantageSIM

IMPAC Medical Systems Future Release QwikSIM

Merge Technologies MergeARK MergeARK
NOMOS CORVUS, BAT CORVUS
Plato, HelaxTMS,
HelaxTMS, O‘DM, Plato,
Plato, HelaxTMS,
HelaxTMS, TPP,
Nucletron
TPP, O‘DA O‘DA
Pinnacle,
Pinnacle, AcQSim,
AcQSim, Pinnacle,
Pinnacle, AcQSim,
AcQSim,
Philips
AcQPlan AcQPlan
Siemens Medical
Imaging Platform Imaging Platform
Systems
TomoTherapy Inc. WIP Implemented
WIP
Varian Medical Systems VARiS/Vision
VARiS/Vision G6 VARiS/Vision
VARiS/Vision G6 Future Release

Data from Hans Sethi, Elekta Oncology Systems

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Tele-Therapy and
Brachytherapy
§ Fractionation, Tolerance
Tables, Positioning
§ Reference to Dose
Distribution (RT Dose)
§ Reference to Frame of
Reference
§ Plan Relations
§ Versions
§ Alternative Plan
§ Control Point Concept
§ MLC, Dynamic Therapy,
IMRT

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Plan Relationship

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Prescription
§ Dose Specification Information
§ Target and Organ at Risk Dose

Underdose Minimum Dose

Volume Prescription Dose
Fraction
Maximum Dose

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Tolerance Table § Patient Positioning

§ One or more Tolerance § Fixation Devices
Tables for entire Plan § Shielding Devices
§ Comparing planned / § Setup Technique
delivered machine § 'Displacement'
parameters information
§ Accounting for different § Referenced from Beams
techniques and Treatment Record
§ Referenced from Beams

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Fractionation Scheme
§ One or more schemes for treatment
§ Dose specification (RT Prescription)
§ Fractionation information
§ Applied to Beams / Brachy Appl. Setup
§ Allows reusing of Beams / Brachy AS
§ Fractionation Pattern:
Mon Tue Wed Thu Fri Sat Sun
0/1 0/1 0/1 0/1 0/1 0/1 0/1

§ Pattern Length:
Pattern Length = NumFractionPatternDigitsPerDay x 7 x RepeatCycleLength

Number of Weeks

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Fractionation Examples

§ 1 Fraction Group,
1 Fraction/Day, Mon-Fri
FG1: 1111100
§ 2 Fraction Groups,
2 alternating Fractions/Day, Mon-Fri
FG1: 10101010100000
FG2: 01010101010000
§ 2 Fraction Groups,
1 Fraction/Day and 2 Fractions/Day, Mon-Fri
FG1: 1111100
FG2: 11111111110000

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Beams
§ Beam identification
§ Treatment Unit description
§ RT Image acquisition information
§ Wedges, Compensators, Boli, Blocks, Applicators
§ Control Point Concept
§ Control Point specific Dose References

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Control Point Concept

A Control Point describes which parameters (including

MU/Time) of the Treatment Unit change during beam
delivery.

§ CP0: Initial Setup; All applicable parameters

§ CP1-N: Parameters which change at any CP

Behaviour between Control Points not described.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 DICOM Control Points

0 1 0 1

0 1 2 3 4 5 6 7 8 9

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Absolute / Relative Positions § Dose Specification

absolute MU/Time / relative
All positions except Table MU/Time
Translations are absolute.
CumulMSWeight
§ Table Translations CPMS = BeamMS x
FinalMSWeight
§ relative:
No initial value specified
§ absolute:
§ absolute: BeamMS = FinalMSWeight
Initial value specified
§ relative:
BeamMS ≠ FinalMSWeight

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan

§ Brachy Application Setup

§ Generalized Model from Remote AL
§ Application Setup ≠ Source Applicator
§ Brachy Accessory Devices
§ Shield
§ Mold
§ Plaque
§ Dilatation
§ ROI based description of 3D Structures
§ Channel = Source Applicator + Transfer Tube
§ Sources referenced from Channel
§ Control Point Concept
§ Specification of Transit Times

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT General Plan Module

Plan Description, Treatment Intent

RT Plan Geometry
Ref. Sructure Set Sq.
Ref. SOP Class/Instance UID
Ref. Dose Sq.
Ref. SOP Class/Instance UID

Ref. RT Plan Sq.

Ref. SOP Class/Instance UID
Ref. Plan Relationship

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Prescription Module

Prescription Description
Dose Reference Sq.
Dose Reference Number
Dose Reference Structure Type
Referenced ROI Number
Reference Point Coordinates
Dose Reference Type
Constraint Weight
Dosage Information

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Tolerance Table Module

Tolerance Table Sq.

Tolerance Table Number, Label
Gantry Angle
Beam Limiting Device Angle

Beam Limiting Device Tolerance Sq.

Beam Limiting Device Type
BLD Position Tolerance

Patient Support Angle Tolerance

Table Top Positions Tolerance

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Patient Setup Module

Patient Setup Sq.

Patient Setup Number
Patient Position, Additional Position
Fixation Device Sq.
Fixation Device Description
Shielding Device Sq.
Schielding Device Description

Setup Technique, Description

Setup Device Sq.
Setup Device Description

Table Displacements

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Fraction Scheme Module

Fraction Group Sq.

Fraction Group Number
Ref. Patient Setup Number
Ref. Dose Sq.
Ref. SOP Class/Instance UID
Ref. Dose Reference Sq.
Ref. Dose Reference Number
Constraint, Dosage Information

Number of Fractions, Fractions/Day

Fraction Pattern
Ref. Beam Sq.
Beam Number, Dose
Ref. Brachy Application Setup Sq.
Brachy AS Number, Dose

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Beams Module
Beam Sq.
Beam Limiting Device Sq.

Ref. Reference Image Sq.

Planned Verification Image Sq.

Ref. Dose Sq.

Wedge Sq.

Compensator Sq.

Ref. Bolus Sq.

Block Sq.

Applicator Sq.

Control Point Sq.

Ref. Dose Reference Sq.

Wedge Pos. Sq.

Beam Limiting Device Pos. Sq.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Brachy Applications Setup Module

Treatment Technique, Type

Treatment Machine Sq.

Source Sq.

Application Setup Sq.

Template Description
Ref. Reference Image Sq.

Brachy Accessory Device Sq.

Channel Sq.
Source Applicator Description
Transfer Tube Description
Channel Shield Sq.

Brachy Control Point Sq.

Brachy Ref. Dose Ref. Sq.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Plan Implementations

Vendor SCP SCU

CMS XiO XiO, FocalSIM
PreciseDesktop,
Elekta Oncology Systems PrecisePlan
PrecisePlan, iView
GE Medical Systems AdvantageSIM AdvantageSIM

IMPAC Medical Systems MultiACCESS QwikSIM

Merge Technologies MergeARK MergeARK

NOMOS BAT CORVUS

Plato, HelaxTMS,
HelaxTMS, Plato, HelaxTMS,
HelaxTMS,
Nucletron O‘IMCON, O‘VISIR, O‘DM, O‘IMCON, O‘VISIR, O‘DM,
TPP, O‘DA TPP, O‘DA
Pinnacle,
Pinnacle, AcQSim,
AcQSim, Pinnacle,
Pinnacle, AcQSim,
AcQSim,
Philips
AcQPlan AcQPlan
Siemens Medical LANTIS, IMFast,
IMFast, Imaging
IMFast,
IMFast, Imaging Platform
Systems Platform Implemented
WIP
Varian Medical Systems VARiS/Vision
VARiS/Vision G6 VARiS/Vision
VARiS/Vision G6 Future Release

Data from Hans Sethi, Elekta Oncology Systems

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Treatment Record

§ Tele-Therapy and
Brachytherapy
§ Session and Summary
Record Information
§ 3 IODs
§ Contains all Treatment-
parameters
§ Dose Calculations
§ Dose Measurements
§ References related RT Plan
§ References related
Treatment Records

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Treatment Record

§ Beams / Brachy Session § Treatment Summary

§ Measured / Calculated § Current Treatment
Dose Status
§ All Treatment § First, Most Recent
Parameters Treatment Date
§ Additionally § Fraction Group Status
§ Date, Time, Fraction § Fraction Status
Number § Cumulative Measured /
§ Termination Status, Calculated Dose to Dose
Code, Verification References
§ Specified / Delivered
Monitor Units/Time

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT General Treatment Record Module

Ref. RT Plan Sq.

Ref. SOP Class/Instance UID
Ref. Treatment Record Sq.
Ref. SOP Class/Instance UID

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Beam Session Record Module
Measured Dose Sq.

Calculated Dose Sq.

Treatment Session Beams Sq.

Ref. Verification Image Sq.

Ref. Measured / Calculated Dose Sq.

Wedge Sq.

Compensator Sq.

Ref. Bolus Sq.

Block Sq.

Applicator Sq.

Control Point Delivery Sq.

Wedge Pos. Sq.

Beam Limiting Device Pos. Sq.

Override Sq.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Brachy Session Record Module
Treatment Technique, Type
Measured Dose Sq.

Calculated Dose Sq.

Treatment Session Application Setup Sq.

Template Number
Ref. Verification Image Sq.

Ref. Measured / Calculated Dose Sq.

Brachy Accessory Device Sq.

Channel Sq.
Source Applicator Number
Transfer Tube Number
Ref. Meas. / Calc. Dose Sq.

Channel Shield Sq.

Control Point Delivery Sq.

Override Sq.

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Treatment Summary Record Module
Treatment Status / Status Comment
First / Most Recent Treatment Date

Fraction Group Summary Sq.

Ref. Fraction Group Number

Faction Group Type
Number of Fractions Planned/Delivered

Fraction Status Summary Sq.

Ref. Fraction Number

Treatment Date / Time / Term. Status

Treatment Summary Meas. Dose Ref. Sq.

Ref. Dose Reference Number, Descr.
Cumulative Dose to Dose Reference

Treatment Summary Calc. Dose Ref. Sq.

Ref. Dose Reference Number, Descr.
Cumulative Dose to Dose Reference

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 RT Treatment Record Implementations

Vendor SCP SCU

Elekta Oncology Systems PreciseDesktop
IMPAC Medical Systems MultiACCESS MultiACCESS
Merge Technologies MergeARK MergeARK

Nucletron O‘VISIR O‘VISIR

Implemented
WIP
Varian Medical Systems VARiS/Vision
VARiS/Vision G6 VARiS/Vision
VARiS/Vision G6 Future Release

Data from Hans Sethi, Elekta Oncology Systems

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Patient Coordinate Systems

Z
DICOM
IEC ZY

Y XX
Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann
 DICOM Coordinate System

§ Right-handed
§ Fixed with resp. to the patient
„When a Frame of Reference is identified, it is not important how the
Patient is positioned relative to the imaging equipment or where the origin
of the Frame of Reference is located. It is important that the position of
the Patient and the origin are constant in relationship to a specific Frame
of Reference.“
(Part 3, p.83)

§ Origin arbitrary but fixed

§ RT-DICOM: FoR Relationship
Relating coordinate systems through
§ RT Structure Set
§ RT Plan

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 ‘DICOM in Real Life‘

The ‘Communication’ part works.

The ‘Interoperability’ part may be difficult.

§ Configuration
§ Label and ID Mapping
§ Interpretation
§ Optional Elements
§ Keep DICOM Elements in dynamic Objects
§ ...Errors in the implementation

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Configuration

§ IP Address / Host Name

§ IP Address Wrong IP Address
§ Upper/Lower case ADVSIM or advsim
§ Alias No / Wrong Alias (host, lmhosts)
§ Port Number
§ Wrong Port
§ Privileged Port 104, 4006
§ Application Entity Title
§ Upper/Lower case MyAETitle or MYAETITLE
§ Spaces MyAETitle _ _ _ _ _ _ _

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Label and ID Mapping

§ Treatment Units, Wedges,

Electron Tubes

Unit: Linac 1 Unit: Li 1

TPS Linac1
? R&V

Linac 1 Li 1
Linac 1Li 1
Lina Li 1
c 1
Linac 1Li 1

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Interpretation

+ =
Four Control Points

Three Control Points

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Optional Elements

§ Patient Position
§ Important for 3D Model
§ User interaction possible

§ Model Name of Imaging Modality

§ Adapt to specific ‘Interpretations’

§ Structure Set Reference in RT Plan

§ Reference to coordinate system used
(Frame of Reference)

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Dynamic Objects

Doctor’s
R&V
Console

Prescription
Patient Setup
Fractionation
Treatment Technique

Virtual
TPS
Simulation

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 ... anything is possible

§ Date of Birth
§ Patient’s Birthdate - (0010,0030) - Type 2 -
‘YYYYDDMM’ or ‘YYYY.MM.DD’
§ ‘_ _ _ _._ _._ _’
§ ‘99.07.05’

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 DICOM Tools

§ OFFIS DICOM Software

§ Agfa DICOM Validation Tool

§ Etiam DicomEye
§ eFilm
§ Others
§ ezDICOM, MRIcro, Rubo Medical, AccuView

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 OFFIS DICOM Software

§ Simple Routines
§ CTN, Store SCU/SCP,
Query/Retrieve
SCU/SCP, Worklist
§ Source Code
§ Different Plattforms
§ Windows, Linux, Solaris,
SunOS, OSF/1, Ultrix,
IRIX, NextStep
§ Some other DICOM Utilities

http://www.offis
http://www.offis..uni-
uni-oldenburg.de/
oldenburg.de/projekte
projekte//dicom/
dicom/project_dicom4.htm
project_dicom4.htm

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Agfa DICOM Validation Tool

§ Evaluation of DICOM Files

§ Evaluation of DICOM
network communication
§ Scripting
§ Own definition of Objects
§ Faulttolerant

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Etiam DicomEye

§ Viewer
§ Browser
§ Query/Retrieve
§ Cine support
§ DICOM Print
§ DICOM Dump
§ Easy to use
§ Affordable (790 EUR)

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 eFilm

§ Viewer
§ clean User Interface
§ several Series
§ Browser
§ Query/Retrieve
§ DICOM Print
§ Create Sub-Set
§ Nice DICOM Editor

§ Removes Pixel Size

(Sub-Set)
§ No RT support

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Osiris

§ Viewer
§ Browser
§ PAPYRUS format
§ Image processing

§ Old fashioned User Interface

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

 Other Tools

§ ezDICOM
§ Drag & Drop

§ MRIcro
§ ROIs, Image processing

§ Rubo Medical
§ Files, CDs

§ AccuView
§ Files, DICOM Info

§ Web Browser Plugins

Educational Course on DICOM-RT, Neuchâtel - 13 June 2003 Michael Neumann

Thank you for your attention.

Questions ?