1300 North 17th Street, Suite 900 Arlington, VA 22209, USA +1-703-475-9217 http://dicom.nema.org dicom@medicalimaging.org MINUTES DICOM Working Group Seven (Radiation Therapy) July 23 – July 26, 2014 Austin Hilton @ AAPM Members Present Austin, Texas USA Represented by W Th Accuray BrainLab Chris Pauer Christof Schadt AAPM Bruce Curran Elekta Jim Percy X Mevion Bruce Rakes Philips Medical Systems Varian Medical Systems WUSTL Michael Moyers Mark Pepelea Uli Busch Walter Bosch Yulong Yan David Wikler Members Not Present Philips Others Present(Observers or alternate representatives) Univ of Texas SW MS IBA Whenzheng Feng X X Sat X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X F X X X X Associated with x Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 Elekta Vastagh, Stephen Presiding Officer: 1. Bob Murry MITA X X X X X X X X Ulrich Busch, Chairman Opening The Chair called the meeting to order 13.00 on July 23. The agenda was reviewed, revised and approved. The antitrust rules were reviewed by the Secretary. The Meeting Minutes of the following meetings and t-cons have been approved: 2. 2.1 Face-to-Face Meeting March 2014 TCon May 27, 2014 Subgroup / Other Reports Experimental Implementation Subgroup (WG07-EI) W. Bosch reported on the available Segmentation objects on the secure ftp server. Parties interested in those objects should contact W. Bosch directly. Also, C. Schadt offered sample 2nd Generation objects to distribute to interested parties. 2.2 Supplement 160 (Patient Positioning and Workflow) U. Busch reported on the work of the joint positioning subgroup. Thomas Schwere of Varian is working on Supplement 160 as the main author. The latest version of Supp 160 can be found on the ftp folder and the DPDW profile is available through the IHE-RO wiki page. 2.3 Ion Subgroup M. Moyers reported on the Ion sub-group meeting in Shanghai. For details on the outcome of these discussions, please refer to the Correction Proposals RT61-RT65. In addition to that there were discussions on further CPs such as representing the rotation of the MLC on an Ion machine. Discussions also included that setup beams should be discouraged over time, especially when Supplement 160 is done. A further proposal for a CP was the definition of the calculation model and related parameters. It was decided that WG-07 will consider this. The ion vendors decided to have a meeting where they want to sort out during a testing session how an ion profile for IHE-RO could be developed. The ballot for a new co-chair will be sent out soon by Stephen. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 2.4 IHE-RO C. Pauer reported on the state of the planning committee(s) and how the re-structuring is going on. Also he reported on the new MITA RT-2 Standard and how this incorporates IHE-RO profiles. Also, he reported that IHE is about to become ISO-certified. U. Busch reported that the Ion and Brachy sub-groups of WG-07 will propose to the IHE-RO Technical Committee to join in the IHE-RO development for new profiles for these domains of RT. 2.5 Dose Reporting (WG-28 / WG-02) With B. Curran now being elected as President of AAPM and M. Pepelea not being able to report anymore, a new individual has to be found that would take over the job as a liaison to WG-28. Maybe a possible successor for Bruce could take over. 3. WG-07 Joint Meeting with IEC / IHE-RO Representatives This item was skipped, since no IEC / IHE-RO Representatives have been present. 4. Workflow, Quality, and Safety Ajay Kapur (Director of Medical Physics Department of Radiation Medicine, North Shore-LIJ) gave a presentation on approaches to analyze and address flaws and errors in the clinical workflow. WG-07 stated that those initiatives will be more efficiently supported as Radiotherapy moves to electronic workflow support, using DICOM Unified Worklist and Procedure Step protocol. This protocol infrastructure will improve the facilities to programmatically manage the workflow, reduce human errors and allow automatic monitoring and post-processing. The DICOM protocol specifications are pretty much in place. Therefore it will be to the most part a topic for IHE-RO to promote and specify electronic workflow implementations. 5. Brachytherapy Topics and Brachytherapy Subgroup (WG07Brachy) Discussion took place about allowing for channels without Control Points in 1st Generation. General consensus was that it is not advisable to make a change like this on existing 1st Generation objects, but rather start with the definition of a 2nd Generation object model soon where such a concept can be considered. It was discussed to send representatives of DICOM WG-07 to the GEC-ESTRO meeting. H. van Dijken is tasked to drive the cooperation from the DICOM side. 6. Supplement 147 (Second Generation RT) The following status information is valid at the time of the meeting. Due to the intended split of Supplement 147 some details may change. Information will be provided once changes are in place. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 Current Documents: Supplement 147 - Revision 42 (sup147_42.doc) Working version during the period of reading with WG-06 Reading Notes (Sup147_42 - Reading_Notes.docx) Continuous accumulation of changes made during the reading process, and tasks for modifications to be done offline in between the WG-06 Meetings. Documents are located on: ftp://d9-workgrps@medical.nema.org/MEDICAL/Private/Dicom/WORKGRPS/Wg07/Supp147 Current Process: Supplement 147 is in final reading with WG-06 prior to public comment. WG-07 does not further work on the document on its behalf. The review results of the WG-06 reading are continuously included in Revision 42 and reviewed by WG-07 as needed. Current Status: At time of writing this agenda: Five final readings (August 2013/October 2013/January 2014/March 2014/June 2014) have been conducted. Last WG-06 Review: June 2014. WG-06 Review ended before the line “Dosimetric Objective Sequence” (30xx,0942) in Table C.AA.B2-1.k Last WG-07 Review: TCon May 27, 2014 Next WG-06 Review: September, 2014. 6.1 Splitting Supplement 147 and new Process At the WG-06 meeting in June 2014, C. Schadt and some WG-06 members talked about ways to improve the reading process of Supp 147. This document is by far the largest supplement in DICOM and it turned out, that handling of supplements of such size is pretty difficult. Therefore the idea to split the current 2nd Generation supplement into smaller parts was established. After a presentation by C. Schadt and a discussion of the options it was decided to split up Supplement 147 in order to speed up the "release process" that comprises Reading for Public Comment, Public Comment and Trial Implementation. Respectively, this may then also speed up the Letter Ballot/Final Text readings. The proposed split of the document was discussed and it was decided to split along the following outline: Part 1: Physician Intent and RT Segment Annotation Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 Part 2: Radiation Set and C-Arm Radiations Part 3: Other Radiations Part 4: Dose Part 5: Informative Part 17 C. Schadt will prepare the first two supplements (Physician Intent/Segmentation Properties and C-Arm Radiation/Radiation Set) for the upcoming WG-06 meeting in September in DC, starting the last week of August. Document ownership until then will be with Uli Busch. 6.2 Reading Review June 2014 The group reviewed various issue of the Reading Notes, which are of common interest: R120: Proposal Accepted R121: Proposal Accepted R122: We keep it as is, with the same rational as it applies for basically all references in Composite Objects: The retrieval information may be outdated as some point, and the study / series information is part of the Common Instance Reference Module included on most of the IODs today. R130: Revised text of attribute Conceptual Volume Optimization Precedence (30xx,0933) R126: Talked about prescription parent child. We stated that we want to have a parent for a prescription in any case. Therefore we changed the type of Parent RT Prescription Index (30xx,0149) from 2C to 1C. This makes the requirement definition easier, since every prescription has always a parent defined, which is either the intent itself, or parent prescription. R132: Accepted, will be worked out offline following the review of CP_ RT61 R133: Text and attribute name has been changed during the meeting. Further on we decided to add a note to give hints to the implementer, what the purpose is. The concrete definition of the distance is anyways defined at the various locations. Additionally, at this occasion we detected that is maybe difficult to add other enumerated values later on. Therefore we decided to use codes rather than enumerated values. 6.2.1 RT Course Instance References (R123) Due to an illustration for the approval concept of instances referenced by the RT Course a discussion started whether all instances should be referenced from within a single sequence and only referenced by value from other locations within the RT Course (in the RT Course Associated Instance Reference C.AA.A7). Currently those instances are referenced at the location where they are used (e.g. Physician Intents, Radiation Sets) and only such instances Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 which are not directly referenced in any module of the RT Course are referenced from an additional sequence of instance references (e.g. Radiation Records). The approach using direct references at the places of use supports better perception of their role, importance and state in the context where they are used. Further on this approach also follows the direct reference approach as used in other IODs (which has the same advantages). The group agreed on keeping the design as it is and leaving the references within the context definition where they are used. The drawing under review will be updated by C. Schadt to make this difference clearer. 6.2.2 Conceptual Volume Neutrality The Conceptual Volume (CV) Macro points to a RT Segment Annotation IOD which makes the CV Macro very RT-specific, although the task was to make it generic so that it can be used in other domains as well. Therefore, the proposal is to make this more generic by introducing a domain-neutral referencing module which will then be a part of the RT Segment Annotation IOD. Use of the CV Macro in other IODs than RT 2nd Generation IODs will require to include the referencing module, but not more than that. The RT specific content will remain in another module, which is not assumed to be present in the CV Macro. C. Schadt presented a proposal, which was discussed, moderately changed and will be included in the current supplement after the meeting. 6.2.3 Radiation Set There was a discussion about whether the Radiation Sets can exist without referencing any Radiations, or whether a Radiation Set should be never empty (i.e. always reference at least one Radiation). The group did not have a strong conclusion, but finally decided to require at least one RT Radiation reference (i.e. no empty Radiation Sets). The topic should be re-considered at a following meeting to make sure, that the group re-confirms how to do that. The discussion also led to the fact that Setup Beams are not supported any longer in 2nd Generation RT Objects. Supplement 160 and the Discrete Positioning Delivery Workflow Profile by IHE-RO will address the issuing positioning instructions and handle the corresponding results. It was stated again, that the joint WG-07/IHE-RO sub-group on positioning is very active with monthly phone calls and is heavily working on the both the profile and the supplement. 6.3 Language Review Following a proposal of S. Vastagh, the group split up the reminder of the Sup 147 document which is not yet reviewed with WG-06 into 5 parts. Those parts have been assigned to C. Pauer, R. Murry, W. Bosch, B. Rakes and J. Percy as native English speakers to review wording grammar etc. during the evening. The review turned out to be pretty useful and the results have been collected at Friday morning and partially reviewed. They will be integrated into the working document after the meeting. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 6.4 Dose Uncertainty Following some CP discussions, WG-07 recognized, that representation of uncertainty data are not yet covered in both 1st and 2nd Generation. However, many TPS start to calculate uncertainty data for dose and alike. Therefore WG-07 should look into what is needed for 1st Gen Doses and what is introduced or missing in Sup 147 in that respect. Based on that analysis, we will re-visit the 2nd Gen Dose Image objects and alike in the context of the now separate supplement for Dose Image. An ad-hoc group was established with Y. Yan and W. Bosch. 7. CPs For detailed status and history, see actual version of WG-07_ChangeProposalStatus_YYYY-MM-DD in the WG-07/CPs subfolder. Documents of CPs itself are located on subfolders there. 7.1 Information about CP status The following CPs are ready for the next Voting Package: Not known at the time of writing the Notes The following CPs are part of next Letter Ballot: cp1360 - Add Performed Procedure Step Comment to Module Definition The following CPs are Final Text: cp1203 - PDR pulse details in RT Brachy Session Record cp1331 - Treatment Time in RT Plan cp1343 - Add Patient Photo to Patient Identification Modules cp1344 - Clarify Type Requirements In Unified Worklist 7.2 CP Proceedings cp_RT55 - Include Motion Mode Permission in RT Tolerance Table Kevin O'Donnell of WG-21 joined the group to support the discussion. Based on Kevin O'Donnell's inputs it was determined, that it is currently not indicated to try to include that feature into Sup 121 or any other imaging object at this time. However, the proposal should be neutral to modalities, so that it may eventually be used by other modalities than Radiotherapy later on. U. Busch will work out a proposal. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 cp_RT60 - Brachy Delivery Instruction WG-07 was informed about the status of that CP: The Brachy Subgroup has determined that it is needed to work on interface definitions between TMS and TDS, since vendors have started worklist-based implementation. Since the approach of IHE-RO TDW profile is suited as well, a similar interface notion is indicated. Therefore a Brachytherapy Delivery Instruction should be introduced. Based on an early proposal by Harold Beunk in the context of Supp 74, which went dormant, this CP will propose such a Delivery Instruction. The CP will be further worked out in the Brachy Subgroup to get a consolidated version for first WG-06 presentation. WG-07 had no further comments on the CP at this point in time, but supports this notion. The Brachy subgroup will continue with the CP. cp_RT62 – Add Beam Effective Dose in RT Fraction Scheme Module Some discussions about use and possible solutions. WG-07 proposed to re-design the tags, by Version 02. Will go back to WG-07 Ion Subgroup. cp_RT64 – Add Support for Ion Therapy Scanning Modes WG-07 proposes minor changes, mostly on representation of examples, by Version 03. Will go back to WG-07 Ion Subgroup. cp_RT65 – Add Motion Management Parameters WG-07 added an alternative proposal, giving a bit more structure, by Version 02. Will go back to Ion Subgroup. cp_RT66 – RT-specific KOS Codes The group discussed the approach to use Key Object Selection IODs in a separate session - see section 'Data Set References: Key Object Selection IOD ' below. C. Schadt will work on list of codes, B. Murry and W. Bosch will review. cp_RT67 – Dose Volume UID The group discussed what the scope of a Dose Volume UID is. We need to specify, what constitutes the conditions when various Dose IODs may and/or should share the same UID. Another question is, why the current attributes in the dose (which tell the scope and contex the of dose, i.e plan scope, beam scope, FOR etc.) are not sufficient to identify, that several dose objects belong to the same dose concept (identified by the envisioned UID). It was identified, that one driver of that proposal is, that there are systems which do not work with a DICOM plans yet, and for those the proposed UID maybe a mean to identify the same dose scope. But this should be rather perceived as a transitional issue and may not constitutes a sufficiently strong reason. A possible thread with this UID is, that it maybe easily mis-used by implementers for various other purpose, when the definition is not sufficiently strict and spelled out. Christof will look into Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 a possible definition of the dose scope UID and put up some use cases, which answers those questions. W. Bosch will serve as the peer reviewer. cp_RT68 – New Query/Retrieve Services This CP is used a starting point for WG-06, we requested be them. WG-07 is interested in those Services and looking forward to WG-06 proposals. Work on this proposal will continue within WG-06 for now. cp_RT69 – Additional SSD Information The situation is similar as the Beam Dose (see CP-RT62): The current use of Source to Surface Distance is used in both ways: Annotating the distance to patient skin – or annotating the distance to patient and patient support devices etc. . Therefore the group agreed, that we want to have both information explicitly supported. SSD definitions may serve the dosimetric regime, esp. for QA, and/or for collision avoidances. Because of the complexity of collision avoidance, and because the devices relevant for collision avoidance do not work with DICOM objects and can never rely on those completely, the standard will not address collision avoidance. Yet the dosimetric regime should be supported in all aspects. The SSD definition and the Coding for structures in 2nd Gen should be revisited to ensure, that we are explicit is the definition whether patient support devices etc. are included in the SSD or not. B. Curran will take this to the AAPM Therapy Physics Committee Meeting at minimum as email discussion and come back to WG-07. In parallel, WG-07 will work out a possible solution for the expected need. C. Schadt will do so, with M. Moyers and B- Rakes as peer reviewers. cp1288 - Add templates and code definitions for QAPV support D. Clunie proposed to not use an SR, but a regular IOD for the QAPV Reports. C. Pauer will work on the CP until the next IHE-RO TC meeting after ASTRO in San Francisco to re-write it as an IOD, and U. Busch will contribute. C. Schadt mentioned that there is some urgency, as the QAPV profile for which this CP was created is referenced from the new RT-2 standard that might be ready by the end of the year. cp1419 - Correct Sequence Level of Procedure Step Cancellation DateTime (new to WG-07 as RT59, but already got a number in WG-06 June 2014 Meeting). Editorial change only. cp1420 – Support for Multi Slab Block in Ion Plan (new to WG-07 as RT61, but already got a number in WG-06 June 2014 Meeting). WG-07 proposes various changes, by Version 02. Will go back to the WG-07 Ion Subgroup. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 cp1421 – Support for Mean Excitation Energy (new to WG-07 as RT63, but already got a number in WG-06 June 2014 Meeting). WG-07 proposes some minor changes only, by Version 02. Will go back toWG-07 Ion Subgroup. 8. 8.1 New Objects Data Set References: Key Object Selection IOD CP_RT66_RTSpecificKOSCodes_01 was discussed in this context. The KOS approach was reconfirmed. Along what we stated in earlier WG-07 meeting, we need 2 levels or organization (see e.g. Plan comparison use case). To accommodate this and since the KOS object only support one level, a tree of KOS object will be needed. Some small overhead to handle a KOS object trees is certainly compensated be the possibly re-use of the smaller KOS scopes in different use cases. Coding: Eventually, the primary level codes are sufficient, since the second level codes (like CID 70N1 as in Version 01) do not bring a lot additional semantic – it is more of a modifier. Further on, since there is only one level of organization available for the referenced objects – i.e. there is only one list of objects in each KOS which is coded, the primary code can already provide sufficient detail. The next step is to define the list of CIDs and find out whether a one level definition of codes is enough or if for some use cases a more detailed code will be necessary. C. Schadt to proceed with cp_RT66. 8.2 Companion Objects The current state and possible solutions were discussed. After input from David Clunie it was decided to not define an SR, but a regular IOD. The agreement is that a draft for new modules shall be created now and with this draft further decisions can be made, such as whether we want to have a single IOD or two IODs. CT calibration information (HU to electron density mapping) could also be stored along this effort. It was also mentioned that Dose Commissioning information is missing in the current draft of the data model and that it should be added along the further discussion. The same is true for information for Ion and Brachy Modalities, as they have interest in storing similar information. The chairmen will search for a way to store proprietary information for all parameters in the Dose Companion Data Model. B. Curran will find some physicists to assist on the detailed definition of the data. B. Murry will be the chairman of a Companion Object sub-group which is tasked to have a first draft for the November meeting. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 The content already identified to be included is available in the Meeting Minutes of WG-07 of March 2014. 9. Query / Retrieve The cp_RT68 is now available as a seed for WG-06 to proceed with that topic. 10. DICOM 2nd Generation Outreach and Education There was a discussion on how to proceed with the introduction of Supplement 147 to the engineering personnel of the RT vendors. A 1-2 day engineering session in the Madison/Chicago area to provide ramp-up and training on 2nd Generation DICOM RT is one option. Focus on first (split-out) Supplement was proposed, which would be RT Physician Intent, RT Segment Annotation and Conceptual Volume. However, as time allows also other concepts of following supplements on RT Radiation and RT Radiation Set could be covered. 10.1 Timing It is expected, that after the split we would be able to finish Reading with WG-06 on the first supplement (Physicians Intent and RT Segment Annotation) by the WG-06 Meeting starting November 14, 2014. The Public Comment (PC) period could be started pretty much a few days after that date. In case we want to hold the training session prior to PC, the week starting November 17 is certainly the only option. The following weeks are not suited because of Thanksgiving and RSNA, and December dates will be too late in the year. Starting November 17 may conflict with the WG-07 Ion Subgroup though, which during their June Meeting envisioned to hold an informal testing event in that week (out of the same constraints). There have been also considerations that it may be better to have training after the start of PC, but within the PC period. The start of the PC would signal to the public, that a comprehensive review is now indicated due to the availability of an official publication (rather than on current preliminary versions). During a training timed as such, attendees may come up with elevated questions originating already from reviews they performed. In this case the event would be held in January / February 2015. Another idea was to take part of WG-07 in November, which would be prior to finalizing the Reading with WG-06. However, we have other business to do in WG-07 as well, which will be delayed in this case. From a content point-of-view it would be possible even before WG-06, since it can be expected that the following Reading will no longer fundamentally change any concepts. Yet another idea brought up was to conduct the training as Web-based virtual classroom sessions, as an alternative for face to face meetings. While face-to-face trainings allow much more efficient presentation and discussions, Web-based training sessions would lower the bar for people to attend, given their other duties. Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 10.2 General Training Event Attributes The goals of those training events are: To be able to read the supplement, perform an efficient and substantial review and provide comments in the public comment phase To be able to propagate 2nd Standard for Implementation later on Other purposes (like the business presentation to promote the standard etc.) may still be addressed on future occasions as well, but are no focus of this event. Audience: System Architects, System Engineers, Tech Leads: Engineering personal, whom are involved in architecture, design and/or implementation where the DICOM Standard is relevant. Although not excluded but not expected are Implementation Engineers to a bigger extend. Just as a watermark, a possible number of attendees mentioned by some vendors is in the range of 2-5 people per vendor. Institutions like academic facilities or hospitals are of course invited as well. However, it must be announced clearly that the focus will be on engineering level, so that there are no wrong expectation (e.g. attendees focused on end-user perspectives may not get a lot out of that meeting). 10.3 Meeting Options In Person Training Session In case of any F2F we are looking for a 3 days meeting with 2 overnight stays only for most of the (US) attendees. A possible layout of a face-to-face training session could be as follows: Day 1 o Start at 13:00: Presentations o Evening: Open informal discussions, combined with Dinner Day 2 o Morning I: Plenary Session o Morning II: Breakouts o Afternoon I: Plenary Session o Afternoon II: Breakouts o Evening: Open informal discussion, combined with Dinner Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 Day 3 o Morning: Plenary (mostly Q&A), Outlook o Closure at 12:00 Location: Chicago (as a central location with good flight connections) Possible venues: o Brainlab o RSNA Web-based Classroom Training Could be an offer of several dates, along time zones 2-3 hours Video-Conferencing sessions 10.4 Further Proceedings Vendor representatives should ask internally for the preferred methods (Face to Face, Web-based Training). J. Percy proposed to hold a survey to find out the best option and vendors / institutions readiness for sponsoring the intended audience to attend. U. Busch will initiate the survey. During ASTRO, we will hold an informal session with the WG-07 members to determine the approach. Details will follow (we may ask the IHE-RO TC to donate one hour for that business, since most WG-07 attendees are usual attending the IHE-RO TC as well). 11. Time, Place and Topics for Future Meetings 11.1 WG-07 The following WG-07 meetings are currently scheduled: Mon, November 3, 2014 – Fri, November 7, 2014 (12:00) MITA, Washington Dates for 2015 will be informally defined in coordination with IHE-RO TC at ASTRO 2014 (following the WG-06 Meeting in September, where the WG-06 meetings for 2015 are determined). Final definition will follow at latest in the WG-07 Meeting in November. Spring Meeting 2015 (March/April) (prior to WG-06) Wed, July 15 – Sat, July 18, 2015 following AAPM, Anaheim, CA Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014 11.2 Autumn Meeting 2015 (November/December) (prior to WG-06) WG-06 WG-06 Meetings: September 8 – September 12, 2014 Washington November 10 – November 14, 2014 Washington 11.3 Other Meetings of Interest ASTRO Sun 14.09.2014 - Wed 17.09.2014, San Francisco, CA RSNA Sun 30.11.2014 - Fri 05.12.2014, Chicago, IL AAPM Sun 12.07.2014 - Thu 16.07.2014, Anaheim, CA ASTRO Sun 18.10.2014 – Wed 21.10.2014 12. Adjournment The meeting was adjourned at 12:10 PM on July 26, 2014. Reported by: Ulrich Busch, Chair, Christof Schadt, Vice-Chair , Stephen Vastagh, SecretaryReviewed by legal Counsel: Clark Silcox Working Group Seven (Radiotherapy) of the DICOM Standards Committee July 23-26, 2014