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) November 18, 2013 – November 22, 2013 MITA Offices Arlington, VA USA Members Present ATC/Wash. U. St. Louis AAPM Brainlab Elekta Varian Medical Systems Represented by Walter Bosch Bruce Curran Christof Schadt Jim Percy Ulrich Busch M x x x T x x x Members Not Present Accuray * Optivus Proton Therapy * Hokkaido University * Mevion Med. Systems * Moyers, Michael Siemens Healthcare Voting Representative Chris Pauer Michael Baumann Hiroki Shirato Bruce Rakes Michael Moyers TBA x Alternate Voting Representatives, Observers, Others Present Affiliation Henk Van Dijken Bob Murry Stephen Vastagh Elekta Elekta MITA Th x x x F x x x x W x x x p x x x M T W Th F x x x x x x x x x x x x x x x (* = Does not count toward a quorum, p = Phone and/or web, x = Present) 1 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 Presiding Officer: 1. Ulrich Busch, Chairman Opening The Chair called the meeting to order at 9:00 am USA Eastern Time. 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: Face-to-Face Meeting August 2013 Tcon August 26, 2013 Tcon Sep 3, 2013 2. Subgroups 2.1 Experimental Implementation W. Bosch reported that there is currently no progress. Two documents produced to date: Private tag white paper. Segmentation paper. Preliminary instances uploaded to ATC server: Segmentation, Segmentation Properties, Radiation, Radiation Set, Physician Intent The group had some discussion on how this should proceed as Segmentations are defined and further steps would be required. It was decided to re-visit this topic, after discussion of “New Objects” agenda item. 2.2 Brachytherapy group H. van Dijken reported on work in progress; many CPs are in preparation. The group is growing. AAPM Brachy group is involved (Larry DeWert). Outreach to GEC ESTRO group (esp. BRAPHYCS) is in place. There are also interoperability issues that the Group will address. As first tangible result, CP1203 is now finished and submitted to WG-07 for review, prior to submission to WG-06. The demand for development for 2nd Gen Brachy radiation has been expressed. 2.3 [Patient] Positioning Workflow - Supplement 160 C. Schadt reported that there is currently no activity. There was a discussion on where priorities should be in the future. The work will now resume in coordination with IHE-RO DPDW Profile development 2 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 Group. Efforts need to be balanced with adoption of workflow in treatment planning: TPS-side needs to be triggered to start issuing 2nd Gen objects in order to get start the process. This led to the discussion of existing clinical solutions: it was decided to invite academic workflow presentations on “Current Investigations into Planning Workflow” (Washington Univ., Long Island Jewish Hospital, and others….) The next WG-07 meeting at AAPM will start one day earlier (on Wednesday) for these presentations. The DICOM – related issues are: What data are needed for the work flow: How can DICOM support these efforts? 2.4 Ion Subgroup U. Busch reported on behalf of the sub-group chairman that there was a next meeting planned beginning of next year in Japan (22-28 January 2014). Another one was tentatively setup at PTCOG (Shanghai, June 2014). S. Vastagh noted that this meeting will not be held. There was a discussion about how to continue the work of this Group and organize the next meeting. It was noted that the new proton technologies are not supported by the 1st generation Ion Supplement. 2.5 IHE-RO Reported by Bruce Curran: Three working groups are set up to work on new profiles. 1. Data Transport – sub-profiles on transparency and data storage in archives, also includes Q/R 2. General Issues – exchange between RT and HIS 3. Consistent Patient ID – CT Sim Profile Clinical impact statements on various existing and new profiles are being developed. The new IHE-RO structure within ASTRO was reported. The chairman asked for an overview of the new structure. It is considered that IHE testing may become ISO/IEC compliant – recognized by regulatory agencies as appropriate for product submissions. IHE-RO Testing and Tools Group is revamping Gazelle to meet standards requirements. Other topics are licensing of test procedures: protection for IHE intellectual property. IHE-RO has the approval for two IHE-RO connectathons in 2014. RO participation in North American and European connectathons has also been discussed. There are differences in economic model for the two Connectathons. IHE-RO remains sufficiently unique in content but increased imaging integration will probably create more common ground with radiology IHE. 3 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 2.5.1 Areas of involvement of WG-07 WG-07 has to support the development of the Data Transparency Profile by developing the necessary Query/Retrieve extensions. Another topic for WG-07 is to determine, where the boundary is for use of HL7 versus DICOM in Patient Header conciliation in the context of interoperability with HIS systems. The discussion led to concluding that there is a need to take a closer look at the Post-Acquisition Workflow Profile which includes the DICOM Part 19 “Application Hosting”. This profile may serve as a pattern/starting point. For information and education, C. Schadt gave a presentation on Application Hosting (DICOM Part 19) to broaden the common understanding. 3. Other WGs / Supps 3.1 WG-28 WG-28 works on a new Patient Dose SR template that extends the existing Dose Reporting SR. The AAPM Task group considers a coarse imaging dose (maybe even just 1cm resolution) to be reported. Recommendation is that imaging dose from patient positioning should be taken into account if the imaging dose exceeds 5% of the therapeutic dose. Recommend that TPS be configured to compute KV organ dose from imaging and report tables of (non-volumetric) organ doses per procedure. WG-07 decided that any major enhancements to account for imaging dose be deferred to 2nd Gen objects. Minor changes, e.g., flagging dose using new Defined Terms (for Dose Summation Type?), may be addressed in the interim. There was a discussion about what WG-07 can do regarding Dose Reporting. There are no technical obstacles to the use the existing Dose SR for CBCT, MVCT, 2D kV imaging. It was decided that currently nothing needs to be done as the existing SRs can be used and it is only an issue whether the vendors implement it in RT. This topic was deferred to the MITA RT Section for further discussion. 3.2 Sup 121 Sup 121 defines a non-patient-centric composite object. As this and other profiles are now non-patientcentric, the discussion came up to utilize DICOM for the ROI Templates and the Machine Characterizations which had been rejected by this group until now. U. Busch and C. Schadt may review this supplement offline. Although Sup 121 is in Public Comment, it is not expected to move forward in WG-06 until perhaps as late as June 2014 but certainly not before March 2014 due to extensive user review being conducted.. 3.3 Sup 167 This supplement contains an informative annex in Part 17 on 3D Angiographic Imaging. 4 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 This is of interest to the group, as it covers basically cone-beam CT (3D reconstruction of C-arm x-ray imagers) 4. IEC U. Busch gave a presentation as a base for discussion with the meeting with IEC in order to define the common areas of interest and responsibility. Some aspects mentioned are: IEC coordinates are useful for C-arm-like geometries, but ranges (0-359 degrees for angles) are problematic. DICOM is referenced in some old IEC Technical Reports; however, some are confusing and should be retired. A draft MOU between DICOM and IEC regarding coordination of standards between DICOM WG-07 (Radiotherapy) and IEC 62C (Therapy) WG-1 (Teletherapy) document was presented that, if agreed upon, could serve as the common understanding of domain responsibilities. The approach was discussed. U. Busch and B. Curran will finalize the MOU to have a candidate document in case it is determined to be useful. Both will explore options to increase coordination with IEC 62C WG-1, including increasing the level of our liaison status with IEC to increase our awareness and ability to respond to IEC activities. Contacts will be Geoff Ibbott as chair of 62C and convener of WG-1. Pfeiffer and DeWert are liaisons. Moyers, Bova, Galvin, Cohen are among other U.S. delegates. 5. New Data Objects (In the following the term 'Plan' is used informally to annotate everything related to a Radiation Set). Three new objects were initially proposed in order to explore their scope and related use cases: Data Set Reference Object Treatment Plan Object Dose Evaluation Object As it was not clear whether these objects would be sufficient, or more or less would be required. Use cases were evaluated in order to determine the need for new objects (see related brain-storming documents in past meeting folders for details.) Some use cases have been already described in the White Paper 'Data Set Reference DICOM object,' dated November 03, 2011 (see Inbox of Meeting folder of 2011-11-07). The base motivation was that when the 2nd Generation RT Objects will be introduced where a managed workflow will not yet be in place, there will be no facility to convey a conceptual treatment plan. That applies especially when “plans” are to be exchanged between systems which are not directly treatmentrelated, such as treatment planning systems or review stations. On the other hand, retrieving archived “plans” is also hardly possible with the current structure of the 2nd Gen Objects, as the number of objects created during planning time will be extended by the objects during treatment. Although the RT Course object has references to almost all of the objects, it does not completely cover everything, especially not those objects that were only “related” to the planning process. The Group further discussed this area in depth. Following that, the Group analyzed use cases and established a list of input and (partially) output objects to determine the reference data structures to be supported. 5 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 The results are as follows: Objects of interest: Data Set Reference Object Would be needed Currently it is not clear, if this is a plain list of instances with no further semantics for easier re-use or rather a report-style object that includes relations and use-case-related semantic Plan Object It seems that there could be a need for that No further evaluation was performed Report Objects SR object definitions that serve the purpose of reporting e.g. dose review, plan review. No further evaluation was performed Dose Companion Object Object that will be the result of plan optimization/dose planning that could include optimization parameters, general dose algorithm parameters and vendor- or algorithm-specific parameters related to dose planning Generally we determined a broad need to develop Reports as output and potentially also input for RT Use Cases. Characteristics of Data Set Reference Object: 1. First-level clusters need to be available for high-level sorting of inputs (basically per line of the Use Case Analysis Excel) 2. Second level clustering needs to be available, since sole organization along SOP Classes is not sufficient. (e.g. to differentiate Planning CT Image Sets from Treatment CT Image Sets) 3. Further level organization may be useful, but there is no clear indications for that yet. 4. Technically, “levels’ above do not suggest leveling of DICOM sequences. It may be represented differently, e.g., by a plain list of clusters, which are organized by a referencing cluster in a data structure in parallel (but inside the IOD). 5. Use case inputs should always work with one IOD only. (i.e. Reference Container IODs should not reference other Reference Container IODs) 6. The Reference Containers should be neutral in just holding references. Purpose should be represented outside. 7. We want to have one part, which is semantically neutral and collect the references. It should have the ability to have multiple clusters (subset). 8. KOS IOD was inspected and has a plain list of references. This may be not sufficient. Questions on Data Set Reference Object: 6 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 1. Object references, type, and purpose/context 2. Internal structure vs. recursive references to object reference objects. What is the scope of the referenced objects? Especially: Is it sufficient to reference the top-level root objects of a cluster – or do we unnecessarily prevent use of the clusters by applications which do not understand the all object detail 3. Data set reference support for workflow – keep procedure instruction IODs, result reports (IOD/SR) and annotation (IOD/SR) separate 4. Collections of objects may be used both for integrated workflow and for export of data for detached mode operations, e.g., clinical trials/registry submissions. 5. It is not clear yet, whether we want to have the Data Reference container and the semantic content in 2 separate objects or in one combined one. The separation would better facilitate general interoperability. On the other hand, the discussion of data set reference object almost always included immediately the semantics of the references – therefore a separate object only handling references may not be of interest as such. Overall the discussion established a good basis of both consistent and disputed viewpoints. It was unambiguously decided that there is a need to have additional objects in the scope outlined. All materials related to the foregoing will be posted in the following folder. It may be reorganized when work items, work groups or other ways of organizing will be decided by this Group. ftp://d9workgrps@medical.nema.org/MEDICAL/Private/Dicom/WORKGRPS/WG07/Other/NewObjects Particular attention is called to the following items in that folder: The Use Case Excel worked out during the meeting Some sketches of Data Set Reference options of that meeting Mind Maps having been prepared by C. Schadt and further modified during the meeting ACTION: An ad-hoc Data Set Reference Subgroup was established: Christof Schadt Walter Bosch Bruce Curran Bob Murry 6. Supplement 147 6.1 Current Documents Current Documents are the following: Supplement 147 - Revision 42 (sup147_42.doc) Working version during the period of reading with WG-06 7 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 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 6.2 Current Process: Supplement 147 is being reviewed by WG-06 in order to approve it for Public Comment. WG-07 completed its work on the document. The review results of the WG-06 reading are continuously included in Revision 42 and presented to WG-07 as needed. Two final readings (August/October 2013) have been conducted. The reading proceeded to C.AA.2.17 External Beam Control Point General Attributes Macro. Various small to medium changes have been made during and following the WG-06 review sessions. Many of the changes are clarifications and about the structure of the specification. A few changes include semantic aspects. 6.3 Review of WG-06 Findings: Wg-07 reviewed various findings and their resolutions as proposed by WG-06 or the Chair and Vice Chair of this Group who are making the presentations to WG-06. The following points are important to be mentioned explicitly: During last WG-06 review, the macro title “Conceptual Volume Segmentation and Combination Macro” was perceived to be misleading since it could be understood also as a verb, indicating that segmentation takes place in this macro. WG-07 now proposes to take "Conceptual Volume Segmentation Reference and Combination Macro". The conceptual volume macros have been reduced from 4 to 2. There is the base "Conceptual Volume Macro" and the "Conceptual Volume Segmentation Reference and Combination Macro". The former 2 other macros indicating whether the conceptual volume has to be segmented of may be segmented has been removed. Instead, that indication is provided at the invocation of the macro defining the allowed values for Conceptual Volume Segmentation Defined Flag (30xx,1311) ("YES or NO", versus "YES" only). The 'Device Identification Macro' now contains a 'Regulatory Device Identifier Sequence' (30xx,5031), which allows to hold identifiers like the device UDI requested by FDA. CID SUP147053 was introduced for that purpose. All of the 3 macros 'Treatment Device Identification Macro', 'RT Patient Support Identification Macro' and 'RT Accessory Device Identification Macro' now contain the following 2 macros: 'Device Model Macro' and 'Device Identification Macro'. This streamlines the devices descriptions and removes unnecessary differences. WG-07 discussed the topic of naming of meterset attributes, i.e. whether to use ‘Cumulative Radiation Meterset’ or ‘Cumulative Meterset’. To void suggesting, that the meterset directly 8 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 indicates the amount of Radiation, the attribute name was changed to Change to ‘Cumulative Meterset’. WG-06 asked, whether it is necessary to specify symmetric mode and alike differently than any rectangular shape in the ‘Outline Macro’. WG-07 confirmed that it is OK to remove Symmetric and Square annotations and cleaned the attribute requirements. Reviewed change in Control Point section (C.AA.2.16.1 Control Point Attribute Requirements) and approved changes. Discussed area of Delivery Rate (formerly Primary Meterset Rate), also section C.AA.2.17.1.12 Delivery Rate. Decided to use 'Delivery Rate' as attribute name since it is not always tight to a meterset. Further on made presence of Delivery Rate depending on real-world condition, whether the device needs that rate. Simplified the unit specification by always requiring a unit whenever Delivery Rate is provided. In that context, changed Primary Radiation Dosimeter Unit (30xx,5113) to be a sequence of codes to make it extensible by Committee. Added CID Sup147055 Radiation Dosimeter Unit Sequence. Two new issues - to be clarified later- were found C.AA.2.12 RT Patient Support Devices Macro: Do we want to model table parts (esp. table top inserts etc.) as well, e.g. as a part sequence in that macro. Do we see that as a part of the Patient Setup IOD? The topic should be re-visited at the WG-07 Meeting in April 2014. How to specify the format of barcodes, RFIDs etc., in respect to Device Alternate Identifier Type (30xx,1327). This is expected to be re-visited at the WG-06 Meeting January 2014. 7. CPs (Correction Proposals) 7.1 CP 1319 The CP was discussed extensively and the White Paper ' DICOM Frame of Reference: issues and proposal' dated November 21, 2012 was visited (the white paper is available in the CP1319 folder). The rationale for the CP has been recognized and shared as putting reasonable forward potential issues with frame of references. WG-07 did not conclude to support that CP as is, but supports and asks for further discussions on that CP, especially by WG-06. Both the Chair and Vice Chair of this Group will be present at the January WG06 meeting. They will address the following issues: Do we really need the capability to reference more than one FOR (despite of Registrations?) The selection of instances used for evidence (what are criteria, how should they be selected?). How to find the canonical? Would it be sufficient to have only a series UID? Aren't series sufficient consistent within their objects – respectively do we need sub-series selection as well? Should it be allowed to accumulate various objects in there to represent a comprehensive collection of objects having been involved while creating the object – or should it be restricted to a minimum set? 9 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 How can we increase the probability that no inconsistencies among referenced objects occur, especially when the inclusion of a large mixture of FORs and objects is allowed? How can it be prevented, that trees of references are established (esp. be separate applications) which are combined on a higher level through some other objects? Should we restrict the references to the objects 'lowest' in the geometrical hierarchy (e.g. somehow restricting the allowed references to images?) 7.2 RT39 Moved to closed status. No further input was received. (General note: Such CPs are moved to 'Finished' subfolder when no further proceedings are planned, but can still be found therein). 7.3 1203 The group had a longer discussion and made some changes. Those changes do not affect the purpose and approach, rather than try to strengthen the proposal. Revision 15 contains those changes. The Brachytherapy subgroup should review the changes. If the subgroup does accept the CP as is, it will be submitted to WG-06. 7.4 1331 WG-07 decided to drop the Calculated Treatment Time (this should also happen in Supp 147). With that change this CP should be put forward to WG-06. 7.5 1343 WG-06 approved the concept.. The group had a short discussion whether this touches areas of other domains such as HL7. HL7 and DICOM UPS will always have some overlapping areas, which does not suggest automatically normalizing the protocols and using them in parallel (often this maybe to inefficient or not even an option from the type of applications). Therefore some data may legitimately appear in both protocols. WG-07 leaves it to WG-06 to eventually raise architectural aspects. 7.6 1345 This CP will be needed for application of UPS in treatment sessions due to the number of steps modelled by UPS, which in turn need to be partitioned as a groups of related in many cases. 8. 2nd Gen of the Standard - Educational Conferences 8.1 DICOM 2nd Generation Conference WG-07 discussed the options for information, education and advice on the purpose and introduction of DICOM 2nd Generation. The following audiences and proposed activities have been identified: Business Level (Engineering Managers, Business Managers): 10 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 Create a business presentation distributable to all vendors. A recorded presentation will be useful. Distribute to all vendors (executives) Present to the MITA RT Section Engineering (Systems Engineers, Architects, Implementers, Experts): Create a Recorded Presentation: Can be distributed and listened to offline Offer 2nd Generation Workshops (in the range of 2.5 days) Intro: Issues with first Gen, Architectural and Design Approaches Area 1: Prescription, Conceptual Volumes, Area 2: Radiation Sets, Radiations, Doses Area 3: RT Course, Relations in general, how it work together Implementation strategies, Transition Hands-on: Small groups to develop the use of 2nd Gen in certain use case. Present the results. Those hands-on sessions should be performed after each block Possible Venues for related activities: RSNA 2013 Gather contacts for both audiences AAPM 2014 Hold Session on 2nd Gen Last possibility to gather contacts ASTRO 2014 Common Purpose Presentation Action items: Check point: February T-Con Collect contacts All (at any occasions possible) Provide contacts to the Chair Business Presentation Christof Schadt (lead), Bruce Curran, Jim Percy, Mark Pepelea, Bruce Rakes. Engineering Presentation Uli Busch (lead), Walter Bosch, Bob Murry Engineering Workshop Planning (until Feb 2014: Agenda, Curriculum, Materials) Uli Busch, Christof Schadt 11 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 AAPM Presentations Bruce Curran, Uli Busch, Christof Schadt 8.2 Outreach of 2nd Generation WG-07 discussed the topic of outreach for 2nd Generation and the possible approaches of adoption of the new Standard. Eventually, it is an option to use IEC in a similar way as for first generation: is there a value in proposing an IEC Technical Report for DICOM? This option should be further explored. The Staged Implementation Approach could look like as follows: 1. Prescription in context with IHE-RO 2. RT Segment Annotation: Link to the prescription. Provides the RT payload (which is not included in Segmentation and Surface IODs). Esp. replacement of RTSS by Segmentation drives the need RT Seg. Annotation That also removes optionality we currently have. As it may be relevant by that time: Allows support of multi-frame images as well. 3. Radiation Sets / Radiations for new modalities Understood and issued natively by TPS, which can plan radiation for certain modalities (esp. the ones not covered by 1st Gen) or all modalities. TMS should be enabled to handle the Radiations transparently for some modalities (as there is no need to understand those in details, as today) 4. Finalization by introducing the other objects. 9. Future Work WG-07 will submit two new work items for adding Brachytherapy and Ion Radiation Objects to 2nd Generation Standard now under review by WG-06: Brachytherapy Object in 2nd Generation RT Ion Therapy Object in 2nd Generation RT Those work items will be considerable smaller than the 2nd generation Standard itself (Supplement 147.) 10. Policies for use of the DICOM WG-07 Mailing Lists The following position statement of this Group was decided: The DICOM WG-07 mailing lists are established to facilitate communication of WG-07 on development of the DICOM standard, about the proceedings of WG-07 and generic topics related to the use of the standard. The communication may only refer to the specifications of the standard itself and classes of applications in case needed. Especially, no references should be included to specific vendor implementations, products or clinical sites. The Anti-trust rules for meetings apply to written communications, as well. If questions, members should contact the Officers of this Group and the 12 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 Secretary, in advance. To clarify the appropriateness of some intended communication. Detailed discussion of technical implementation and application and specific scenarios or product issues should be held in the Google group for DICOM. There is also a Yahoo group on the topic of DICOM RT, which appears rarely used. The chair will contact the mail list owner, Mark Bloom, and advise that the Google group appears to be monitored by more DICOM experts, perhaps consider moving those discussions to the Google group for more exposure and visibility. Stephen Vastagh will explore adding mailing list use policies to the DICOM procedures perhaps just extending the Guidelines for conducting meetings. 11. Agenda for the Next Meetings Topics for the next meetings will include: DICOM 2nd Generation: what is the definition of 'Plan' in the 2nd Generation Standard? New Objects discussions 12. Time, Place and Topics for Future Meetings 12.1 WG-07 The following WG-07 meetings are currently scheduled: Tcon: Feb 11, 2014, 11:00 – 1:00 EST In Person: Mon, March 24, 2014 – Fri, March 28, 2014, 12:00 Location: Washington Wed, July 23, 13:00 – Sat, July 26 2014, 12:00 AAPM, Austin, TX Mon, November 3, 2014 – Fri, November 7, 2014 (12:00) (location TBD, seeking hosts) 12.2 WG-06 WG-06 Meetings (in Arlington, VA, unless otherwise stated): January 6 – January 10, 2014 Washington March 31 – April 4, 2014 Washington June 23 – June 27, 2014 Edinburgh , UK 13 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013 September 8 – September 12, 2014 Washington November 10 – November 14, 2014 Washington 12.3 Other Meetings of Interest 13. ESTRO Fri 04.04.2014 - Tue 08.04.2014, Vienna AAPM Sun 20.07.2014 - Thu 24.07.2014, Austin, TX ASTRO Sun 14.09.2014 - Wed 17.09.2014, San Francisco, CA RSNA Sun 30.11.2014 - Fri 05.12.2014, Chicago, IL Adjournment The meeting was adjourned at 12:30 on November 22, 2013. Reported by: U. Busch, Chair Christof Schadt, Vice-Chair Walter Bosch, ATC Stephen Vastagh, Secretary Reviewed by: CRS 2013-12-20 14 Working Group Seven (Radiotherapy) of the DICOM Standards Committee Nov. 18-22, 2013