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MINUTES
DICOM Working Group Twelve
(Ultrasound)
Oct. 29-31, 2013
Siemens Conference Room
Mountain View, CA
Members Present
Represented by
Agfa HealthCare
GE Healthcare
Philips Healthcare
Siemens Healthcare
Toshiba Med. Res. Inst.
Paul Varghese, M.D.
Gopi Pattaswamy
Earl Canfield
Kluiwstra, Jan-Ulco
Kevin O’Donnell
Members Absent
Voting Representative
AIUM/UC San Diego
CoreLab Partners
Tom Nelson
David Clunie
Alternate Representatives, Observers and Others Present:
Kahng, Ann
Knipe, Ruth
Vastagh, Stephen
Presiding Officer:
Philips Healthcare
Siemens Healthcare
MITA
Paul Varghese, Chair Pro Tem
1. Opening
The Chair called the meeting to order at 09.00 on Oct. 29. Self-introductions followed. The
Agenda was reviewed and approved. The Secretary reviewed the antitrust rules. The Chair
thanked Siemens for providing the meeting room for this meeting of the Group.
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Working Group Twelve (Ultrasound)
of the DICOM Standards Committee
October 29-31, 2013
2. History
This meeting builds upon the work started January 2012 to address inadequate interoperability
between devices that produce Structured Reports and devices that store/display these reports,
with focus upon adult echocardiography measurements. Specifically, despite the features of
DICOM structured report template TID-5200, both inter and intra ultrasound vendor
measurement encoding variability introduces obstacles to PACS/information system vendors
attempting semantic interoperability. WG-12 members contributed a list of causes and solutions,
with the focus upon 1) establishing a baseline set of echocardiography measurements to address
immediate clinical concerns (with acknowledgement of research needs remain to be evaluated);
and 2) using pre-coordination as a means of reducing variability in encoding.
The published guidelines of American Society of Echocardiography (ASE) were used to derive a
baseline set of echocardiography measurements; against this list, WG-12 members created a
proof-of-concept to show the utility/feasibility of the pre-coordinated approach to reduce
ambiguity/variation in encoding. With WG-12 consensus, a draft proposal to introduce a
simplified adult echocardiography report template (which would remove redundant hierarchical
structures and create a new mapping to the baseline set of ASE measurements) as an addition to
the DICOM standard was submitted to WG-06, which has subsequently given its approval for
WG-12 to complete this new supplement.
3. Review existing Draft Supplement proposal
K. O’Donnell is maintains the current draft and reviewed the open issues recorded to date.
Throughout the meeting consensus was reached on items that will be proposed as open issues.
Additional notations were made on the draft supplement throughout the meeting. It will be
posted in the meeting folder.
4. Review ASE baseline measurement set
The working document for this review is the Google-document which will be posted in the
meeting folder. The ensuing technical discussion’s conclusions and discussions were recorded
in this document.
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Working Group Twelve (Ultrasound)
of the DICOM Standards Committee
October 29-31, 2013
a. Scope of initial measurement set
A lengthy discussion resulted in a consensus on the initial measurement set which
now numbered approximately 200. If it comes to our attention that there are
updates to the ASE guideline derived measurement list (e.g. new guidelines
published), the baseline measurement list will be updated as well.
Supplemental measurements beyond the “initial set”:
It was concluded that this requires an analysis of measurements (outside of
baseline measurement set) that are common to most vendors. P. Varghese will
upload a starter set of comprehensive SR files to WG-12 folder; E. Canfield will
perform analysis. Recommendations will be pending until these steps. It was
decided that these steps will be addressed at future meetings.
b. Evaluation of extent of pre-coordinated code gaps (i.e. how to
create new pre-coordinated codes if there is no appropriate
code extant)
Discussion revealed that the course of action would be to submit requests for new
codes to 1) DICOM, 2) LOINC, or 3) SNOMED, with option #1 being the most
likely to occur in a reasonable time frame.
c. Consensus on:
The Group discussed in detail the foregoing topics and reached consensus as
described in italics:
 Cardiac/Chamber cycle semantics - cardiac cycle will refer to duration of
chamber cycle (e.g. “atrial systole”), with specific time instance of cycle
specified as needed (e.g.“end systole”)
 Flow direction semantics – will be specified to remove ambiguity
 Measurement unit consistency – will be consistent with ASE guideline
documents
 Target site semantics – will be incorporated in the pre-coordinated code
 Method semantics – will be specified for derived values
1. Supplemental information beyond the “minimum necessary” – see
above in 4.a.
In addition, a new item for further development was established:
Build of content for the Use Case section of the draft supplement with the
following use cases proposed for consideration:
2. Database incorporation of imported baseline measurements
3. Database incorporation of user-defined measurements
4. Data plotting/Database incorporation for decision support.
5. Test consensus against subset of ASE baseline measurement set

The Group conducted a mapping exercise on a subset of baseline measurement set
(Aortic Valve) with agreement that pre-coordination using the consensus items was
feasible.
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Working Group Twelve (Ultrasound)
of the DICOM Standards Committee
October 29-31, 2013
6. Homework Assignment – to be completed for review on teleconference 11/18/2013
Members accepted the following assignments. The homework will be recorded on the
Google document.
Step 1:
Insert new Column B titled “DICOM Code meaning”. Populate Column B cells as
shown under “Aortic Valve” tab
Step 2:
Confirm Units. Highlight in yellow if units (or anything) need discussion
Step 3:
Review measurement table columns. Consider which is more appropriate for
DICOM Code meaning: Column E or Column F AND highlight cell as green
(meaning).

Notes:
o Eventually Column E&F will be replaced with a Precoordination Column
o No need to look for Col E value if none exist
o If none in Column F and pressed for time, leave it so
o Color orange more discussion is needed as a group
o Color yellow is for Paul to research and “fix”
o Color Green indicates that this is the best selection in the opinion of the
reviewer
Step 4:
Populate the columns: Method, Imaging Mode, image view, Cardiac Cycle Point ,
Respiration Cycle point, Flow Direction
Specific assignments:
Ann Kang:
LV-B
Ruth Knipe:
Long Tail (Pulmonic Valve, Aortic Valve, Pulmonary Artery )
Kevin O’Donnell :
LV- A & C
Earl Canfield:
Mitral Valve
Gopi Pattaswamy:
RA, Tricuspid Valve
Paul Varghese:
Clarification of items marked with “yellow” highlight
Jan-Ulco Kluiwstra:
RV, LA
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Working Group Twelve (Ultrasound)
of the DICOM Standards Committee
October 29-31, 2013
7. New Business - None
8. Next Meetings
Tcons:
2013-11-18
15.30-17.00 USA Eastern Time
2013-12-16
16.00-18.00 USA Eastern Time
In Person:
2014-02-04 to 2014-02-06
Hosted by the University of California, San Diego
9. Adjournment
The meeting recessed daily, at 17.00, and reconvened at 09.00. It was adjourned at 13.00 on
Oct. 31.
Reported by
Stephen Vastagh, Secretary
Reviewed by legal counsel: CRS 2013-11-06
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Working Group Twelve (Ultrasound)
of the DICOM Standards Committee
October 29-31, 2013