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MINUTES
DICOM WORKING GROUP ONE
(Cardiac and Vascular Information)
March 27, 2009
Orlando, FL
Members Present:
Represented by:
American College of Cardiology
GE Healthcare
LightLab Imaging
Philips Medical Systems
Pie Medical Imaging
Siemens Medical Systems
Volcano Therapeutics
Peter Tilkemeier
Jon Elion
Harry Solomon
Robert Steinbrecher
Tom Dolan
Boudewijn Verstraelen
Jorge Bohorquez-Millan
Tom Probasco
Members Not Present:
Voting Representative:
Boston Scientific
European Society of Cardiology
Jeehyun Kim, PhD.
Tat-Jin Teo
Tim Becker
Others Present:
Representing:
Byung Ju
Isao Mori
Gary Tearney
Terumo Medical
Terumo Medical
International Working Group for Intracoronary
OCT Standardization and Validation (IWG-OCT)
IWG-OCT
Rosenberg, Mireille
Presiding Officers:
Harry Solomon, Co-Chair
Jon Elion, Co-Chair
Peter Tilkemeier, Secretary
The meeting was called to order at 1:00 pm. on Friday, March 27, 2009. A quorum was
achieved.
1. Preliminary Events
Participants identified themselves and their affiliations.
Mr. Solomon reviewed the Procedures of the DICOM Standards Committee with regard to
antitrust and intellectual property.
Non-members were invited to join WG-01 and/or the DICOM Standards Committee. Several
such memberships will be proposed by the chair of WG-01 to the DSC for consideration at their
next meeting.
The agenda as distributed was approved with the addition of discussion of a work item on
Quantitative Arterial and Ventricular Analysis.
2. Report on Recent DICOM Activities
Mr. Solomon reported on recent additions to the DICOM Standard of interest to members of
WG-01. The presentation has been placed in the meeting folder on the NEMA/DICOM FTP
server.
3. Work Item: Intravascular Optical Coherence Tomography (IVOCT) Image Information Object
Definition (IOD)
Gary Tearney presented an overview of IVOCT, its similarities and differences compared to
IVUS, and the work of the International Working Group for Intracoronary OCT Standardization
and Validation (IWG-OCT).
IWG-OCT is an academic collaboration between Harvard (US), Erasmus (NL), and Wakayama
(JP) universities, with significant participation from other researchers and the vendor
community. Their work program has been divided among several sub-groups, one of which is
focused on DICOM standardization. Their DICOM sub-group has begun analyzing the
requirements for an IVOCT IOD and an IVOCT SR Template, deriving their work from the
DICOM Multiframe Ultrasound IOD and IVUS SR Template.
WG-01 agreed to establish a single effort between the two groups to develop the IVOCT
DICOM standard supplement, to be under the editorship of Dr. Tearney. It was agreed to use a
web-based collaboration for development of the supplement, to be hosted by Harvard /
Massachusetts General Hospital as part of their support for IWG-OCT. Members of the IWGOCT may (and are encouraged to) apply for membership in WG-01, and members of WG-01
may apply to be added to the rosters of IWG-OCT.
There was general consensus that the IVOCT Image IOD should be similar to the Multiframe
Ultrasound IOD used for IVUS images. Because of the critical nature of arterial flush to image
interpretation, the Enhanced Contrast/Bolus Module will probably be used, and may need to be
augmented with additional parameters of the flushing agent (e.g., refraction index). [Basis on the
older Multiframe Ultrasound IOD, rather than the Enhanced Multiframe paradigm used in newer
image IODs, is expected to be a topic for further discussion with WG-06.]
Also discussed was the “Z-index” essential to calibration of the images for quantitative
measurement and analysis. It was noted that retrospective re-calibration may require
reprocessing of the A-line (raw 1-D) data prior to its conversion to the image display format
(circularization and rasterization); the mechanism of the referenced Raw Data Object was
identified as a possible solution to this issue.
L-mode display (a longitudinal plane reconstruction through the 3-D volume) was noted as a
function of the IVOCT image object display application, like multi-planar reconstruction (MPR)
in CT and MR. An L-mode image could be saved as a derived Secondary Capture image.
[Current DICOM Presentation State objects do not support MPR type display control.]
A target timeline was agreed for development of the IVOCT Image IOD Supplement:
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Editorial committee drafting work, with full WG-01 review (tcon) late July/early August
2009
First read by WG-06 ~ August 24
Rework by editorial committee, with full WG-01 review (face-to-face) in Boston ~ Oct. 12
WG-06 release for Public Comment ~ Oct. 30
Review of comments January 2010
WG-06 release for Letter Ballot January or Mar. 2010
The development of an SR Template for IVOCT measurements is expected to follow 3-6 months
behind the Image IOD. This work will be dependent on a different IWG-OCT sub-group
establishing consensus terminologies and measurement sets.
ECG and audio recordings associated with the acquisition may be collected in already defined
DICOM objects synchronized (and possibly cross-referenced) to the IVOCT Image object. It
was noted that the audio recording, as an independent object, is not limited to the time duration
of the IVOCT acquisition.
The nature of OCT lends itself to tissue and non-tissue (stent, macrophages) identification and
characterization. DICOM Segmentation Image objects were identified as a mechanism to store
such characterizations. Dr. Tearney showed a dramatic “fly-through” based on a surface
rendering of a segmented OCT.
An item which may warrant further investigation is spatial registration of IVOCT (or IVUS)
image frames with angiographic (projection) views of the artery, or 3-D models of the artery.
Recent DICOM work in 3-D spatial coordinates for Colon Computer Aided Detection may be
useful. [Current DICOM Spatial Registration objects do not support frame-by-frame
registrations.]
Due to the large number of diverse object types that may be associated with an IVOCT
acquisition, an informative annex of DICOM Part 17 Explanatory Information may be warranted.
4. Report on IHE Cardiology
Tom Dolan reported on the status of the IHE Cardiology, which was scheduled to have a
restructuring meeting on March 28. IHE Cardiology has been dormant for one year following
withdrawal of ACC funding.
5. Proposed Work Item: Quantitative Arterial and Ventricular Analysis SR Extension
Boudewijn Verstraelen presented a proposal to extend the existing QAVA SR templates to
support bifurcated artery and 3D analysis. The proposal has been placed in the meeting folder on
the NEMA/DICOM FTP server.
Dr. Verstraelen moved the approval of submission of the proposal to the DICOM Standards
Committee. Approved unanimously.
6. DICOM Structured Reports (SR) Templates for Imaging Modalities
Peter Tilkemeier described some of the process behind the ACC Health Policy Statement on
Structured Reporting and Cardiac Imaging Data Standards documents. Dr. Tilkemeier
undertook a task to further investigate standard encodings for the concepts and vocabulary of the
Data Standards document, including SNOMED and NDF-RT (for drug classes). Mr. Solomon
volunteered to encourage one or more of his graduate students to assist in this task. The result of
this task may be used to refine the value sets for use in DICOM SR and HL7 CDA templates.
7. Work Item: Supplement 129: Electrophysiology Structured Reports and Procedure Log
Templates
There was not input from the Electrophysiology editorial group on advancing the Supplement to
Letter Ballot.
8. WG-01 Chairs
WG-01 accepted the resignation of Jon Elion as co-chair. There was no motion for election of a
new co-chair, so Mr. Solomon will serve as sole chair. After new members are appointed to the
WG-01 from the membership of the IWG-OCT, the issue of a co-chair from the larger
membership will be in order.
9. WG-01 Strategic Direction
The WG-01 entry in DICOM’s Strategic Document was amended to remove Dr. Elion as cochair, but no other changes were made.
10. Time and Place for Next Meeting
Members agreed to teleconferences as needed to review the work in progress. In particular, a
tcon will be scheduled late July/early August 2009 for the IVOCT Image IOD.
The next face to face meeting is planned for early October in Boston (specific date TBD).
11. Adjournment
The meeting was adjourned at 4:53 p.m.
Reported by:
Peter Tilkemeier, Secretary
March 28, 2009
Reviewed by Counsel:
April 10, 2009