DRAFT MINUTES:
WORKING GROUP 9
(OPHTHALMOLOGY),
DICOM STANDARDS COMMITTEE
PLACE OF MEETING:
SAN DIEGO, CALIFORNIA
ASCRS ANNUAL MEETING
DATES AND TIMES:
THURSDAY, APRIL 26, 2001
9:00 A.M. TO 1:00 P.M.
PRESIDING OFFICERS (CO-CHAIRS):
Lloyd Hildebrand, DICOM Committee Co-Chair
PRESENT:
MEMBERS PRESENT:
Jorge Cuadros
Lloyd Hildebrand, M.D.
Flora Lum, M.D.
University of California, San Francisco
American Academy of Ophthalmology
American Academy of Ophthalmology
MEMBERS NOT PRESENT:
Bert Bowden, M.D.
Kubilay Cardakli, Ph.D.
Shane Dunne
Pedro Miguel da Fonseca Marques Ferreira
David Liu
John Michon, M.D.
Ryoichi Nadachi
Kazuo Nunokawa
`
Michael Trost
Bob Ulius
Rainer Waedlich
Claudia Wente
Klaus Wente, Prof., Dr.
Sebastian Wente
Gudrun Zahlmann, MD
Eye for God
Penn Medical Informatics
Ophthalmic Technologies, Inc.
University of Coimbra
EYESYS Vision Group
Stanford University
Topcon Corporation, Japan
Topcon Corporation, Japan
Carl-Zeiss-Jena GmbH/OG-E
Ophthalmic Imaging Systems
ifa Software Systems. Germany
ifa Software Systems, Germany
University of Applied Sciences, Germany
Integration AG, Germany
GSF Medis Institut
OTHERS PRESENT:
Vendors:
Dr. Alexander Berestov
Shawnnah Castillo
Kevin Connell
Peter Jäggi
Masunori Kawamura
Canon R & D Center America
Laser Diagnostic Technologies, Inc.
Consultant, Topcon Corporation
Interzeag AG, Switzerland
Nidek Co., Ltd., Japan
Draft, 5/23/00
Per Pedersen
Jerry Reed
Peter Scherer
Charles Wallace
1.
Zeiss Humphrey Systems
Laser Diagnostic Technologies, Inc.
Integration AG, Germany
Laser Diagnostic Technologies, Inc.
WELCOME AND INTRODUCTORY REMARKS
Lloyd Hildebrand (representing the American Academy of Ophthalmology) welcomed the
participants of the meeting of WG 9. Members were introduced, and expressed their interest in
DICOM and standards. The agenda was approved.
2.
APPROVAL OF MINUTES FROM OCTOBER 20, MEETING IN DALLAS
The minutes of the previous meeting from October 20th in Dallas were approved.
3.
INTRODUCTION TO WORKING GROUP 9 AND DICOM
Dr. Hildebrand discussed the history of WG9 and the AAO’s involvement in standards that
govern the way the ophthalmologists evaluate and communicate about patients. The Secretariat
for the WG9, Quality of Care, is within the AAO’s Ophthalmic Practice Division, and additional
activities include the Preferred Practice Patterns, Ophthalmic Technology Assessments and
Outcomes, in addition to Medical Information Technology. Dr. Hildebrand chairs the Medical
Information Technology Committee. This Committee decided to target computer patient
records and applications for telemedicine, with remote diagnosis and linking physicians with
patients across distance and time. Thus, the Committee became involved in standard setting and
in DICOM efforts.
This is a general schema for how ophthalmology imaging fits into the DICOM standards.
Fundus photos
Fluoroscein
Angiography
External photos
Ophthalmic
Pathology
Slit-lamp bioMicroscopy
Ophthalmic
Ultrasound
Orbital and
Neuro imaging
SNOMED
SNOMED
Visible Light
Visible
Light
Structured
Structured
Reporting
Reporting
DICOM Content
Mapping Resource
(DCMR)
Ultrasound
Ultrasound
LOINC
LOINC
CTCT
MR
MR
IOD
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The DICOM Content Mapping Resource (DCMR) is a mapping resource that defines templates
and context groups for biomedical applications from the SNOMED (Systematized Nomenclature
of Medicine), LOINC, BIRADS and other standard coding schemes.
DICOM is also working with HL7. HL7 is concerning mainly with messaging from large health
information systems, and developing the messaging architecture used to convey patient related
information.
DICOM Committee has decided at this time not to integrate XML with DICOM standards. The
Committee will monitor this on an ongoing basis.
There were two suggestions to bring back to the DICOM Committee:
1)
Consideration of having a DICOM booth at the HIMSS meeting. There is already an HL7
booth at the HIMSS, but no DICOM presence.
2) HIPAA Law – Should there be a linkage between DICOM and the various groups
organizations trying to understand HIPAA and meet the needs of communications/information
systems
4.
UPDATE FOR DICOM COMMITTEE
Dr. Hildebrand presented several items for discussion, as requested by the DICOM Committee
Co-Chair, David Clunie. These items for a status report included:
1.
2.
3.
4.
5.
6.
7.
8.
9.
What is the evidence for vendor adoption of VL?
Is there further refinement needed for VL?
What new DICOM SOP classes are needed? (e.g., topography, visual fields)
What is the evidence for vendor use of DICOM SR?
What is the progress on adapting the DICOM workflow (modality worklist)?
What draft supplements are under development?
What are template examples for ophthalmic SR?
What schedules are there for work items?
Place minutes of meetings on the NEMA server (All WG9 minutes have been submitted
in the past to NEMA staff for legal review)
These were discussed by the group, and questions will be circulated to members not present in
the group for responding.
1.
What is the evidence for vendor adoption of VL?
Several vendors described their adoption of VL. Some have products in development,
others have products that are being used by customers.
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Draft, 5/23/00
2.
Is there further refinement needed for VL?
The group did not believe that further refinement was needed for VL. VL appears to fit
the needs for the imaging modalities of fundus photography, external photography,
biomicroscopy, fluorescein angiography and ophthalmic pathology.
However, the group did discuss the need to address compression issues. JPEG 2000 is
being viewed as the standard for the future. One issue deals with the technical aspects. The
second issue deals with the clinical aspects. How does a compressed image (and subsequent
decompressing) compare to a noncompressed image for purposes of clinical decision making?
Studies should be performed on the clinical quality of images affected by compressing by the
various techniques.
3.
What new DICOM SOP classes are needed? (e.g., topography, visual fields)
Actually, WG17 and WG9 have many things in common. Many of the ophthalmic
modalities mentioned for SOP (Service Object Pairs) classes, such as corneal topography, stereo
imaging, retinal tomography, 3-D ultrasound, and visual fields, can be brought together under
multi-dimensional images in WG17. There are 2 new DICOM SOP classes developed by
WG17: 3-D imaging and 3-D ultrasound, which would cover the modalities in ophthalmology
mentioned previously. For a 2-D image, such as corneal topography, VL standard can be used.
If it is displayed in three dimensions, then the 3D-imaging SOP class can be used, with
additional attributes specified for the 3rd dimension. With these 2 additional SOP classes, it
appears that the ophthalmic imaging modalities can be covered by these or the VL, US, CT or
MR standards. Modalities such as Infrared imaging and indocyanine green imaging should also
be able to use the VL standard. A member of WG9 attended the December meeting of the
WG17 to share ideas and discuss common areas.
4.
What is the evidence for vendor use of DICOM SR?
Several vendors expressed interest in use of SR, and a few vendors have internal
development of a SR product.
5.
What is the progress on adapting the DICOM workflow (modality worklist)?
At the last WG9 meeting, issues with using the modality worklist in ophthalmology were
discussed. The problem is that ophthalmology workflows may change frequently, and there is a
need to continually refresh the worklist and alert the client of changes. The DICOM modality
worklist is more slowly evolving and updating requires tremendous overhead. Currently, the
worklist is not event driven. It cannot refresh the worklist just for changes. Ideally for
ophthalmology settings, if something changes, then the server would inform the client, and the
client can interact with the server to ask for more detail and to synchronize. If the client does not
respond to the message immediately, each message can be tagged, and prior messages can be
viewed.
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Draft, 5/23/00
However, these issues were brought up at the DICOM Committee meeting in December,
and it appeared that there was no possibility for changing the modality worklist. If there are
possibilities for change, then Peter Scherer will produce a work item for a new service in the
modality worklist to meet the needs of ophthalmology workflow.
6.
What draft supplements are under development?
A draft supplement will be worked on to add a new service to the modality worklist
(Peter Scherer).
7.
What are template examples for ophthalmic SR?
The problem with DICOM SR is that it is difficult to use in the real world of ophthalmology.
There needs to be a concerted effort of clinicians to develop the templates. In the past, the
Medical Information Technology Committee developed a series of templates based on the
Academy’s Preferred Practice Patterns or guidelines. These will be reviewed again to see if they
could serve as templates. There also needs to be a subset of terminology from SNOMED to use
in these templates. Some of the companies have templates, which have standardized data fields
for information on a particular condition or technology. Template examples include the
following: glaucoma, diabetic retinopathy screening, refractive surgery and cataract. Other
examples to be developed could be refractive state, age-related macular degeneration, visual
fields, nerve fiber analyzer, progression analysis, and optic disc analysis. Developed templates
should be shared with AAO terminology modelers, so that the SNOMED terminology can be
modeled using the same logic.
8.
What schedules are there for work items?
A schedule will be worked out for the work item discussed above.
5.
NEXT MEETING
The next meeting is planned in conjunction with the DICOM Standards Committee in
Washington DC. The purpose of this meeting will be to test and finalize plans for the AAO
2001 Annual Meeting IEE demonstration. For those attending DICOM, the WG10 meeting will
be on Tuesday, September 25 and the DICOM Standards Meeting will be on Wednesday,
September 26. Another meeting of the group has already been scheduled for November 9, 2001
at the Doubletree Hotel, New Orleans. Members are urged to register for hotel space as soon as
possible. Housing on the Academy’s website for nonmembers will be open on July 5, 2001.
8.
ADJOURNMENT
The meeting adjourned at 1:15 p.m.
Reported by:
Lloyd Hildebrand, Co-Chair
May 1, 2001
Reviewed by counsel:
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