Advancing DICOM with Web Technology in Healthcare Imaging

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Explore the work item focused on enhancing DICOM in healthcare imaging using web-based technologies. Addressing challenges like interoperability, PACS migrations, and leveraging web servers for efficient transmission, storage, and display of DICOM studies. The goal is to enable seamless access to imaging data across healthcare providers and locations, streamlining workflows and reducing costs.


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  1. Work Item for Web Based DICOM Jim Philbin/Cor Loef Co-chairs WG27: Web Technology in DICOM

  2. Healthcare Trends Customer Issues with Imaging Enterprise Imaging Images must be available across enterprise All providers All locations (hospitals, clinics, offices, homes, ) Imaging studies coming from many different specialties Need one aggregated imaging record Multiple PACS/mini-PACS, many different workflows Multiple Viewers/Workflow (by specialty) Study size increasing DICOM push model complicated & expensive Moving studies outside of data center slow (to a diagnostic or modality workstation)

  3. Customer Interoperability Problems Upgrades (changing vendors) impeded by migration Multiple viewers <-> one image archive Most viewer use proprietary interface to proprietary local cache that talks DICOM archive [DICOM push] Multiple Mini-PACS and modality workstations Most mini-PACS use proprietary interface to proprietary local cache that talks DICOM archive [DICOM push] Thick client apps difficult & expensive to maintain

  4. Work Item Goal The Web is the technology that has arguably had the greatest impact on our society in the last 20 years. The goal of this Work Item is to enable the efficient transport, storage and display of DICOM studies though an HTTP interface thus allowing applications to leverage Web technologies to deliver DICOM data.

  5. Work Item Sub-Goals Web based transmission, storage and display of DICOM studies PACS independent Web based DICOM Storage Eliminate the need for PACS migrations Support the DICOM information model and IODs without modification. Interoperability between viewers, PACS, VNA/PNA, etc.

  6. Leverage Web Technologies Web server infrastructure to support DICOM Enables interoperability Use web technologies for: Automatic re-direction Routing, Caching and Storage Replication, failover and load balancing Allow DICOM to track technology evolution Enable browser based applications to lower costs Deployment & maintenance Anytime, anywhere availability

  7. Web Based Transmission of DICOM Studies DICOM information model and IODs unchanged Transmit all or part of a study in one message Ease of access to study metadata Eliminates end of transmission time-out problem Storage commit (http header) Extensible to non-DICOM objects using standard Web technologies

  8. Web Based Interface to DICOM Storage Single interface supports Long Term Archive, Caches, Routers Addressing by studyUIDs Ability to fully index a DICOM store Storage commit is inherent in protocol Enables support for multiple PACS Enables Elimination of PACS migrations Enables Store once and distribute

  9. MINT Web Based DICOM Storage MINT is designed for the efficient transport and storage of DICOM objects using Web technologies Viewers Viewers Modalities Modalities typically proprietary DICOM MINT PACS PACS MINT Store

  10. Essence of MINT Efficient encoding of DICOM IODs for use with HTTP Studies are normalized, i.e. no metadata duplication Study create, read, update, delete, copy, move using HTTP DICOM objects addressed by URI s using UIDs All or part of a study can be transmitted in one message

  11. Backup Slides

  12. Problems MINT Addresses Study size increasing Time to display images increasing Multiple mini-PACS w/ separate caches Speed Proprietary data Increases complexity DICOM Push model Migrating the archive when changing vendors Need for enterprise archive

  13. Logical View of the MINT Encoding of DICOM Metadata Includes all non binary attributes found in all DICOM SOP instances in a given study Normalized attributes according to DICOM Information Model Is accessed independently from the binary data References binary data items using their id Binary Items Can be retrieved in batch or individually Are identified by study scoped ids (bids or binary ids) Voice Clip Private Attributes x Patient Image Study Series Series Series SOP Instances SOP Instances SOP Instances Binary Data Metadata

  14. How MINT is Different from WADO Focused on DICOM transport & storage using HTTP No support for rendered (e.g. JPEG) objects (only DICOM) Normalized metadata Creates, Updates and Deletes DICOM studies Uses REST style resources rather than parameters to identify studies, series and SOP instances

  15. DICOM->MINT->DICOM Isomorphic DICOM->MINT MINT->DICOM Conformance tests are part of reference

  16. Proposed MINT Operations

  17. Study Create Study Create POST <s>/studies/create [content] -> <studyUID> Note: <s> = <service> POST mint.jhu.edu/studies/create [content]

  18. Read Study GET <s>/studies/<studyUID> -> <study> GET <s>/studies/<studyUID>/<seriesUID> -> <series> GET <s>/studies/<studyUID>/<seriesUID>/<objectUID> -> <sop instance>

  19. Read (cont) Study Summary GET <s>/studies/<studyUID>/DICOM/summary.ext -> <summary> Study Metadata GET <s>/studies/<studyUID>/DICOM/metadata.ext -> <metadata> Where .EXT = XML, XML.gz, GPB, GBP.gz

  20. Read (cont) Study Binary Items GET <s>/studies/<studyUID>/DICOM/binaryitems -> [binary items] Study Read Report GET <s>/studies/<studyUID>/DICOM/reports.ext -> [DICOM SR] Study Read ChangeLog GET <s>/studies/<studyUID>/DICOM/changeLog -> [changeLog info]

  21. Update Get Update Lock POST <s>/studies/<studyUID>?lock=true -> <lock> Update Study POST <s>/studies/<studyUID>?lock=<lock> [content] -> [status msg]

  22. Move, Copy & Delete Study Copy POST <s>/studies/<studyUID>?action=copy; target= <URIorCon> -> [status msg] Study Move POST <s>/studies/<studyUID>?action=move; target= <URIorCon> -> [status msg] Study Delete DELETE <s>/studies/<studyUID> -> [status msg]

  23. Study Search Study Search GET <s>/studies/search?<query> -> [search results] Query Parameters StudyUID, IssuerOfPatientID, PatientID, IssuerOfAccessionNumber, AccessionNumber, ModalityTypes, MinStudyDate-Time, MinStudyDate, MaxStudyDate-Time, MaxStudyDate

  24. Other Backup Slides

  25. A Studys History Time 5 min 1 Hour 2 Days P10 P10 P10 HL7 - PID Instance 1 P10 Instance 2 P10 Instance 3 P10 Instance 4 P10 Instance 5 P10 Instance 6 P10 Instance 7 Instance 9 P10 Instance 10 P10 Instance 11 P10 Instance 12 P10 Instance 13 P10 Instance 14 Instance 15 Need to update all instances in all caches with this change P10 Instance 8 Series 1, 2 & 3 (From Modality) Series 4 (From Modality Patient Name Change (From HIS) Presentation State Added (From Viewer) Studies are not created at one single point in time New SOP Instances may be added to a study at any time Changes to existing instances may be made at any time

  26. MINT is Web Based RESTful interface to DICOM studies Transport = HTTP 1.1 (includes chunking) Leverages existing technologies Transmission through firewalls Encoding XML Operations CRUD (Create, Retrieve, Update, Delete) Search Notification Data Model = DICOM Part 3 Leverages existing web technologies Allows transmission through firewalls

  27. Current Status MINT Reference Implementation of Version 1.0 available at www.GOTMINT.org 4 vendors are implementing products 3 more vendors have committed to implement Currently working on version 1.1

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