M I N U T E S
DICOM Working Group Seven
(Radiation Therapy)
June 16 – June 19, 2008 Santa Fe, NM
Members Present
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Represented by
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M
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T
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W
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T
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F
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AAPM; U. of Michigan
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Bruce Curran
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X
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X
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X
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X
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Calypso Medical
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Andrea Morgan
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X
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X
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X
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Computerized Medical Systems
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Bill Bennett
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X
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X
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X
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X
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Nucletron
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Harold Beunk
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X
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X
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X
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X
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Optivus Technology
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Michael Baumann
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X
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X
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X
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X
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Philips Medical Systems
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Scott Johnson
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X
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X
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X
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Siemens Medical Solutions
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Johannes Stahl
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X
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X
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X
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X
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TomoTherapy Incorporated
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Dave Murray
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X
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X
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X
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X
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Varian Medical Systems
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Uli Busch
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X
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X
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X
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X
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Members Absent
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Represented by
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BrainLab
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Christof Schadt
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Elekta
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Michael Ullrich
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IMPAC Medical Systems
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Scot Hogan
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ITC-ATC, Wash. Univ. St. Louis
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Walter Bosch
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RCET-ATC
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Vincent Frouhar
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RPC-ATC
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Jose Bencomo
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Others Present
(Observers or alternate representatives
of member organizations)
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Associated with
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Tony Apicella
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ViewRay Inc
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Bob Philbin
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TomoTherapy
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X
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X
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X
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X
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John Sarafa
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Computerized Medical Systems
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X
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X
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X
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X
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Colin Sims
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Accuray
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X
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X
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X
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X
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John Weston
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IMPAC Elekta
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X
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X
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X
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X
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Howard Clark
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MITA
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X
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X
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X
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X
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Presiding Officer: David Murray, Chair
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Preliminary Events
The secretary reported that a quorum was present.
Members reviewed and approved the agenda for this meeting.
Members approved the minutes for the meeting on April 22 – 25, 2008 at MITA HQ.
FTP Site Organization: WG-07 members discussed the organization of the FTP site and concluded that the most recent version of the second generation object documents be kept in a single place. Also, it was decided to move the meeting minutes up the hierarchy. Dave Murray made these and other modifications to the structure. There were no comments.
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Change Proposals
Update to CP805: Uli Busch’s original CP needs to be re-introduced to complete the modifications originally intended for CP805. Uli will resurrect this by drafting a new CP.
CP_FORinRTIonPlan.doc: FOR Module in Ion Plan. This corrects a ‘U’ typo in the overall module table for the FOR module in Ion Plan.
CP_GeneralizeBeamDeliveryRequestIOD.doc: This adds ‘or RT Ion Plan SOP’ to the RT Beams Delivery Instruction plan references.
CP_CouchParametersInDeliveryRequest.doc: This comment on Supplement 74 adds a set of table-related parameters in the delivery request. It was agreed to move forward with this CP, but with positions and displacements only (not offsets) added.
Common Instance Reference Clarification: (Thursday) Scott Johnson presented a CP to remove the requirements for instance references in the mandatory Common Instance Reference Module of the Registration IOD, especially in the case where there are no referenced instances. The group decided to propose instead a clarification that this module can effectively be empty in the case where no instances are actually referenced elsewhere in the object. Bill will draft a CP to present to WG-06, and send to Bruce for discussion at the WG-06 T-con. Also, this CP will be useful for IHE-RO testing.
Note: Bruce Curran is editing the documents listed above and will present them to WG-06 via T-con at the next opportunity (approximately the beginning of October).
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IHE-RO Update
Dave Murray and Bruce Curran reviewed the progress of IHE-RO.
AAPM Meeting IHE-RO Schedule:
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Thursday 7/31 – Setup,
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Fri-Sat 8/1 & 2 – Testing of 2007 basic and 2008 registration profiles,
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Mon-Tues 8/4 & 5 – Testing continued.
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Wednesday 8/6 – TC wrap-up meeting 9-12am.
Test tools are available. Bruce will update the IHE-RO wiki (wiki.ihe.net). Most likely, 2007 testing will occur on Thursday-Friday of AAPM week, and the 2008 profile will be tested the following week. There were field of view and row/column transposition issues with MR data, but these have been fixed and sent to ICT.
ASTRO Meeting IHE-RO Schedule: 2008 Registration will be formally demonstrated; 2007 will be re-demonstrated, and 2008 Workflow will be informally demonstrated. Bruce will find out about scheduling of booth demonstration time.
Currently there are no IHE-RO related requirements for WG7 work. The most likely upcoming need is development of treatment intent, should IHE-RO wish to demonstrate treatment prescription workflow.
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Second-Generation Radiotherapy Objects
Note: Current status of documents pertaining to Second-generation objects can be found in Annex A.
MONDAY
RT Dose: Bob Philbin presented V5 of the RT Dose Image IOD:
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It was decided that the RT Dose Image should be able to reference first generation plans without compromising the design of the new objects.
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VR for pixel data: It was decided that representation of the data shall be 32 bit integer (OW). Pixel padding value shall be actively used.
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Dose Summation Type: There was an involved discussion regarding the permissible types of summation, and a proposed set of types was determined.
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Control Point Dose summation: This was rejected.
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Registrations: A registration IOD shall be included in contribution sequence and shall be required for IODs that are in different frames of reference.
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It was decided to add an attribute to distinguish between QA dose and therapy dose.
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It was decided to add an attribute to distinguish between measured and calculated dose.
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It was decided to add an attribute to distinguish between dose for one fraction of a radiation set and dose for more than one fraction in a radiation set.
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It was decided to use the macro that handles real-world scaling (Real World Value Mapping Macro), supporting linear slope and intercept, and piecewise linear slope and intercept.
Bob updated for discussion on Wednesday.
RT Physician Intent: Uli presented V8 of the document, containing changes since the recent T-cons. In particular, he reviewed Bruce’s proposed use cases
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“ROI” term needs to be replaced with a term more conceptual in nature (e.g. a ‘kidney’ c.f. a ‘contoured kidney’)
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There was an involved discussion regarding how references linking conceptual anatomical structures should reference or be referenced by the RT Segmentation Properties IOD (that itself references the Segmentations). No firm decision was made.
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Dose Constraint Value Types were reviewed for duplication.
TUESDAY (7:30 a.m. start)
RT Physician Intent: Uli continued review of the use cases, especially how essentially free-form prescriptive text can be coded, as well as more specific text fields for specific aspects of the prescription. Uli will use the Content Item Macro to enable coding of these attributes as free form text or coded terminology.
Colin then reviewed the constraints of a specific RTOG protocol to ensure that they can be addressed by the RT Physician Intent ROI.
The list of open items for this part of the proposed standard was updated.
Bruce will work with Sunita to schedule a T-con (after 4 July) with IHE-RO Planning Committee members to discuss prescription use cases.
A RT Physician Intent T-con will be held Tuesday August 12, at 1800 GMT (14:00 Eastern Time). Subgroup members: Bruce, Stuart (active?), John, Colin, Walter, Scott Johnson.
E-R Modeling: Bill presented a discussion of the relationship between a ‘conceptual anatomic structure’ a.k.a. ‘anatomy reference’ (e.g. ‘liver’, with its own UID); a geometrical ROI (e.g. Segmentation IOD); and RT Segmentation Properties (such as density override, structure type, etc). After much discussion, it was agreed that an RT Segmentation Properties IOD should reference a Segmentation IOD or similar, but that a ‘anatomy reference’ such as that used in up-front prescription should not make any references, nor be referenced except perhaps by an RT Segmentation Properties instance as a historical record of the conceptual structure used when the RT Segmentation Properties instance was created.
Any ‘user IOD’ (such as a RT Physician Intent IOD) will typically need to reference both an Anatomy Reference UID and an RT Segmentation Properties IOD instance.
It was also considered that a ‘Relationship Macro’ could be created to provide a generic way of specifying IOD references.
Uli then presented a UML-like ‘Uligram’ showing proposed relationships. Uli used a specific ‘Anatomy Reference Macro’ (UID/segmentation UID pair) for one of the key relationships, rather than a generic ‘Relationship Macro’. It was decided to revisit the need (or otherwise) for a generic reference macro when all the relationships that need to be modeled become more clear.
RT Radiation Set IOD: Uli reviewed V8 of the RT Radiation Set IOD. Some minor modifications were suggested. The utility of reference dose ‘depth’ was discussed and added as an open issue. The concept of predecessors has been moved to RT Course.
RT Segmentation Properties: Uli and Scott Johnson reviewed V5 of the RT Segmentation Properties IOD. In particular, the relevance of an ROI UID and its possible semantics were discussed. Also, reservations were expressed regarding specification of ‘Labeled Target Dose,’ which has been requested for tracking RTOG protocols. It was considered that these may not be sufficiently widely used to warrant inclusion. An open item was added to consult Walter Bosch regarding this.
WEDNESDAY (7:30 a.m. start)
Patient Position Modules: Uli reviewed V8 of the Patient Position Modules document. A long and involved discussion ensued, and some new open issues were added to the document. In particular, there were discussions regarding encoding, application and ordering of registration and patient positioning coordinates, use of IEC equipment and room-based coordinates, how far we go with specifying corrections, modifying the origin of such corrections for certain types of imaging, and what we reference against (Radiations, Patient Setups, etc).
Patient Monitoring was also discussed at length, including how to specify the monitoring and what data to record and when to record it in DICOM (at the end of the monitoring period).
RT Dose (revisited): Bob Philbin presented V6 of the RT Dose Image IOD. This contained changes following the previous discussion and in response to other comments from Walter.
THURSDAY (7:30 a.m. start)
RT Dose (revisited, continued): Bob Philbin continued presentation V6 of the RT Dose Image IOD. This contained changes following the previous discussion and in response to other comments from Walter. Bob will update following further discussions with Walter.
RT Course: Uli Busch presented V9 of RT Course, and described in detail the relations between course, treatment intent, and radiation set.
Dave will add a “Radiation Usage” enumerated value (simulation, dosimetric, treatment) to the Radiation ID macro. Specific Radiation IODs may choose to use the attribute in condition for specific attributes. It may also be needed at the Radiation Set Level.
OTHER BUSINESS
Potential Treatment Planning Lab: Bruce talked about Rhode Island Hospital’s diversity of treatment planning systems, and potential for setting up a ‘treatment planning lab’. WG-07 members indicated interest in a legally compliant vendor-neutral testing ground, object repository, availability of multiple systems, web-accessible archive/PACS, etc. Bruce will investigate further.
Next Meetings: Next WG-07 meeting scheduled for Tuesday October 21- Friday October 24, 2008 (ending 12:00 Friday) in Charleston, South Carolina (change from Tampa). The following meeting is proposed for March 17-20, 2009 at NEMA (ending 12:00 Friday). One or two members will stay over to present to WG-06 the following Monday (at NEMA).
Planning for Supplement Development: The second generation tasks document was updated as a group (see Annex). It was decided that for all T-cons, a meeting subdirectory be created. In general, the output of a T-con should be communicated to WG-07 in general.
T-con Secretaries: A secretary is required for each and every T-con. Appropriate secretaries are Howard Clark, Bruce Curran, Walter Bosch. Are there others we can enlist? Bruce will check with IHE-RO groups to see if user community individuals can help. Organizers of T-cons will email Howard, Walter, and Bruce for allocation of a secretary.
Adjournment
The meeting was adjourned at 12:07on 19 June, 2008.
Reported by: David Murray, Chair
Howard Clark, Secretary
July 23, 2008
Reviewed by counsel: July 28, 2008
Annex A: DICOM WG7 (RT) Task Assignments for Second Generation RT Objects
Last Update: 23 June 2008 (D Murray)
Doc Name
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Content
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Sub-editor Assigned
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Reviewers/coworkers
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Last update
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YY for Tags
(30xx,YY00) - (30xx,YYFF)
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Status
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supRT2TopLevel_11.doc
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Integration of overall document; front matter; Part 6, Part 17; etc; Storage Objects
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David Murray
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-
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2007/08/20
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50-5F
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Updated in D.C. Now contains some common macro definitions and common radiation modules; Workflow content moved to another document.
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supRT2ExtBeamMacros_06.doc
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Macros
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Murray
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-
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2007/08/20
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50-5F
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Updated in D.C.; Removed some common macro definitions (moved to top-level document).
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supRT2RegistrationInstruction_05.doc
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Registration Instruction IOD
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Scott Johnson
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Bennett, Bosch, Beunk
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2007/08/20
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01
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Reviewed in LV. This version is stable.
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supRT2SegmentationInstruction_05.doc
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Segmentation Instruction IOD
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Scott Johnson
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Bennett, Bosch, Beunk
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2007/08/20
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02
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Reviewed in LV. Stable.
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RT Planning Instruction IOD
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-
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-
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03
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Postponed until IODs defined.
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supRT2PatientPositioning_09.doc
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Setup Reference Acquisition
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Christof Schadt
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Morgan, Johnson, Busch, Baumann,
Stahl, Apicella
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2007/08/20
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04
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Reviewed in Santa Fe; Posted in Santa Fe outbox. RT Patient Position IOD (tag range 0A) will eventually be integrated into this document. Christof will organize T-cons to advance work prior to October meeting.
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Registration (TBD)
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05
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Position Modification
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06
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Position Monitoring
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07
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supRTCourse_10.doc
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RT Course IOD
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Uli Busch
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Moyers (?), Bennett, Murray, Beunk, Johnson, Bosch, Apicella
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2007/08/20
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08
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Reviewed in LV (version 4); Reviewed in D.C. Reviewed in Santa Fe. T-cons will progress work prior to October 2008 meeting
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supRT2PhysicianIntent_10.doc
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RT Physician Intent IOD
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Uli Busch
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Curran, Swerdloff (?), Sarafa, Sims, Bosch, Johnson, Philbin
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2007/08/20
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09
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Reviewed in LV by Uli & Bruce (version 1). Reviewed in D.C. Reviewed in Santa Fe. Bruce will schedule T-con with IHE-RO PC to get further input.
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supRT2RadiationSet_09.doc
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RT Radiation Set IOD
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Uli Busch
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Stahl, Sims Sarafa, Beunk, Johnson
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2007/08/20
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0B
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Reviewed in LV (version 1); Discussed in T-con prior to D.C., and at D.C. Discussed at Santa Fe. T-cons will progress work prior to October 2008 meeting
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supRT2CArmPhoton_03.doc
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C-Arm Photon Beam IOD
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Johannes Stahl
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Johnson, Busch or delegate, Weston, Sarafa, Beunk
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2007/08/20
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0C
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Reviewed in LV; Reposted in LV outbox. Not discussed in D.C. T-cons will progress work prior to October 2008 meeting.
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upRT2CArmElectron_03.doc
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C-Arm Electron Beam IOD
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2007/08/20
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0D
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supRT2Ion_03.doc
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Ion Beam IOD
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Michael Baumann
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Hogan (?), Moyers (?), Schaffner
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2007/08/20
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0E
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Reviewed in LV; Reposted in LV outbox. Not discussed in D.C. T-cons will progress work prior to October 2008 meeting.
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supRT2Robotic_04.doc
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Robotic Radiation IOD
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Colin Sims
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Hogan, Sarafa
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2008/08/20
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0F
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Discussed in D.C. Essentially finished.
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supRT2Tomo_06.doc
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Tomotherapeutic Radiation IOD
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Dave Murray
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Philbin, Curran
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2008/08/20
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10
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Discussed in D.C. Essentially finished.
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-
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RT Catheter IOD
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-
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-
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Not addressed in this Supplement (insufficient resource available). Harold may analyze this work to ensure the new model is consistent with brachytherapy techniques.
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RT Delivery Session Record IOD
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-
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-
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Postponed until planning-related IODs developed.
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supRT2Dose_07.doc
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RT Dose Image IOD
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Bob Philbin
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Bosch
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2008/08/20
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11
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Discussed in LV;. Not discussed in D.C. Discussed in Santa Fe and updated. Bob and Walter will further refine for October meeting.
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supRT2DoseHist_05.doc
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RT Dose Histogram IOD
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Walter Bosch
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Philbin
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2008/08/20
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12
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Walter developed initial draft in LV; reposted in LV outbox. Not discussed in D.C or Santa Fe. Walter will update in line with ROI Macro etc as needed.
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supRT2SegmentationProps_07.doc
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RT Segmentation Properties IOD
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Uli Busch
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Johnson, Bosch
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2008/08/20
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13
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WG7 developed initial draft in D.C. Discussed in Santa Fe. Uli will progress work prior to September meeting.
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Change proposal for RT Image IOD to reference new RT objects; Examination of Blending Softcopy Presentation State as a replacement for the obsolete Curve module.
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-
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-
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-
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14
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Postponed until planning-related IODs developed.
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SUPPORTING DOCUMENTS
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supRT2aUseCases_01.doc
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High-level clinical use cases
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Bruce Curran
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Moyers
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2007/12/13
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In supporting docs directory
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supRT2aERDiagram_01.pdf
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Overall Entity-Relationship Model
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Bill Bennett
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Busch, Beunk, Sarafa
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2007/12/14
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-
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In supporting docs directory
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Email Addresses
Dave Murray dmurray@tomotherapy.com
Bill Bennett bbennett@cmsrtp.com
Harold Beunk harold.beunk@nl.nucletron.com
Scott Johnson scott.l.johnson@philips.com
Christof Schadt christof.schadt@brainlab.com
Andrea Morgan amorgan@calypsomedical.com
Uli Busch Ulrich.busch@varian.com
Stuart Swerdloff sswerdloff@impac.com
Michael Moyers mfmoyers@roadrunner.com
Walter Bosch bosch@wustl.edu
John Sarafa sarafa@cmsrtp.com
Bruce Curran bcurran1@lifespan.org
Scot Hogan shogan@impac.com
Johannes Stahl johannes.stahl@siemens.com
Colin Sims csims@accuray.com
Bob Philbin bphilbin@tomotherapy.com
Bob Pekarek bpekarek@tomotherapy.com
Ulrich Beifuß ulrich.beifuss@brainlab.com
Jaap Pijpelink jaap.pijpelink@nl.nucletron.com
Michael Baumann baumann@optivus.com
John Weston jweston@impac.com
Tony Apicella aapicella@viewray.com
____________________________
WG-07 (Radiation Therapy) of the
DICOM Standards Committee
June 16-19, 2008
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