IEC TR 62266:2002

TECHNICAL IEC
REPORT
TR 62266
First edition
2002-03
Medical electrical equipment –
Guidelines for implementation of
DICOM in radiotherapy
Reference number
IEC/TR 62266:2002(E)
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TECHNICAL IEC
REPORT
TR 62266
First edition
2002-03
Medical electrical equipment –
Guidelines for implementation of
DICOM in radiotherapy
 IEC 2002  Copyright - all rights reserved
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– 2 – TR 62266  IEC:2002(E)
CONTENTS
1 Introduction to this document.5
2 Introduction to DICOM.5
3 DICOM RT Extension .7
4 DICOM RT Capabilities .8
5 DICOM RT Objects.8
6 A DICOM Example (inc RT Objects) .9
7 The DICOM Conformance Statement (DCS) .9
8 DICOM Storage Media Concept.10
9 DICOM Implementation Guide .10
10 DICOM Testing.11
11 Caution to Users.11
12 Concluding Remarks .12
13 References.12
Annex A XYZ/Company Oncology Systems Ltd An Example DICOM Conformance
Statement forXYZ/Product Treatment System .15
A.1 Introduction .15
A.2 Implementation Model.16
A.3 AE Specifications.18
A.4 Communication Profiles .20
A.5 Extensions/Specialisations/Privatisations.21
A.6 Configuration .21
A.7 Support of Extended Character Sets .22
Annex B Applied RT Plan IOD and Mapping to XYZ/PRODUCT Database Import of RT
Plan Prescriptions.23
Annex C C-STORE Response Status Codes .44
Annex D Configurable AE-Specific Attribute Mapping to XYZ/PRODUCT Database .46

TR 62266  IEC:2002(E) – 3 –
INTERNATIONAL ELECTROTECHNICAL COMMISSION
____________
MEDICAL ELECTRICAL EQUIPMENT –
GUIDELINES FOR IMPLEMENTATION OF
DICOM IN RADIOTHERAPY
FOREWORD
1) The IEC (International Electrotechnical Commission) is a worldwide organization for standardization comprising
all national electrotechnical committees (IEC National Committees). The object of the IEC is to promote
international co-operation on all questions concerning standardization in the electrical and electronic fields. To
this end and in addition to other activities, the IEC publishes International Standards. Their preparation is
entrusted to technical committees; any IEC National Committee interested in the subject dealt with may
participate in this preparatory work. International, governmental and non-governmental organizations liaising
with the IEC also participate in this preparation. The IEC collaborates closely with the International
Organization for Standardization (ISO) in accordance with conditions determined by agreement between the
two organizations.
2) The formal decisions or agreements of the IEC on technical matters express, as nearly as possible, an
international consensus of opinion on the relevant subjects since each technical committee has representation
from all interested National Committees.
3) The documents produced have the form of recommendations for international use and are published in the form
of standards, technical specifications, technical reports or guides and they are accepted by the National
Committees in that sense.
4) In order to promote international unification, IEC National Committees undertake to apply IEC International
Standards transparently to the maximum extent possible in their national and regional standards. Any
divergence between the IEC Standard and the corresponding national or regional standard shall be clearly
indicated in the latter.
5) The IEC provides no marking procedure to indicate its approval and cannot be rendered responsible for any
equipment declared to be in conformity with one of its standards.
6) Attention is drawn to the possibility that some of the elements of this technical report may be the subject of
patent rights. The IEC shall not be held responsible for identifying any or all such patent rights.
The main task of IEC technical committees is to prepare International Standards. However, a
technical committee may propose the publication of a technical report when it has collected
data of a different kind from that which is normally published as an International Standard, for
example "state of the art".
Technical reports do not necessarily have to be reviewed until the data they provide are
considered to be no longer valid or useful by the maintenance team.
IEC 62266, which is a technical report, has been prepared by subcommittee 62C: Equipment
for radiotherapy, nuclear medicine and radiation dosimetry, of IEC technical committee 62:
Electrical equipment in medical practice.
The text of this technical report is based on the following documents:
Enquiry draft Report on voting
62C/309/CDV 62C/321/RVC
Full information on the voting for the approval of this technical report can be found in the
report on voting indicated in the above table.
This technical report does not follow the rules for structuring International Standards as given
in Part 2 of the ISO/IEC Directives.
NOTE This report has been reproduced without significant modification of its original content or drafting.

– 4 – TR 62266  IEC:2002(E)
This document, which is purely informative, is not to be regarded as an International
Standard.
The committee has decided that the contents of this publication will remain unchanged until
2007. At this date, the publication will be
• reconfirmed;
• withdrawn;
• replaced by a revised edition, or
• amended.
TR 62266  IEC:2002(E) – 5 –
MEDICAL ELECTRICAL EQUIPMENT –
GUIDELINES FOR IMPLEMENTATION OF
DICOM IN RADIOTHERAPY
1 Introduction to this document
For a number of years, the International Electrotechnical Commission (IEC) worked on the
development of a standard addressing Electronic Data Exchange in Radiotherapy. At about
the same time, another group with international representation had been working to extend
the DICOM (Digital Imaging and Communication in Medicine) standard initially used for
diagnostic images to include images/data used in radiotherapy. Ultimately, a decision was
made by the IEC to adopt four DICOM RT objects as an IEC standard which appeared in April
1998 as IEC 61852 ‘Medical Electrical Equipment – Digital Imaging and Communication
System in Medicine (DICOM) – Radiotherapy Objects First Edition’. The present document
has been developed to introduce and to call attention to the complexity of the DICOM
standard with its radiotherapy extension. It also addresses the importance of a complete
evaluation of the "DICOM Conformance Statement" prepared by manufacturers, and the need
for a qualified individual such as a medical physicist to evaluate the compatibility of pieces of
radiotherapy equipment impact in the clinic of electronic data transfer, and the integrity of
data exchange.
This document gives a brief introduction to DICOM including its extension to Radiotherapy.
Parts of this document are derived from the brochure produced by the DICOM WG 7
responsible for producing the RT extension to the DICOM Standard. This document outlines
preliminary steps required to implement and test a DICOM interface to a medical application
system.
(1a)
The DICOM standard has been published by the National Electrical Manufacturers
Association of America. Based on this standard there are a number of DICOM development
tool kits produced by academia and available in the public domain. There are also commercial
toolkits produced by a number of vendors. Details of these can be obtained on the Internet.
(1b)
The DICOM newsgroup on the Internet provides state of the art news on DICOM Standard

development, related products, problems etc. Some of the Internet references have links to
other companies’ DICOM-related Web sites which are extremely useful for further information
on DICOM related subjects.
NOTE This document is an implementation guide. For full normative description of the DICOM standard consult
(1a)
the official standard .
2 Introduction to DICOM
In the 1980's with the development and proliferation of medical imaging equipment, it became
clear to radiologists and the manufacturers of medical imaging equipment that the tremendous
growth in image acquisition systems, display workstations, archiving systems, and hospital-
radiology information systems made vital the connectivity and interoperability of all pieces of
equipment. In order to simplify and improve equipment connectivity, medical professionals
(American College of Radiology – ACR) joined forces with medical equipment manufacturers
(US National Electrical Manufacturers Association – NEMA) in an international effort to
develop DICOM, the Digital Imaging and Communications in Medicine Standard. When
DICOM interface is implemented into a medical device, it can be directly connected to another
DICOM-compatible device, eliminating the need for a custom interface. DICOM was first
developed to address connectivity and inter-operability problems in radiology, but today there
are sections of the DICOM standard which define radiotherapy objects. Fig 1 shows the scope
of the DICOM connectivity of these objects as supported by the standard.

– 6 – TR 62266  IEC:2002(E)
(1a)
The DICOM Standard currently provides the following Services:
• Network Image Transfer: Provides the capability for two devices to communicate by
sending objects such as radiology images (eg CT, MR, CR, X-Ray Angiography & RF,
PET, NM, US etc) or RT images and data (RT Structure Set, Plan, Image, Dose, &
Treatment Record). It also allows the facility to identify and retrieve/transfer images/data
from the remote devices. Network transfer is currently the most common connectivity
feature supported by DICOM products.
• On-Line Imaging Study Management: Provides medical devices with the network
capability to integrate with various information systems eg Hospital Information System
(HIS) for clinical and administrative data, and Radiotherapy Information System (RIS) for
radiology and radiotherapy images and data.
• Network Print Management: Provides the capability to print images on a networked
printer/camera. An example of this is multiple scanners or workstations printing images on
a single shared hardcopy media.
• Open Media Interchange: Provides the capability to manually exchange objects (images
or RT objects) and related information (such as reports or filming information). DICOM
standardizes a common file format, a medical directory structure, and a physical media
(eg CD, floppy disk). Examples include the exchange of images for a publication and
mailing a patient imaging study for remote consultation.
• Workflow Management: The standard has been extended to define Modality Worklist and
General Purpose Worklist which are designed to request, schedule, and describe the
performance of imaging and other procedures. Integration of these procedures provide
harmonisation with other standardization bodies. Further services in this area are being
considered.
The DICOM standard is structured as:
Open Networking (Parts 1-9)
Part 1 – Introduction and Overview – describes the overall structure of the Standard.
Part 2 – Conformance – Explicit statement of Objects (eg CT, MR, RT Images), Service
Classes (such as Storage, Query/Retrieve) and Communication Profile supported (such as
TCP/IP, Ethernet).
Part 3 – Information Object Definitions (IOD) – specifies the structure and attributes of objects
which are operated by Service Classes. These objects include images, studies, and patient.
Part 4 – Service Class Specifications – defines the operations that can be performed on
instances of Information Objects (defined in Part 3) to provide a specific service such as
Storage, Query/Retrieve, Print.
NOTE Parts 3 and 4 of the standard represent the core of the DICOM Open Network formalism. Services Classes
defined in part 4 are combined with specific Information Object Definitions (IODs) defined in part 3 to form a
service-object pair (SOP). The SOP is the basic building block of DICOM communication. Further an SOP can
either be a Client (Service Class User – SCU) or a server (Service Class Provider – SCP). So for the two DICOM
compliant partners to communicate with each one of the partners must define its role as an SCU and the other as
an SCP.
Part 5 – Data Structures and Encoding – specifies the encoding of the data content of
messages which are exchanged to accomplish the operations used by the Service Classes
(Part 4)
Part 6 – Data Dictionary – defines the individual information attributes that represent the data
content (Part 5) of instances of Information Objects.
Part 7 – Message Exchange – specifies the operations and protocol used to exchange
messages. These operations are used to accomplish the services defined by the Service
Classes (Part 4)
TR 62266  IEC:2002(E) – 7 –
Part 8 – Network Communication Support for Message Exchange – defines the services and
protocols used to exchange messages (Part 7) directly on OSI (Open Systems
Interconnection) and TCP/IP networks.
Part 9 – Point-to-Point Communication Support for Message Exchange- defines the services
and protocols used to exchange messages (Part 7) on the DICOM 50-pin interface. (Included
for compatibility with ACR/NEMA 2 ). It is no longer used with DICOM3.0.
Open Media Storage (Parts 10-12)
Part 10 – Media Storage and File Formats for Media Interchange – standardises the overall
open Storage Media architecture used by this part, including the definition of a generic File
Format, a Basic File Service and a Directory concept.
Part 11 – Media Storage Application Profiles – Standardises a number of choices related to a
specific clinical need (selection of a Physical Medium and Media Format as well as specific
Service/Object Pair Classes). It aims at facilitating the inter-operability between
implementations which claim conformance to the same Application Profile. Part 11 is intended
to be extended as the clinical needs for Media Storage Interchange evolve.
Part 12 – Media Formats and Physical Media for Data Interchange – defines a number of
selected Physical Medium and corresponding Media Formats. These Media Formats and
Physical Medium selections are referenced by one or more of the Application Profiles of Part
11. Part 12 is to be extended as the technologies related to Physical Medium evolve.
Point-to-Point Print Print Management (Part 13)
Part 13 – Print Management Point-to-Point Communication Support – specifies the services
and protocol necessary to support the communication of DICOM Print Management
Application Entities over point-to-point links between print users and print providers.
Greyscale Standard Display Function (Part 14)
Part 14 – Grayscale Standard Display Function – specifies standardised Display Function for
display of grayscale images.
Security Profiles (Part 15)
This standard provides mechanism that could be used to implement security policies with
regard to the interchange of DICOM objects between Application Entities.
3 DICOM RT Extension
During the RSNA 1994 at Chicago, a meeting was held at which a clear need was expressed
for standardization of the way radiotherapy data (such as external beam and brachytherapy
treatment plans, doses, and images) are transferred from one piece of equipment to another.
The importance of such a standard was clear. The cost of developing custom interfaces,
especially in radiotherapy departments where multi-vendor installations are common, is high,
an expense which must be passed on to the user. Not only are such developments costly,
they can be technically difficult, slowing down the progress of integration of the radiotherapy
department, and are also safety critical. Although a standard such as DICOM does not
eliminate these issues, it can facilitate development of safe, reliable inter-operability.
As a result of the RSNA meeting, an ad-hoc Working Group, later to become DICOM Working
Group 7 (Radiotherapy Objects) was formed under the auspices of NEMA. Participating
members of this group include many manufacturers of radiotherapy equipment, some
academics, and also members involved with the AAPM and the IEC.
In 1997, four DICOM RT objects were ratified: RT Structure Set, RT Plan, RT Dose, and RT
Image. These objects were integrated into Part 3 of the DICOM standard published in 1998.

– 8 – TR 62266  IEC:2002(E)
An additional three objects: RT Beam Treatment Record, RT Brachy Treatment Record & RT
Treatment Summary Records were finalised in 1998 which subsequently appeared in DICOM
standard in 1999.
4 DICOM RT Capabilities
In order to understand what DICOM objects can and cannot provide it is important for
radiotherapy professionals to distinguish between DICOM connectivity and application
interoperability. DICOM connectivity refers to the DICOM message exchange standard
responsible for establishing connections and exchanging properly structured messages so
that an information object sent from one node will be completely received by the receiving
node. In other words, the successful transfer of information: the successful "plug and
exchange" between two pieces of medical equipment.
Beyond connectivity lies application interoperability – the ability to process and manipulate
information objects. DICOM plays a crucial role in enabling such interoperability, but
sometimes "plug and play" at this level requires more than the standardized definition and
coding of information provided by DICOM. Specification and testing of the clinical application
capabilities and data flow needs to be performed by the healthcare facility to ensure effective
integration of the various DICOM applications. For example, transfer of IMRT (intensity-
modulated) data from an IMRT-capable treatment planning system requires a record and
verify or treatment system capable of managing such dynamic treatments. As we will see
later, DICOM requires implementers to explicitly specify these application-specific information
needs in a DICOM Conformance Statement which will provide the basis for achieving such
application interoperability.
The key feature of DICOM is the capability of “connectivity”. This refers to the protocols
established by DICOM which permit the establishment of connections and the exchange of
properly structured messages so that an information object sent from one piece of equipment
will be received intact by another piece of equipment.
5 DICOM RT Objects
The DICOM RT objects, added to part 3 of the DICOM Standard, are defined as:
• RT Structure Set, containing information related to patient anatomy, for example
structures, markers, and isocenters. These entities are typically identified on devices such
as CT scanners, physical or virtual simulation workstations, or treatment planning
systems.
• RT Plan, containing geometric and dosimetric data specifying a course of external beam
and/or brachytherapy treatment, for example beam angles, collimator openings, beam
modifiers, and brachytherapy channel and source specifications. The RT Plan entity may
be created by a simulation workstation, and subsequently enriched by a treatment
planning system before being passed on to a record and verify system or treatment
device. An instance of the RT Plan object usually references a RT Structure Set instance
to define a coordinate system and set of patient structures.
• RT Image, specifying radiotherapy images which have been obtained on a conical
imaging geometry, such as those found on conventional simulators and portal imaging
devices. It can also be used for calculated images using the same geometry, such as
digitally reconstructed radiographs (DRRs).
• RT Dose, containing dose data generated by a treatment planning system in one or more
of several formats: three-dimensional dose data, isodose curves, DVHs, or dose points.
• RT Beam Treatment Record: This scope of the RT Beam Treatment Record is external
beam session record during a radiotherapy treatment course with an optional treatment
summary indicating the cumulative state of a treatment course.

TR 62266  IEC:2002(E) – 9 –
• RT Brachy Treatment Record: This scope of the RT Brachy Treatment Record is
brachytherapy treatment session record during a radiotherapy treatment course with an
optional treatment summary indicating the cumulative state of a treatment course.
• RT Treatment Summary Record: The scope of this object is treatment summaries
indicating the cumulative state of a treatment course.
Fig 2 describes the DICOM Information Model with the additional RT objects.
6 A DICOM Example (including RT Objects)
To illustrate, see Fig 3, how DICOM, including RT objects, can be used during an external
beam patient treatment, here is a list of possible treatment steps, and their associated DICOM
objects:
1. The patient is scanned on a CT scanner, producing a DICOM CT image study. Other
DICOM image modalities, such as MR, could also be produced.
2. A virtual simulation application queries the scanner using DICOM, retrieves the images,
and performs a virtual simulation. An RT Structure Set object is produced, containing
identified structures such as the tumor and critical organs. An associated RT Plan is also
created, containing beam geometry information. Digitally-reconstructed radiographs
(DRRs) may also be created as RT Image objects.
3. A treatment planning system (TPS) then reads the CT Images, RT Structure Set, and RT
Plan. It adds beam modifiers, modifies the beam geometries where necessary, and also
calculates dosimetry data for the plan. A new RT Plan object is created, and RT Image
DRRs may also be produced.
4. A record and verify system then obtains the completed RT Plan object, and uses the data
contained within it to initialize a linac treatment. Alternatively, the linac itself could make
use of the object directly. An Electronic Portal Imaging Device (EPID) can create RT
Image verification images, or compare acquired images with DRRs created by the above
steps.
5. Periodically during the course of treatment, the linac or record and verify system creates
Treatment Record objects, generally one for each treatment session.
The above sequence illustrates just one scenario. In reality there is a wide variety of different
utilizations possible, and DICOM RT objects have been designed with this flexibility in mind.
7 The DICOM Conformance Statement (DCS)
It is not enough for a vendor to simply claim conformance to DICOM, and the statement "This
product has DICOM" has even less meaning in the radiotherapy domain, in which inter
operability is a very complex issue. A vendor must produce a DICOM Conformance Statement
(1a)
(DCS). Part 2 of the DICOM Standard describes the format of such a statement. It
stipulates that a DCS should contain DICOM Objects, Services and their Roles, and the
Communication media implemented by a manufacturer. The standard does not stipulate to list
the Object modules and their relevant attributes implemented. This information is vital to aid
and establish inter-connectivity between the two systems intending to communicate to each
other. A prospective purchaser of a new equipment must study the DCS supplied by a vendor
to ensure successful communication between his/her and the vendor’s equipment.
A typical ‘Example’ of a DCS for RT Plan IOD as SCP is given in Annex A of this document
where Chapters 1-7 of the DCS contains information stipulated by the DICOM standard.
Appendices A-C of the DCS gives additional information which is useful and necessary for
practical application. Appendix A of this DCS specifies the RT Plan modules and their
attributes implemented by the Example. Appendix B lists the status code returned by the
Example DCS and Appendix C lists the DICOM attributes which do not map exactly on to the
example DCS.
– 10 – TR 62266  IEC:2002(E)
Connectivity between two pieces of equipment can be evaluated ahead of time by the use of
the equipment's DCSs. However, for RT applications, it is not usually possible to determine
inter-operability – this must be done by extensive testing. Nevertheless, conformance
statements provide a foundation to determine connectivity and assess the potential inter-
operability of two products, and in some cases identify potential problems without ever having
physically connected them.
Radiotherapy professionals should insist upon a conformance statement for any device that
claims to be DICOM conformant with RT Objects. Many manufacturers make their
conformance statements available on the Internet.
Developing and testing product inter-operability is a time consuming process. This is
particularly so in radiotherapy, where the complexity of the objects far exceeds those found in
nearly all other modalities. After over a year of behind-the-scenes effort, many manufacturers
are now selling or demonstrating versions of their products with DICOM RT Objects.
8 DICOM Storage Media Concept
(1a)
The DICOM Storage Media Standard (parts 10-12) defines concept to implement DICOM
based distributed processing which is different from that of the Network Distributed
Processes. In the Storage Media concept no direct link is available between the two systems.
Instead the information is stored by a system on a removable media according to the directory
and file formats defined by the DICOM Media Storage Standard. The storage media eg CD,
floppy disk can be used by another system conforming to the DICOM Media Storage
Standard.
A DICOM Media Storage DCS is also a pre-requisite for a storage device produced by a
system. The salient part of the DCS is an Application Profile (AP) which contains necessary
information which is the format of the media and the extent of information contained on the
media.
available from a number of vendors contain facilities for developing
The DICOM Toolkits
DICOM Media Storage on a removable physical media. There are a number of vendors/users
producing images/information on physical media (e.g. CD ROM, MOD and soon DVD) based
on the DICOM Media Storage Standard for use by other systems.
9 DICOM Implementation Guide
This section provides guidelines for implementing a DICOM interface to an application
system:
1. From the communication requirement specifications of a system for which the DICOM
Interface is to be developed:
– Deduce the DICOM Objects (e.g. images) to be implemented,
– For each Object define the Service Class that is required,
– For each Service Class establish whether the DICOM interface has is to developed as
a Service Class Provider (Server) or a Service Class User (Client) of the service,
2. Each Object defines Mandatory, Conditional and User Optional modules. Define which of
the User Optional modules are to be implemented.
3. Each module contains mandatory or optional attributes. It is recommended to list all the
mandatory and optional attributes within all the modules implemented.

4. There are a number of commercially available DICOM Toolkits based on the DICOM
standard. A Toolkit usually provides an environment to develop DICOM interface to an
application system and some of these also provide initial testing facilities.

TR 62266  IEC:2002(E) – 11 –
There are also a number of public domain Toolkits available on the Internet which are not
normally used to develop a DICOM interface to an application system to be developed as a
commercial product. Notwithstanding that, these toolkits provide an easy to understand and
implement DICOM interface. These toolkits also provide a very convenient initial test
environment.
As it is obvious from (1) – (3), that there are a number of options available in implementing a
DICOM interface to an application system. A DCS contains the Objects and the associated
Service Classes implemented by an application system. A good DCS must also include the
Object modules and their attributes implemented. The next step is to consult the DCS, usually
published on the Internet, of a system you are intending to interconnect with. From the
comparisons of two DCSs, it should be possible to deduce the level of interconnectivity of the
two systems.
For a complicated DICOM RT Object (eg RT Plan), different implementers are likely to
implement different module/attribute options. Before an implementation is started, it is
suggested to consult major providers of already existing DICOM interfaces about the
commonly accepted implementations and the way the attributes are used officially. In any
case where an implementer is uncertain about how the attributes are used, the DICOM WG7
committee for RT Objects should be contacted for advice on correct usage.
It is also important for two or more implementers intending to inter-communicate to decide
upon the common set of module/attribute options and check the consistency of the attribute
usage of each module against the DICOM standard. In case of uncertainty, the DICOM WG7
should be contacted to avoid possible implementations that contradict the officially
established usage. Some implementations may become invalidated in the course of other
implementations which correctly use the standard definition.
10 DICOM Testing
The DICOM standard does not specify a test suite or a compliance verification mechanism.
There are working groups/centers developing compliance verification tools, but it is still the
users responsibility to define initial cross-platform test plans to demonstrate compliance
between the new and existing pieces of equipment.
To verify a DICOM interface, the following steps are usually conducted:
• Test the conformance of the application system against the DCS produced. This is an in-
house test to check that the system meets the DCS.
• There are a number of public domain DICOM test environments available on the Internet
which can provide initial test facilities.
• To test it more rigorously there are also commercially available DICOM test centers. So
far these are only available for the non-RT environment.
• Arrange one or more cross vendor testing with third party equipment. This should
determine the level of inter-connectivity between various equipment.
11 Caution to Users
The DICOM standard follows the IEC convention in all cases except for the patient coordinate
system which is the only known inconsistency between the DICOM standard and the IEC. The
IEC, through its publication IEC 61217, Amendment 1 (1999) defines patient coordinate
systems for radiotherapy equipment. As the DICOM defines the patient co-ordinate system
that is related to the portrayal of cross-sectional images, an amendment to IEC 61217
includes transformation matrices to allow conversion of patient coordinates from the DICOM
convention to the IEC convention.

– 12 – TR 62266  IEC:2002(E)
The health care facility is responsible for confirming the veracity of data transferred using the
DICOM standard. This requires specification of the needed capabilities, evaluations of the
accuracy data transfer, and testing of the implementation of these data by the receiving
station.
Although DICOM compliance is a necessary condition for radiation oncology information to be
transferred among pieces of radiation oncology equipment, it is not necessarily a sufficient
condition. DICOM provides a common interface language, and DICOM compliance ensures
that all equipment "speaks the same language". However, DICOM compliance does not
ensure that the information passed from one piece of equipment to another will be compatible
with the capabilities of the receiving equipment, such that the two systems can inter-operate.
The situation is analogous to communication among people: A communication language (say,
English or French) might be defined, but one also needs a mechanism, such as a telephone
or email connection, to actually effect the transfer of information from one individual to
another. Thus, purchasers of radiation oncology equipment must verify that their equipment
will actually communicate with other equipment and successfully transfer information using
the DICOM protocols and definitions.
12 Concluding remarks
DICOM has been demonstrated successfully in a number of international conferences and
exhibitions. It has increasingly gained confidence from the equipment vendors and users. The
DICOM interface is beginning to become pre-requisite for acquisition modalities, highly
desirable for RT & image processing, and hardcopy systems.
The DICOM Standard Committee is the governing body with members drawn from user and
vendor organisations, government agencies and other standard developing organisations with

NEMA secretariat.
The DICOM is expanding its scope from radiology and cardiology imaging to radiotherapy,
reporting about findings and information exchange between imaging system and information
systems. Addition to the Standard are made as new DICOM Supplements that are
incorporated into the standard and the maintenance work is carried out via Correction
Proposals.
13 References
(1) The DICOM Standard
(a) The Digital Imaging and Communications in Medicine (DICOM) Standard
David Snavely, Industry Manager
NEMA PS3.1-15 (2000)
National Electrical Manufacturers Association (NEMA) Publication Sales
th
1300N 17 Street, Suite 1847
Rosslyn, Va 22209, USA Phone (703) 841 3285 Fax (703) 841 3385
http://www.nema.org/nema/medical/dicom/
(b) DICOM newsgroup
Comp.protocols.Dicom
TR 62266  IEC:2002(E) – 13 –
Workstations                 Acquisition Modalities
(TPS, EPI, Review Stn)                      (eg CT, MR)
Information
Systems
DICOM
Connectivity
Archiving
Systems
Printers
Treatment
System
Fig 1 The Scope of DICOM Connectivity

– 14 – TR 62266  IEC:2002(E)
Patient
Visit Study Study
Images
RT Beam Treatment Record
RT Brachy Treatment Record
RT Image RT Dose RT Structure Set RT Plan
RT Treatment Summary Records
DICOM                  DICOM RT
Fig 2 DICOM Information Model (with RT Extensions)
Acquisition Systems:     Portal             Information/Archiving                 Hard Copy
(CT, MR etc)          Imaging                   System                      (Printer, Camera)
Images                 Images                      All                         All
Image          SS, Plan, Image                SS, Plan, Dose         All       Record
Image                  Image, SS, Plan                   Plan
Simulator       Virtual Simulator     Treatment         Review Station       Linac               Linac
Planning System                      Control System
Fig 3 A DICOM Example (inc RT Objects)
(During an external beam patient treatment)

TR 62266  IEC:2002(E) – 15 –
Annex A
XYZ/Company Oncology Systems Ltd
An Example DICOM Conformance Statement
for XYZ/Product Treatment System
A.1 Introduction
This chapter provides general information about the purpose, scope and contents of this
Conformance Statement.
A.1.1 Scope and field of application
The scope of this DICOM Conformance Statement is to facilitate data exchange with
equipment of XYZ/COMPANY Oncology Systems Ltd. This document specifies the compliance
to the DICOM standard (formally called the NEMA PS 3.X-1998 standards). It contains a short
description of the applications involved and provides technical information about the data
exchange capabilities of the equipment. The main elements describing these capabilities are
the supported DICOM Service Object Pair (SOP) Classes, Roles, Information Object
Definitions (IOD) and Transfer Syntax’s.
The field of application is the integration of the XYZ/COMPANY Oncology Systems equipment
into an environment of medical devices.
This Conformance Statement should be read in conjunction with the DICOM standard and its
addenda.
A.1.2 Intended audience
This Conformance Statement is intended for:
• (potential) customers,
• system integrators of medical equipment,
• marketing staff interested in system functionality,
• software designers implementing DICOM interfaces
It is assumed that the reader is familiar with the DICOM standard.
A.1.3 Contents and structure
The DICOM Conformance Statement is contained in chapter A.2 through A.7 and follows the
contents and structuring requirements of DICOM PS 3.2-1998 Additionally, the Appendices
following chapter A.7 specify the details of the applied IODs, SCP-specific status codes and
extended configuration details.
A.1.4 Used definitions, terms and abbreviations
• DICOM definitions, terms and abbreviations are used throughout this Conformance
Statement. For a description of these, see DICOM PS 3 1998.
• The word XYZ/COMPANY in this document refers to XYZ/COMPANY Oncology Systems
Ltd.
• The word XYZ/PRODUCT in this document refers to the XYZ/COMPANY Oncology
Systems Precise Treatment System Product, Release 1.0.

– 16 – TR 62266  IEC:2002(E)
A.1.5 References
[DICOM PS 3 1998]
The Digital Imaging and Communications in Medicine (DICOM) standard:
NEMA PS 3.X (X refers to the part 1 – 13) and Supplements.
National Electrical Manufacturers Association (NEMA) Publication Sales
1300 N. 17th Street, Suite 1847
Rosslyn, Va. 22209, United States of America
A.1.6 Important note to the reader
This Conformance Statement by itself does not guarantee successful interoperability of
XYZ/COMPANY equipment with non-XYZ/COMPANY equipment. The user (or user’s agent)
should be aware of the following issues:
• Scope
The goal of DICOM is to facilitate inter-connectivity rather than interoperability.
Interoperability refers to the ability of application functions, distributed over two or more
systems, to work successfully together. The integration of medical devices into a
networked environment may require application functions that are not specified within the
scope of DICOM. Consequently, using only the information provided by this Conformance
Statement does not guarantee interoperability of XYZ/COMPANY equipment with non-
XYZ/COMPANY equipment. It is the user’s responsibility to analyse thoroughly the
application requirements and to specify a solution that integrates XYZ/COMPANY
equipment with non-XYZ/COMPANY equipment.
• Validation
XYZ/COMPANY equipment has been carefully tested to assure that the actual
implementation of the DICOM interface corresponds with this Conformance Statement.
Where XYZ/COMPANY equipment is linked to non-XYZ/COMPANY equipment, the first
step is to compare the relevant Conformance Statements. If the Conformance Statements
indicate that successful information exchange should be possible, additional validation
tests will be necessary to ensure the functionality, performance, accuracy and stability of
prescription and prescription related data. It is the responsibility of the user (or user’s
agent) to specify the appropriate test suite and to carry out the additional validation tests.
• New versions of the DICOM Standard
The DICOM Standard will evolve in future to meet the user’s growing requirements and to
incorporate new features and technologies. XYZ/COMPANY is actively involved in this
evolution and plans to adapt its equipment to future versions of the DICOM Standard. In
order to do so, XYZ/COMPANY reserves the right to make changes to its products or to
discontinue its delivery. The user should ensure that any non-XYZ/COMPANY provider
linking to XYZ/COMPANY equipment also adapts to future versions of the DICOM
Standard. If not, the incorporation of DICOM enhancements into XYZ/COMPANY
equipment may lead to l
...