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 infor
...