Digital Imaging and Communications in Medicine (DICOM)

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180 Chapter 9 DICOM Associations or worse, “no reason specified” (adored by many DICOM manufacturers) work about as well in error troubleshooting as reading tea leaves. In brief, troubleshooting association errors with mysterious reasons always takes longer than you would like. In this case, the more you know about the exact association protocol, the better your chances are of pinpointing the problem. This chapter is dedicated to building this knowledge. First, there will be a basic overview of the association establishment process (something you need to know regardless of your DICOM needs and goals), and then a more technical and complete description of the association establishment protocol is provided. 9.1 Association Establishment Basics The key to any DICOM association establishment is the concept of Presentation Context. When an AE wants to initialize a network transaction, it packs all information about itself into a Presentation Context message and sends it to the receiving AE. Basically, the Presentation Context is a business card that each DICOM unit hands out to its potential partners. Then the partners decide whether they can reply to this “business opportunity”. Just like in business, we can mentally break the presentation information into two parts: essential and negotiable. The essential part (known as the DICOM Abstract Syntax) represents the core functionality of each DICOM device, and therefore cannot be altered. For example, the Abstract Syntax for an MR scanner reflects the MR image format. The negotiable part (called the DICOM Transfer Syntax) represents dataencoding formats, and therefore can be altered. Transfer Syntaxes are meant to make DICOM connection more flexible, allowing the partners agree on whatever is most acceptable to them both, just like people, providing several phone numbers and emails on their cards. When a Presentation Context card is sent to the receiving AE, the latter either accepts it (replying with an “Accepted Presentation Context” message, specifying any optional choices), or rejects the connection. Rejection represents an association failure, a refusal for subsequent communications, and you want to avoid this whenever possible. Let’s go back to our ARCHIVE-MR example. A new MR study has just been completed on the MR scanner and needs to be stored on the ARCHIVE server. An MR technologist pushes the “Send” button on her MR scanner interface to send the study to the ARCHIVE. If she could actually hear the AEs talk, she would hear something like this:
9.1 Association Establishment Basics 181 Act 1—Association Establishment MR scanner (to ARCHIVE): Hi, I am MR scanner and I speak DICOM. Do you? ARCHIVE (to MR scanner): Hi, I am ARCHIVE and I speak DICOM, too. MR: Are you SCP for MR image storage? (Can you store MR images?) ARCHIVE: I sure am. MR: Listen, I have 100 new uncompressed MR images and I want to send them to you as is. I can also send them compressed with JPEG2000, or compressed with 12-bit lossless JPEG. ARCHIVE: No problem, I can take MR images, but I prefer them un compre s s e d . MR: OK, starting to send. ARCHIVE: OK, ready to receive. This dialog, which we translated from “Dicomean” into plain English, constitutes the association establishment part. In the very first lines, the devices introduce their functionality (Abstract Syntaxes), and then agree on image transfer format (Transfer Syntaxes). As images start to flow, the two units continue to communicate the image transfer part, verifying the process of image transaction: Act 2—Image Transfer (Right after Act 1, same environment, same actors) MR (sending each image to ARCHIVE): Here is the first. Here is the second. Here is … ARCHIVE: First received, OK. Second received, OK. Third… Finally (yet still very importantly), when all images are transmitted, the AEs need to gracefully terminate their active association: Act 3—Association Termination MR (after the last image is sent): All 100 images sent, 0 images failed, success, goodbye. ARCHIVE (after the last image is received): All images received, goodbye. (association terminated) As you can see, the association protocol is very simple and intuitive, and allows the communicating AEs to control the entire flow of the data exchange.
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Oleg S. Pianykh Digital Imaging and
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Oleg S. Pianykh, Ph.D. Department o
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Foreword VII Foreword Digital Imagi
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X Foreword so technically challengi
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Contents XIII Contents Part I: Intr
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Contents XV 7.2.4 The Verification
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Contents XVII 12.2 Testing, Testing
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abbreviations 3D Three-Dimensional
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Part I: IntroductIon to dIcoM
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4 Chapter 1 What is DICOM? Fig. 1 M
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Chapter 2 How Does DICOM Work? “E
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Establishment-DICOM handshake, when
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12 Chapter 3 Where Do You Get DICOM
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18 Chapter 4 A Brief History of DIC
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20 ACR-NEMA vs. DICOM Chapter 4 A B
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22 ACR-NEMA 2.0 Chapter 4 A Brief H
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5.1 IT Boot Camp 25 Chapter 5 Parle
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5.2 Text vs. Binary 27 consisting o
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5.3 DICOM Grammar: Value Representa
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5.4 DICOM Data Dictionary 43 Table
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5.4 DICOM Data Dictionary 45 5.4.2
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5.5 DICOM Objects 47 mation and com
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5.5 DICOM Objects 49 Table 5 Implic
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5.5 DICOM Objects 51 Table 9 Explic
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5.5 DICOM Objects 53 5.5.2 Encoding
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5.5 DICOM Objects 55 2. Modifying a
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5.5 DICOM Objects 57 change the pri
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5.5 DICOM Objects 59 Table 11 SQ en
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5.5 DICOM Objects 61 mark the end o
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5.5 DICOM Objects 63 5.5.6 Required
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5.5 DICOM Objects 65 5.5.8 Unique I
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5.6 DICOM Information Hierarchy 67
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5.7 Modules, IODs, and Information
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86 Chapter 6 Medical Images in DICO
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88 Fig. 20 Storing pixel sample bit
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94 CAD and lossy compression Chapte
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98 6.2.4 Choosing the Right Compres
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100 Chapter 6 Medical Images in DIC
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Part III: DICOM COMMunICatIOns
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116 Chapter 7 DICOM SOPs: Basic net
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118 Connecting the unconnectable Ch
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120 7.2 Services and Data Chapter 7
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122 Fig. 34 Building DICOM Message
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124 Table 21 C-Echo-Rsp: responding
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126 Table 22 C-Echo-Rq in a final D
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232 Table 50 (continued) DICOMDIR e
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234 10.2.2 Secure DICOM File Format
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236 Chapter 10 DICOM Media: Files,
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248 Fig. 77 DICOM file in WordPad C
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250 Chapter 11 DICOM Security All e
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252 Chapter 11 DICOM Security The c
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254 Chapter 11 DICOM Security senti
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256 11.3.2 Encryption Chapter 11 DI
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258 Chapter 11 DICOM Security from
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260 Fig. 82 Digital signature Chapt
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12.1 DICOM Conformance 263 Chapter
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12.2 Testing, Testing, and Yes, Mor
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12.4 DICOM from a Black Box 267 Thi
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12.6 Open-Source DICOM 269 on their
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12.6 Open-Source DICOM 271 processo
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13.1 Can I See the Image? 275 Chapt
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13.1 Can I See the Image? 277 confe
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13.2 You’ve Got Mail 279 bytes. I
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13.3 Teleradiology 281 Fig. 85 Exte
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13.3 Teleradiology 283 Stealth tele
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13.3 Teleradiology 285 not always r
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13.4 DICOM and the WWW 287 (see 5.5
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13.5 “DICOM Email” 289 4. XML i
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13.5 “DICOM Email” 291 Fig. 87
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13.6 From PACS to PDAs? 293 images
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13.7 Starting Your Teleradiology Pr
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13.7 Starting Your Teleradiology Pr
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13.8 Conclusion 299 C-Stores, and f
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302 14.1 HL7: HIS and RIS Chapter 1
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304 Chapter 14 Standards and System
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15.1 What it Takes to Kill a PACS 3
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15.2 Extreme PACS 317 15.2.1 Diggin
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15.2 Extreme PACS 319 unstable netw
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15.2 Extreme PACS 321 cally configu
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323 Fig. 93 Modular, distributed PA
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326 Chapter 16 DICOM Software Devel
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332 Chapter 17 DICOM Implementation
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334 Real case: teleradiology or bac
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336 Chapter 17 DICOM Implementation
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18.1 Frequent Problems 339 Chapter
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18.1 Frequent Problems 341 18.1.5 I
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18.2 Naive Questions Physicians Lik
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A.1 DICOM Transfer Syntaxes 351 App
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A.2 DICOM SOPs 353 A.2 DICOM SOPs T
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A.3 C-Find Bytes 359 Table 53 (cont
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380 References Langer S (2005) Cont
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382 DICOM email 221, 289, 290, 292
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