DICOMan^©

-- The Universal DICOM Wizard for Radiation Oncology and  Radiology

The latest version is 251, Build 611, Released on November 01, 2009

Figure 1 The typical look of DICOMan.

What is DICOM?

DICOM stands for Digital Imaging and COmmunication in Medicine. It is a standard developed by the National Electrical Manufacturers Association (NEMA) in conjunction with American College of Radiology (ACR). It covers most image formats for all of medicine, and it also specifies messaging and communication protocols between imaging modalities and their utilizing modalities. In 1997, four DICOM extension modules for radiation therapy (RT Structure Set, RT Dose, RT Plan and RT Image) were added, the fifth RT module, RT Record, was added in 1999. Currently it supports 47 active modalities (CT, MRI, CR, US, PET, SPECT...). Unfortunately as stated in the DICOM standard documents, the DICOM Standard committee does not provide any implementation details of any features of the standard, nor does it specify overall set of features and functions to be expected from specific systems, or provides procedures to test/validate an implementation’s conformance to the standard. It is the manufacturers’ responsibilities to comply with this standard and make their implementation interchangeable with others. When incompatibility problems occur, the end users usually do nothing but wait for a new release.

What is DICOMan?

As stated above, DICOM is the standard that all imaging modalities and relevant applications in medicine should comply. But in clinical realities, incompatibility problems occur due to inhomogeneous evolutionary states of implementations and the standing status of the standard itself. DICOMan is such a software system that aims to help tackle DICOM incompatibility problems in DO-IT-YOUSELF manner which is much faster than waiting for manufacturer’s new release or patches. It helps you address DICOM issues to meet immediate clinical needs.

Why Do We Need DICOMan?

Image Guided Radiation Therapy (IGRT) is the next-generation of technology for high precision radiotherapy, a state-of-the-art technology that combines planning and in-room imaging of the patient’s targets in the treatment position, before treatment delivery, and the images can be examined on on-line or off-line, for optimization of the accuracy and precision of the radiotherapy. Four-dimensional imaging, PET/CT, MRI, Computed Radiography, Ultrasound, and online portal imaging modalities, such as real-time x-ray imaging or cone-beam CT, are pouring much more image data into radiation therapy clinic in the current IGRT era than ever before. New emerging modalities such as MVCT are continuously joining this choir. All those imaging modalities are supposed to comply with DICOM standard, but in fact it takes time for manufacturers to adapt their systems to new imaging modalities with new features.

DICOM RT is an extension to the current DICOM standard specifically created to accommodate the fast evolving radiation therapy modalities. The manufacturers are adapting this evolving standard extension discreetly at various paces. A universal DICOM RT viewer of this kind is much needed in a radiation therapy clinic with equipment from various manufacturers.

High quality diagnostic imaging for target definition and image guidance plays an essential role in the process of IMRT / IGRT for precise daily target localization. Most often multiple imaging modalities and RT objects claiming DICOM conformance are involved in the processes of planning and delivery of radiation therapy. DICOM incompatibility problems may arise from various sources. A DICOM CD-ROM, for instance, is often the form of imaging studies of outer community patients. It is not unusual that images on those CD-ROMs can not be viewed because of corrupt built-in viewers or some corrupt image data. Sometimes images on good CD-ROMs can not be transferred to treatment planning workstations due to unsupported compression algorithms or the lack of a DICOM pusher. 

A missing or incompatible tag in the DICOM file, inconsistent image dimension and so on can also make DICOM objects unacceptable by some systems. It often happens when the facility is installing new equipment or upgrading existing systems. With the help of DICOMan, one should be able to pinpoint the problem and fix it in the DICOM editor module. For patients in the community, retrieving previous imaging studies for planning purposes can become laborious because of too much unwanted data or the absence of attending staff. The built-in DICOM retriever finds and fetches specified DICOM objects from PACS or imaging modalities whenever they are needed.

DICOMan is meant to tackle all those DICOM discommodities. With this application at hand, treatment planning and delivery of radiation therapy procedures will become practical in a timely fashion when those problems occur. As the DICOM standard evolving and new imaging modalities emerging, DICOM incompatibility problems will continue to occur. A fast adaptive DICOM application like this is very helpful for clinicians to view the imaging studies, register and fuse the diagnostic imaging for radiation treatment planning purpose, and image-guidance for treatment delivery.

Who needs DICOMan?

All clinics and research laboratories that need to handle DICOM and DICOM RT objects are the possible users. It is especially useful for users in the fields of Radiation Oncology and Radiology.

Main Features of DICOMan

For detailed description of DICOMan features, you are referred to the online manual "DIOCMan.chm". It is also included in the software package.

• View DICOM & DICOM RT Objects and Non-DICOM Images

  This application was written in C++ from scratch. It was optimized in efficiency and user-friendly graphical user interface (GUI) design. Its GUI was made flexible eye-friendly. Images of multiple studies of one or more patients can be viewed simultaneously in multiple image windows. Each image window can be maximized or even displayed in full-screen mode.  Changing window and level, zooming in/out and panning are right at your finger tips. The tree window on the left side organizes DICOM objects in hierarchical structure as stated in the DICOM standard. The drag-and-drop feature was implemented to make object selection easy.

  Compression algorithms have been integrated into this software seamlessly so that compressed images (it is very common for DICOM CD-ROM) can be decompressed and transferred to treatment planning systems that currently do not support compressed imaging studies. Please be advised that images on some CD-ROMs are not in DICOM format but in whatever format the built-in viewer reads.

  The stack of planar image slices can be reconstructed into volumetric data in real-time and rendering in orthogonal view to help the user localize the region of interest.

  Non-DICOM images of common formats (BMP, GIF, J2K, JBG, JPEG, PCX, PNG, RAW, TGA and TIFF) and the most popular dose distribution formats (dose distributions in DICOM format, such as of Eclipse and Helix, are of course supported) can also be viewed together with DICOM objects. Since Version 2.50, the most popular radiotherapy dosimetry image formats can also be read and displayed. They are recognized by file name suffixes. The supported non-DICOM image formats are listed alphabetically as follows.

  1. Bitmap (*.bmp)
  2. BrainLAB iPlan dose map (*.flu)
  3. CMS Focus/XiO dose map (*.cms)
  4. GIF(*.gif)
  5. JPEG 200 (*.j2k or *.jp2)
  6. JBG (*.jgb)
  7. JPEG (*.jpg or *.jpeg)
  8. PCX (*.pcx)
  9. Philips Pinnacle³ dose map (*.header)
  10. PLATO dose map (*.mlc)
  11. PNG (*.png)
  12. PTW Seven29 ion chamber array measurement (*.mcc)
  13. RAW (*.raw)
  14. RIT film dosimetry version 4 (*.rv4)
  15. TIFF (*.tif or *.tiff)
  16. TGA (*.tga)
  17. TomoTherapy dose map (*.header)
  18. Varian Eclipse fluence (*.efl)
  19. XRD X-Ray multi-framed image (*.his)

  

  Figure 2 The orthogonal view of an imaging study.

   

  

  Figure 3 View radiotherapy dosimetry images.

  It supports non-image DICOM objects such as RT Structure Set, RT Dose and RT Plan. RT PLAN module is extensively supported. It supports regular external beam radiation therapy plan including wedges and blocks, it also support IMRT plans using MLC or compensators. MLC segments either in step-and-shoot or sliding-window technique can be viewed interactively. It supports brachytherapy plan so that plan parameters such as machine features, source information and treatment channels can be extracted and tabulated. When reading RT DOSE module, DVHs and dose matrix can be tabulated or exported.

  It also provides the users with a three-dimensional rendering engine (Figure 1).

• Push DICOM Objects

DICOMan can push any selected DICOM objects to remote listening DICOM storage servers that declare the supports for mentioned DICOM objects. It helps one move DICOM objects around. For instance, when compressed imaging studies on a CD-ROM need to be transferred to a radiation therapy planning (RTP) system which does not support that compression algorithm, DICOMan can be used to decompress imaging studies and pusher them over. When some RTP systems do not allow direct DICOM file deposit (it may impinge their databases), the DICOM pusher helps you transfer DICOM files.

Figure 4 The DICOM pusher.

• Retrieve DICOM  Objects

When it is configured, it can find and retrieve seamlessly whatever imaging studies the user selected without extra junky data. When data transfer is completed, the fetched DICOM images will be automatically displayed. It works just like a terminal workstation of a commercial PACS without extra hardware investment. To help you establish DICOM connection, it also equipped with a network analyzing tool.

Figure 5 The DICOM retriever.

• Act as a DICOM Storage Server

The multi-threading programming technology was used to maximize the performance. It runs unnoticeably at the background and can be easily turned on or off. Figure 6 shows the configuration module for the storage server when it is to be started. A message window will be shown in the bottom-left corner of the main frame, indicating that the DICOM storage server is on and monitoring the communication process when receiving incoming DICOM objects.

Figure 6 The configuration module for DICOM the starting storage server.

• Edit DICOM Objects

It works like a text editor in the DICOM world. It functions far more than common de-identification. In fact it is capable of editing all data elements. For tags with large amount data, data can be extracted or be replaced with external data. It also validates the conformance against the DICOM standard of the latest revision and pinpoints the problems if there were any. In figure 6, one tag (300A,0002) is red flagged because the data length of 46 bytes has exceeded the maximum (16 bytes). The help message tells you the brief description the tag at your cursor position. This is a handy tool for serious DICOM users. I need it myself.

Figure 7 The DICOM editor.

• Anonymize DICOM Objects

As stated in the editor section, all tags in individual DICOM files can be modified, so can be patient’s name tag and ID tag. But when there are many DICOM files to be anonymized, DICOMan provides the user with a specific tool to anonymize all relevant DICOM files of one patient in a single job session.

• Convert Image Formats

Many imaging applications in either clinics or research laboratories do not support DICOM format or need extra capital investment for DICOM interfacing module to read images. This format converter will take care of the image format hustle in a few clicks.

DICOM image is treated as one kind of image formats along with common image formats such as BMP, JPEG and TIFF etc. Format conversion between any two of ten is available.

A dedicated feature to read/view multi-framed XRD-FG X-ray image sequence and convert it into multiple image files in either one of ten formats stated above. Here listed are a few examples.

Create Virtual DICOM Phantom

Convert multiple non-DICOM images to a DICOM series. It is particular useful for users who want to create artificial DICOM image phantom from non-DICOM images. Here are a few steps to make your own DICOM image phantom:

1. Paint a series of phantom slices in common image editor such as Microsoft Paint (Figure 8);
2. Name your images in ascending alphabetic order and pay attention to colors for your structures;
3. Read those images in DICOMan and convert them into DICOM images. For details, you are referred to online user's guide.
4. Read converted DICOM image phantom to verify data conversion (Figure 9).

Figure 8 A sample BITMAP image of a virtual phantom slice.

Figure 9 Verify the converted virtual phantom.

Generate AVI Movie

AVI is a common movie format. It is very well supported in the computer world. When a imaging study of multiple slices is converted to an AVI movie, it can be viewed on any computer or included in a presentation. To download a sample DICOM movie, please click on Figure 10.

Figure 10 A sample CT scan movie viewed in Windows Media Player.

Create Phantom Data  for Monte Carlo Simulation Code EGS4

This module is designed to export DICOM objects including imaging series and DICOM RT structure set in EGS4 phantom format. EGS4 is a software package for Monte Carlo simulation. This function is a result of inter-institutional collaboration with Yale University. The interested users are referred to Department of Therapeutic Radiology Yale University School of Medicine for Monte Carlo simulation codes.

Figure 11 A sample of EGS4 phantom attributes.

• Fully support DICOM RT objects (RT Image, RT Structure Set, RT Dose, RT Plan)

DICOMan is designed for medical imaging users with an emphasis on Radiation Oncology. DICOM RT objects are supported. Here are a few snapshots of RT object rendering.

Figure 11 DVH data rendering.

 

Figure 12 Compensator data rendering.

 

Figure 13 Isodose setting and rendering.

What is New in Version 2.51 Build 611

1. BrainLAB iPlan planar dose map can be read and displayed.
2. CMS Focus planar dose map can be read and displayed.
3. Philips Pinnacle planar dose map can be read and displayed.
4. Varian Eclipse fluence and dose map can be read and displayed.
5. RIT film disometry format is fully supported.
6. PTW Seven29 ion chamber array measurement can be read and displayed.
7. PLATO dose map can be read and displayed.
8. Image rotation for non-DICOM image is supported.
9. A MLC control panel is added for each rendering window.

Download the latest DICOMan here.

What is New in Version 2.46 Build 606

1. A bug in DICOM Editor is removed.
2. More attributes of all kinds of DICOM objects are read and displayed.
3. RT Plan module is updated.
4. A new function "REVAMP" is added to image window menu, allowing the user to replace current image data with that of another image, making it possible to edit DICOM image data in other image editing tools and put the data back in.
5. Reading/Saving As RAW image is supported.
6. Support 8-bit image data of either double precision floating point or 8-bit signed/unsigned integer.
7. RIT film scan format is supported.
8. An error in labeling jaw setting is corrected.
9. More controls are provided to handle MLC display.
10. Control points can be exported in individual MLC files.

What is New in Version 2.43 Build 602

1. Extra large image is supported.
2. Histogram and W/L panel is updated.
3. An error in computing orthogonal images is corrected.
4. A few minor bugs are removed.

What is New in Version 2.42 Build 600

1. Data in RT Plan and RT Structure objects will be extracted automatically for the first patient.
2. Auto windowing / leveling is improved.
3. Window/level (histogram) control panel is beautified.
4. More menu items in the tree window are added.
5. Format conversion from non-DICOM to DICOM is further enhanced to facilitate making artificial phantom for researchers.
6. An error in aligning RT Dose object with image set is fixed.
7. Efficiency of file parsing is further improved.
8. An error in computing z-coordinate of RT Dose object being in descending plane order is fixed.
9. Tone of UI is changed.
10. The W/L histogram panel and pilot window will move with the mail window now.
11. Individual ROI can be dragged to display.
12. Patient ID in both the tree window and the image window will be instantaneously anonymized when the preference item "Hide Patient ID" is set true.
13. DICOM editor is beautified.
14. Individual ROIs can be dragged and displayed in 3D window.

What is New in Version 2.38 Build 520

1. Auto windowing & leveling function is added.
2. Menu items are added for restoring original window and level.
3. Online manual is updated with corrected links and cross references.
4. Minor memory leaks are patched.

What is New in Version 2.37 Build 518

1. ROI volume can be computed.
2. The width of tree window becomes adjustable.
3. A handy image toolbox is added for each image window.
4. Histogram W/L preset window and pilot window are made translucent.
5. Isodose lines can be computed in real time and rendered onto either RTDOSE object or the referenced planning images.
6. Orthogonal view of 3D isodose distribution is supported.
7. Up to 254 isodose levels can be detected simultaneously.
8. Push function extended to allowing pushing all DICOM files of selected patient or study.
9. File parsing efficiency is significantly improved.
10. Interlocking is further enhanced.
11. More shortcut keys and buttons are added.
12. Pilot window is back to work.
13. Window/Level preset window is upgraded with mouse wheel use to change window/level values in the input slots in large steps.
14. A shortcut image toolbox is added to each image window.
15. Working status in image window can be changed by pressing mouse wheel.
16. Isodose display change is synchronized at OrthoView mode.
17. Many more cross referencing hyperlinks are added in its online manual.
18. A few minor bugs are removed.

What is New in Version 2.33 Build 402

1. Search function in DICOM editor is added.
2. TOMO RTPLAN is fully read.
3. ROIs can be displayed in thick lines or in thin lines.
4. It supports all FIVE data types in reading embedded curves (only one type was supported before).
5. The bug in orthogonal view for non-square image dataset is fixed.
6. The bug in DICOM pusher is fixed.
7. The bug of incomplete display of input dialog when exporting TOMO dose matrix to Pinnacle is fixed.

What is New in Version 2.32 Build 400

1. Exporting TomoTherapy RTDOSE to Pinnacle³ RTP system is fully functioning. A brief instruction was exclusively made for this process. Please download it from here. http://www.radonc.uams.edu/software/tomo_rtdose_to_pinnacle.pdf. A dedicated poster is also available here Dose_Summation_Poster_AAPM2009.ppt.

2. A dictionary of private tags was added. We will keep adding more private tags.
3. A bug in updating setting in storage server message window was fixed.

Downloading and Installation Steps

DICOMan 2.2x is recompiled in Microsoft Visual Studio 2005 with service pack one. Microsoft So it needs two redistribution packages and a dynamic link library for DirectX that can be downloaded from Microsoft. The user is advised to follow the following installation steps to make it work.

1. Download the needed runtime packages:
   • Microsoft DirectX End-User Runtimes (March 2008 or later) directx_mar2008_redist.exe.
   • Microsoft Visual C++ 2005 Service Pack 1 Redistributable Package (x86) vredist_x86.exe. Please be aware that its version should be version 8.0.50727.726 published on 8/27/2007.
   • If  you can't find them with above links, you are welcome to get them here.
2. Execute directx_Mar2008_redist.exe to unpack installation files to a temporary folder (there should be 88 files) and execute DXSETUP.exe.
3. Execute vcdist_x86.exe. For some reason, the installation order matters. vcdist_x86.exe should be executed AFTER DXSETUP.exe.
4. Create a directory as the home directory for DICOMan, “C:\DICOMan” for instance.
5. Download DICOMan software package here DICOMan_pakage.exe and put it in DICOMan home directory. Since DICOMan is constantly evolving, the users are advised to check our website periodically and have your systems upgraded in the latest version.
6. Execute the self-extracting software package "DICOMan_package.exe" in the home directory of DICOMan. If you are upgrading it, please execute it in any other folder and copy files and "config" folder back to its home directory.
7. Double click the executable “DICOMan.exe” and follow the prompts to get a license.

A PDF file of brief installation instruction is also available here .

License Types

There are two kinds of licenses as follows,

1. Permanent license. That is what we strongly recommended. The user is provided with full unleashed functions plus free life upgrades.

2. Temporary license. It is time-limited license ( about one week ). DICOMan functions exactly the same as the permanently licensed version as long as the license stays valid. Anyone who is interested in this product can request a time-limited license. Limited number of free permanent licenses are to be issued to whoever are interested in R&D collaboration.

How to Get a Demo License?

To get demo license, the user is advised to install DICOMan following "Installation Steps" posted above and then execute "DICOMan.exe" to generate a computer-specific license request  file, "BeerLicense.req", and attach this file in the email to yanyulong@uams.edu. In the email you should also include a brief introduction about yourself, your facility and what use DICOMan for.

How to Contact Us?

For the license and technical support, please contact

 

Yulong Yan PhD
Tel: (501) 526 6591
Fax: (501) 686 7285
Email: YanYulong@uams.edu
 

For sales information, please contact

Dawn Bolt, MHSA
Tel: (501) 526 6157
Fax: (501) 686 7285
Email: BoltDawnM@uams.edu