The purpose and scope of WG-32 is to extend DICOM to be usable as a common Standard format for clinical neurophysiology data exchange. This would include time-based neurophysiology signal data (and associated video recordings, if present) from electroencephalography (EEG), video-electroencephalography (VEEG), electromyography (EMG), evoked potentials (EP), polysomnograms (PSGs), electrocardiograms (ECGs), and other types of neurophysiology signals. The main reasons are to provide a single format in order to promote ease of data exchange, to create a format which is more advanced than the currently available non-DICOM) formats, to provide features which are needed in the 21st century, and to integrate with enterprise infrastructure and security requirements.

Scope

• To extend and promote the use of DICOM for the creation, storage and management of neurophysiology data in a healthcare setting

Within this mandate the WG has identified the following specific scope of activities:

• Identify and maintain a roadmap of use cases and compatibility concerns that should be addressed
• Develop or consult on relevant change proposals (CPs) and Supplements
• Serve as a liaison body between the multiple involved stakeholders, including
  • clinical end-users of neurophysiology equipment and software
  • vendors offering neurophysiology equipment and software for healthcare applications
  • vendors of medical image and video acquisition, processing, and management systems
  • standards and professional organizations addressing neurophysiology in general (e.g. IEEE)
• Facilitate including data relevant to the neurophysiology community in DICOM objects
• Provide best practice guidance and reference implementations to promote the use of DICOM in neurophysiology applications
  • in particular, ensure that neurophysiology vendors find it easy to adopt the Standard (and encourage such vendors to participate in MITA)
    

Roadmap

As a new WG, our roadmap will be  based upon the analysis of the neurophysiology data and workflow needs through a Standard framework.  The results of this analysis will then be used to specify information objects and services needed to best serve patients and the neurophysiology community. As much as possible and compatible with DICOM guiding principles,  new specifications will be proposed in a manner to (a) leverage the existing and growing ecosystem of DICOM-capable systems in use in healthcare institutions and (b) leverage Standards already in use in the neurophysiology industry. The ultimate goal is a comprehensive, Standards-based digital platform for neurophysiology in the patient care setting.

Short-Term Objectives

• Establish productive working relationships with other DICOM Work Groups currently responsible for related DICOM features: WG 13 Visible Light, WG 4 Compression, and others as identified
• Propose a new IOD, with references to existing IODs, to address the two already identified highest priority needs of the neurophysiology community
  • storing neurophysiology in the Picture Archiving and Communication Systems (PACS) and Vendor Neutral Archive (VNA) systems in a manner that allows direct association with the relevant patient (and any related objects such as video, ECG and pulse waveforms with which the data is synchronized)
• Perform further gap analysis of the existing DICOM Standard with respect to potential neurophysiology requirements (e.g. time-based waveform compression)
• Establish priorities for filling gaps identified
  

Current Status

• WG-32 was approved by the DICOM StandardsCommittee in late 2018 and held its first formal kickoff meeting in December 2018 at the conclusion of the American Epilepsy Society (AES) Annual Meeting.
  

Current Work Items

• Develop a new IODs for neurophysiology waveforms, including Routine EEG IOD, Sleep IOD, EMG IOD, Evoked Potential IOD, High Density EEG IOD, Continuous VEEG Monitoring IOD, and Intracranial EEG Monitoring IOD, Intra-operative Monitoring IOD
• Supplement 217 Neurophysiology Waveforms [WI 2018-09-D] (Pre-Public Comment)
  

Risks

• Adoption by creators
  • existing vendors may be reluctant to adopt the new format; mitigation - provide open source reference converters
• Adoption by recipients
  • existing non-neurophysiology (PACS, archive, media) vendors may be reluctant to support new SOP Classes; mitigation - the trend towards SOP Class agnostic "vendor neutral archives" (VNAs) minimizes this risk
  • existing neurophysiology (storage, viewer) may be reluctant to ingest the new format; mitigation - short term: provide open source reference converters, long term: provide open source viewers to demonstrate value
• Might not be able to recruit enough neurophysiology user or vendor stakeholders.
  • current level of enthusiasm for a Standards-based approach in both end-user and vendor community appears high, judging by the participation in the IFCN taskforce.
    

Challenges and Opportunities

• The current level of enthusiasm for a Standards-based approach in both end-user and vendor community appears high.
• There are competing non-DICOM data format proposals that would require a completely novel infrastructure and not address the silo problem. It is important to assure that the best features of such proposals are assimilated into DICOM to avoid fragmentation of competing new proposals and not sacrifice the effort and knowledge that has been invested.