Philips Epiq 5 Manual

							 
3  INTRODUCTION  
3.1   AUDIENCE  
This document is intended for hospital staff, health care system integrators, software designers or 
implementers. It is assumed that the reader has a working understanding of DICOM.  
3.2    REMARKS  
DICOM, by itself, does not guarantee interoperability. However, the Conformance Statement facilitates a first -
level validation for interoperability between different applications supporting the same DICOM func tionality. 
This Conformance Statement is not intended to replace validation with other DICOM equipment to ensure 
proper exchange of information intended.  
The scope of this Conformance Statement is to facilitate communication between Philips Medical Systems  
and other vendors’ Medical equipment. The Conformance Statement should be read and understood in 
conjunction with the DICOM Standard [DICOM]. However, by itself it is not guaranteed to ensure the desired 
interoperability and successful interconnectivity.  
The user should be aware  of the following important issues:  
—  The comparison of different conformance statements is the first step towards assessing interconnectivity 
between Philips Medical Systems and non -  Philips Medical Systems equipment.  
—  Test procedures should be defined to validate the desired level of connectivity.  
—  The DICOM standard will evolve to meet the users’ future requirements. Philips Medical Systems is 
actively involved in developing the standard further and therefore reserves the right t o make changes to 
its products or to discontinue its delivery.  
—  This DICOM Conformance Statement reports the implementation of four  ultrasound systems,  EPIQ  7 and 
EPIQ 5 , Affiniti 70 and Affiniti 50.  Also referred to as E7 and E5; A70 and A50.  
 
3.3    DEFINITIONS, TERMS A ND ABBREVIATIONS 
Definitions, terms and abbreviations used in this document are defined within the different parts of the DICOM 
standard.  
Abbreviations and terms are as follows:  
AE   Application Entity  
AET   Application Entity Title  
ASCE  Association Control Service Element  
CD- R  Compact Disk Recordable  
CID   Context ID.  Reference to a DICOM code “context group” defined in DICOM PS3.16 
CSE   Customer Service Engineer  
DICOM  Digital Imaging and Communications in Medicine  
FSC   File-Set Creator  
FSU   File-Set Updater  
FSR   File-Set Reader  
GSDF  Grayscale Standard Display Function  
HIPAA  United States “Healthcare Insurance Portability and Accountability Act of 1996”  
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							 IOD  Information Object Definition 
ISO   International Standard Organization  
LOINC  Logical Observ ation Identifiers Names and Codes  
MPPS  Modality Performed Procedure Step  
MW L   Modality Worklist  
R   Required Key Attribute  
O   Optional Key Attribute  
PDIR   Patient Directory screen on EPIQ/Affiniti  
PDU   Protocol Data Unit  
PDE   Patient Data Entry  screen on EPIQ/Aff initi 
PS3.x   Reference to part ‘x’ the DICOM 3.0 Standard  
PSC   Philips Support Connect.  It is the primary interface on  EPIQ/Affiniti for configuring DICOM 
services.  It is reached by pressing the “Support” key on the EPIQ/Affiniti  control panel.  
SCU   Service  Class User (DICOM client)  
SCP   Service Class Provider (DICOM server)  
SOP   Service -Object Pair  
SNOMED  Systematized Nomenclature of Medicine (SRT)  
SPS   Scheduled Procedure Step  
SR   Structured Report  
TID   Template ID.  Reference to a DICOM Structured Report “template” defined in DICOM 
PS3.16 
U   Unique Key Attribute  
US   Ultrasound  
USB   Universal Serial Bus  
 
The following upper -case abbreviations represent specific Attributes.  Refer to PS3.3 Section 8 for a 
description:  
CV   Code Value (0008,0100)  
CSD   Coding Scheme Desi gnator (0008,0102) 
CM   Code Meaning (0008,0104)  
CSV   Coding Scheme Version (0008,0103)  
 
3.4    REFERENCES  
[DICOM] Digital Imaging and Communications in Medicine (DICOM), NEMA PS 3.1- 3.20, 2011, available free 
at  http://medical.nema.org/standard.html  
Integrated  Healthcare Enterprise (IHE) Radiology Technical Framework, Vol. 1, Integration Profi les, version 
11.0 Final Text July 24, 2012  
Integrated Healthcare Enterprise (IHE) Radiology Technical Framework,  Vol. 2, Transactions, version 11.0 
Final Text July 24, 2012  
Integrated Healthcare Enterprise (IHE) Radiology Technical Framework, Vol. 3, Transacti ons continued, 
version 11.0 Final Text July 2 4, 2012 
Integrated Healthcare Enterprise (IHE) Cardiology Technical Framework , Vol. 1, Integration Profiles, Revision 
4 .0,  Final Text, August 5, 2011  
E7 and E5/A70 and A50 1.5.x.x    DICOM Conformance Statement 000490000000111   Rev  A   Page 12   
						

							 
Integrated Healthcare Enterprise (IHE) Cardiology Technical Framework, Vol. 2, Transactions, Revision 4.0, 
Final Text, August 5, 2011  
Integrated Healthcare Enterprise (IHE) Cardiology Technical Framework  S upplement,  Stress Testing 
Workflow, Trial Implementation Revision 2.1, October 15, 2010  
Joint VA / DoD DICOM Conformance Requirements for Digital Acquisition Modalities, Version 3.0, September 
28, 2005  
 
 
 
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4  NETWORKING  
4.1  IMPLEMENTATION  MODEL  
4.1.1    Applicati on Data  Flow 
Send 
Images, Reports, Commits; Query  ImagesStorage 
Application  Entity
Update 
Worklist
Acquire Images
Workflow 
Application  Entity
Film
ImagesHardcopy 
Application  Entity
DICOM Standard Interface
Local AE's Connected AE's
Receives Images, 
Reports, Commits;  Returns 
Commitments
Sends images
Receives queries
Provides Worklist Items
Receives MPPS  Create / Set
Prints 
Film Sheets
 
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							 Figure 1:  APPL IC AT ION DAT A FLOW DI AG R AM  
—  The  Storage Application Entity  sends  Images  and  Structured Reports  to a remote AE.  It is associated with the 
local real -world activity “Acquire”  on  EPIQ/Affiniti .  Sending of images may occur automatically when configured to 
do so, either “After Each  Print/Acquire” or “At End of Exam” w ith or without “Send on Demand”, with separate 
export destination configurati on of each acquisition control. The system can also be configured to automatically 
end and send an exam after a specified time of system inactivity. In addition, exam data may be sent manually 
upon request of the user.  
If configured to  send  “After Each Print/Acquire” , images are transferred immediately after acquisition and 
Structured Reports and Private 3D Presentation States are transferred at the end of the exam.  If configured for 
send “ At End Exam, images and Structured Reports are transferred when the exam is ended.    
An exam may be sent manually by user selection from the Patient Directory (PDIR), including exams that have 
been imported or retrieved into  EPIQ/Affiniti from other sources.  Further, individually -selected images acquired on 
EPIQ/Affiniti  may be sent manually from image rev iew. 
If the remote AE is configured for Storage Commitment , the Storage AE will request Storage Commitment 
immediately  after the instances are sent to the Storage device associated with the Storage Commitment device.   If 
a commitment response is successful ly obtained for all instances acquired in the exam , this information is 
recorded in the local database, placing a checkmark in the commit portion of the Patient Directory display and 
signaling the Auto- delete function that the exam qualifies for deletion.  
There are several available mechanisms for importing images acquired on other devices, including Ultrasound 
images and images of other modalities:  
•   When configured, images may be retrieved using the  Query/Retrieve service 
•   DICOM images may be imported direct ly from local media 
•   DICOM images may be pushed onto  EPIQ/Affiniti by another Storage SCU device without being initiated 
by the  EPIQ/Affiniti  user  
Send on Demand  allows for sending acquired images and/or Structured Report during an active exam without 
ending the exam or in- progress MPPS.  Print images will be sent without requiring a full print page to be filled.  
Send on Demand is invoked by pressing an icon located at the bottom center of the system display after acquiring 
the first image of the study . 
—  The  Workflow Application Entity  receives  Modality Worklist (MWL ) information from and sends Modality 
Performed Procedure Step (MPPS) information  to remote AEs.  It is associated with the local real -world activities 
“Update W orklist”, “Patient Search” and “Acquire Images”.  
When either the “Update Worklist” or “Patient Search” local real -world activity is performed, the Workflow 
Application Entity queries a remote AE for worklist items and provides the set of worklist items matching the query 
request.  ”Update Worklist” is performed as a result of an operator request or can be is performed automatically at 
specific time intervals. “Patient Search” is  manually initiated.  
Modality Performed Procedure Steps are created and updated with the following real -world events:  
o   MPPS N -Create, Status = IN PROGRESS:  
  Acquisition of  images will result in automated creation of an MPPS Instance managed by a remote 
AE.   
o   MPPS N -Set, Status = COMPLETE 
  Completion of the MPPS is performed as the result of an operator action of ending the exam.   
o   MPPS N -Set, Status = DISCONTINUED 
  “Cancel Exam” causes the “Discontinued” status to be sent. A “Paused” exam does not initiate an 
MPPS event.  
 
Images and SRs may be  appended  to an ended exam.  There are two fundamental methods to perform append:   
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							 o  Append from Patient Directory  
  Select an Ended study from the Patient Directory  and press c hoose “Append.” Two options are 
available:   
•   “Add”  (if less than 24 hours old), allows images to be added to the original Study, using 
the same Study Instance UID, and a new  Performed Procedure Step SOP Instance UID. If 
more than 24 hours old, only “Create” will be available.   
•   “Create”, which will create a new Study Instance UID.  
o   Append from Image Review  
  Open  the Study  in Review  from the Patient Directory.  
  Default behavior  (Add to existing study vs. Create new study)  is selecta ble via a configuration 
screen for Append from Image Review –  Create Study  Instance UID 
o   For Exams appended by creating the image from Image Review and changing visualization of the existing 
images, for example, changing chroma map, added images would have the same Acquisition  DateTime 
value  of the original images in which the images were acquired.  This is not the case for append from 
Patient Directory, which creates completely new images with the current date and time.  
o   Study Date on the Report page refers to the date of an exam in which the evidences were acquired. This 
is export ed as DICOM Study Date. This includes all Appended and Non- Appended exams. 
o   For Exams appended from Image Review, the Report footer has the statement “Appended: “followed  by 
the date in which the exam is started for Appending/Appended exams from Image Revie w.  
o   SR Vendors shall refer to DICOM Study Date to determine the date of the original exam in which the 
evidences were acquired and refer to DICOM Performed Procedure Step Start Date for the date of 
Appended exam.  
 
—  The  Hardcopy Application Entity  prints images on a remote AE (Printer or print server).  It is associated with the 
local real -world activity  ”Acquire”  depending on configuration.  The user action creates a Film Session  containing 
one or more Film Boxes and Image Boxes  composed from images acquired by the user.  The AE  creates and 
sends fully rendered pages according to  the user’s selected formatting choices in a single Image Box per page .  
This Image Box  is rather large compared to sending individual Image Boxes  to the  printer.  If the user has both BW  
and Color DICOM printer s configured and selected, and is using  send “After Each Print/Acquire”, the images 
containing no Color Flow or Chroma data will be sent to the BW printer, all others will be sent to the Color print er.   
 
Exam data is sent to all selected Store, Print and Workflow destinations simultaneously in accordance with system 
configuration of  send  “After Each Print/Acquire” or “At End of Exam” . If Send on Demand had been invoked,  images 
and Structured Reports  modified  since the last Send on Demand  are sent at End Exam. 
4.1.2  Functional  Definition of AEs  
4.1.2.1  Functional  Definition of Storage  Application  Entity   
The existence of a Network Store queue with associated network destination will activate the Storage AE. An 
asso ciation request is sent to the destination AE and upon successful negotiation of a Presentation Context , the image 
transfer is started. If the association cannot be opened, the related queue is set to a “Failed” state, indicated by a Red 
dot on the Network  Icon, and can be restarted by the user via the queue management interface.  The user may need 
to cancel the queue, and then restart manually. Multiframe (loop) objects will be transferred first, then single frames 
when configured for End of Exam. When “Im age Export Format” is selected as “monochrome”, single frame images 
that have no Color Flow Doppler or Chroma maps applied, will export as grayscale using Monochrome2 Photometric 
Interpretation. Single frame images that include Color Flow Doppler will be s ent as RGB. If the non-active region of a 
2D/scrolling image has a chroma map, it will be sent as monochrome.  
The Storage AE is also responsible for accepting images for storage in EPIQ/Affiniti , though any of the following 
mechanisms:  
•   Import from removabl e media 
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							 •  Retrieve using the Query/Retrieve service  
•   Unsolicited  push from a Storage SCU to EPIQ/Affiniti  acting as a Storage SCP.  This mechanism requires that 
the Storage SCU to have previously been configured as an acceptable DICOM Storage Device.  
4.1.2.2  Function al Definition of Workflow Application Entity  
Update Worklist attempts to download a Modality Worklist from a Modality W orklist SCP  with studies matching the 
search criteria.  Default query criteria are  Modality of US  (ultrasound)  and Scheduled Procedure S tep Start Date of the 
current  date.  Additional changes to Modality Worklist search include customizing to search for a different AE Title, 
Station Name, System Location and Custom Modality.  If the W orkflow AE establishes an Association to a remote AE, it 
w ill transfer all matching  worklist items via the open Association. The results of a successful Worklist Update will 
overwrite the data in the Worklist display.  Specific queries for Patient Last Name, Patient ID, Accession #,  Exam Date 
or Date Range, and Requested Procedure ID may  also be performed using the Patient Search.    
There is no queue management for Modality Worklist.  
Note: A wildcard (broad) patient query can be performed by entering a * in the Patient Name field.  
The Workflow AE performs t he creation of a Modality Performed Procedure Step (MPPS) i nstance automatically when 
the first image of a study is acquired.  MPPS message queues are listed along with Image and Structured Report 
queues in the Network status window.    
The user may also change patient identification information while a MPPS is in progress.  If this is done, the prev ious 
MPPS is discontinued and a  new MPPS is created with the changed patient information.  The Storage AE is informed, 
and if images acquired under the previous patient information have already been transferred (because send “ After 
Each Print/Acquire”  or  “Send On Demand” ) the images are regenerated and sent again with  updated patient 
information and new DICOM UID’ s. 
4.1.2.3  Functional Definition of Hardcopy Application  Entity  
The existence of a print queue will activate the Hardcopy AE.  An association is established with the printer(s) and the 
printer’s status determined.  If the printer is operating normally, the film sheets will be printed.  If the printer is not 
operating normally, the print queue will set to a “Failed” state and can be restarted by the user via the queue 
management interface.  In the case that a user has both a BW and a Color DICOM printer configured, during an exam 
with  send  “After Each Print/ Acquire” selected, the images that contain color data, i.e., Color Flow Doppler or Chroma, 
will be sent to the Color printer only, and all other images sent only to the BW printer.  
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4.1.3 Sequencing of Real -World Activities  
StorageHardcopyWorkflowDepartment SchedulerPrinterImage Manager
1  Query Worklist
 2  Receive Worklist
3 Create MPPS
9 Complete MPPS 
5 Print Film Sheet
10 Image and SR Document Commit Request 
12 Accept Commitment Response
user update or query
7  Store SR Document
4 Store Image
acquire first image
end exam
store completion 
acquireimage
end exam
sheet full
commit status update
8 Discontinued MPPS cancel exam
optional append11 Optional Append
or Accept Stage
6 Print Film Sheet
end exam
acquireimages
FIGURE 2A: 
SEQUENCING CONSTRAINTS  – CONFIGURED TO SEND A FTER EACH PRINT/ACQUIRE 
Figures 2a and 2b illustrate normal scheduled workflow conditions.   
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Notes:  
•   Messages may slightly change order occasionally.  
•   All selected store, print and workflow devices are sent data during  the exam when configured for send  “After 
Each Print/ Acquire” or at “At End of Exam.”  
•   Selecting a study from Review for export will send to all selected devices.  
Other workflow situations (e.g. unscheduled procedure steps) will have other sequencing constr aints.  Printing or 
storage could equally take place after image acquisition. Printing could be omitted completely if no printer is connected 
or hardcopies are not required.  
StorageHardcopyWorkflowDepartment
SchedulerPrinterImage
Manager
1  Query Worklist
 2  Receive Worklist
4 Create MPPS
7 Discontinue or Complete MPPS 6 Print All Film Sheets
8 Image and SR Document Commit Request
10 Accept Commitment Response
user update or query
5 Store All Images and Report
end exam
store
completion
end exam
commit status
update
end exam
cancel or
end exam
optional
append 9 Optional Append (no PPS)
 3  Acquire Images
 
FIGURE 2B:  
SEQUENCING CONSTRAINTS  – CONFIGURED TO SEN D AT END EXAM 
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Figures 2c Illustrates Flow Changes to Send At End of Exam with Send on Demand (SoD)  
StorageHardcopyWorkflowDepartmentSchedulerPrinterImageManager
3 Create MPPS
7 Complete MPPS
4 Print Film Sheet
8 Image and SR Document Commit Request
9 Accept Commitment Response
6 Store Final SR Document
1 Acquire Images
first storedimage
end exam
storecompletion
end exam
sheet full
commit statusupdate
Send onDemand2 Store Images, SR and Print Film Sheets since last SoD
5 Store Remaining Images, Send Remaining Film Sheet
end exam
FIGURE 2C: 
SEQUENCING CONSTRAINTS  – SEND ON DEMAND CONFI GURATION 
E7 and E5/A70 and A50 1.5.x.x    DICOM Conformance Statement 000490000000111   Rev  A   Page 20