Rad Tech Minutes 2026-04-20-24

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Participants

In Person

  • Andrei Leontiev
  • Wim Corbijn
  • Mike Bohl
  • Brad Genereaux
  • Kevin O'Donnell
  • Steve Nichols
  • Antje Schroeder
  • Alia Khan
  • Jamie Dulkowski
  • Chris Carr

Remote

  • Jason Nagels (TPM)
  • Charles Parisot
  • Yasunari "Salt" Shiokawa
  • Harald Zachmann
  • David Kwan
  • Griffin Fairchok
  • Bas van den Heuvel
  • Ana Kostadinovska


All times are U.S. Central Time.

Monday, April 20, 2026

  • Wim (in future meetings) will tally topics we spend significant time on (to compare to assessments)
  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-11:00am: Manifest-based Access to DICOM Objects (MADO) [2 hr]
  • S2: 11:15am-12:45pm: Imaging Diagnostic Report (IDR) - Phase 2 [1.5 hr]
  • S3: 1:30pm-3:30pm: Imaging Diagnostic Report (IDR) - Phase 2 [3.5 hr]
  • S4: 3:45pm-5:00pm: Maintenance [1.25 hr]
    • Explore idea of formalizing the specification conventions for SR templates probably in conjunction with CP-RAD-562 Move DICOM Usage Conventions
    • See List of Maintenance topics at the bottom of the agenda

Tuesday, April 21, 2026

  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-11:00am: Imaging Diagnostic Report (IDR) - Phase 2 [5.5 hr]
  • S2: 11:15am-12:45pm: Manifest-based Access to DICOM Objects (MADO) [3.5 hr]
  • S3: 1:30pm-3:30pm: Manifest-based Access to DICOM Objects (MADO) [5.5 hr]
  • S4: 3:45pm-5.00pm: Maintenance [2.5 hr]
    • See List of Maintenance topics at the bottom of the agenda
  • Group Dinner @ 6:00pm

Wednesday, April 22, 2026

  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-11:00am: Imaging Diagnostic Report (IDR) - Phase 2 [7.5 hr]
  • S2: 11:15am-12:45pm: Manifest-based Access to DICOM Objects (MADO)[7 hr]
  • S3: 1:30pm-3:30pm: Imaging Diagnostic Report (IDR) - Phase 2 [9.5 hr]
    • 1:30pm-2:30:pm: Clinical Consult Hour
  • S5: 3:45pm-5:00pm: Maintenance [3.75 h]
    • See List of Maintenance topics at the bottom of the agenda

Thursday, April 23, 2026

  • A1: 8:45am-9:00am Administrative Time
  • S1: 9:00am-10:30am: Manifest-based Access to DICOM Objects (MADO) [8.5 hr]
  • S2: 10:45am-12:45pm: Imaging Diagnostic Report (IDR) - Phase 2 [11.5 hr]
  • S3: 1:30pm-3:30pm: Imaging Diagnostic Report (IDR) - Phase 2 [13.5 hr]
  • S4: 3:45-5:00pm Maintenance [5 hr]
    • See List of Maintenance topics at the bottom of the agenda

Friday, April 24, 2026

Profile Name: MADO 2nd TI version Assessment

  • Did we line-by-line the entire document
  • Not Yet completely. The DICOM KOS Based imaging manifest specification was entirely reviewed in March 2026. At this meeting we reviewed the FHIR based Manifest (6.X.3), still working on the MHD envelope (6.X.4) and the mapping of FHIR manifest format into the KOS Manifest format (6.X.5).
  • How ready is it to go out for TI: Completely, Almost, Soonish, Hmmm
  • Soonish. All major comments have been resolved on the FHIR Manifest IG (60% of the three sections), but the final line by line review of FHIR envelope (20% of the three sections) has only been covered at 50% and the Mapping (20% of the three sections) needs to be completely reviewed.
  • How did the work fit in the allocated bandwidth? (Time to spare? Just right? Things were left undone?)
  • bandwidth was not sufficient. More work than expected.
  • Review the evaluation. Which complexity/uncertainty/effort points missed the mark?
  • very specific details that were not obvious surfaced. Committee/Commenters reversed earlier agreed position (e.g. one new transaction or adpat existing, shift use case aspects on rendered images, scope induced by combining with existing profiles). Coordination with DICOM for KOS alignment was not planned. Underestimated size of PC text. On the FHIR sections, it was the first time that the new FHIR imaging resource was specified and somme potential gaps and interpretation issues for an Imaging Study Manifest.
  • Or alternatively, estimate how many points you went over and assign the overage effort/complexity/uncertainty to the appropriate points.
  • most points that went over are mostly none of the major topics identified in the evaluation, but details that appeared unexpected complex issues.
  • Are all the open issues closed?
  • Yes, the three open issues have been closed in February and the main open issues with the FHIR part of the specifications have been closed at this Meeting.
  • What significant debates in TI-prep were not anticipated in the Kickoff or PC-Prep
  • These were for the first part of the profile: one new transaction or adapt existing, shift use case aspects on rendered images, scope induced by combining with existing profiles, style of use case description, obtaining referenced instances for significant images, design of the profile actors, time zone offset mgt. For the FHIR part of the profile, the main issue was to debate the proper use for a Manifest of the FHIR Imaging Study Resource, the use of Bundle/Document, anatomical regions, workflow around manifest. Refer to Wim notes
  • Did the Breakdown of Tasks accurately reflect the work? What extra tasks arose?
  • It is was a logical profile functional breakdown. The challenging issues appeared focussed on specific issues at a lower level.
  • What residual risks are worth noting
  • The FHIR related parts have not been widely reviewed.
  • Time with RAD Tech Committee to complete the work may be limited for the remainder of the cycle.
  • There does not seem to be any other "substance residual risks", but the challenge to complete the TI version is an execution challenge. The FHIR specs were referenced in the PC and it seems that most reviewers missed these in their reviews. It will need more time than expected to finalized.
  • Does it feel we've met all the use cases
  • Yes
  • Did the promised resources manifest
  • On the European side in a rather effective way (Bas, Rick, Ben Andries, Nick, Antoine, Charles). Rad Tech Committee alocated twice the number of requested hours.
  • What vendors are engaged (for each actor)
  • Doc Source / Content Creator: Philips, Siemens, Spanish MoH, GE, Founda, Univ of Leuven/Agfa, A-thon.
  • Doc Consumers:: Philips, Spanish MoH, Founda, Univ of Leuven/Agfa.(Merge)
  • Who should specifically be targeted for TI notification (implementors & advocates)
  • Rotterdam HL7 meeting (Bas), October 2026 North American Connectathon (Steve N./Aaron) and 2027 Den Haag IHE Connectathon (Charles, Bas).
  • The TI notification has sbeen very visible in Europe through the EHDS initiative/Xt-EHR Project and the organization of a Projectathon end of March, with good participation, including test tools development by Kereval/IHE-Catalyst. This has been possible with the timely availability of the first part of the MADO TI version by mid-March has supported this momentum. A complementary effort is needed in the rest of the world. In the USA, the current Federal consultation on image exchange is an important opportunity.
  • When will we have sample data/objects
  • We already have DICOM KOS based samples available that have been validated by the end of March MADO/XC-WADO Projectathon. A focused effort is needed to add FHIR-based Manifest samples as soon as the second release of the TI will be publicly released.
  • Was the profile where it needed to be at the start of the TI meeting, if not what was the gap
  • Technical this the fourth of three meetings. But the full TI draft was availble at the beginning of the Meeting. It included both the draft of the FHIR Part and the rest of the TI approved in March 2026.
  • Was the profile where it needed to be at the end of the TI meeting, if not what was the gap
  • The expectation was that the comment resolution would be completed on that second FHIR-Base Part of MADO. It is unlikely to be completed, although what remains is a third of the line by line review of these three FHIR sections. Additional reviews will be neded.
  • Do you need any tcons between now and TI Publication
  • Yes:
  • Two TI finalization 2 hour T-cons need to be scheduled to focus on the second part, the FHIR based sections for the TI version in the first half of May 2026. The first T-con will finish the line by line review of the MHD Envelope and of the FHIR/DICOM Mapping. April 29, 1:00pm-3:00pm
  • A pre-final version would be produce and a week review should be allowed before the second t-con be held to finalized this second TI Version of the MADO Profile. May 13th, 10:00am-12:00pm.
  • The second TI version should be published before the end of May.

TI Checkpoint: IDR Phase II

  • Did we line-by-line the entire document
  • Yes
  • How ready is it to go out for TI: Completely, Almost, Soonish, Hmmm
  • Almost (in PDF) (Note that conversion to IG is an additional publication step)
  • How did the work fit in the allocated bandwidth? (Time to spare? Just right? Things were left undone?)
  • Over but not unexpected given the large scale
  • Review the evaluation. Which complexity/uncertainty/effort points missed the mark?
  • Spent less effort on the Use Cases.
  • Spent more complexity and uncertainty figuring out how to model imaging observation concepts in FHIR. Working with a new base standard/components.
  • Also enumerating and exploring edge cases and extent of scope.
  • Also working out the mechanics of allowing both FHIR R6 and R4 (and R5) implementations.
  • Some extra complexity and uncertainty dealing with things at the edges of our scope (stuff triggered by report contents)
  • Or alternatively, estimate how many points you went over and assign the overage effort/complexity/uncertainty to the appropriate points. (Maybe take out of template)
  • Are all the open issues closed?
  • Yes. (Decided, just need to finish writeup)
  • What significant debates in TI-prep were not anticipated in the Kickoff or PC-Prep
  • Don't recall extended debates. No notes from Wim.
    • Did the Breakdown of Tasks accurately reflect the work? What extra tasks arose? (move/merge this up the template)
  • Mostly. See evaluation above.
  • What residual risks are worth noting
  • Report vendor engagement. Need for examples. Complexity of "compiling" IGs
  • Possible profiling work if FHIR Core disagrees with DiagnosticReport$document
  • Complexity of reports might exceed our spec to the point of being not useful. (hopefully the unstructured text helps)
  • Does it feel we've met all the use cases
  • Yes
  • Did the promised resources manifest
  • Mostly, yes.
  • What implementers are engaged (for each actor)
  • Report Creator - GE, Siemens,
  • Report Consumer - Merge, Visage, Philips, Siemens, Epic,
  • Who should specifically be targeted for TI notification (implementors & advocates)
  • Reporting vendors - Will try to slipstream CDE also. Good engagement there. Andrei will ping RadAI
  • Also consider "transformers" that encode legacy reports.
  • The radiologist features may help incentivize the purchasers of the report creators.
  • Note also the potential to reuse the Findings in V2 of IRA as discussed earlier.
  • When will we have sample data/objects
  • :-) We'll see. Before CAT.
  • Was the profile where it needed to be at the start of the TI meeting, if not what was the gap
  • Not bad but Lots of TODOs, partly because comments were received a few days before the TI meeting.
  • Was the profile where it needed to be at the end of the TI meeting, if not what was the gap
  • Not bad but lots of TODOs. Got the discuss and review done though.
  • Do you need any tcons between now and TI Publication
  • Yes. 2x2hr to get approval for TI IG Integration.
  • Will likely need another call in summer for formal IG approval.

Maintenance items for the meeting

Note: Strikethrough font marks topics completed as the week proceeds

RAD Tech Monthly CP Processing

--> See RAD CP Tracking Spreadsheet

(1) Process Newly Submitted CPs:

Link to Submitted folder on Google Drive

(2) Process Top Ten CPs

  • CP-RAD-436 Fix inconsistencies in IOCM actor / transaction and grouping requirements (Lynn)
  • CP-RAD-464 EBIW MWL Message semantics behavior (Wim)
  • CP-RAD-500 RAD-137 clarify request/response (Kevin)
  • Identify additional Top 10 from the XDS-I.b- and SWF.b-related CPs :
    • CP-RAD-248 Clarify bodyPartExamined in XDS-I Metadata
    • CP-RAD-251 RAD-69 WADO-WS Refactor
    • CP-RAD-252 Request to add C-GET to XDS-I.b
    • CP-RAD-294 Update RAD-55 transaction name to WADO-URI Retrieve
    • CP-RAD-333 Author and creation date metadata
    • CP-RAD-335 XDS-I report update on image availability
    • CP-RAD-336 XDS-I clarify references to prior submissions
    • CP-RAD-402 XDS-I.b Update Async Language and Support AS4
    • CP-RAD-437 New ATNA STX options & updates to XDS-I.b, XCA-I dependencies / mandatory groupings
    • CP-RAD-421 Clarify mimeType for CDA-wrapped text & PDF docs
    • CP-RAD-228 MIMA Query optional when IM/IA grouped with XDS-I Image Document Source
    • CP-RAD-232 Items for clarification in HL7v2.5.1 option
    • CP-RAD-239 Refactor RAD-01 and RAD-12 Transactions with IHE ITI PAM
    • CP-RAD-257 Clearly add Admitting Diagnosis to SWF for REM and TCE
    • CP-RAD-259 Clarify that Scheduled Protocol Code is required
    • CP-RAD-137 IM/IA receives more or less instances than it expects as per MPPS
    • CP-RAD-224 Add Document References to MWL
    • CP-RAD-299 Effect of Rejected Instances on Availability Notification behavior
    • CP-RAD-304 Add Multiple Identity Resolution Option to SWF.b
    • CP-RAD-353 Update RAD-28 to send non-SR-based ORU
    • CP-RAD-354 Add Billing Transaction
    • CP-RAD-422 SWF.b Case 10 clarification
    • CP-RAD-445 Add note to Appendix A tables
    • CP-RAD-489 Clarify CT/MR Localizer image requirements
    • CP-RAD-506 Group Case clarification
    • CP-RAD-508 OBR Consistency for Modality
    • CP-RAD-509 Study Date/Time mapping from HL7 Order messages
    • CP-RAD-514 Vol 2x: Procedure Code Sequence clarifications
    • CP-RAD-515 Vol 2x: Fully integrate SWF.b into Appendix D
    • CP-RAD-558 SWF.b – Clarify Group Case Mapping in Appendix A
    • CP-RAD-538 Clarify population of Institution attributes in Enterprise Identity Option

(3) Assigned CPs ready for discussion:

link to Assigned folder on Google Drive

  • CP-RAD-305-03 - Revise profile dependencies (grouping) in Vol 1) (Lynn; + input from Philips in Sep 2024) -- cmte input needed
  • CP-RAD-410-03 - XCA-I is out of date for Async (Lynn)
  • CP-RAD-487 - Enterprise Identity Option - Institution mapping context (Andrei)
  • CP-RAD-493-00 - ARI Ambiguity (Andrei)
  • CP-RAD-559 - EBIW – Image Manager mandatory option specification (Jason)
  • CP-RAD-561 - XC-WADO – option doesn’t follow profile template - Assigned (Andrei)
  • CP-RAD-562 - Move DICOM Usage Conventions (Lynn)

(4) Assessment of RAD TI supplements: link to Assessment document on Google Drive

  • Final Text
    • AIR (Kevin)
    • DIFF (Wim)
    • XDR-I (Kinson)
    • IRWF - need advocate
  • Deprecate:
    • CDS-OAT
    • PAWF
    • RWF
    • PWF
    • XRR-WD
  • Retire:
    • FUS
    • PDI Extensions
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