1 rsna/ ihe 2003 dicom, a second generation image standard for mr, ct and x-ray angio: large data...

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RSNA/ IHE 2003RSNA/ IHE 2003

DICOM, a second generation image standard DICOM, a second generation image standard for MR, CT and X-Ray Angio: large data sets for MR, CT and X-Ray Angio: large data sets

and new applications.and new applications.

Tuesday, December 2nd, 200308:45-09:30

InfoRad / IHE Classroom

RSNA

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Agenda

• Enhanced MR and Enhanced CTEnhanced MR and Enhanced CT

• Enhanced XAEnhanced XA

• Implementation PlanImplementation Plan

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Advances in DICOM will Advances in DICOM will Enhance the clinical operation of Enhance the clinical operation of

MR and CTMR and CT

Kees Verduin, Philips Medical Systems

Chair DICOM WG16

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Presentation outlinePresentation outline

• The new MR StandardThe new MR Standard

• The clinical examples of its benefitsThe clinical examples of its benefits

• CT CT

• Roadmap for effective implementation Roadmap for effective implementation

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What is new ?What is new ?

Three new object definitionsThree new object definitions:

– Enhanced MR Image

– MR Spectroscopy

– Raw Data

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A new set of DICOM MR objectsA new set of DICOM MR objects

Not this time:Not this time:

the new Enhanced MR Image object serves the whole range of DICOM users: – from the modality specialist – to the user of a simple viewer in the same way.

So…. what is so exiting about it?So…. what is so exiting about it?

A new object, as such, is not great news.

8Multi-stack

Color

Spectroscopy

Dimensions

Multi-frame

Real World Values

Raw Data

A new MR Standard A new MR Standard (Supplement 49)(Supplement 49)

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The basics of Supplement 49The basics of Supplement 49

• Support of newest applications by New attributes• Less ambiguity through Stricter definitions and rules• Clear relationships through Reference mechanism• Header size reduction through Multi-frame technique• Context information from Image Type and Dimensions• File size flexibility through Concatenations• Functional images with Real World Values • Functional images with Palette Color LUT information

ALL these improve InteroperabilityALL these improve Interoperability

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What is really new ?What is really new ?

• Multi-Frame module with its Shared and Non-Shared header parts

• Dimensions and Dimension Organizations• Coded Object relationships

All these provide CONTEXT INFORMATION !

• Further: – Real World Values– Grayscale images with Color information

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The Multi-frame propertiesThe Multi-frame properties

• Whenever possible, all images of a scan-series shall become frames in one object.

• What is common to all frames, shall not be repeated: Elements that do not change vs. elements that change.

These have a different place in the object header.

• Related elements are defined in functional groups.

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From Single Image to Multi-frameFrom Single Image to Multi-frameN Objects, N Headers

Pixel data (not to scale)Non-Shared (per-frame) HeaderShared Header

N Frames, One Header

HEADER SIZE REDUCTION = less MB, faster transfer

KV

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From Single-frame to MultiFrameFrom Single-frame to MultiFrameN Objects, N Headers

N Frames, One Header

Pixel data (not to scale)Dimension data (not to scale)Per-frame headerFixed Header

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Multi-Frame not only for MR!Multi-Frame not only for MR!

The Enhanced MR Image and

MR Spectroscopy objects

have a multi- frame structure that is

also useful for adoption by other modalitiesalso useful for adoption by other modalities.

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DimensionsDimensionsMR images can have many attributes that change from MR images can have many attributes that change from

frame to frame.frame to frame.• When such a change in an attribute is fundamental

for the object, this data element can be structured by the creator as part of the Dimension ModuleDimension Module.

• It supplies the Context Information required for a specialized workstation.

• It also provides an explicit display ordering for the frames in the MR object, that can be used by viewing systems without specific MR application knowledge.

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Object RelationshipsObject Relationships

Image

PriorImage

Spectro-scopy

RawData

0 -n

0-n

Source ImageSequence for derivedimages

Ref. Image Sequencerequired if planned onprior images

0 - n0 - n

Ref. ImageSequencerequired if plannedon prior images

Ref. Raw DataSequence

Ref. Image SequenceOnly if image type isMETABOLITE MAP

0-n

Ref. Raw DataSequence

Source Image Sequencefor derived spectroscopydata

Ref. Image Sequencerequired if planned onprior spectroscopy data

0 - n PriorSpectro-

scopy

Ref. Image Sequence if planned onprior image

0-n

Referenced Image Sequence Source Image Sequence

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Clinical ExamplesClinical Examples

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Diffusion ImagingDiffusion Imaging

“Diffusion b-values” from 0 to 8000 and an ADC image

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Diffusion Tensor Imaging dataDiffusion Tensor Imaging data

Reconstructed Fiber Maps in the colors as seen by the creator

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MR Perfusion ImagingMR Perfusion Imagingtime

non perfused stroke area

Sig

nal

delayed perfusion

time-to-peak map

Real World Value Slope (0040,9225)

Real World Value Intercept

(0040,9224)

RW values

Sto

red

va

lues

Quantitative data with Real World Values

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Cardiac Cine LoopsCardiac Cine Loops

Enables automatic multi-slice / multi-phase display, even for standard workstations

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Total body ImagingTotal body Imaging

Display the correct image at the correct spot using Stacks and In-stack positions

1

3

4

1 2 3 54

2

5

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Functional Brain ImagingFunctional Brain Imaging

• 10-60 slices• all slices measured

in one TR• repeated 100-1000

times to get sufficient signal

• leading to > 60,000 images in one object

Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module

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Relative NAA peak-height

Ratio ofCholine andCreatinine peaks

Spectroscopy ImagingSpectroscopy Imaging

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Spectroscopy RelationsSpectroscopy Relations

Relation:MR Image

Metabolite map

Ratio ofCholine andCreatinine peaks

Relative NAA peak-height

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Supplement 58 Enhanced CTSupplement 58 Enhanced CT

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Supplement 58 Enhanced CTSupplement 58 Enhanced CT

New applications such as – cardiac CT, cardiac CT, – gated studies, gated studies, – perfusion CT, perfusion CT, – CT fluoroscopy, CT fluoroscopy, – contrast tracking and contrast tracking and – post-processing post-processing (e.g. lung cancer screening, colonography);(e.g. lung cancer screening, colonography);

are not supported by the current standard. Not only are technique attributes insufficient, but also, the organization of

increasingly large datasets as single-frame objects is awkward, and limitations of the existing definitions of spatial and temporal attributes are apparent.

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DICOM Header InformationDICOM Header Information• Restrictive handling of parameters to ensure interoperability;• Detailed description of parameters needed, e.g.:

– meaning of table position, – image flavour and image type definition,– acquisition type– device information

• Exposure information and X ray details• Bolus application included• Synchronisation model, e.g. ECG, Respiratory• Precondition is Soft Copy Presentation• Handling of palette colour

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Geometry of CT Acquisition System Geometry of CT Acquisition System

Data Collection Diameter

Distance Source to Data Collection Center

Scan Field

Detector System

Scan Angle = 0 Positive in CW direction

Distance Source to Detector

+ -

Gantry Tilt

Reconstruction Target (width)

Reconstruction Target (height)

X-Ray Source

Data Collection Center

Reconstruction Target Center x y z

Reconstruction Diameter

Shaded area is image pixel data

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CT Multi-frameCT Multi-frame

• The CT Multi-frame solution addresses the same data-explosion issues as for MR.

• Multi-detector CTMulti-detector CT generates large volumes of images that need to be provided with sufficient and adequate context information.

• Multi-frame solutions may provide more interoperability for navigation and processing.

• But, 3D processing requires more than a Multi-frame structure.

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Multi-modality - Multi-frame

• Implementations for processing of the generated volumetric data will largely benefit from multi-modality implementations of the multi-frame concept.

• Common structures may lead to common architecture, which in turn will speed up the implementations.

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Implementation RoadmapImplementation Roadmap

Who should be the first ?Who should be the first ?

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The timing dilemma for the The timing dilemma for the Enhanced MR/CT objectsEnhanced MR/CT objects

• For the MR / CT vendorsFor the MR / CT vendors:– Why implement it, while nobody is ready to

use it?

• For the Workstation vendors:For the Workstation vendors:– Why implement it, when no one is creating it?

• For the PACS vendorsFor the PACS vendors:– Support it, but how to deal with the mix of

workstations that can yes/no receive it ?

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MR/CTMR/CT

ArchiveArchive

WorkstationWorkstation

NegotiateNegotiateNegotiateNegotiate

The negotiation scenarioThe negotiation scenarioDecide to Decide to

send New object send New object or send Old object or send Old object

(depending on hospital workflow)(depending on hospital workflow)

Negotiate Decide to Decide to send Old objectsend Old object

Decide to send old object (if available)

Or Cancel

Supports Enhanced SOP Class

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When will implementationWhen will implementation be required ? be required ?

• As soon as stability is proven.• As soon as the object definition is tested• As soon as resulting changes are implemented

in the standard.

• Or…..

So, pacing may be neededSo, pacing may be needed

As soon as possible!As soon as possible!

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NEMA Members are funding NEMA Members are funding a Demonstration & Test Toola Demonstration & Test Tool

PurposePurpose:• Prove that implementation is possible• Prove the multi-frame header construction• Prove the use of dimensions• Provide a test tool for vendors and other

implementers• Validate implemented objects

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NEMA Demonstration &Test-toolNEMA Demonstration &Test-tool

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Tool availabilityTool availability

• The tool is available to the funding participants

• It is currently under test

• The tool will become available in the public domain in 2003

But…No need to wait with implementation

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Collective support is neededCollective support is needed

The benefits of Supplements 49 and 58 as The benefits of Supplements 49 and 58 as described in this presentation will described in this presentation will onlyonly be be visible if and whenvisible if and when:: – MR scanners (creators)– DICOM workstations (receivers)– PACS systems (intermediaries)

will collectively support the newwill collectively support the new MR and CT DICOM objects MR and CT DICOM objects.

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• Vendors of Workstations / PACS need to prepare for implementation:

What should be done? What should be done?

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– Prepare the color pipeline


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Functional Color on Anatomic Grayscale Images

....

Palette Color

Number of

entries

Range of Stored

Values to be mapped to grayscale

Range of Stored

Values to be mapped to

color

R G B

Largest Monochrome Pixel Value

ModalityLUT

Color Display

Mapped to gray level RGB values by display deviceVOI

LUTP-

LUT

+

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– Prepare the color pipeline– Prepare your databases for large objects


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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations

• An object may be split up into two or more SOP Instances, using the same concatenation UID

Legend:

Pixel data (not on scale)

Dimension data (not on scale)

Per-frame header

Fixed Header

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI


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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations


Legend:



Per-frame header

Fixed Header

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Real World Values

• Relates the pixel value to the actual value and unit it represents (e.g., velocity in mm/sec)

Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT

MeasurementUnits CodeSequence

(0040,08EA)

Real WorldValue LUT

Data(0040,9212)

Real WorldValue Intercept

and Slopeattributes

or

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI – Prepare for Dimensions

and Dimension Organizations


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Real World Values


Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT


(0040,08EA)

Real WorldValue LUT

Data(0040,9212)


and Slopeattributes

or

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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations


Legend:



Per-frame header

Fixed Header

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Multi Stack

Stack ID3

Frame Number1 - 5

Frame Number6-10

Frame Number11-15

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1In-Stack Position

Stack ID2

Stack ID1

54

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1In-Stack Position

54

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1In-Stack Position

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI– Prepare for Dimensions

and Dimension Organizations


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Real World Values


Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT


(0040,08EA)

Real WorldValue LUT

Data(0040,9212)


and Slopeattributes

or

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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations


Legend:



Per-frame header

Fixed Header

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Multi Stack

Stack ID3

Frame Number1 - 5

Frame Number6-10

Frame Number11-15

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1In-Stack Position

Stack ID2

Stack ID1

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1In-Stack Position

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1In-Stack Position

BH

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SummarySummary

• The New DICOM MR and CT Objects:The New DICOM MR and CT Objects:

– will enhance interoperability

– will increase cross system functionality

– will reduce transfer time

• Success requires also action by Workstation Success requires also action by Workstation and PACS implementers.and PACS implementers.

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Further InformationFurther InformationMore in-depth discussions and presentations about:• Relationships between images • Concatenations• Dimension Organization• Real World Value mapping• Extended Image Type• Color Mappingcan be found at :http://medical.nema.org/dicom/presents.html

A new CT Standard

http://medical.nema.org/dicom/presents.html

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Acknowledgement and copyrightAcknowledgement and copyright

• Images for this presentation were provided by:– GE Medical Systems

– Philips Medical Systems

– Siemens Medical Systems

• The slides of this presentation may be quoted if reference and credit to DICOM WG-16 is properly indicated

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Thank you for your attentionThank you for your attention

Now over to X-rays…..

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A Glimpse at the emerging A Glimpse at the emerging Enhanced XA/XRF ObjectEnhanced XA/XRF Object

(DICOM Supplement 83)(DICOM Supplement 83)

Heinz Blendinger, Siemens Medical Solutions

Chair DICOM WG-02

Presented by Rainer Thieme, Siemens Medical Solutions

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Presentation outlinePresentation outline

• The emerging XA/XRF StandardThe emerging XA/XRF Standard– Difference to other Enhanced IODsDifference to other Enhanced IODs– Clinical Benefit of Enhanced XAClinical Benefit of Enhanced XA

• Call for ParticipationCall for Participation

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The add-ons of Supplement 83The add-ons of Supplement 83• New Functional groups (not complete)

– Projection Pixel Calibration Macro

– Table Position Macro

– X-Ray Collimator Macro

– Reversed Modality LUT Macro

• Multi-frame Presentation Module

• Enhanced XA/XRF Image Module Attributes

ALL these improve Functionality & InteroperabilityALL these improve Functionality & Interoperability

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New functionality: an exampleNew functionality: an example

Dimension Module in enhanced XA images.Dimension Module in enhanced XA images.

• Rotational Angiography examination can include the cardiac cycle as structural information.

• Dimensions can be used to group multi-frame image frames taken at identical positions of a stepping table device.

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ECG

ECG-gated Cardiac Application

#Px

D

11 2

2

3

3

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New attributes

• Simple Filter Factor

• DSA Window Values

• Dedicated Reversed Modality DeLog LUT

• Dedicated Sequence to Reference other plane for Biplan

• Acquisition Context attributes

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Multi-Frame Presentation ModuleEdge Enhancement

Not the same, but “closer”

XA Object: private encodingReason: Hard to “standardize” Algorithms

Approximation XA enhanced:Attribute for “applied percentage”

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Dedicated Calibration Module

• Attributes to describe iso-centric geometry

• Include Table plane in geometric context

• Object plane relative to table

58UKK 2001

(TVP-1/2 TD)

°Rot

°Ang

#Px

D

D = # Px * Px * SOD / SID

SOD = ISO - (TVP - 1/2 TD) / cos°Rot * cos°Ang

Internal Calibration for Quantitative AssessmentsInternal Calibration for Quantitative Assessments

=> Practical solution based on user experience

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Supplement 83 RoadmapSupplement 83 Roadmap = Meeting of the WG-02 (green indicates the meetings already hold) = Meeting of the WG-06 (green indicates the meetings already hold)

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2002 2003 2004

Q1 Q2 Q3 Q4

2005

WG-02 writes the draft of the supplement « Enhanced XA ».

Re-activation of the WG-02. Identify list of requirements of the new XA

WG-06 reviews the draft

WG-02 updates the supplement

Public comments

WG-02 updates the supplement

Supplement Draft

Supplement issued for

public comments

Supplement In letter ballot

Supplement In final text

WG-06 includes the supplement in the standard

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Further workFurther work

• Differentiation on “processed” or “original” Differentiation on “processed” or “original” contents needed?contents needed?– Super SOP Class and SOP Classes for particular useSuper SOP Class and SOP Classes for particular use– ““For Processing” or “For Presentation” SOP ClassesFor Processing” or “For Presentation” SOP Classes

• ““Cut-line” between shared and non-shared Cut-line” between shared and non-shared contentscontents

• Further new attributes to support new Further new attributes to support new applications or procedures.applications or procedures.

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SummarySummary• The New DICOM The New DICOM enhancedenhanced XA/XRF Objects: XA/XRF Objects:

– will enhance interoperability – will increase cross system functionality– will create platform for new applications

• Success requires more clinical inputSuccess requires more clinical input

– Use CasesUse Cases– Requirements for new applications and Requirements for new applications and – ProceduresProcedures

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Further Information / ContactsFurther Information / Contacts

Please contact WG-02 chairman

[email protected]

Supplement 83 Draft can be found at :

http://dclunie.com/dicom-status/status.html

Next meetings:December 9th and 10th, 2003 in BerlinFebruary 11th and 12th, 2004 at NEMAMay 4th and 5th, 2004 in Europe

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Thank you for your attentionThank you for your attention

Now over to …implementation..

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Introduction of the newIntroduction of the newDICOM MR and CT Enhanced DICOM MR and CT Enhanced

Multi-frame Image StandardMulti-frame Image Standard

Charles Parisot, GE Medical Systems

Chair NEMA DICOM Advancement Committee

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After 10+ years of effective DICOM After 10+ years of effective DICOM connectivity in MRI and CT introducing a connectivity in MRI and CT introducing a new Image Object poses three challenges:new Image Object poses three challenges:

A new CT Standard

–Avoid user confusionInform about the benefits of the enhanced multi-frame image Inform about the benefits of the enhanced multi-frame image standard and need to manage coexistence.standard and need to manage coexistence.

–Synch-up industryFacilitate availability of compatible PACS and Workstations Facilitate availability of compatible PACS and Workstations along with the release of the MRI and CT scanners.along with the release of the MRI and CT scanners.

–Reduce incompatibilitiesProvide to interested vendors testing tools and opportunities Provide to interested vendors testing tools and opportunities to quickly retire misinterpretations or bugs.to quickly retire misinterpretations or bugs.

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NEMA Advancement CommitteeNEMA Advancement Committee• Foster industry cooperation to facilitate the adoption Foster industry cooperation to facilitate the adoption

of new DICOM capabilitiesof new DICOM capabilities

• Members are Members are NEMA Medical Imaging InformaticsNEMA Medical Imaging Informatics Section members, plus other vendors & users.Section members, plus other vendors & users.

• Establish a voluntary plan and process to assist in Establish a voluntary plan and process to assist in introduction. Does not dictate product release.introduction. Does not dictate product release.

• Has done this successfully for 10 years.Has done this successfully for 10 years.

• Independent from the DICOM Standards Committee. Independent from the DICOM Standards Committee. Cooperation with COCIR in Europe and JIRA in Cooperation with COCIR in Europe and JIRA in Japan.Japan.

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What is the proposed plan ?What is the proposed plan ?Release test images and test viewer:Release test images and test viewer:

– Done in 2003 for Enhanced MR Image– To be planned for Enhanced CT: Oct 2004

A testing event followed by an education eventA testing event followed by an education event– Commitment by interested vendors 2Q 2004– Plan testing event for 2Q 2005 – Plan education and promotion event for 2Q 2005– Finalize education and promotion at RSNA 2005.

Reach Industry Agreement on plan Reach Industry Agreement on plan by 1Q 2004by 1Q 2004

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How can vendors get involved ?How can vendors get involved ?

To get involved in the proposed NEMA InitiativeTo get involved in the proposed NEMA Initiative

Contact Stephen VastaghContact Stephen Vastaghat NEMA: at NEMA: [email protected]

Interested Users are WelcomeInterested Users are Welcome

mailto:[email protected]






1 rsna/ ihe 2003 dicom, a second generation image standard for mr, ct and x-ray angio: large data...

Documents

new enhanced mr image

object header

dimensions mr images

new mr standard supplement

interoperability slide

enhanced ctenhanced

new object definitions

color information slide