dicom & ihe : an update on -> the dicom standard -> the ... · • ps 3.10 media storage...

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RADIOLOGY

RESEARCH

DICOM & IHE : An Update On

-> the DICOM Standard-> the IHE Radiology Framework

Michael Flynn, [email protected]

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The DICOM Standard http://medical.nema.org/

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DICOM Parts

• PS 3.1 Introduction and Overview• PS 3.2 Conformance• PS 3.3 Information Object Definitions• PS 3.4 Service Class Specifications• PS 3.5 Data Structures and Encoding• PS 3.6 Data Dictionary• PS 3.7 Message Exchange• PS 3.8 Network Communication Support for Message Exchange• PS 3.10 Media Storage and File Format for Data Interchange• PS 3.11 Media Storage Application Profiles• PS 3.12 Media Formats and Physical Media for Data Interchange• PS 3.14 Grayscale Standard Display Function• PS 3.15 Security Profiles• PS 3.16 Content Mapping Resource• PS 3.17 Explanatory Information• PS 3.18 Web Access to DICOM Persistent Objects (WADO)

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DICOM Review

DICOM

• Utilizes an open standards development process that encourages the involvement and consensus of both vendors and users

• Specification of a conformance mechanism so that a user can decide whether or not devices are likely to interoperate

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DICOM Review

• DICOM Standards Committee (DSC)• DICOM’s executive body whose members

are imaging equipment manufacturers, physician organizations, and others• 26 manufacturer members• 20 other members

• DICOM's activities are coordinated through a general secretariat at MITA • formerly NEMA

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DICOM Standards Committee (DSC)

• Development of DICOM Standard is done through committees termed “Working Groups” (WG)• AAPM Members can participate in any WG

to develop the Standard

• WG propose work items based on suggestions from members or at the direction of the DSC

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DICOM WGs 1-6

Detailed technical evaluation of proposed additions or changes to the DICOM standard

Base Standard 6

Distribution of images on CD-ROMs, DVDs, and USB “flash” drives

Exchange Media 5**

Application of data compression standards, such as JPEG 2000 and JPIP

Compression 4

Nuclear medicine and PETNuclear Medicine 3

Development of enhanced x-ray and angiography information objects

Projection Radiography and Angiography

2

Cardiovascular imaging, stress nuclear cardiology structured reporting

Cardiac and Vascular Information

1Relevance to RadiologyWorking Group Name

WG#

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Ultrasound imaging, including echocardiography; 3D/4D images

Ultrasound 12

Presentation and display of images on workstations, i.e., “hanging protocols.”

Display Function Standard

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Long-range planning; coordination of DICOM with other international standards organizations

Strategic Advisory 10

Standardized vocabularies, encoding of structured reports, and integration with

Structured Reporting 8

Radiation therapy, including ion therapyRadiotherapy 7Relevance to RadiologyWorking Group NameWG#

DICOM WGs 7-12

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Application of imaging to clinical trials and medical education

Clinical Trials and Education

18*

Volumetric (multiframe) imaging modalities, including CT, MR, and ultrasound

3D17

MRIMagnetic Resonance16

Breast imaging; structured reporting of computed-aided detection and diagnosis (CAD) results for mammography and CT colonography

Digital Mammography and CAD

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Secure information exchangeSecurity14Relevance to RadiologyWorking Group NameWG#

* starting activity

DICOM WGs 14-18

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Pathology ApplicationsPathology26

Image-guided surgery and other surgical dataDICOM in Surgery24VeterinaryVeterinary Applications25**

Develop specifications for interfaces between hosted application software

Application Hosting23DentistryDentistry22

DermatologyDermatology Standards19**

Web service extensionsWeb Technology27

CT imaging and dosimetry reportingComputed Tomography21**

Coordination of DICOM with Health Level Seven (HL7) standard for messaging between health information systems

Integration of Imaging and Information Systems

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Relevance to RadiologyWorking Group NameWG#

** Not currently active

DICOM WGs 19-26

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DICOM “workflow”

• Work items are divided into Supplements and Change Orders

• Supplements define new objects, content or structure

• Change Orders modify the existing Standard

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• Output of any work item is submitted to the Base Standards Working Group (WG6) for review throughout the process• WG6 may request changes or clarification to

the work item to ensure it complies with Standard

• Once the work item is complete WG6 petitions the DSC to approve work item and send out for public comment

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• After public comment and all issues listed in the comments are responded to, the DSC authorizes the work item for letter ballot by DICOM members

• Change proposals do not require the same rigorous review process and are often “batched” for public comment and letter ballot,• Some Change proposals can be instituted without

comment or ballot if the change is required to reduce potential patient care issues or it is typographical or trivial in nature

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Changes to Standard

• Currently over 100 approved Supplements incorporated into Standard• Over 20 in progress or in comment stage

• Currently over 1000 Change Proposals incorporated into Standard• Ongoing process with changes being

reviewed at every WG6 meeting

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Recent DICOM Enhancements that are important to Medical Physicists

• Clinical Trial De-identification Profiles,

• Surface Segmentation Storage SOP Class,

• CT Radiation Dose Reporting (Dose SR),

• Tomosynthesis Image Storage SOP Class,

• JPEG 2000 Transfer Syntaxes and Interactive Protocol

• Enhanced CT and MR Image Storage SOP Class.

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Topics

A. De-IdentificationB. Surface SegmentationC. CT Dose ReportingD. Breast TomosynthesisE. JPEG2000 & JPIPF. Enhanced CT/MR

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A – De-Identification

Clinical Trial De-identification Profiles

• Working Group 18 Clinical Trials• Supplement 142• Working draft 3, 2008

“The existing confidentiality profile in PS 3.15 lists possible attributes that may cause identity leakage, without weighing the relative merits of their inclusion or replacement, or describing strategies to prioritize or selectively replace attribute values.

WG 18 has determined that it is necessary to add additional confidentiality profiles to the DICOM Standard that are appropriate to specific types of trials, both to provide instruction for implementers, to assure compliance, and to provide guidance for sites and trial administrators that has been subject to expert review.

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Topics


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B – Surface Segmentation

Polygonal Segmentation Storage SOP Class

• Working Group 17 (3D) & 24 (Surgery)• Supplement 132• Standard, 2008

The Supplement contains a new Common Surface Mesh Module that is used do encode the segmentation data. It is intended for composite data objects of any modality or clinical specialty.

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• All images are stored as 2D frames• If more than one image is acquired, and there is

some information linking the images (e.g. cross sectional images, temporal images, etc.) the images can be stored as multi-frame objects

• The images are still single 2D frames

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• 3D reconstructions can be created from the multi-frame objects

• Yet results can only be saved as “snapshots” of specific views (i.e. single- or multi-frame images)

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• Surface renderings are commonly derived from polygonal surface primitives

• This supplement provides a method in DICOM to store these primitives instead of images

From Osirix

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Topics


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C – CT Dose Reporting

CT Radiation Dose Reporting (Dose SR)

• Working Group 21 (CT)• Supplement 127• Standard, 2007

“The Computed Tomography X-Ray dose report is based on the SOP class of ‘X-Ray Radiation Dose SR’. Specific templates for the recording of the dose and the acquisition parameters in a CT environment have been developed.

The development of the CT Dose Report Template was accomplished by the DICOM WG 21 and by IEC SC62B MT30, which have defined a common set of dose-related information ...

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1 to n separate irradiation eventstemplateCT Irradiation Event

Accumulated irradiation for an entire examination

templateCT Accumulated Irradiation Dose Study

DICOM basic for definition of objectC.12.1SOP Common

Specifies the attributes contained in the SRC.17.3SR Document Content

General context of SR documentC.17.2SR Document GeneralDocumentAttributes to identify the equipmentC.7.5.1General EquipmentEquipment

Synchronization to patient studyC.7.4.2SynchronizationFrame of Reference

Identify context of clinical trialC.7.3.2Clinical Trial Series

Defines attributes of the SR documentC.17.1SR Document SeriesSeries

Identify context of clinical trialC.7.2.3Clinical Trial Study

Describes information about studyC.7.2.2Patient Study

Describes the study performed upon patientC.7.2.1General StudyStudy

Identify clinical trial subjectC.7.1.3Clinical Trial Subject

Describes the identity of patientC.7.1.1PatientPatientDescriptionReferenceModuleIE

C - SR Dose IOD

CT SR Dose IOD Modules and Structure

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C – CT dose content

• CT Acquisition Parameters• The tube voltage and the tube current are stated.• The effective exposure in mAs is stated.• The exposure time and the scanning length are stated.• Acquisition parameters related to the volume acquisition

are stated (collimation, pitch factor).• For each CT Acquisition (irradiation event):

• The CITDIvol and DPL are stated.• The corresponding CTDIfreeair is stated.• The effective dose may be stated (optional).• The parameters used are stated.• The reference values for dose estimation and calculation

are stated, e.g. calibration factor, effective dose type

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Topics


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D – Breast Tomosynthesis

Breast Tomosynthesis Image Storage SOP Class

• Working Groups 2 (xray), 15 (mamm)• Supplement 125• Standard, 2008

The scope of this Supplement is to customize the X-Ray multi-dimensional storage SOP Class .. to define the 3D volume or volumes created from digital breast tomosynthesis x-ray projections.”

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B – Breast Tomosynthesis

New object modules defined for• Breast tomosynthesis contributing

sources (Part 3 - C.8.21.2.3)• Breast tomosynthesis acquisition

(Part 3 - C.8.21.2.3)

PS 3.4 SOP Class

Breast TomosynthesisImage Storage

1.2.840.10008.5.1.4.1.1.13.1.3

Part UID Type UID Name UID Value

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E – JPEG2000 & JPIP

JPEG 2000 Interactive Protocol

• Working Group 4 (Compression)• Supplement 106• Final Text, January 26, 2006

“This Supplement extends the Pixel Data Module to allow reference to a JPIP URL to access pixel data, rather than encoding it in the image instance…The use cases for this extension to the standard relate to an application's desire to gain access to a portion of DICOM pixel data without the need to wait for reception of all the pixel data. Examples are:

1) Stack Navigation of a large CT Study.2) Large Single Image Navigation3) Thumbnails4) Display by Dimension 32A

APM

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E - JPIP: Implementations

• Many PACS systems provide services for client access to images using proprietary progressive streaming technology.

• DICOM JPIP provides a standardized method that might have particular use in an open-source application.

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Image Streaming GUIs

JPIP facilitates advanced image viewing GUIs

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DICOM SUP 106 (2006), JPIP

DICOM JPIP REFERENCED TRANSFER SYNTAX1.2.840.10008.1.2.4. 94

“This Supplement extends the Pixel Data Module to allow reference to a JPIP URL to access pixel data, rather than encoding it in the image instance.”

“Data Element (7FE0,0010) Pixel Data shall not be present, but rather pixel data shall be referenced via Data Element (0028,7FE0) Pixel Data Provider URL”

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E - JPIP: Tag (0028,7FE0)

Supplement 106 establishes a JPIP transfer syntax and adds a tag that provides a URL to the image data that is used instead of the traditional pixel data tag (7FE0,0010).

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E - JPIP: Informative Annex

Annex X JPIP Referenced Pixel Data

Transfer Syntax NegotiationCase 1: AE1 and AE2 both support both a JPIP Referenced Pixel Data Transfer Syntax and a non-JPIP Transfer Syntax

• AE1makes a C-MOVE request to AE2

• AE2proposes two presentation contexts to AE1, one for with a JPIP Referenced Pixel Data Transfer Syntax, and the other with a non-JPIP Transfer Syntax

• AE1accepts both presentation contexts

• AE2may choose either presentation context to send the object

• AE1must be able to either receive the pixel data in the C-STORE message, or obtain it from the provider URL

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DICOM with JPIP: Diagram

Weisfeiler, Dicom WG4, Feb 2006 38AA

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Topics


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F – enhanced MR

Enhanced MR Image Storage SOP Class

• Working Group 16 (MR)• Supplement 49• Final Text, 26 March, 2002

“The supplement describes 3 new IODs:1. Enhanced MR Image2. MR Spectroscopy3. Raw Data

“A Multi-Frame concept is introduced which allows attributes grouped together to vary on a frame by frame base. This method is modality independent.

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F - eMR: Multiframe

Pixel Measures

Frame Content

Plane Position

Plane Orientation

Referenced Image

Derivation Image

Cardiac Trigger

Frame Anatomy

Pixel value Transformation

Frame VOI LUT

Real World Value Mapping

MR Image Frame Type

MR Timing & Parameters

MR FOV/Geometry

MR Echo

MR Modifier

MR Image Modifier

MR Receive Coil

MR Transmit Coil

MR Diffusion

MR Averages

MR Spatial Saturation

MR Metabolite Map

MR Velocity Encoding

From Charles Parisot , May 5, 2002, Korean PACS Conference

24 Dynamic Functional Groups

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F - eMR: Multiframe

Pixel Measures

Frame Content

Plane Position

Plane Orientation

Referenced Image

Derivation Image

Cardiac Trigger

Frame Anatomy

Pixel value Transformation

Frame VOI LUT

Real World Value Mapping

MR Image Frame Type

MR Timing & Related Parameters

MR FOV/GeometryMR EchoMR ModifierMR Image ModifierMR Receive CoilMR Transmit CoilMR DiffusionMR AveragesMR Spatial SaturationMR Metabolite MapMR Velocity Encoding

For a Specific MR Image Instance :• some Functional Groups are

shared across all frames, • some vary per frame

Per Frame FunctionalGroup Sequence

Frame 1attributes

Frame 2attributes

Shared FunctionalGroups

AttributesFor all frames

MR Image Instance


24 Dynamic Functional Groups

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F - eMR: Image Description Macro

• Supplement 49 proposes a reasonably orthogonal set of attributes for image type useful to reading applications:

• Image Type (0008,0008) values:1: Original/Derived – redefined2: Primary/Secondary – Only Primary valid for MR3: Image Flavor – the overall most important

characteristic of this Image – e.g. flow encoded, max-IP, Perfussion, Stress, T1, T2, etc.

4: Derived Contrast – Diffusion aniso, Subtraction, Velocity, None – generally an indication of post processing performed


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F - eMR: Image Description Macro

• Other Image Types are separate attributes:• Pixel Presentation

(Palette) Color/Monochrome (color supported or not)

• Volumetric PropertiesVolume, Sampled, Distorted (used by Grx, 3D to determine image compatibility with the application)

• Volume Based Calculation TechniqueMAX_IP, MPR, Curved-MPR… (used by Grx, 3D to determine image compatibility)

• Complex Image ComponentMagnitude, Phase, Real, Imaginary (standard MR transformations of the raw data)

• Acquisition ContrastT1, T2, Perfusion, Combination… (MR acquisition contrast types)

From Charles Parisot , May 5, 2002, Korean PACS Conference 44AA

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F - eMR: color, spectroscopy

Color

Spectroscopy

From David Clunie , May 22, 2004, SCAR Hot Topics

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F - eMR: mandatory tags

A large percent of the new tags in the enhanced MR object are mandatory and are those in the enhannced CT object.

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F – enhanced CT

Enhanced CT Image Storage SOP Class

• Working Group 21 (CT)• Supplement 58• Final Text, January 14, 2004

(Amended July 5, 2004)

“.. it is necessary to create a new CT object to meet the needs of state of the art CT technology that has evolved substantially since the existing CT object was standardized in 1993.”

“Furthermore, new applications such as cardiac CT, gated studies, perfusion CT, CT fluoroscopy, contrast tracking and post-processing are not supported by the current standard. ...”

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F - eCT: Spiral Pitch

C.8.15.3.4.1 Spiral Pitch FactorThe formula for Spiral Pitch Factor (0018,9311) in terms of Table Feed per Rotation (0018,9310) and Total Collimation Width (0018,9307) is:

Spiral Pitch Factor = (Table Feed per Rotation (mm)) /(Total Collimation Width (mm))

An example calculation of Spiral Pitch Factor (0018,9311) for a single slice spiral acquisition of an image with a Total Collimation Width of 2.5mm and a Table Feed per Rotation of 10mm is:

Spiral Pitch Factor = (10 mm)/(2.5 mm) = 4.0An example calculation of Spiral Pitch Factor (0018,9311) for a multiple slice spiral acquisition having a Total Collimation Width of 20mm and a Table Feed per Rotation of 10mm is:

Spiral Pitch Factor = (10 mm)/(20 mm) = 0.5

4 mandatory tags in the CT table Dynamics Macro are unambiguously defined in an informative paragraph .

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F - eCT: Acquisition Type

C.8.15.3.2.1 Acquisition TypeAcquisition Type (0018,9302) has the following Defined Terms:•SEQUENCED identifies that the acquisition was performed by acquiring single or multi detector data while rotating the source about the gantry while the table is not moving. Additional slices are acquired by incrementing the table position and again rotating the source about the gantry while the table is not moving.

•SPIRAL identifies that the acquisition was performed by acquiring data while rotating the source about the gantry while continuously moving the table.

•CONSTANT_ANGLE identifies that the acquisition was performed by holding the source at a constant angle and moving the table to obtain a projection image (e.g., a localizer image).

•STATIONARY identifies that the acquisition was performed by holding the table at a constant position and acquiring multiple slices over time at the same location.

•FREE identifies that the acquisition was performed while rotating the source about the gantry while the table movement is under direct control of a human operator or under the control of an analysis application (e.g., fluoroscopicimage).

The Acquisition Type (0008,9303) contains a description of the method used during acquisition

of the frame from a list of defined terms .

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F - eCT: Dynamic Contrast

• Conventional hanging protocols are rarely sophisticated enough to recognize multiple phases of contrast enhancement, e.g., during CT of liver

• Old DICOM objects have no standard information about contrast phase

• New objects name phases of contrast administration for each framePRE-CONTRAST, POST-CONTRAST, IMMEDIATE, DYNAMIC,STEADY-STATE, DELAYED, ARTERIAL,CAPILLARY, VENOUS,PORTAL-VENOUS

From David Clunie , 2006, New DICOM Objects 50AA

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F - eCT: Multi Frame Performance

• Reduced communication latency (delay)• Opportunity for inter-slice (3D) compression

From David Clunie , 2006, New DICOM Objects

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F - eMR & eCT conformance

SOP Class UIDs• Enhanced CT 1.2.840.10008.5.1.4.1.1.2.1• Enhanced MT 1.2.840.10008.5.1.4.1.1.4.1

• The enhanced CT and MR objects were incorporated in the DICOM standard in 2003 and 2004.

• Implementation testing & demonstration• June 2005 - SCAR demonstration• November 2005 - RSNA InfoRAD demonstration

• Despite strong industry involvement in the development of the objects, support has not been available on commercial CT and MR systems

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Questions?

?

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IHE http://www.ihe.net/

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IHE

IHE: Integrating the Healthcare Enterprise

• “IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information.”

• “IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care.”

• “Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively.”

http://www.ihe.net/

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IHE Member Organizations

IHE: Member Organizations

• 27 Healthcare Professional AssociationsAAPM, ASTRO, RSNA, SNM …

• 104 Healthcare companies• 8 Government Agencies

CDC, NIST, VA …• 7 Standards Organizations• 8 Healthcare provider organizations• 8 Healthcare education & research orgs.

http://www.ihe.net/56A

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IHE Domains

IHE: Active Domains

• Cardiology• Eye Care• IT Infrastructure• Laboratory• Patient Care

Coordination• Patient Care Devices• Quality

http://wiki.ihe.net/

• Radiation Oncology• Radiology

• Mammography• Nuclear Medicine

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Recent IHE Profiles

IHE Profiles relevant to Medical Physics• [NTPL-S] Normal Treatment Planning-Simple• [MMR-RO] Multimodality Registration, Rad. Onc.• [TRWF] RT Treatment Workflow• [PWF] Post-Processing Workflow• [NM] Nuclear Medicine Image• [FUS] Image Fusion (in Trial)• [REM] Radiation Exposure Monitoring• [MAMMO] Mammography Image• [PDI] Portable Data for Imaging

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Recent IHE Enhancements that are important to Medical Physicists

• Radiation exposure monitoring (REM),• Mammography acquisition workflow(MAWF),• Extensions to the Portable Data for Imaging

(PDI) integration profile,• Basic Image Review Profile (BIR),• MR Diffusion Imaging (MDI), and• CT/MR Perfusion Imaging with Contrast (PIC).

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Topics

A. REM – Rad. Exp. MonitoringB. MAWF – Mamm. Acq. workflowC. PDI – New ExtensionsD. BIR – Basic Image ReviewE. MDI – MR Diffusion imagingF. PIC – CT/MR Perfusion imaging

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IHE - REM

This profile facilitates the collection and distribution of information about estimated patient radiation exposure resulting from imaging procedures.

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IHE – REM Actors

ACTORS• Acquisition Modality - <Creates and stores Dose SR.• Image Manager/Archive - <Accepts/Commits dose

data and supports Q/R.• Dose Information Consumer – Responsible for

supplemental handling of irradiation events, generally on an individual basis, e.g. display, analysis, or further processing.

• Dose Information Reporter – Responsible for the aggregation, analysis, reporting and business logic related to irradiation events

• Dose Register – Collates information about irradiation events from a number of facilities

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IHE – REM Actors

The profile describes relevant transactions between actors.

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IHE – REM Use

REM General Use Case

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IHE – REM Q & A

• Is there any need for translating the dose objects into an HL7 format?• Answer: No needs could be identified at this time, but the possibility of

sending data into HL7 was acknowledged. It will not be addressed now.• Should we include dose from Radiotherapy procedures in the profile?

• Answer: Not yet. Focus on imaging initially. RT can be added later.• Should we include dose from SPECT/PET procedures in the profile?• Answer: Not yet. The dose SR work in DICOM does not exist for these

modalities. When it does, they could be added.• Should IHE make equipment identification details mandatory?

• Answer: Yes. A DICOM CP will be submitted to add the Enhanced Equipment Module (C.7.5.2) to the Radiation Dose IOD. (Manufacturer, model and serial number attributes would then be Type 1).

Q & A from the Trial Implimentation Draft, July 2008

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IHE – REM Connectathon

Every year, IHE conducts a connectathon to demonstate vendor implementations of new profiles.

http://sumo.irisa.fr/con_result/

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Topics


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IHE - MAWF

Mammography Acquisition Workflow describes mechanisms to handle situation-specific exceptions to routine image acquisition scenarios based on the IHE Radiology Scheduled Workflow Integration Profile.

• It defines how a Modality communicates ad-hoc procedure changes when supplemental images are taken or when the exam type changes.

• It defines interactions between Digital X-ray (FFDM) Modalities and systems managing departmental workflow when an examination is begun in one room and is finished in another room.

• It defines how corrections to view labels at the Modality are communicated to and used by an Image Archive.

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IHE – exam type change

The MAWF profile graphically illustrates the use cases considered.

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IHE – MAWF Open Issue

Open Issues (July 2008)

• “While working on this Profile and finding technical solutions to its underlying use cases, the Technical Committee requested changes to the DICOM standard to realize needed Actor behavior.

• This includes one new attribute in MPPS and images, as well as code extensions to the Content Mapping Resource (see vol. 1, Appendix B).

• Corresponding Change Proposals to the DICOM Standards were submitted. This IHE Profile specification depends on these Change Proposals to be accepted and finalized. The IHE Radiology Technical Committee will stay in contact with the DICOM Committees and update this Profile as necessary based on the actions taken by DICOM. “

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Topics


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IHE – PDI extensions

This supplement adds options to the Portable Data for Imaging Integration Profile,

• To broaden from CD media only to include DVD and USB, • To add support for lossless and lossy compression ,• To add an application on the media to decompress and

decrypt the contents to send over the network.

June 21, 2009

Trial Implementation Draft

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Topics


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IHE – PDI extensions

“Working closely with representatives of the American Medical Association and the American Association of Neurological Surgeons, the IHE Radiology Technical Committee has developed this profile to define the appropriate baseline functionality and behaviors for image viewing software on CD.”

June 10, 2009


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IHE – BIR objective

It is common practice for imaging facilities to distribute images on CDs, and for receiving physicians to review those images using aviewer included on the CD.Physicians have increasingly expressed frustration that frequently:

• viewers do not run successfully,• viewers do not load the images successfully,• the viewer loads too slowly,• the viewer claims to be "not of diagnostic quality,"• functions critical to review are missing from the viewer or• the various viewers encountered on CDs have unique graphical user

interfaces that do not provide obvious access to basic functions.The impact is delayed care, inaccessible information, repeat examination and irradiation, and poor use of valuable clinician time.Creators of CDs may be unaware of the problems encountered by the physicians receiving the CDs and thus critical feedback about these issues is not communicated to the vendor of the system.

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IHE – BIR minimum computer

Minimum hardware and software• One x86 (Intel or AMD) processor or core• Windows XP Home Edition and Windows Vista Home Basic Edition• .NET 2.0 framework installed• 512MB RAM for XP and 1024 MB RAM for Vista• Graphics hardware and a single monitor of any type supported by

Windows at 1024x768 resolution in 24 bit RGB color• a mouse or other pointing device with a single button• one drive that supports reading writable CD and DVD media• a consumer-grade printer• without requiring installation of, or permission to install,

applications, frameworks (such as Java or other .NET versions), libraries (such as DLLs or ActiveX controls), device or graphicsdrivers or software other than those shipped with the basic operating system

• without requiring the presence of a network connection (for download of software, licensing or registration or exchange of any other information whether via the Internet or local area network)

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IHE – BIR mouse W/L functions

• For grayscale images, a tool shall be provided to select the use of the mouse to window the images in all tiles of the currently selected viewport. This support shall include:

• a tool that selects windowing by mouse movement with the left (or only) mouse button held down

• acceleration of the rate of windowing by a keyboard modifier or detection of the rate of mouse movement

• Another tool is provided to toggle between two modes of windowing behavior, Center/Width and Clamped. When the Window tool is selected and the mode is Center/Width:

• horizontal movement of the mouse to the right will widen the window width (flatten the perceived contrast)

• vertical movement of the mouse upwards will lower the window center (increase the perceived brightness)

• When the Window tool is selected and the mode is Clamped:• the bottom of the window shall be clamped to a rescaled

pixel value of 0• vertical movement upward shall lower the upper limit of

the window (increase the perceived brightness)

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IHE – BIR ICONS

37 standard icons are defined along and the function specifically delineated.

Patient Selection

B-W W-B Reversal

Localizer Lines WL Mode

Annotation CINE WL Default Values ZOOM

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IHE – DIFF display

• “The MR Diffusion Imaging Integration Profile leverages enhanced MR diffusion images containing standard attributes for Diffusion B value, Diffusion gradient orientation and Diffusion image type.

• These objects are exchanged in an interoperable way allowing correct and convenient display.

• Applications using older single-frame DICOM image objects depended on knowledge of private attributes for this information..”

June 21, 2009


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IHE – Diffusion display

• MR Diffusion Imaging creates stacks of images (slices) with different meaning and derived contrast by using techniques of MR Diffusion Weighted Imaging (DWI).

• This Integration Profile defines how a set of images resulting from a completed MR Diffusion exam are stored and archived into frames of one Enhanced MR DICOM (Multi-frame) object so that they can later be retrieved and displayed in an unambiguous way on image viewers supporting Enhanced MR DICOM objects.

• This enables widespread and adequate review and interpretation of b=0, ISOTROPIC and ADC diffusion frames by radiologists in an environment where all Actors support the Enhanced MR DICOM objects

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IHE – DIFF tags

This profile requires certain DICOM tags be present in addition to mandatory enhanced MR tags.

The values of these tags are used to establish the manner in which diffusion imaging sequences are stored in the multi-frame object

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Topics


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IHE – PERF display

• “The CT/MR Perfusion Imaging with Contrast Integration Profile facilitates the exchange of contrast enhanced images containing standard attributes for timing and position.

• The exchange of these attributes allow for correct and convenient display.

• Applications using the older single-frame DICOM image objects depended on proprietary assumptions about which timing attributes 75 were expected to be present, and were not generally interoperable.”

June 21, 2009


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IHE – Perfusion display

• CT/MR Perfusion Imaging with Contrast creates stacks of images at different timeslots, in order to demonstrate the uptake of a contrast agent over time.

• This Integration Profile defines how these perfusion images are stored and archived into frames of one Enhanced DICOM (Multi-frame) object so that they can later be retrieved and displayed in an unambiguous way on image viewers supporting Enhanced DICOM objects.

• This enables widespread and adequate review and interpretation of contrast-enhanced frames by radiologists in an IT environment where all Actors support the Enhanced CT or Enhanced MR DICOM objects.

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IHE – PERF tags

Similar to the DIFF profile, this profile requires certain tags to be used to facilitate perfusion images storage and display.

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DICOM & IHE

DICOM Standards Committee&

Integrating the Healthcare Enterprise (IHE) InternationalMemorandum of Understanding

Effective Date: May 15, 2009

• The DSC will become a member of IHE International and appoint a liaison representative. Likewise, IHE International will become a member of the DSC and appoint one voting representative

• Each organization must execute the other’s Intellectual Property Agreement.

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Questions?

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