ihe workshop – february 2007what ihe delivers 1 marco eichelberg ihe-d technical manager nm image
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1IHE Workshop – February 2007 What IHE Delivers
Marco EichelbergMarco Eichelberg
IHE-D Technical ManagerIHE-D Technical Manager
NM ImageNM Image
2IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM ImageNM Image The ProblemThe Problem
DICOM NM objects are different and support in products is inconsistent
NM cardiac display needs are different and support in products is inconsistent
Clinical Analysis Programs are used extensively (particularly for Cardiology), but no support for distribution and display of those Result Screens
NM Users are not adept at getting these requirements accurately included in RFPs
Vendors (especially of general purpose systems) are not adept at accurately representing their support for such features
3IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
General NM Viewing SuboptimalGeneral NM Viewing Suboptimal
NM PACS
4IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
General NM Viewing SuboptimalGeneral NM Viewing Suboptimal
NM PACS
5IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
General NM Viewing SuboptimalGeneral NM Viewing Suboptimal
Click and move mouse down to adjust window level, right to adjust window center
6IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Cardiac Viewing SuboptimalCardiac Viewing Suboptimal
If sent as Short axis Images not
displayed in a useful format.
If sent as screen snapshots(ie, static Secondary Capture) Can’t separately adjust stress and rest images Can’t view gated cine
7IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
New in 2006 !New in 2006 !
Cardiac Option Better addresses cardiac needs
Minor restructuring of remaining profile General NM option MPR option
(Review option retired) (Comparison display eliminated)
8IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM Image NM Image Abstract / ScopeAbstract / Scope
Content Profile for Users to request and Vendors to claim
No New Actors or Transactions Additional requirements on existing actors and transactions Total of 4 options
New Informative Text in Vol. 1 Clarifications of NM Workflow mapping to SWF Explanation of NM Data Explanations of NM Clinical Display concepts
New Normative Text in Vol. 2 < See Following Slides >
9IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM ImageNM ImageValue PropositionValue Proposition
Use general Radiology Infrastructure to:
Satisfy Basic NM Data Needs Access to NM Images Access to usable presentations of NM Images Access to Clinical Processing Results
Satisfy NM Workflow Needs Map Cardiac and Multi-phase Studies to SWF Improved Query
10IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM ImageNM ImageTransaction DiagramTransaction Diagram
11IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM ImageNM ImageStandards UsedStandards Used
DICOM NM Image Object
DICOM Multiframe Secondary Capture Dynamic Results Collection of Static Results
DICOM Secondary Capture Static Results
ACC NM Cardiac Display format
12IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM Image ActorsNM Image ActorsAcquisition Modalities Create NM objects as specified (Series, attribute & vector handling) Include specific codes in Cardiac studies
Evidence Creators Create NM objects as specified (Series, attribute & vector handling) Include specific codes in Cardiac studies
Image Manager/Archives Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects Support Query on Study Description
Image Displays Display NM and Secondary Capture (SC & MFSC) Images Support specified display capabilities
13IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Image DisplayImage Display
Display NM and Result-Screen Images
Support specified NM essential display capabilities
Additional attribute handling e.g. Patient State, Image Orientation, Detector Sequence, View
Code Sequence
14IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Options: Image DisplaysOptions: Image Displays
General NM Option Whole body display
Cardiac NM Option ACC NM Cardiac display
Displays must support at least one of these options!
15IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Handle multi-frame / multi-vector images
Multiple simultaneous cines
Grayscale and color result screens
Dynamic and static result screens
Original resolution and scaled
Separate adjustment of upper and lower window levels
Apply local color tables to grayscale screens
Add new local color tables to system
Change intensity of grayscale result screens
Display Series Description tag
Image DisplayImage Display
16IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
NM Image FormatNM Image Format
Understood by dedicated NM systems
Often Misunderstood by general storage and display systems
Multiframe Dynamic
Anterior Posterior Multi-energy
NM Image
Image vectors
17IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Image DisplayImage Display
Scale “intelligently” to avoid presenting postage-stamp size NM images
Allow user to select different vectors/framesets of complex multi-frame images
Allow user to separately adjust intensity for different framesets (eg, phases) in the same “image”
18IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Display FormatsDisplay Formats
Grid display Frames from one
image set
A32
…
…………………
……………………
…………………A9
A8 A7 A6A5 A4 A3 A2 A1
C1 C1
B2B1 A2 A1 Fit display Frames from multiple image
sets
19IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
ACC NM Cardiac DisplayACC NM Cardiac Display
Generate long axis from short axis images
Display of 2 image sets (Stress and Rest)
Use patient state tags to set display order
Follow ACC guidelines for display
Controls for adjusting stress and rest Image alignment Window upper and lower levels.
20IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
ACC NM Display ExampleACC NM Display ExampleShort axis
Horizontal Long
Vertical Long
21IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
ACC NM Display ExampleACC NM Display ExampleShort
Horizontal
Vertical
Stress
Rest
Stress
Rest
Stress
Rest
Stress
Rest
22IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Another ACC Display ExampleAnother ACC Display Example
Different Layout
Same stress and rest views
23IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
MPR Option: Image DisplaysMPR Option: Image Displays
Adds Image Display requirements to support Review of SPECT NM Images with Multi-planar reconstruction (MPR) Transaxial Sagittal Coronal
24IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Result Screen Export OptionResult Screen Export Option
25IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Result Screen Export Option:Result Screen Export Option:Evidence CreatorsEvidence Creators
Render Dynamic Result Screens Based on the following DICOM Objects:
• Multi-Frame Grayscale Byte Secondary Capture• Multi-Frame True Color Secondary Capture
Creating multiple single frame objects is NOT sufficient.Render Static Result Screens Using single frame DICOM Secondary Captures is sufficient Using Multi-frame to render single or several related static result
screens is recommended• provides better image comment/label attributes• provides implicit display order• displayed by stepping, not cine
Must generate appropriate Secondary Capture objects from any Result Screens created.
26IHE Workshop – Feb. 2007IHE Workshop – Feb. 2007
Points of Interest - NMPoints of Interest - NM
Appendix E, Volume 1 (Informative) New to Nuclear Medicine? Trouble matching NM to Scheduled Workflow? Start Here.
E.2 NM Workflow – What happens in NM procedures E.3 NM Worklists – How to schedule/model it E.4 NM Data – What to expect in the DICOM E.5 NM Display – How it should be presented
Many subtleties here