nov 29, 2006ihe rsna 2006 1 integrating the healthcare enterprise nuclear medicine and ihe: whats...

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Nov 29, 2006 IHE RSNA 2006 1 Integrating the Healthcare Integrating the Healthcare Enterprise Enterprise Nuclear Medicine and IHE: What’s New? Jerold Wallis Mallinkcrodt Institute of Radiology IHE NM Technical Committee co-chair SNM DICOM Committee chair

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Page 1: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20061

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Nuclear Medicine and IHE: What’s New?

Jerold Wallis

Mallinkcrodt Institute of Radiology

IHE NM Technical Committee co-chair

SNM DICOM Committee chair

Page 2: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20062

HealthcareConnectivity

Problem

Vendorand Userexpertise

“Integration Profile”

Proposed solutionUsing existing standards

Vendor implements solutioninto

REAL product

Vendor testingat

Connect-a-thon

Public Demonstration

Healthcare SiteIncludes IHE

in RFP

Page 3: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20063

New in 2006New in 2006Import Reconciliation Workflow Profile Bringing outside studies into your PACS

• Prior comparisons• Exams done elsewhere to be read locally• Transfer of care

Reconciliation of demographics

Mammography Image Optimal softcopy image display

• Special Mammography issues

NM Image with Cardiac option

Image Fusion

Page 4: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20064

IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Presentation

ofImages

Audit Trail & Node Authentication - Radiology Option

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

XDS for Imaging

NMImage

Scheduled Workflow

Teaching Files &

Clinical Trials Export

Portable Data for Imaging

NMImage

Cardiac NM Option

ImageFusion

ImageFusion

Page 5: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20065

NM Image – The ProblemNM Image – The Problem

Support in Products is inconsistent DICOM NM objects are different NM Display needs are different NM Cardiac Display needs are different

Poor communication during product purchase NM Users are not adept at getting these requirements

accurately included in RFPs Vendors are not adept at accurately representing their

support for such features

Page 6: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20066

General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

Page 7: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20067

General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

Page 8: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20068

General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

Click and move mouse down to adjust window level, right to adjust window center

Page 9: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 20069

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

Page 10: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200610

New this year !New this year !

Cardiac option Better addresses cardiac needs

Minor restructuring of remaining profile

= NEW

Page 11: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200611

NM Image NM Image Abstract / ScopeAbstract / Scope

Content Profile for Users to request and Vendors to claim

No New Actors or Transactions

New Informative Text in Vol. 1

New Normative Text in Vol. 2

Page 12: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200612

NM ImageNM ImageGoalGoal

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

Page 13: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200613

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

Page 14: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200614

NM ImageNM ImageTransaction DiagramTransaction Diagram

Page 15: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200615

NM Image ActorsNM Image Actors

Image Displays

Acquisition Modalities

Evidence Creators

Image Manager/ Archives

Display NM and Secondary Capture (SC & MFSC) Images

Support specified display capabilities

Handle specific NM DICOM attributes

Page 16: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200616

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!

Page 17: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200617

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

Display Series Description tag

Image DisplayImage Display

Page 18: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200618

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

Page 19: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200619

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”

Page 20: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200620

Upper and Lower LevelsUpper and Lower Levels

Upper and lower window levels

(Not just center/width)

Separate

Design is up to vendor

Page 21: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200621

Display FormatsDisplay FormatsGrid display Frames from one

image setA32

…………………

……………………

…………………A9

A8 A7 A6A5 A4 A3 A2 A1

C1 C1

B2B1 A2 A1 Fit display Frames from multiple image

sets

Comparison Display

Page 22: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200622

ACC NM Cardiac DisplayACC NM Cardiac DisplayGenerate long axis from short axis images (MPR)

Page 23: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200623

ACC NM Cardiac DisplayACC NM Cardiac DisplayGenerate long axis from short axis images (MPR)

Display of 2 image sets (Stress and Rest)

Follow ACC guidelines for display

Use patient state tags to set display order

Controls for adjusting stress and rest Image alignment, window upper and lower levels.

Page 24: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200624

ACC NM Display ExampleACC NM Display ExampleShort axis

Horizontal Long

Vertical Long

Page 25: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200625

ACC NM Display ExampleACC NM Display ExampleShort

Horizontal

Vertical

Stress

Rest

Stress

Rest

Stress

Rest

Stress

Rest

Page 26: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200626

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

Replaces Review Option

Page 27: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200627

NM Image ActorsNM Image Actors

Image Displays

Acquisition Modalities

Evidence Creators

Image Manager/ Archives

Create NM objects as specified (Series, attribute & vector handling)

Include specific codes in Cardiac studies

Page 28: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200628

NM Image ActorsNM Image Actors

Image Displays

Acquisition Modalities

Evidence Creators

Image Manager/ Archives

Create NM objects as specified (Series, attribute & vector handling)

Include specific codes in Cardiac studies

Use Cardiac codes during processing

Page 29: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200629

Result Screen Export OptionResult Screen Export Option

Page 30: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200630

Result Screen Export Option:Result Screen Export Option:Evidence CreatorsEvidence Creators

Render Static Result Screens SIngle frame DICOM Secondary Capture

• or Multi-frame (preferred, displayed by stepping, not cine)

Render Dynamic Result Screens Multi-Frame Secondary Capture

• Grayscale Byte• True Color

Page 31: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200631

NM Image ActorsNM Image Actors

Image Displays

Acquisition Modalities

Evidence Creators

Image Manager/ Archives

Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects

Return Series Description at time of query

Page 32: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200632

Image Fusion ProfileImage Fusion Profile

Page 33: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200633

Image Registration and FusionImage Registration and Fusion

•Translate

•Rotate Rigid Registration

•Scale

•Warp- optional (Deformable Registration)

•Fuse

Page 34: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200634

Image Fusion- General Use CaseImage Fusion- General Use Case

Tech acquires two series of Tech acquires two series of images. images.

Tech reconstructs images, Tech reconstructs images, performs registration, and performs registration, and stores results.stores results.

Workstation presents fused view Workstation presents fused view based on full image data for based on full image data for Radiologist or Oncologist. Radiologist or Oncologist.

PACS Display shows Fused PACS Display shows Fused views to Referring Physicianviews to Referring Physician

CTCT MRMR

Page 35: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200635

Fusion- The Integration ProblemFusion- The Integration Problem

Results not readily transferable between systems Proprietary or inconsistent implementations Lack of guidance

Results presented on different systems may not appear the same.

Systems must correctly handle issues such as Identifying and retrieving the right datasets Matching data between single-slice and multi-slice

datasets Performing spatial translations Rendering the fused display

Page 36: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200636

Fusion- The Integration SolutionFusion- The Integration Solution

A collection of DICOM objects exists to address the problem.

Their use is constrained and clarified to avoid misinterpretation and promote compatibility.

Page 37: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200637

Spatial Registration ObjectSpatial Registration Object

Not required for already-registered PET-CT data from a hybrid scanner

SROImage 1

Image 2

Transformation

Page 38: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200638

Blending Presentation StateBlending Presentation State

Image 1

Image 2

SRO

Transformation BPS

Window – 1

Window – 2

Color Table

Transparency

Page 39: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200639

Image Fusion Actors Image Fusion Actors

Acquisition Modality

Evidence Creator

Image

Manager

↓ [RAD 18] Creator Images Stored ↓ [RAD 57] Blending Presentation States Stored↓ [RAD 56] Spatial Registrations Stored↓ [RAD 10] Storage Commitment

↓ [RAD 14] Query Images↓ [RAD 16] Retrieve Images↓ [RAD 15] Query Presentation States↓ [RAD 17] Retrieve Presentation States↓ [RAD 58] Retrieve Spatial Registrations

Image Archive

[RAD 8] Modality Images Stored ↓[RAD 57] Blending Presentation States Stored ↓[RAD 56] Spatial Registrations Stored ↓[RAD 10] Storage Commitment ↓

Image Display

Page 40: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200640

Load CT and PET images

Align images (automatically or manually) and fuse with desired blending factor

Store the alignment, including

Registration object Blending State (defining the blending

factor, window levels and referencing all other objects)

Storage can be on PACS or disk. Images do not need to be stored if already stored.

Fusion- PreparationCTCTCTCT

PETPETPETPET

Registration Registration ObjectObject

Blending State

Page 41: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200641

Blending state can be searched and retrieved from PACS Can be used to retrieve the image data

and the alignment automatically. User selects a Blending state. Automatically load referenced objects.

Alignment applied, PET re-sampled to CT and displayed fused automatically .

Display is required to provide Scrolling through volume Adjustment of fusion blending and

window levels MPR Side-by-side display

Fusion- Display

CTCTCTCTPETPETPETPET

Registration Registration ObjectObject

Blending State

Page 42: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200642

Essential Clinical FeaturesEssential Clinical Features

MPR

Fusion

Side-by-side Registered

Page 43: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200643

What are Benefits to the User?What are Benefits to the User?

Consistency of results across vendors. Fusion on vendor “A” system Display on vendor “B” system

Easy to list in RFP

Easy to distribute and display fused images

Applies to PET/CT, CT/MR etc

Page 44: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200644

What are Benefits to the Vendor?What are Benefits to the Vendor?

The Fusion Profile Provides:The Fusion Profile Provides:

A framework for interoperability with other vendors

A baseline feature set to meet clinical needs

Common approach for all modalities

Page 45: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200645

NM Image and Image Fusion NM Image and Image Fusion Profile StatusProfile Status

Published for Trial Implementation.

http://www.ihe.net/Technical_Framework/index.cfm#radiology

Vendors: Complying with the profiles will help meet users needs.

Users: Ask vendors

“Do you offer systems that comply with the NM Image and Image Fusion profiles?”

Page 46: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200646

Page 47: Nov 29, 2006IHE RSNA 2006 1 Integrating the Healthcare Enterprise Nuclear Medicine and IHE: Whats New? Jerold Wallis Mallinkcrodt Institute of Radiology

Nov 29, 2006 IHE RSNA 200647

Questions?Questions?