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UC SF LRI The SCAR TRIPTM Initiative & DICOM Katherine P. Andriole Katherine P. Andriole Society for ociety for Computer omputer Applications in pplications in Radiology adiology PACS Clinical Coordinator PACS Clinical Coordinator University of California at San Francisco University of California at San Francisco Department of Radiology Department of Radiology Laboratory for Radiological Informatics Laboratory for Radiological Informatics and and Department of Bioengineering Department of Bioengineering University of California at Berkeley University of California at Berkeley

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Page 1: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

The SCAR TRIPTM Initiative & DICOM

The SCAR TRIPTM Initiative & DICOM

Katherine P. AndrioleKatherine P. Andriole

SSociety for ociety for CComputer omputer AApplications in pplications in RRadiologyadiology

PACS Clinical CoordinatorPACS Clinical CoordinatorUniversity of California at San FranciscoUniversity of California at San Francisco

Department of RadiologyDepartment of RadiologyLaboratory for Radiological InformaticsLaboratory for Radiological Informatics

and and Department of BioengineeringDepartment of Bioengineering

University of California at BerkeleyUniversity of California at Berkeley

Katherine P. AndrioleKatherine P. Andriole

SSociety for ociety for CComputer omputer AApplications in pplications in RRadiologyadiology

PACS Clinical CoordinatorPACS Clinical CoordinatorUniversity of California at San FranciscoUniversity of California at San Francisco

Department of RadiologyDepartment of RadiologyLaboratory for Radiological InformaticsLaboratory for Radiological Informatics

and and Department of BioengineeringDepartment of Bioengineering

University of California at BerkeleyUniversity of California at Berkeley

Page 2: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

OUTLINEOUTLINE

The ProblemThe Problem

The SCAR TRIPThe SCAR TRIPTMTM Initiative Initiative

Historical ReviewHistorical Review

–Imaging in Other Fields vs MedicineImaging in Other Fields vs Medicine

»Entertainment Industry, DoD & NASAEntertainment Industry, DoD & NASA

The ProblemThe Problem

The SCAR TRIPThe SCAR TRIPTMTM Initiative Initiative

Historical ReviewHistorical Review

–Imaging in Other Fields vs MedicineImaging in Other Fields vs Medicine

»Entertainment Industry, DoD & NASAEntertainment Industry, DoD & NASA

Page 3: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

OUTLINEOUTLINE

Concepts InvolvedConcepts Involved

–Human Perception, Image Processing, Human Perception, Image Processing,

Visualization, Navigation, Usability, Standards, Visualization, Navigation, Usability, Standards,

Databases, Integration, Evaluation, ValidationDatabases, Integration, Evaluation, Validation

Concepts InvolvedConcepts Involved

–Human Perception, Image Processing, Human Perception, Image Processing,

Visualization, Navigation, Usability, Standards, Visualization, Navigation, Usability, Standards,

Databases, Integration, Evaluation, ValidationDatabases, Integration, Evaluation, Validation

Page 4: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

OUTLINEOUTLINE Affected Processes Affected Processes

–Interpretation, Communication, Workflow & Efficiency, Diagnostic Accuracy, Interpretation, Communication, Workflow & Efficiency, Diagnostic Accuracy,

Quality of CareQuality of Care

Role of / Impact on DICOMRole of / Impact on DICOM

–Incorporated but not widely used conceptsIncorporated but not widely used concepts

–Necessary new features & functionalityNecessary new features & functionality

Affected Processes Affected Processes

–Interpretation, Communication, Workflow & Efficiency, Diagnostic Accuracy, Interpretation, Communication, Workflow & Efficiency, Diagnostic Accuracy,

Quality of CareQuality of Care

Role of / Impact on DICOMRole of / Impact on DICOM

–Incorporated but not widely used conceptsIncorporated but not widely used concepts

–Necessary new features & functionalityNecessary new features & functionality

Page 5: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

The ProblemThe Problem Information & Image Data OverloadInformation & Image Data Overload

Requires Requires medical image interpretation paradigm medical image interpretation paradigm

shiftshift to evaluate, manage & exploit the massive to evaluate, manage & exploit the massive

amounts of data acquired for improvedamounts of data acquired for improved

–EfficiencyEfficiency

–AccuracyAccuracy

–SurvivalSurvival

Information & Image Data OverloadInformation & Image Data Overload

Requires Requires medical image interpretation paradigm medical image interpretation paradigm

shiftshift to evaluate, manage & exploit the massive to evaluate, manage & exploit the massive

amounts of data acquired for improvedamounts of data acquired for improved

–EfficiencyEfficiency

–AccuracyAccuracy

–SurvivalSurvival

Page 6: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

The SCAR TRIPTM InitiativeThe SCAR TRIPTM Initiative

TTransforming the ransforming the RRadiological adiological

IInterpretation nterpretation PProcessrocess

to to spearheadspearhead research, education, & research, education, &

discovery of discovery of innovative solutions to innovative solutions to

address the problem of information address the problem of information

& image data overload& image data overload..

TTransforming the ransforming the RRadiological adiological

IInterpretation nterpretation PProcessrocess

to to spearheadspearhead research, education, & research, education, &

discovery of discovery of innovative solutions to innovative solutions to

address the problem of information address the problem of information

& image data overload& image data overload..

Page 7: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

SCAR TRIPTM InitiativeSCAR TRIPTM Initiative

Radiology must Radiology must shift its image shift its image

interpretation & management processesinterpretation & management processes

to deal with the burgeoning medical to deal with the burgeoning medical

image data sets acquired by digital image data sets acquired by digital

imaging devices.imaging devices.

Radiology must Radiology must shift its image shift its image

interpretation & management processesinterpretation & management processes

to deal with the burgeoning medical to deal with the burgeoning medical

image data sets acquired by digital image data sets acquired by digital

imaging devices.imaging devices.

Page 8: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

SCAR TRIPTM InitiativeSCAR TRIPTM Initiative

Will Will foster interdisciplinary research foster interdisciplinary research

on technological, environmental & on technological, environmental &

human factorshuman factors to better manage & to better manage &

exploit the massive amount of data.exploit the massive amount of data.

Will Will foster interdisciplinary research foster interdisciplinary research

on technological, environmental & on technological, environmental &

human factorshuman factors to better manage & to better manage &

exploit the massive amount of data.exploit the massive amount of data.

Page 9: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

SCAR TRIPTM InitiativeSCAR TRIPTM Initiative

WillWill focus on:focus on:

–Improving Improving efficiency of interpretationefficiency of interpretation

–Improving Improving timeliness & effectivenesstimeliness & effectiveness

–Decreasing medical errorsDecreasing medical errors

Goal is to improve the quality & safety of patient care.Goal is to improve the quality & safety of patient care.

WillWill focus on:focus on:

–Improving Improving efficiency of interpretationefficiency of interpretation

–Improving Improving timeliness & effectivenesstimeliness & effectiveness

–Decreasing medical errorsDecreasing medical errors

Goal is to improve the quality & safety of patient care.Goal is to improve the quality & safety of patient care.

Page 10: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Historical Review – Why Is Medicine So Far Behind?(DoD, NASA, Hollywood)

Historical Review – Why Is Medicine So Far Behind?(DoD, NASA, Hollywood)

Special & Challenging EnvironmentSpecial & Challenging Environment

–Urgency of ResultsUrgency of Results

–Safety Limitations & RestrictionsSafety Limitations & Restrictions

–Cost of ErrorCost of Error

–Tremendous Variability of Human Tremendous Variability of Human

Data within & between Individuals.Data within & between Individuals.

Special & Challenging EnvironmentSpecial & Challenging Environment

–Urgency of ResultsUrgency of Results

–Safety Limitations & RestrictionsSafety Limitations & Restrictions

–Cost of ErrorCost of Error

–Tremendous Variability of Human Tremendous Variability of Human

Data within & between Individuals.Data within & between Individuals.

Page 11: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Why Is Medicine So Far Behind?Why Is Medicine So Far Behind?

Special & Challenging EnvironmentSpecial & Challenging Environment

–Difficult to Validate PerformanceDifficult to Validate Performance

–Poor Understanding of Human Poor Understanding of Human

Perception & its Relationship to the Perception & its Relationship to the

Art of Medicine.Art of Medicine.

Special & Challenging EnvironmentSpecial & Challenging Environment

–Difficult to Validate PerformanceDifficult to Validate Performance

–Poor Understanding of Human Poor Understanding of Human

Perception & its Relationship to the Perception & its Relationship to the

Art of Medicine.Art of Medicine.

Page 12: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Why Is Medicine So Far Behind?Why Is Medicine So Far Behind?

Slower Adoption of Technology in GeneralSlower Adoption of Technology in General

–Cultural & Practicality BarriersCultural & Practicality Barriers

–More Difficult to See Clinical Impact InitiallyMore Difficult to See Clinical Impact Initially

–InterdisciplinaryInterdisciplinary Nature of the Solution Nature of the Solution

Slower Adoption of Technology in GeneralSlower Adoption of Technology in General

–Cultural & Practicality BarriersCultural & Practicality Barriers

–More Difficult to See Clinical Impact InitiallyMore Difficult to See Clinical Impact Initially

–InterdisciplinaryInterdisciplinary Nature of the Solution Nature of the Solution

Page 13: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Often there is a disconnect between

Scientist-Researchers & End-Users in the Clinical Arena

Often there is a disconnect between

Scientist-Researchers & End-Users in the Clinical Arena

Page 14: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Enabling Technologies(creating urgency for TRIPTM)

Enabling Technologies(creating urgency for TRIPTM)

Computing & Networking CapabilitiesComputing & Networking Capabilities

–““Real-Time” ProcessingReal-Time” Processing

–Increased Bandwidth & Ubiquitous AccessIncreased Bandwidth & Ubiquitous Access

Visualization TechnologiesVisualization Technologies

–3-D Rendering, Color, Motion3-D Rendering, Color, Motion

Computing & Networking CapabilitiesComputing & Networking Capabilities

–““Real-Time” ProcessingReal-Time” Processing

–Increased Bandwidth & Ubiquitous AccessIncreased Bandwidth & Ubiquitous Access

Visualization TechnologiesVisualization Technologies

–3-D Rendering, Color, Motion3-D Rendering, Color, Motion

Page 15: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Enabling TechnologiesEnabling Technologies

Digital Imaging ModalitiesDigital Imaging Modalities

–True 3-D Data Acquisition & Isotropic VoxelsTrue 3-D Data Acquisition & Isotropic Voxels

More Intuitive Graphical User InterfacesMore Intuitive Graphical User Interfaces

–Although much more needs to be doneAlthough much more needs to be done

Digital Imaging ModalitiesDigital Imaging Modalities

–True 3-D Data Acquisition & Isotropic VoxelsTrue 3-D Data Acquisition & Isotropic Voxels

More Intuitive Graphical User InterfacesMore Intuitive Graphical User Interfaces

–Although much more needs to be doneAlthough much more needs to be done

Page 16: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Concepts InvolvedConcepts Involved

Human Perception Human Perception

Image Processing & CADImage Processing & CAD

VisualizationVisualization

Navigation – UsabilityNavigation – Usability

Standards, Databases & IntegrationStandards, Databases & Integration

Evaluation & ValidationEvaluation & Validation

Human Perception Human Perception

Image Processing & CADImage Processing & CAD

VisualizationVisualization

Navigation – UsabilityNavigation – Usability

Standards, Databases & IntegrationStandards, Databases & Integration

Evaluation & ValidationEvaluation & Validation

Page 17: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Human PerceptionHuman Perception

Develop a Develop a Standard for Image QualityStandard for Image Quality

Develop Develop Objective Methodologies & CriteriaObjective Methodologies & Criteria

–From which to determine optimal From which to determine optimal

presentation parameterspresentation parameters

–Based on Diagnostic PerformanceBased on Diagnostic Performance

Develop Develop Display StandardsDisplay Standards

Develop a Develop a Standard for Image QualityStandard for Image Quality

Develop Develop Objective Methodologies & CriteriaObjective Methodologies & Criteria

–From which to determine optimal From which to determine optimal

presentation parameterspresentation parameters

–Based on Diagnostic PerformanceBased on Diagnostic Performance

Develop Develop Display StandardsDisplay Standards

Page 18: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Psychophysical Models for Detection of AbnormalitiesPsychophysical Models for Detection of Abnormalities

Define & Develop Optimal Presentation Parameters Define & Develop Optimal Presentation Parameters

by understandingby understanding

–What is desired by the observerWhat is desired by the observer

–What properties of radiological images are most What properties of radiological images are most

useful in their interpretationuseful in their interpretation

–How can these properties be enhanced to How can these properties be enhanced to

improve accuracy of interpretation.improve accuracy of interpretation.

Define & Develop Optimal Presentation Parameters Define & Develop Optimal Presentation Parameters

by understandingby understanding

–What is desired by the observerWhat is desired by the observer

–What properties of radiological images are most What properties of radiological images are most

useful in their interpretationuseful in their interpretation

–How can these properties be enhanced to How can these properties be enhanced to

improve accuracy of interpretation.improve accuracy of interpretation.

Page 19: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role

WG 11WG 11: Display Function Standard: Display Function Standard

–Gray Scale Std Display Function GSDFGray Scale Std Display Function GSDF

–Presentation-LUTPresentation-LUT

IHEIHE: Consistent presentation of images: Consistent presentation of images

AAPM TF18AAPM TF18: Image Quality, QA: Image Quality, QA

Still must addressStill must address Clinical Correspondence Clinical Correspondence

WG 11WG 11: Display Function Standard: Display Function Standard

–Gray Scale Std Display Function GSDFGray Scale Std Display Function GSDF

–Presentation-LUTPresentation-LUT

IHEIHE: Consistent presentation of images: Consistent presentation of images

AAPM TF18AAPM TF18: Image Quality, QA: Image Quality, QA

Still must addressStill must address Clinical Correspondence Clinical Correspondence

Page 20: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Image Processing & CADImage Processing & CAD

Man-Machine Systems for Image-Based Man-Machine Systems for Image-Based

DiagnosisDiagnosis which take advantage of both which take advantage of both

human & machine capabilities.human & machine capabilities.

–Relinquish more routine chores to the Relinquish more routine chores to the

computer.computer.

–Have human concentrate on judgment Have human concentrate on judgment

& comprehension tasks.& comprehension tasks.

Man-Machine Systems for Image-Based Man-Machine Systems for Image-Based

DiagnosisDiagnosis which take advantage of both which take advantage of both

human & machine capabilities.human & machine capabilities.

–Relinquish more routine chores to the Relinquish more routine chores to the

computer.computer.

–Have human concentrate on judgment Have human concentrate on judgment

& comprehension tasks.& comprehension tasks.

Page 21: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Image Processing & CADImage Processing & CAD

Develop Computer Aids for Feature PerceptionDevelop Computer Aids for Feature Perception

–Cuing, Overlay & AnnotationCuing, Overlay & Annotation

Develop Radiology Workstation of the FutureDevelop Radiology Workstation of the Future

–Implement computer aids into a broadly Implement computer aids into a broadly

supportive workstation.supportive workstation.

–Decision Support, Data Mining & Reference Decision Support, Data Mining & Reference

LibrariesLibraries

Develop Computer Aids for Feature PerceptionDevelop Computer Aids for Feature Perception

–Cuing, Overlay & AnnotationCuing, Overlay & Annotation

Develop Radiology Workstation of the FutureDevelop Radiology Workstation of the Future

–Implement computer aids into a broadly Implement computer aids into a broadly

supportive workstation.supportive workstation.

–Decision Support, Data Mining & Reference Decision Support, Data Mining & Reference

LibrariesLibraries

Page 22: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Image Processing & CADImage Processing & CAD

–Design a workstation that can grow to Design a workstation that can grow to

accommodate future computer tools & accommodate future computer tools &

advances.advances.

–Support clinical, research & teaching Support clinical, research & teaching

needs.needs.

–Design a workstation that can grow to Design a workstation that can grow to

accommodate future computer tools & accommodate future computer tools &

advances.advances.

–Support clinical, research & teaching Support clinical, research & teaching

needs.needs.

Page 23: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role Image processing Image processing capabilitiescapabilities at the PACS display at the PACS display

are currently very are currently very minimalminimal..

Processing typically done at the modality and/or Processing typically done at the modality and/or

required required specialty workstationsspecialty workstations..

How can DICOM pass image processing How can DICOM pass image processing

parameters without disclosing proprietary parameters without disclosing proprietary

information?information?

Structured Reporting & CAD (Structured Reporting & CAD (WG8WG8 & & 1515))

Image processing Image processing capabilitiescapabilities at the PACS display at the PACS display

are currently very are currently very minimalminimal..

Processing typically done at the modality and/or Processing typically done at the modality and/or

required required specialty workstationsspecialty workstations..

How can DICOM pass image processing How can DICOM pass image processing

parameters without disclosing proprietary parameters without disclosing proprietary

information?information?

Structured Reporting & CAD (Structured Reporting & CAD (WG8WG8 & & 1515))

Page 24: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

VisualizationVisualization

Static FilmStatic Film

Dynamic Soft Copy & Image ManipulationDynamic Soft Copy & Image Manipulation

Tile ModeTile Mode

Stack or Cine ModeStack or Cine Mode

Linked Stack Mode for 3-D CorrespondenceLinked Stack Mode for 3-D Correspondence

Multimodality Image FusionMultimodality Image Fusion

Static FilmStatic Film

Dynamic Soft Copy & Image ManipulationDynamic Soft Copy & Image Manipulation

Tile ModeTile Mode

Stack or Cine ModeStack or Cine Mode

Linked Stack Mode for 3-D CorrespondenceLinked Stack Mode for 3-D Correspondence

Multimodality Image FusionMultimodality Image Fusion

Page 25: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Page 26: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Combining Functional & Anatomical InformationCombining Functional & Anatomical Information

Page 27: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

3D Spectra Anatomy Overlay

“Normal” Tumor Necrosis

Courtesy Cynthia Chin, M.D., UCSF

Page 28: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

VisualizationVisualization

Maximum Intensity ProjectionMaximum Intensity Projection

Multi-Planar ReconstructionMulti-Planar Reconstruction

3-D Surface/Volume Rendering3-D Surface/Volume Rendering

Virtual Reality RepresentationsVirtual Reality Representations

??????

Maximum Intensity ProjectionMaximum Intensity Projection

Multi-Planar ReconstructionMulti-Planar Reconstruction

3-D Surface/Volume Rendering3-D Surface/Volume Rendering

Virtual Reality RepresentationsVirtual Reality Representations

??????

Page 29: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

CT Cholangiogram - AxialCT Cholangiogram - Axial

Courtesy Richard S.Breiman, M.D., UCSF

Page 30: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Sliding MIPSliding MIP

Courtesy Richard S.Breiman, M.D., UCSF

Bile Duct Anomalies missed by MRCP in potential

partial liver donors.

Page 31: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Courtesy Gary R. Caputo, M.D., UCSF

3-D Surface/Volume Rendering3-D Surface/Volume Rendering

Page 32: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Courtesy Cynthia Chin, M.D., UCSF

Page 33: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role

Currently most Currently most 3-D3-D representations must be representations must be

– processed on processed on specialty workstationsspecialty workstations

–some must be saved as screen-capture some must be saved as screen-capture

–manually push to PACS workstations & manually push to PACS workstations &

Enterprise-wide Web (if capable of displaying)Enterprise-wide Web (if capable of displaying)

–Raw data Raw data oftenoften not stored not stored..

Currently most Currently most 3-D3-D representations must be representations must be

– processed on processed on specialty workstationsspecialty workstations

–some must be saved as screen-capture some must be saved as screen-capture

–manually push to PACS workstations & manually push to PACS workstations &

Enterprise-wide Web (if capable of displaying)Enterprise-wide Web (if capable of displaying)

–Raw data Raw data oftenoften not stored not stored..

Page 34: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role

How can DICOM pass 3D Model without How can DICOM pass 3D Model without

disclosing proprietary information?disclosing proprietary information?

How simplify interoperability? How simplify interoperability?

–Unify ArchitectureUnify Architecture

How can DICOM pass 3D Model without How can DICOM pass 3D Model without

disclosing proprietary information?disclosing proprietary information?

How simplify interoperability? How simplify interoperability?

–Unify ArchitectureUnify Architecture

Page 35: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role DICOM conceived as a strategy for moving & storing DICOM conceived as a strategy for moving & storing

collections of single imagescollections of single images..

–Network utilization is suboptimalNetwork utilization is suboptimal

PACS must accommodate PACS must accommodate multiple imagesmultiple images which can be which can be

treated as a treated as a single unitsingle unit

–Series-Awareness, 3D, 4D, Functional Sets, Cross-Series-Awareness, 3D, 4D, Functional Sets, Cross-

Referencing of Objects & FusionReferencing of Objects & Fusion

Unified presentation of Unified presentation of Color Color WG11WG11 & others. & others.

DICOM conceived as a strategy for moving & storing DICOM conceived as a strategy for moving & storing

collections of single imagescollections of single images..

–Network utilization is suboptimalNetwork utilization is suboptimal

PACS must accommodate PACS must accommodate multiple imagesmultiple images which can be which can be

treated as a treated as a single unitsingle unit

–Series-Awareness, 3D, 4D, Functional Sets, Cross-Series-Awareness, 3D, 4D, Functional Sets, Cross-

Referencing of Objects & FusionReferencing of Objects & Fusion

Unified presentation of Unified presentation of Color Color WG11WG11 & others. & others.

Page 36: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role

WG16, Supplement 49WG16, Supplement 49 defines multiframe (MR) defines multiframe (MR)

images; model for CT; images; model for CT; WG17WG17, , 2020, , 2121..

–enhanced image storage SOP class enhanced image storage SOP class

–allows multiple images to be combined into one allows multiple images to be combined into one

instanceinstance

–Raw DataRaw Data

–DimensionalityDimensionality

–Context InfoContext Info

WG16, Supplement 49WG16, Supplement 49 defines multiframe (MR) defines multiframe (MR)

images; model for CT; images; model for CT; WG17WG17, , 2020, , 2121..

–enhanced image storage SOP class enhanced image storage SOP class

–allows multiple images to be combined into one allows multiple images to be combined into one

instanceinstance

–Raw DataRaw Data

–DimensionalityDimensionality

–Context InfoContext Info

Page 37: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Navigation & UsabilityNavigation & Usability

3-D & Motion3-D & Motion

Virtual Reality – Fly-ThroughsVirtual Reality – Fly-Throughs

Hand-Eye CuesHand-Eye Cues

Hand-Helds for Point-of-Care DeliveryHand-Helds for Point-of-Care Delivery

Context Matching Context Matching

Voice ActivationVoice Activation

??????

3-D & Motion3-D & Motion

Virtual Reality – Fly-ThroughsVirtual Reality – Fly-Throughs

Hand-Eye CuesHand-Eye Cues

Hand-Helds for Point-of-Care DeliveryHand-Helds for Point-of-Care Delivery

Context Matching Context Matching

Voice ActivationVoice Activation

??????

Page 38: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

3-D Surface RenderingCABG

3-D Surface RenderingCABG

Courtesy Gary R. Caputo, M.D., UCSF

Page 39: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Virtual Reality Fly-Through of Coronary Arteries

Virtual Reality Fly-Through of Coronary Arteries

Courtesy Gary R. Caputo, M.D., UCSF

Page 40: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Sliding VRSliding VR

Courtesy Richard S.Breiman, M.D., UCSF

Page 41: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Michael Teistler, Technical Institute of Braunschweig

Page 42: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Hand-Helds for Point-of Care Delivery

Hand-Helds for Point-of Care Delivery

Page 43: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role Navigation by radiologist/clinicianNavigation by radiologist/clinician at the at the

PACS display (or enterprise-wide web) in real-PACS display (or enterprise-wide web) in real-

timetime

–Raw Data & Processing ModelRaw Data & Processing Model

–Color EncodingColor Encoding

–OverlaysOverlays

–WaveformsWaveforms

–Audio or Other Sense?Audio or Other Sense?

Navigation by radiologist/clinicianNavigation by radiologist/clinician at the at the

PACS display (or enterprise-wide web) in real-PACS display (or enterprise-wide web) in real-

timetime

–Raw Data & Processing ModelRaw Data & Processing Model

–Color EncodingColor Encoding

–OverlaysOverlays

–WaveformsWaveforms

–Audio or Other Sense?Audio or Other Sense?

Page 44: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Standards, Databases & Integration

Standards, Databases & Integration

Open StandardsOpen Standards

Real-Time Processing at PACS DisplayReal-Time Processing at PACS Display

3-D Integrated into PACS Display & Web3-D Integrated into PACS Display & Web

Other Relevant Data – Integrated HIS-Other Relevant Data – Integrated HIS-

RIS-PACS-Speech & IHE (maintaining RIS-PACS-Speech & IHE (maintaining

user & patient focus)user & patient focus)

Open StandardsOpen Standards

Real-Time Processing at PACS DisplayReal-Time Processing at PACS Display

3-D Integrated into PACS Display & Web3-D Integrated into PACS Display & Web

Other Relevant Data – Integrated HIS-Other Relevant Data – Integrated HIS-

RIS-PACS-Speech & IHE (maintaining RIS-PACS-Speech & IHE (maintaining

user & patient focus)user & patient focus)

Page 45: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Evaluation & ValidationEvaluation & Validation

Objective MethodologiesObjective Methodologies

Standard Datasets for Performance TestingStandard Datasets for Performance Testing

Collaborative & Comparison ResearchCollaborative & Comparison Research

Objective MethodologiesObjective Methodologies

Standard Datasets for Performance TestingStandard Datasets for Performance Testing

Collaborative & Comparison ResearchCollaborative & Comparison Research

Page 46: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

Affected Processes Affected Processes

InterpretationInterpretation

CommunicationCommunication

Workflow & EfficiencyWorkflow & Efficiency

Diagnostic AccuracyDiagnostic Accuracy

–Reduction of Medical ErrorsReduction of Medical Errors

Quality of CareQuality of Care

InterpretationInterpretation

CommunicationCommunication

Workflow & EfficiencyWorkflow & Efficiency

Diagnostic AccuracyDiagnostic Accuracy

–Reduction of Medical ErrorsReduction of Medical Errors

Quality of CareQuality of Care

Page 47: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

We Have Come a Long Way, But…

We Have Come a Long Way, But…

Page 48: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

What SCAR Hopes To DoWhat SCAR Hopes To Do Bring Forward the ProblemBring Forward the Problem

Facilitate Exchange of IdeasFacilitate Exchange of Ideas

–Between Researchers, End-Users, Industry, Between Researchers, End-Users, Industry,

Other FieldsOther Fields

–Via Workshops & ForumsVia Workshops & Forums

–By Lobbing NIH & Other AgenciesBy Lobbing NIH & Other Agencies

Sponsor ResearchSponsor Research

Communicate Issues & ResultsCommunicate Issues & Results

Bring Forward the ProblemBring Forward the Problem

Facilitate Exchange of IdeasFacilitate Exchange of Ideas

–Between Researchers, End-Users, Industry, Between Researchers, End-Users, Industry,

Other FieldsOther Fields

–Via Workshops & ForumsVia Workshops & Forums

–By Lobbing NIH & Other AgenciesBy Lobbing NIH & Other Agencies

Sponsor ResearchSponsor Research

Communicate Issues & ResultsCommunicate Issues & Results

Page 49: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM Role(especially)DICOM Role(especially)

WG4WG4 Compression Compression WG8WG8 Structured Reporting Structured Reporting

WG10WG10 Strategic Strategic WG11WG11 Display Function Std Display Function Std

WG16WG16 Magnetic Resonance, Magnetic Resonance, Sup49Sup49 WG17WG17 3D 3D

WG20WG20 Imaging & Information Systems Integration Imaging & Information Systems Integration

WG21WG21 Computed Tomography Computed Tomography

WG4WG4 Compression Compression WG8WG8 Structured Reporting Structured Reporting

WG10WG10 Strategic Strategic WG11WG11 Display Function Std Display Function Std

WG16WG16 Magnetic Resonance, Magnetic Resonance, Sup49Sup49 WG17WG17 3D 3D

WG20WG20 Imaging & Information Systems Integration Imaging & Information Systems Integration

WG21WG21 Computed Tomography Computed Tomography

Page 50: UC SF LRI The SCAR TRIP TM Initiative & DICOM Katherine P. Andriole Society for Computer Applications in Radiology PACS Clinical Coordinator University

UCUCSF LRISF LRI

DICOM RoleDICOM Role

Join in the TRIP!Join in the TRIP!Join in the TRIP!Join in the TRIP!