1IHE Workshop – June 2006 What IHE Delivers

Kevin O’DonnellKevin O’Donnell

Toshiba Medical SystemsToshiba Medical Systems

NM ImageNM Image

2IHE Workshop – June 2006IHE Workshop – June 2006

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

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

NM PACS

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General NM Viewing SuboptimalGeneral NM Viewing Suboptimal

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

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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 – June 2006IHE Workshop – June 2006

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 – June 2006IHE Workshop – June 2006

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 – June 2006IHE Workshop – June 2006

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

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NM ImageNM ImageTransaction DiagramTransaction Diagram

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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

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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

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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

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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!

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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 – June 2006IHE Workshop – June 2006

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

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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 – June 2006IHE Workshop – June 2006

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 – June 2006IHE Workshop – June 2006

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.

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ACC NM Display ExampleACC NM Display ExampleShort axis

Horizontal Long

Vertical Long

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ACC NM Display ExampleACC NM Display ExampleShort

Horizontal

Vertical

Stress

Rest

Stress

Rest

Stress

Rest

Stress

Rest

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Another ACC Display ExampleAnother ACC Display Example

Different Layout

Same stress and rest views

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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

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Result Screen Export OptionResult Screen Export Option

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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 – June 2006IHE Workshop – June 2006

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

27IHE Workshop – June 2006IHE Workshop – June 2006