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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
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
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
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
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
Nov 29, 2006 IHE RSNA 20066
General NM Viewing SuboptimalGeneral NM Viewing Suboptimal
NM PACS
Nov 29, 2006 IHE RSNA 20067
General NM Viewing SuboptimalGeneral NM Viewing Suboptimal
NM PACS
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
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
Nov 29, 2006 IHE RSNA 200610
New this year !New this year !
Cardiac option Better addresses cardiac needs
Minor restructuring of remaining profile
= NEW
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
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
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
Nov 29, 2006 IHE RSNA 200614
NM ImageNM ImageTransaction DiagramTransaction Diagram
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
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!
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
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
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”
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
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
Nov 29, 2006 IHE RSNA 200622
ACC NM Cardiac DisplayACC NM Cardiac DisplayGenerate long axis from short axis images (MPR)
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.
Nov 29, 2006 IHE RSNA 200624
ACC NM Display ExampleACC NM Display ExampleShort axis
Horizontal Long
Vertical Long
Nov 29, 2006 IHE RSNA 200625
ACC NM Display ExampleACC NM Display ExampleShort
Horizontal
Vertical
Stress
Rest
Stress
Rest
Stress
Rest
Stress
Rest
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
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
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
Nov 29, 2006 IHE RSNA 200629
Result Screen Export OptionResult Screen Export Option
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
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
Nov 29, 2006 IHE RSNA 200632
Image Fusion ProfileImage Fusion Profile
Nov 29, 2006 IHE RSNA 200633
Image Registration and FusionImage Registration and Fusion
•Translate
•Rotate Rigid Registration
•Scale
•Warp- optional (Deformable Registration)
•Fuse
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
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
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.
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
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
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
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
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
Nov 29, 2006 IHE RSNA 200642
Essential Clinical FeaturesEssential Clinical Features
MPR
Fusion
Side-by-side Registered
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
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
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?”
Nov 29, 2006 IHE RSNA 200646
Nov 29, 2006 IHE RSNA 200647
Questions?Questions?