Nuclear Medicine Image Profile

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  • Nuclear Medicine Image Profile

    1. 1. 1IHE Workshop – June 2006 What IHE Delivers Kevin O’DonnellKevin O’Donnell Toshiba Medical SystemsToshiba Medical Systems NM ImageNM Image
    2. 2. 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
    3. 3. 3IHE Workshop – June 2006IHE Workshop – June 2006 General NM Viewing SuboptimalGeneral NM Viewing Suboptimal NM PACS
    4. 4. 4IHE Workshop – June 2006IHE Workshop – June 2006 General NM Viewing SuboptimalGeneral NM Viewing Suboptimal NM PACS
    5. 5. 5IHE Workshop – June 2006IHE Workshop – June 2006 General NM Viewing SuboptimalGeneral NM Viewing Suboptimal Click and move mouse down to adjust window level, right to adjust window center
    6. 6. 6IHE Workshop – June 2006IHE Workshop – June 2006 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
    7. 7. 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)
    8. 8. 8IHE Workshop – June 2006IHE Workshop – June 2006 NM ImageNM 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 >
    9. 9. 9IHE Workshop – June 2006IHE Workshop – June 2006 NM ImageNM Image Value 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
    10. 10. 10IHE Workshop – June 2006IHE Workshop – June 2006 NM ImageNM Image Transaction DiagramTransaction Diagram
    11. 11. 11IHE Workshop – June 2006IHE Workshop – June 2006 NM ImageNM Image Standards 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
    12. 12. 12IHE Workshop – June 2006IHE Workshop – June 2006 NM Image ActorsNM Image Actors Acquisition 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
    13. 13. 13IHE Workshop – June 2006IHE Workshop – June 2006 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
    14. 14. 14IHE Workshop – June 2006IHE Workshop – June 2006 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!
    15. 15. 15IHE Workshop – June 2006IHE Workshop – June 2006 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
    16. 16. 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
    17. 17. 17IHE Workshop – June 2006IHE Workshop – June 2006 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”
    18. 18. 18IHE Workshop – June 2006IHE Workshop – June 2006 Display FormatsDisplay Formats Grid display  Frames from one image set A32 … ………………… …………………… …………………A9 A8 A7 A6 A5 A4 A3 A2 A1 C1 C1 B2 B1 A2 A1 Fit display  Frames from multiple image sets
    19. 19. 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.
    20. 20. 20IHE Workshop – June 2006IHE Workshop – June 2006 ACC NM Display ExampleACC NM Display Example Short axis Horizontal Long Vertical Long
    21. 21. 21IHE Workshop – June 2006IHE Workshop – June 2006 ACC NM Display ExampleACC NM Display Example Short Horizontal Vertical Stress Rest Stress Rest Stress Rest Stress Rest
    22. 22. 22IHE Workshop – June 2006IHE Workshop – June 2006 Another ACC Display ExampleAnother ACC Display Example Different Layout Same stress and rest views
    23. 23. 23IHE Workshop – June 2006IHE Workshop – June 2006 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
    24. 24. 24IHE Workshop – June 2006IHE Workshop – June 2006 Result Screen Export OptionResult Screen Export Option
    25. 25. 25IHE Workshop – June 2006IHE Workshop – June 2006 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.
    26. 26. 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
    27. 27. 27IHE Workshop – June 2006IHE Workshop – June 2006

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