1September, 2005 What IHE Delivers
Dr. Jerry Wallis (SNM),Dr. Jerry Wallis (SNM), IHE Radiology Technical CmteIHE Radiolog...
2
Patient
Info.
Recon-
ciliation
Access to Radiology Information
Consistent
Presentation
of
Images
Audit Trail & Node Auth...
3
NM Image – The ProblemNM Image – The Problem
DICOM NM objects are different and
support in products is inconsistent
NM c...
4
NM ImageNM Image
Abstract / ScopeAbstract / Scope
Content Profile
 for Users to request and Vendors to claim
No New Act...
5
NM ImageNM Image
Value PropositionValue Proposition
Use general Radiology Infrastructure to:
Satisfy Basic NM Data Needs...
6
NM ImageNM Image
Transaction DiagramTransaction Diagram
7
NM ImageNM Image
Standards UsedStandards Used
DICOM NM Image Object
DICOM Multiframe Secondary Capture
 Dynamic Results...
8
NM Image ActorsNM Image Actors
Acquisition Modalities
 Create NM objects as specified (Series, attribute & vector handl...
9
Image DisplayImage Display
Display NM and Result-Screen Images
Support specified NM essential display capabilities
Addit...
10
Handle multi-frame / multi-vector images
Multiple simultaneous cines
Grayscale and color result screens
Dynamic and sta...
11
NM Image FormatNM Image Format
Understood by
dedicated NM
systems
Often
Misunderstood
by general
storage and
display sy...
12
NM ImageNM Image
NM PACS
13
NM ImageNM Image
NM PACS
14
Image DisplayImage Display
Must use “intelligent” scaling to
avoid presenting postage-stamp
size NM images
Must allow t...
15
Display FormatsDisplay Formats
Grid display
 One image set
A1
A2
A3
A4
A5
A6
A7
A8
A9
… … … … … … …
… … … … … … … …
… ...
16
Review Option: Image DisplaysReview Option: Image Displays
Adds Image Display requirements to
support Review of NM Imag...
17
Result Screen Export OptionResult Screen Export Option
18
Result Screen Export Option:Result Screen Export Option:
Evidence CreatorsEvidence Creators
Render Dynamic Result Scree...
19
Points of Interest - NMPoints of Interest - NM
Appendix E, Volume 1 (Informative)
 New to Nuclear Medicine?
 Trouble ...
20
IHE Web site: www.IHE .netIHE Web site: www.IHE .net
 Frequently Asked QuestionsFrequently Asked Questions
 Integrati...
21
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    1. 1. 1September, 2005 What IHE Delivers Dr. Jerry Wallis (SNM),Dr. Jerry Wallis (SNM), IHE Radiology Technical CmteIHE Radiology Technical Cmte Kevin O’Donnell (Toshiba Corp.),Kevin O’Donnell (Toshiba Corp.), Co-Chair, IHE Radiology Planning CmteCo-Chair, IHE Radiology Planning Cmte Cor Loef (Philips Medical Systems),Cor Loef (Philips Medical Systems), Co-chair, IHE Radiology Technical CmteCo-chair, IHE Radiology Technical Cmte Nuclear Medicine ImageNuclear Medicine Image
    2. 2. 2 Patient Info. Recon- ciliation Access to Radiology Information Consistent Presentation of Images Audit Trail & Node Authentication - Radiology Option Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting XDS for Imaging NM Image Scheduled Workflow Teaching Files & Clinical Trials Export Portable Data for Imaging Nuclear Medicine Image - NMNuclear Medicine Image - NM
    3. 3. 3 NM Image – The ProblemNM Image – The Problem DICOM NM objects are different and support in products is inconsistent NM clinical display practices 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
    4. 4. 4 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  Two New 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 >
    5. 5. 5 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
    6. 6. 6 NM ImageNM Image Transaction DiagramTransaction Diagram
    7. 7. 7 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
    8. 8. 8 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
    9. 9. 9 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 Review Option
    10. 10. 10 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
    11. 11. 11 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
    12. 12. 12 NM ImageNM Image NM PACS
    13. 13. 13 NM ImageNM Image NM PACS
    14. 14. 14 Image DisplayImage Display Must use “intelligent” scaling to avoid presenting postage-stamp size NM images Must allow the user to select different vectors/framesets of complex multi-frame images Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image” (e.g. set of time sequence)
    15. 15. 15 Display FormatsDisplay Formats Grid display  One image set A1 A2 A3 A4 A5 A6 A7 A8 A9 … … … … … … … … … … … … … … … … … … … … … … A32 … A1 A2 A3 A4 A5 A6 A7 A8 B1 B2 B3 B4 B5 B6 B7 B8 A1 A2 B1 B2 C1 C1 Fit display  Multiple image sets Comparison display  Multiple image sets
    16. 16. 16 Review Option: Image DisplaysReview Option: Image Displays Adds Image Display requirements to support Review of NM Images  MPR Display  More series at once  Different series types together  Pixel value display
    17. 17. 17 Result Screen Export OptionResult Screen Export Option
    18. 18. 18 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.
    19. 19. 19 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
    20. 20. 20 IHE Web site: www.IHE .netIHE Web site: www.IHE .net  Frequently Asked QuestionsFrequently Asked Questions  Integration Profiles in Technical Frameworks:Integration Profiles in Technical Frameworks:  CardiologyCardiology  IT InfrastructureIT Infrastructure  LaboratoryLaboratory  Patient Care CoordinationPatient Care Coordination  RadiologyRadiology  Connectathon ResultsConnectathon Results  Vendor Products Integration StatementsVendor Products Integration Statements  Participation in Committees & ConnectathonsParticipation in Committees & Connectathons
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