1 DICOM Anniversary 2003 Monday, September 22nd, 2003 15:00-15:20 Renaissance Harborplace Hotel...

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Advances in DICOM will Advances in DICOM will Enhance the clinical operation of Enhance the clinical operation of

MRMR

Kees Verduin, Philips Medical Systems

Chair DICOM WG16

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Presentation outlinePresentation outline

• The new MR StandardThe new MR Standard

• The clinical examples of its benefitsThe clinical examples of its benefits

• Roadmap for effective implementation Roadmap for effective implementation

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What is new ?What is new ?

Three new object definitionsThree new object definitions:

– Enhanced MR Image

– MR Spectroscopy

– Raw Data

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A new set of DICOM MR objectsA new set of DICOM MR objects

Not this time:Not this time:

the new Enhanced MR Image object serves the whole range of DICOM users: – from the modality specialist – to the user of a simple viewer in the same way.

So…. what is so exiting about it?So…. what is so exiting about it?

A new object, as such, is not great news.

7Multi-stack

Color

Spectroscopy

Dimensions

Multi-frame

Real World Values

Raw Data

A new MR Standard A new MR Standard (Supplement 49)(Supplement 49)

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The basics of Supplement 49The basics of Supplement 49

• Support of newest applications by New attributes• Less ambiguity through Stricter definitions and rules• Clear relationships through Reference mechanism• Header size reduction through Multi-frame technique• Context information from Image Type and Dimensions• File size flexibility through Concatenations• Functional images with Real World Values • Functional images with Palette Color LUT information

ALL these improve InteroperabilityALL these improve Interoperability

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What is really new ?What is really new ?

• Multi-Frame module with its Shared and Non-Shared header parts

• Dimensions and Dimension Organizations• Coded Object relationships

All these provide CONTEXT INFORMATION !

• Further: – Real World Values– Grayscale images with Color information

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The Multi-frame propertiesThe Multi-frame properties

• Whenever possible, all images of a scan-series shall become frames in one object.

• What is common to all frames, shall not be repeated: Elements that do not change vs. elements that change.

These have a different place in the object header.

• Related elements are defined in functional groups.

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From Single Image to Multi-frameFrom Single Image to Multi-frameN Objects, N Headers

Pixel data (not to scale)Non-Shared (per-frame) HeaderShared Header

N Frames, One Header

HEADER SIZE REDUCTION = less MB, faster transfer

KV

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From Single-frame to MultiFrameFrom Single-frame to MultiFrameN Objects, N Headers

N Frames, One Header

Pixel data (not to scale)Dimension data (not to scale)Per-frame headerFixed Header

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Multi-Frame not only for MR!Multi-Frame not only for MR!

The

Enhanced MR Image and

MR Spectroscopy

have a multi- frame structure that is

also useful for adoption by other modalitiesalso useful for adoption by other modalities.

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DimensionsDimensionsMR images can have many attributes that change from MR images can have many attributes that change from

frame to frame.frame to frame.• When such a change in an attribute is fundamental

for the object, this data element can be structured by the creator as part of the Dimension ModuleDimension Module.

• It supplies the Context Information required for a specialized workstation.

• It also provides an explicit display ordering for the frames in the MR object, that can be used by viewing systems without specific MR application knowledge.

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Object RelationshipsObject Relationships

Image

PriorImage

Spectro-scopy

RawData

0 -n

0-n

Source ImageSequence for derivedimages

Ref. Image Sequencerequired if planned onprior images

0 - n0 - n

Ref. ImageSequencerequired if plannedon prior images

Ref. Raw DataSequence

Ref. Image SequenceOnly if image type isMETABOLITE MAP

0-n

Ref. Raw DataSequence

Source Image Sequencefor derived spectroscopydata

Ref. Image Sequencerequired if planned onprior spectroscopy data

0 - n PriorSpectro-

scopy

Ref. Image Sequence if planned onprior image

0-n

Referenced Image Sequence Source Image Sequence

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Clinical ExamplesClinical Examples

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Diffusion ImagingDiffusion Imaging

“Diffusion b-values” from 0 to 8000 and an ADC image

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Diffusion Tensor Imaging dataDiffusion Tensor Imaging data

Reconstructed Fiber Maps in the colors as seen by the creator

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MR Perfusion ImagingMR Perfusion Imagingtime

non perfused stroke area

Sig

nal

delayed perfusion

time-to-peak map

Real World Value Slope (0040,9225)

Real World Value Intercept

(0040,9224)

RW values

Sto

red

va

lues

Quantitative data with Real World Values

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Cardiac Cine LoopsCardiac Cine Loops

Enables automatic multi-slice / multi-phase display, even for standard workstations

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Total body ImagingTotal body Imaging

Display the correct image at the correct spot using Stacks and In-stack positions

1

3

4

1 2 3 54

2

5

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Functional Brain ImagingFunctional Brain Imaging

• 10-60 slices• all slices measured

in one TR• repeated 100-1000

times to get sufficient signal

• leading to > 60,000 images in one object

Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module

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Relative NAA peak-height

Ratio ofCholine andCreatinine peaks

Spectroscopy ImagingSpectroscopy Imaging

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Spectroscopy RelationsSpectroscopy Relations

Relation:MR Image

Metabolite map

Ratio ofCholine andCreatinine peaks

Relative NAA peak-height

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CT Multi-frameCT Multi-frame

• The CT Multi-frame solution addresses the same data-explosion issues as for MR.

• Multi-detector CTMulti-detector CT generates large volumes of images that need to be provided with sufficient and adequate context information.

• Multi-frame solutions may provide more interoperability for navigation and processing.

• But, 3D processing requires more than a Multi-frame structure.

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Multi-modality - Multi-frame

• Implementations for processing of the generated volumetric data will largely benefit from multi-modality implementations of the multi-frame concept.

• Common structures may lead to common architecture, which in turn will speed up the implementations.

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Implementation RoadmapImplementation Roadmap

Who should be the first ?Who should be the first ?

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The timing dilemma The timing dilemma for the Enhanced MR objectfor the Enhanced MR object

• For the MR vendorsFor the MR vendors:– Why implement it, while nobody is ready to

use it?

• For the Workstation vendors:For the Workstation vendors:– Why implement it, when no one is creating it?

• For the PACS vendorsFor the PACS vendors:– Support it, but how to deal with the mix of

workstations that can yes/no receive it ?

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MRMR

ArchiveArchive

WorkstationWorkstation

NegotiateNegotiateNegotiateNegotiate

The Negotiation scenarioThe Negotiation scenarioDecide to Decide to

send New object send New object or send Old objector send Old object

Negotiate Decide to Decide to send New object send New object or send Old objector send Old object

Decide to send New object

or Cancel

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MRMR

ArchiveArchive



The Partial Conversion scenarioThe Partial Conversion scenarioDecide to Decide to




or Convert object

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MRMR

ArchiveArchive



The Full Conversion scenarioThe Full Conversion scenarioDecide to Decide to

send New object send New object or or Convert Convert

Negotiate Decide to Decide to send New object send New object

or or Convert Convert


or Convert object

All old objects

will be identical

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When will implementationWhen will implementation be required ? be required ?

• As soon as stability is proven.• As soon as the object definition is tested• As soon as resulting changes are implemented

in the standard.

• Or…..

So, pacing may be neededSo, pacing may be needed

As soon as possible!As soon as possible!

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NEMA Members are funding NEMA Members are funding a Demonstration & Test Toola Demonstration & Test Tool

PurposePurpose:• Prove that implementation is possible• Prove the multi-frame header construction• Prove the use of dimensions• Provide a test tool for vendors and other

implementers• Validate implemented objects

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NEMA Demonstration &Test-toolNEMA Demonstration &Test-tool

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Tool availabilityTool availability

• The tool is available to the funding participants

• It is currently under test

• The tool will become available in the public domain in 2003

But…No need to wait with implementation

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Collective support is neededCollective support is needed

The benefits of Supplement 49 as described in The benefits of Supplement 49 as described in this presentation will this presentation will onlyonly be visible if and be visible if and whenwhen:: – MR scanners (creators)– DICOM workstations (receivers)– PACS systems (intermediaries)

will collectively support the newwill collectively support the new MR DICOM objects MR DICOM objects.

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• Vendors of Workstations / PACS need to prepare for implementation:

What should be done? What should be done?

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– Prepare the color pipeline


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Functional Color on Anatomic Grayscale Images

....

Palette Color

Number of

entries

Range of Stored

Values to be mapped to grayscale

Range of Stored

Values to be mapped to

color

R G B

Largest Monochrome Pixel Value

ModalityLUT

Color Display

Mapped to gray level RGB values by display deviceVOI

LUTP-

LUT

+

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– Prepare the color pipeline– Prepare your databases for large objects


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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations

• An object may be split up into two or more SOP Instances, using the same concatenation UID

Legend:

Pixel data (not on scale)

Dimension data (not on scale)

Per-frame header

Fixed Header

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI


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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations


Legend:



Per-frame header

Fixed Header

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Real World Values

• Relates the pixel value to the actual value and unit it represents (e.g., velocity in mm/sec)

Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT

MeasurementUnits CodeSequence

(0040,08EA)

Real WorldValue LUT

Data(0040,9212)

Real WorldValue Intercept

and Slopeattributes

or

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI – Prepare for Dimensions

and Dimension Organizations


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Real World Values


Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT


(0040,08EA)

Real WorldValue LUT

Data(0040,9212)


and Slopeattributes

or

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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

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Concatenations


Legend:



Per-frame header

Fixed Header

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Multi Stack

Stack ID3

Frame Number1 - 5

Frame Number6-10

Frame Number11-15

54

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1In-Stack Position

Stack ID2

Stack ID1

54

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1In-Stack Position

54

32

1In-Stack Position

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– Prepare the color pipeline– Prepare your databases for large objects– Create your real-world values UI– Prepare for Dimensions

and Dimension Organizations


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Real World Values


Value Unit

StoredValues

RealValueLUT

VOILUT

PLUT Display

Real worldvalue

Modality

LUT


(0040,08EA)

Real WorldValue LUT

Data(0040,9212)


and Slopeattributes

or

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....

Palette Color

Number of

entries

Range of Stored


Range of Stored


color

R G B


ModalityLUT

Color Display


LUTP-

LUT

+

107

Concatenations


Legend:



Per-frame header

Fixed Header

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Multi Stack

Stack ID3

Frame Number1 - 5

Frame Number6-10

Frame Number11-15

54

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1In-Stack Position

Stack ID2

Stack ID1

54

32

1In-Stack Position

54

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1In-Stack Position

BH

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And finally… or first ?

Vendors of Workstations / PACS need to decide on the conversion scenario.


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MRMR

ArchiveArchive



The Full Conversion scenarioThe Full Conversion scenarioDecide to Decide to

send New object send New object or or Convert Convert

Negotiate Decide to Decide to send New object send New object

or or Convert Convert


or Convert object

All old objects

will be identical

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MRMR

ArchiveArchive



The Negotiation scenarioThe Negotiation scenarioDecide to Decide to




or Cancel

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SummarySummary

• The New DICOM MR Objects:The New DICOM MR Objects:

– will enhance interoperability

– will increase cross system functionality

– will reduce transfer time

• Success requires also action by Workstation Success requires also action by Workstation and PACS implementers.and PACS implementers.

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Further InformationFurther InformationMore in-depth discussions and presentations about:• Relationships between images • Concatenations• Dimension Organization• Real World Value mapping• Extended Image Type• Color Mappingcan be found at :http://medical.nema.org/dicom/presents.html

http://medical.nema.org/dicom/presents.html

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Acknowledgement and copyrightAcknowledgement and copyright

Images for this presentation were provided by:

– GE Medical Systems– Philips Medical Systems– Siemens Medical Systems

• The slides of this presentation may be quoted if reference and credit to DICOM WG-16 is properly indicated

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Thank you for your attentionThank you for your attention

1 DICOM Anniversary 2003 Monday, September 22nd, 2003 15:00-15:20 Renaissance Harborplace Hotel...

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