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New DICOM CT/ MR objects will New DICOM CT/ MR objects will

enhance clinical radiologyenhance clinical radiology

Budapest, Hilton Westend

Tuesday, November 27th , 2005; 8:05 –8:25 a.m.

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New DICOM CT/ MR objects will New DICOM CT/ MR objects will

enhance clinical radiologyenhance clinical radiology

Kees VerduinKees VerduinPhilips Medical SystemsPhilips Medical Systems

CoCo--Chair CTChair CT--MR Taskforce, Chair DICOM WG16 (MR)MR Taskforce, Chair DICOM WG16 (MR)

CoCo--author: Reinhard Rufauthor: Reinhard Ruf

Siemens Medial SolutionsSiemens Medial Solutions

CoCo--Chair CTChair CT--MR TaskforceMR Taskforce

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AbstractAbstract

• This presentation will describe the enhanced enhanced enhanced enhanced interoperabilityinteroperabilityinteroperabilityinteroperability for many clinical CT and MR applications in distributed networks once the new standard has been implemented in both the modalities and in clinical workstations.

• We will summarize the results of the SCAR 2005 session and familiarize those that have not been involved so far with the future plans of the Enhanced CTEnhanced CTEnhanced CTEnhanced CT----MR TaskforceMR TaskforceMR TaskforceMR Taskforce for RSNA 2005.

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Clinical QuestionsClinical Questions

• Can I store my research results with the clinical images,

without a separate server

• Can I store the raw data for a second reconstruction

• Can I store my Spectroscopy results?

• Can I separate the different Diffusion images

• Can I sort cardiac images according to their timing

• Can I improve the performance of transfer for CT/MR

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YESYES

All these questions can be answered with YES

when both the modality and the PACS

support the Enhanced CT or MR objects

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What is the difference?What is the difference?

• DICOM 1993

– contained many MR and CT attributes,

without much of a structure

• DICOM 2003

– contains more attributes,

but now with a clinically oriented structure.

– The new attributes remove the need for many Private

attributes,

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What is the consequence?What is the consequence?

• The Clinical Structure enables the combination of the attributes in functional groups. (this required a lot of analysis)

• The values in a Functional group may be equal for all images in a series, or differ from image to image.

• The combination of images into frames of a multi-frame object.

• The structure herewith provides context information

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1993

2003

Functional

Groups

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1 N2

Shared Per-Frame

Frame 1-N

21 N

Pixel values Frame 1-N

Dimensions

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Dataset (attributes+pixels)

C-Store response (acknowledgement)

C-Store request

A

s

s

o

c

i

a

t

i

o

n

Store, parse, check

DB DB DB

DB

ImplementationImplementation--dependent delaydependent delay

Imagine 10.000 images = 10.000 delays of 1 sec

Networking PerformanceNetworking Performance

1delay only

~3 hours~3 hours

11Multi-stack Color

Dimensions pr

ovide context Multi-frame

More Clinical InformationMore Clinical Information

available in less timeavailable in less time

Real World Values

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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 perfusedstroke area

Signal delayed perfusion

time-to-peak map

Real World

Value Slope

(0040,9225)

Real World

Value Intercept

(0040,9224)

RW

values

Stor

ed

valu

es

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 > 60,000images 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 of

Choline

and

Creatinine

peaks

Spectroscopy andSpectroscopy and

Spectroscopic ImagingSpectroscopic Imaging

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New Standard’s BenefitsNew Standard’s Benefits

• Improved networking performance

• Improved context information

• Improved clinical information

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Vendors of CTVendors of CT--MR, Workstations & MR, Workstations &

Archives prepare for implementation:Archives prepare for implementation:

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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

Modality

LUT

Color

Display

Mapped to gray level

RGB values by display

deviceVOI

LUT

P-

LUT

+Prepare the color pipeline

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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

Prepare the databases for large objects

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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 LUTData

(0040,9212)

Real WorldValue Interceptand Slopeattributes

or

Prepare for real-world values

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Multi Stack

Stack ID3

Frame Number1 - 5

Frame Number

6-10

Frame Number11-15

54321

In-Stack Position

Stack ID2

Stack ID1

54321

In-Stack Position

54321

In-Stack Position

BH

Prepare for Dimensions and

Dimension Organizations

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How to manage the transition ...How to manage the transition ...

•• The DICOM Standards Committee and the The DICOM Standards Committee and the

DICOM Working groups for CT and MR DICOM Working groups for CT and MR

have decided for: have decided for:

– The creation of a facility to introduce and test the facility to introduce and test the

new objects. new objects.

– an educational programeducational program for users and vendors

They have established a taskforcetaskforce to arrange this.

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CTCT--MR Taskforce: activitiesMR Taskforce: activities

•• Create CTCreate CT--MR DICOM TestMR DICOM Test--tool (contracted to tool (contracted to PixelMed (D.Clunie))PixelMed (D.Clunie))

– Create Sample Enhanced MR Image sets

– Create Sample Enhanced CT Image sets

– Display of images and DICOM header tags

– Import of enhanced image sets

– Validation tool for enhanced image sets

•• Organize: Organize: TTest and demonstrate “early and est and demonstrate “early and successful” implementations at SCAR 2005successful” implementations at SCAR 2005

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““The” Test and Demonstration session The” Test and Demonstration session

hosted by SCAR 2005,hosted by SCAR 2005,

for the implementation and promotion of:for the implementation and promotion of:

–– Enhanced CT ImageEnhanced CT Image

–– Enhanced MR ImageEnhanced MR Image

–– MR Spectroscopy dataMR Spectroscopy data

–– Raw DataRaw Data

Ready For The New CT & Ready For The New CT &

MRI DICOM Standard? MRI DICOM Standard?

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Participating companies/groups at Participating companies/groups at

SCAR 2005:SCAR 2005:– Agfa,

– Dynamic Imaging,

– GE,

– Hitachi,

– INFINITT,

– jMRUI,

– McKesson,

– Philips,

– Siemens,

– Toshiba,

– Vital Imaging (not demonstrating)

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Agenda for SCAR 2005 (Orlando)Agenda for SCAR 2005 (Orlando)

•• a testing session open to participating vendors only: a testing session open to participating vendors only:

–– June 1June 1stst and 2and 2ndnd

•• a dedicated education session: a dedicated education session:

–– June 3June 3rdrd 8:008:00--9:30 am9:30 am

•• 2 days of demonstration for all SCAR participants: 2 days of demonstration for all SCAR participants:

–– June 3June 3rdrd 9:30 am 9:30 am –– 4:30 pm and June 44:30 pm and June 4th th 9:30 am 9:30 am –– 12 noon12 noon

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The New CT and MR DICOM

Objects:Why All the Fuss?

Brad Erickson

David Clunie

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Group AGroup A

Image Manager

McKesson

MR

Philips

WS

INFINITT

WS

jMRUI

CT

Siemens

WS

GE

CT

Hitachi

spectro

Philips SpectroCardiac

Hitachi Abdomen

Hitachi “Go and Return” Abdomen

“Go and Return”

CT Thorax Siemens CT Thorax

Philips Cardiac

Siemens CT Thorax

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Group BGroup B

Image Manager

Dynamic Imaging

MR

GE

MR

Siemens

WS

Agfa

WS

Philips

WS

Siemens

MR

Toshiba

perfusion

Siemens Perfusion

diffusion

perfusion

Toshiba Perfusion

GE Diffusion

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Supported optionsSupported options

• Dimensions (limitations on functional groups)

• Concatenations (max size per object)

• Real world mapping (LUT or Rescale Intercept)

• Color images (color only or mixed)

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Purpose of the test and demo sessionPurpose of the test and demo session

• Show that it works

• Show the benefits

• Explain that users have to invest,

if they want the benefits in their

infrastructure

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Dimension choicesDimension choices

SpaceSpace

TimeTimeNavigation in multiNavigation in multi--dimensional datasets ?dimensional datasets ?

• Dimension Module gives a clue

• May be used by specialist systems

• Or they decide to take another order

Still there is some freedom in the construct of the dimension moStill there is some freedom in the construct of the dimension moduledule

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How to deal with the freedom of How to deal with the freedom of

choice ?choice ?

• Provide Clinical Scenarios

• Ask vendors to adhere to them

• Get feedback from clinical users

• At InfoRad at RSNA 2005

• After that provide the adapted scenarios to IHE for

the development of Clinical Profiles

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Clinical ScenariosClinical Scenarios

• Cardiac CT and MR ,

• Perfusion,

• Multi-station Peripheral Angio,

• Diffusion,

• fMRI

• Spectroscopy

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Promotion at RSNAPromotion at RSNA

•• RSNA 2005: RSNA 2005:

– Repeat and extension of SCAR demonstration

– Provide 2-tier approach

– Tier 1 for Technical Compliance with tools

– Tier 2 for Clinical Compliance with Scenarios

Educational sessions daily at the booth

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RSNA RSNA InforadInforad ParticipantsParticipants

– Agfa,

– Dynamic Imaging,

– Hitachi,

– INFINITT,

– jMRUI,

– McKesson,

– Philips,

– Siemens,

– Toshiba,

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Thank you