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

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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

Nuclear Medicine Image - NMNuclear Medicine Image - NM

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NM Image – The ProblemNM Image – The ProblemDICOM 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

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NM ImageNM ImageAbstract / 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 >

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NM ImageNM ImageValue 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

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NM ImageNM ImageTransaction DiagramTransaction Diagram

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NM ImageNM ImageStandards UsedStandards Used

DICOM NM Image Object

DICOM Multiframe Secondary Capture Dynamic Results Collection of Static Results

DICOM Secondary Capture Static Results

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NM Image ActorsNM Image ActorsAcquisition 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

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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

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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

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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

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NM ImageNM Image

NM PACS

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NM ImageNM Image

NM PACS

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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)

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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

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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

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Result Screen Export OptionResult Screen Export Option

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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.

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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

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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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