1. DICOM nD Presentation State Toshiba Cross-Sectional Imaging Use Cases Updated 15 Feb, 2011

2. Modalities Considered CT MR PET 4/27/2015nD Presentation State Use Cases2

3. Clinical Specialties Considered Radiology Cardiology Gastroenterology 4/27/2015nD Presentation State Use Cases3

4. CT Coronary Artery Stenosis Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: Three MPRs aligned with the axes of the heart intersecting at the point of stenosis Curved MPR following the centreline of the stenotic vessel with stenosis marked Cross-curved MPR at the point of stenosis with % stenosis measurement SVR and / or volumetric MIP, oriented to show stenosis Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Position of cross-curved MPR Orientation and VOI for SVR / MIP W/L for MPR and MIP views Opacity for SVR views – accuracy of colour mapping unimportant 4/27/2015nD Presentation State Use Cases4

5. CT Coronary Artery Plaque Evaluation Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: Slab MPR aligned with the affected vessel 3-4 MPR views perpendicular to the above view demonstrating the extent of the plaque Curved MPR following the centreline of the affected vessel Set of cross-curved MPRs with colour-coded plaque burden Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Width and Intensity Projection of MPRs Position of cross-curved MPRs W/L for MPR views 4/27/2015nD Presentation State Use Cases5

6. CT Coronary Artery Stent Evaluation Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: MPR aligned with the affected vessel 3-4 MPR views perpendicular to the above along the length of the stent Curved MPR following the centreline of the affected vessel Set of cross-curved MPRs along the length of the stent Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Position of cross-curved MPRs W/L for MPR views 4/27/2015nD Presentation State Use Cases6

7. CT Coronary Artery Aneurysm Evaluation Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: Curved MPR following the centreline of the affected vessel Cross-curved MPR at end-points of aneurysm and point of maximal diameter with measurements Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Position of cross-curved MPRs W/L for MPR views 4/27/2015nD Presentation State Use Cases7

8. CT Coronary Artery Anomalous Vessel Evaluation Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: Three MPRs intersecting at the vessel origin Slab MPR demonstrating the vessel anomaly Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Width and Intensity Projection of MPRs W/L for MPR views 4/27/2015nD Presentation State Use Cases8

9. CT Coronary Artery CABG Evaluation Input is a gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Heart / myocardium Coronary arteries Automated / semi-automated coronary artery centreline finding Views saved: Curved MPR following the centreline of the bypass graft SVR views oriented to show junction of bypass graft and coronary artery with different VOIs (survey and focused on junction) Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Orientation and VOI for SVR / MIP W/L for MPR views Opacity for SVR views – accuracy of colour mapping unimportant 4/27/2015nD Presentation State Use Cases9

10. CT Cardiac 4D Valve Evaluation Input is a retrospectively gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Left ventricle endocardium Left ventricle epicardium Views saved: Three MPRs aligned with the axes of the heart intersecting at the aortic valve cycling through cardiac phases SVR view oriented to show the aortic valve cycling through cardiac phases Three MPRs aligned with the axes of the heart intersecting at the mitral valve cycling through cardiac phases SVR view oriented to show the mitral valve cycling through cardiac phases Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Position and orientation of MPRs Cine details? Orientation and VOI for SVR W/L for MPR views Colour / opacity guideline – accuracy of colour and opacity mapping unimportant 4/27/2015nD Presentation State Use Cases10

11. CT Cardiac 4D Myocardial Contractility Input is a retrospectively gated, contrast-enhanced CT cardiac exam Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Left ventricle endocardium Left ventricle epicardium Views saved: Three MPRs aligned with the axes of the heart intersecting at the left ventricle cycling through cardiac phases SVR view oriented to show the left ventricle valve cycling through cardiac phases Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Position and orientation of MPRs Orientation and VOI for SVR W/L for MPR views Colour / opacity guideline – accuracy of colour and opacity mapping unimportant 4/27/2015nD Presentation State Use Cases11

12. CT Calcium Scoring Input is a retrospectively gated, non-enhanced CT cardiac phase Device/user creating derived views and presentation states CT technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Coronary artery calcification Output saved: Assignment of calcification to coronary arteries Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Assignment of calcification to coronary arteries Use case may be more appropriate to a CAD-like object than to an nD PS 4/27/2015nD Presentation State Use Cases12

13. CT Colonography Input is a combination of prone, supine and decubitus CT volumes, with or without contrast Device/user creating derived views and presentation states CT technologist, radiologist or gastroenterologist using post-processing application Automated / semi-automated segmentation of: Luminal surface of colon Colonic centerline Air in small intestine Polyps/flat lesions Contrast tagged stool Residual fluid Views saved: SVR of air in colon MPR/slab views to illustrate individual lesions Endoscopic (SVR/SSD) of colon Dissected SVR view Device/user using presentation state to replicate derived views Radiologist / gastroenterologist performing primary read after tech workup Radiologist / gastroenterologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Position and orientation of MPRs Orientation and VOI for SVR W/L for MPR views Opacity /threshold for SVR/SSD views – accuracy of colour mapping unimportant 4/27/2015nD Presentation State Use Cases13

14. CT Angiography Input is a contrast-enhanced CT angiography exam Device/user creating derived views and presentation states CT technologist or radiologist using post-processing application Automated / semi-automated segmentation of: Arteries to be analyzed Bone adjacent to arteries of interest Automated / semi-automated artery centreline finding Views saved: Three MPRs aligned with the artery intersecting at the point of stenosis Curved MPR following the centreline of the stenotic vessel with stenosis marked Cross-curved MPR at the point of stenosis with % stenosis measurement SVR and / or boneless volumetric MIP, oriented to show stenosis Device/user using presentation state to replicate derived views Radiologist performing primary read after tech workup Radiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Centrelines Markers / measurements Position and orientation of MPRs Position of cross-curved MPR Orientation and VOI for SVR / MIP W/L for MPR and MIP views Opacity for SVR views – accuracy of colour mapping unimportant 4/27/2015nD Presentation State Use Cases14

15. MR Cardiac LV Analysis Input is a gated, contrast-enhanced MR cardiac exam Device/user creating derived views and presentation states MR technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Left ventricle endocardium Left ventricle epicardium Views saved: Set of LV short axis views with overlaid segmentation Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation W/L for MPR views 4/27/2015nD Presentation State Use Cases15

16. MR Cardiac Perfusion Input is a contrast-enhanced MR cardiac perfusion exam Device/user creating derived views and presentation states MR technologist, radiologist or cardiologist using post-processing application Automated / semi-automated segmentation of: Left ventricle endocardium Left ventricle epicardium Views saved: Set of LV short axis views with functional overlays – stress and rest acquisitions Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation W/L for MPR views 4/27/2015nD Presentation State Use Cases16

17. MR Cardiac Delayed Enhancement Input is a delayed-enhancement MR cardiac exam Device/user creating derived views and presentation states MR technologist, radiologist or cardiologist using post-processing application Automated / semi-automated determination of infarct enhancement threshold Automated / semi-automated segmentation of infarct Views saved: Cross-sectional view highlighting infarct with overlays and measurements Device/user using presentation state to replicate derived views Radiologist / cardiologist performing primary read after tech workup Radiologist / cardiologist reviewing priors alongside follow-up exams Need to reproduce: Segmentation Signal intensity threshold used to perform infarct segmentation 4/27/2015nD Presentation State Use Cases17

18. PET / CT Fusion – Added 15 Feb Input is a set of registered PET /CT exams, typically from a combined PET / CT scanner. A set of prior exams may also be loaded. Device/user creating derived views and presentation states Technologist or radiologist using post-processing application If views are not already registered, registration is performed Views saved: Blended CT / PET MIP views demonstrating areas of interest with measurement overlays (point measurements or ROIs) 3D MIP view with an inverted W/L Device/user using presentation state to replicate derived views Radiologist performing primary read after tech workup Radiologist reviewing priors alongside follow-up exams Need to reproduce: MPR positions Blending function W/L and or color maps Measurement position and ROI details 4/27/2015nD Presentation State Use Cases18