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Integrating the Healthcare Enterprise Image Fusion Integration Profile Todd Kantchev Siemens Molecular Imaging IHE TC and Nuclear Medicine Meeting RSNA.

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Presentation on theme: "Integrating the Healthcare Enterprise Image Fusion Integration Profile Todd Kantchev Siemens Molecular Imaging IHE TC and Nuclear Medicine Meeting RSNA."— Presentation transcript:

1 Integrating the Healthcare Enterprise Image Fusion Integration Profile Todd Kantchev Siemens Molecular Imaging IHE TC and Nuclear Medicine Meeting RSNA

2 IHE Nuclear Medicine – RSNA Terminology  Image Registration- A process of changing the pixel spatial coordinates of a TDS so that the patient’s anatomical features are aligned with those of the SDS  Rigid Registration- as defined in SRO  Deformable Registration- out of scope  Image Fusion- The process of superimposing (overlaying) two DS so that they can be seen as one combined image with the intention to complement features, present in both.  DS- Data Set- a series of images or set of frames with a specified image position and orientation in the patient’s space, from which a 3-D image volume can be built and displayed for some clinical purpose. They may or may not have same orientation or be uniformly spaced in x-y-z. The requirements to build a volume from the DS are application specific and are outside the scope of this profile.  SDS- Source data Set- a DS which is used as a base to which a TDS can be registered.  TDS- Target Data Set- a DS, which is spatially transformed to the SDS by the process of Image Registration  SRO- Spatial Registration Object- as defined in DICOM PS 3 Section A.39  BSPS- Blending Softcopy Presentation State as defined in DICOM Supplement 100.

3 Fusion Brain CT Brain MR

4 3-D Spatial Registration Image Orientation (Patient)- x Image Position (Patient) X Y Z Align the patient anatomic region of the Target Data Set (TDS) to match the same anatomical region in the Source Data Set (SDS). X Y Z Image Orientation (Patient)- y Two Patient-based Coordinate Systems, defined by two Frames of Reference Source Data Set (SDS) Target Data Set (TDS)

5 Registration=>Fusion (CT-MR) Translate Rotate Rigid Registration Scale Warp- optional (Deformable Registration)- not in scope Fuse (display superimposed)

6 IHE Nuclear Medicine – RSNA Normal Workflow  On Evidence Creator  Load Source Data Set (SDS) and Target Data Set (TDS).  Find best anatomical matching of TDS to the SDS (usually pixel intensity statistical methods are used or manual). The methods are out of scope!  Compute Transformation for the TDS (translate, rotate, scale) and apply  Re-sample the TDS (take new axial slices in the new image orientation). The resolution usually is to the x-y-z resolution of the SDS. Fuse and display.  Store Transformation  On Image Display (possibly via IM)  Load original SDS and TDS  Apply the Transformation to the TDS  Fuse and display

7 Use Case- Brain CT-MR Store-Retrieve-Apply Transformation Store CT Store MR Retrieve CT, MR Register MR to CT get T Store T Store BSPS Retrieve CT, MR, T, BSPS Fuse CT and MR R get BSPS Fuse CT and MR CTMR Storage Post Processing Workstation or CAD Review Workstation Apply T to MR

8 IHE Nuclear Medicine – RSNA Alternative Workflow  On Evidence Creator  Load Source Data Set (SDS) and Target Data Set (TDS)  Find best anatomical matching of TDS to the SDS (usually pixel intensity statistical methods are used or manual). The methods are out of scope!  Compute Transformation for the TDS (translate, rotate, scale) and apply  Re-sample the TDS (take new axial slices in the new image orientation). The resolution usually is to the x-y-z resolution of the SDS. Fuse and display.  Store the re-sampled TDS (resolution may differ)  On Image Display (possibly via IM)  Load original SDS and the re-sampled TDS  Apply the Transformation to the TDS  Fuse and display

9 Use Case- Brain CT-MR Store-Retrieve- Display Transformed TDS CTMR Storage Post Processing Workstation or CAD Review Workstation Store CT Store MR Retrieve CT, MR Register MR to CT get MR R Store MR R Store BSPS Retrieve CT and MR R Retrieve BSPS Fuse CT and MR R get BSPS Fuse CT and MR R

10 Pros and Cons  Export Transformation Matrix:  Pros:  Save storage space and bandwidth (SRO is small compared with TDS)  Cons.  More expensive (Image Display higher cost)  Slower  Export Derived TDS:  Pros:  Less expensive (Image Display lower cost)  Quicker  Cons:  Re-sampled data may be too big (ex. PET res. to CT res.)

11 Blending Presentation State SOP Class DICOM Standard, Supplement 100

12 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed select underlying Slide provided by David Clunie

13 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] select underlying Slide provided by David Clunie

14 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample select underlying Slide provided by David Clunie

15 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample within slices select underlying Slide provided by David Clunie

16 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample within slices [between slices] select underlying Slide provided by David Clunie

17 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample within slices [between slices] select underlying rescale and window Slide provided by David Clunie

18 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample within slices [between slices] select underlying rescale and window pseudo-color Slide provided by David Clunie

19 IHE Nuclear Medicine – RSNA Blending for CT-PET select superimposed [register] resample within slices [between slices] select underlying rescale and window blend pseudo-color Slide provided by David Clunie

20 IHE Nuclear Medicine – RSNA % Blending Presentation overlay transparency (blending factor) 20% 50% 100% 80% 50%

21 Interoperability for Image Registration  We want to display fused data, generated from an acquisition device or workstation on another vendor’s system.  Two possible solutions:  Export the alignment solution (transformation matrix) and reproduce the transformation on the receiving workstation. (Supplement 73, Spatial Registration Storage SOP Classes - in the Standard since 2003)  Export the transformed TDS and display it on the receiving workstation.  Both methods are complemented by the use of Blending Softcopy Presentation State (BSPS) (Supplement 100: Color Softcopy Presentation State Storage SOP Classes- in the 2005 Standard)

22 The Problem DICOM Spatial Registration object enables a very broad context and does not guarantee consistency in terms of data referencing, workflow transactions etc. Blending Softcopy Presentation state object can be used to reference image series for fusion, but referencing can sometimes be ambiguous and vendors may choose not to support it or interpret it differently. Existing DICOM objects need to be constrained and further clarified in order to avoid misinterpretation and ambiguity. Require optional attributes to be present. Display capabilities such as multi-planar reformatting, color blending etc. which are essential to reading many types of fused studies, are either not supported by some display devices or are not consistently applied to achieve interoperability Sending fused data from a workstation to another system for further processing, display, and interpretation is currently loosely defined in standards to achieve the necessary multi-vendor inter-operability. Vendors are not accurately representing their support for such features

23 The Solution New Profile No New Actors or Transactions. Additional requirements on existing actors and transactions Clarifications of Fusion Workflow mapping to SWF Constraints on Fusion related Data Requirements/Recommendations on Fusion Clinical Display concepts, facilitating interoperability Connectathon to help test and confirm

24 Image Fusion Integration Profile Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging Image Fusion

25 Affected Actors and Transactions ADT Image Display 4: Procedure Scheduled 11: Image Availability Query 12: Patient Update 13: Procedure Update Evidence Creator 6: Modality PPS in Progress 7: Modality PPS Completed 20: Creator PPS in Progress 21: Creator PPS Completed 6: Modality PPS in Progress 7: Modality PPS Completed 20: Creator PPS in Progress 21: Creator PPS Completed 6: Modality PPS in Progress 7: Modality PPS Completed 20: Creator PPS in Progress 21: Creator PPS Completed Performed Procedure Step Manager Image Manager Image Archive Order Filler 5: Modality Worklist Provided Acquisition Modality Order Placer 2: Placer Order Management 3: Filler Order Management 1: Patient Registration 12: Patient Update 1: Patient Registration 12: Patient Update 18: Creator Image Stored  8: Modality Image Stored  10: Storage Commitment  10: Storage Commitment  14: Query Images  16: Retrieve Images  C-STORE Storage Commitment C-STORE Storage Commitment C-FIND C-MOVE

26 Acquisition Modality (Modality Images Stored [8])  Shall create image objects as specified (additional attributes mandatory, same Frame of Reference for hybrid modalities, etc.)  Fusion related objects- SRO, SBPS, shall be consistent (referencing, blending etc.)  Registration object shall be stored. The SRO shall be in the same Study as either SRS or TDS. If no additional alignment will be required before presentation, the SRO shall encode IDENTITY transformation.  Blending PS object shall be required if the use of specific blending factor and color are essential to the clinical workflow and interpretation. The BSPS object shall be in the same Study as either SRS or TDS.

27 Evidence Creators- Required Creator Images Stored [18])  Shall be able to co-register and fuse data sets with images from multiple modalities (PET, CT, MR, NM in different combinations, including same modalities).  The user shall be able to specify one of the input datasets to be the primary, so that registration uses that volume as the source (typically CT or MR).  The user shall be able to specify which of the target volumes (typically PET or MR) to register to the source.  Registration object shall be stored. The SRO shall be in the same Study as either SRS or TDS. If the transformed TDS is also stored and no additional alignment will be required before presentation, the SRO shall encode IDENTITY transformation.  Storage Commitment- not required

28 Evidence Creators- Recommended Creator Images Stored [18])  Transformed TDS, if stored, may or may not be re-sampled to the same pixel and slice spacing, as SDS.  The transformed target data set, if exported, shall be in the same frame of reference as the source data set and all other attributes shall be consistent with the new pixel data.  Blending PS object shall be required if the use of specific blending factor and pseudo color are essential to the clinical workflow and interpretation. The BSPS object shall be in the same Study as either SRS or TDS.

29 Shall be able to:  Fuse (superimpose) and display at least two previously registered data sets (for example a structural CT and a registered PET scan re-sampled to the same pixel and slice spacing). If Spatial Registration object for the pair is available it shall be used.  Note: The ID may load and display data without an SRO present. However the fact that both DS are in the same Frame of Reference is not enough to guarantee that they can be fused.  Display the fused data either color blended, or as a checker board (grayscale squares of the “checkerboard” are one image set, and the pseudo color squares are the other image set. ). If Blending SP object for the pair is available, it shall be used for initial presentation.  Enable fusion-specific user interaction like transparency of fusion overlay (blending factor); color map selection; Window Width/Level control.  Display MPR (Multi Planar Reconstruction) so that coronal and sagittal planes could be displayed from available transaxial data  Display specific values like Derivation Code Sequence (0008,9215) or Derivation Description (0008, 2111), Series Description (0008,103E) Image Display- Required (Query Images [14], Retrieve Images [16])

30 Should be able to:  Read a SRO and apply transformation, fuse and display two data sets, which may have not been previously re-sampled to the same pixel and slice spacing. The pixel intensity interpolation method associated with this will not be specified, but may be recommended. Image Display- Recommended (Query Images [14], Retrieve Images [16])

31 Image Manager/Archive (Modality Images Stored [8], Creator Images Stored [18] Query Images [14], Retrieve Images [16]) Shall be able to:  Store necessary objects like PET, CT, MR, NM, Spatial Registration, Pseudo Color and Blending SP State, Real World Value Mapping etc.  Support query and retrieval of necessary objects at series level with required specific keys

32 General Framework (from discussions so far)  It will be a general Image Fusion profile (applicable to CT, MR, PET and NM), rather than be specific for PET-CT.  SWF may not be required  Fusion profile is not intended at this stage to be all-encompassing. For example, a reasonable limitation would be that it would deal with paired 3D data sets (no 2D, image stitching etc. ). No elaboration will be made at this stage on multidimensional presentation. Only generic features like 3D fusion/blending.  Explain how SR and BSPS object reference TDS and SDS etc.

33 IHE Nuclear Medicine – RSNA Open Issues/ Questions  Do we need specific matching and return keys to be specified for query transactions?  Shall we consider MPPS support for EC (Transactions 20,21 for Implicit Post- Processing- see Vol )?

34 IHE Nuclear Medicine – RSNA Table 1- Attributes NameTagAcquisition Modality Evidence Creator Comment Related Series Sequence (0008,1250)May be R+ for hybrid PET-CT If so, may help ID to link SDS and TDS in case it cannot read SRO May extend CID 7210, Part 16. Mind NM which is MF Series Description (0008,103E)??yesReturn key for ID/IM Derivation Code Sequence or Derivation Description (0008,9215) (0008, 2111) noYes (if re-sampled) Matching key for ID/IM??? Request Attribute Sequence (0040,0275)Yes (if SWF supported) yes (if SWF)Already in SWF

35 IHE Nuclear Medicine – RSNA Expected Timeline Public comment preparation: December- January (TCON for Jan 6) Draft approved on a face to face meeting: Jan 30-Feb Released for public comment: Feb Public Comment closed : March Face to Face Meeting: April , Chicago Publish for Trial Implementation: April Connectathon: End of 2006-June 2007 (possibly SNM)


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