1. Toward DICOM n-Dimensional Presentation State Joe Luszcz, Co-Chair DICOM Working Group 11

2. Viewing 3D/4D Volume Data A volume dataset isn’t visually useful by itself We need meaningful Views of the volume data 24 June 2011Towards DICOM n-Dimensional Presentation State2

3. Viewing 3D/4D Volume Data There are a number of ways of viewing volume data Multi-Planar Reformatted (MPR) slices of the volume Rendering of the voxels in the volume (VR) Rendering of surfaces derived from the volume dataset or from a library of implantable devices (SR) Fusion of above representations 24 June 2011Towards DICOM n-Dimensional Presentation State3 axial slice MPR views VR view VR + SR view

4. Multi-Planar Reformatting Multi-Planar Reformatting is a visualization technique that creates a 2D image depicting only volume data lying on or within a specified slice thickness of a planar or curved surface through a volume 24 June 2011Towards DICOM n-Dimensional Presentation State4

5. Rendering of Volumes Volume Rendering is a visualization technique in which a view of a volume dataset from a particular viewpoint is obtained while possibly allowing both near and far structures to be visualized by making nearer structures semi-transparent. 24 June 2011Towards DICOM n-Dimensional Presentation State5 Cropping may also be performed to removed unwanted foreground structures.

6. Rendering of Surfaces Surface Rendering is a visualization technique in which a surface derived from voxel data or models (rather than volume data) are viewed from a particular viewpoint 24 June 2011Towards DICOM n-Dimensional Presentation State6 These surfaces may be obtained by segmentation from a volume dataset geometric models from a library of objects such as implants or surgical tools co-aligned with voxel data in a fusion image

7. Presentation State The processing required to create a View from a volume and its related inputs I’ll call a “Display Algorithm” 24 June 2011Towards DICOM n-Dimensional Presentation State7 These Display Parameters may be saved so that the particular View might be re-created at a later time (on the same device or on a different device). This saved set of Display Parameters is called a Presentation State The Display Algorithm requires a set of Display Parameters to specify the particular View to create

8. Clinical Perspectives Presentation workflow varies depending on the role of the clinician Diagnosis Intervention and Surgery 24 June 2011Towards DICOM n-Dimensional Presentation State8

9. Diagnosis Physician or technician acquires volume data and creates MPR and volume render views on the imaging device Reviewing physician displays Views on a review device Views may be changed or added during review Measurements may be taken on the image Views or calculated algorithmically from the volume data Annotations may be made on the Views and new Views saved as documentation of the diagnosis A report is created, which may reference one or more Views 24 June 2011Towards DICOM n-Dimensional Presentation State9

10. Diagnosis Workflow 24 June 2011Towards DICOM n-Dimensional Presentation State10

11. Intervention and Surgery There are many different types of interventional treatment specialists and procedures, each with specific needs Cardiologist patching a ventricular septal defect – needs to size the patch and guide it into place Orthopedic surgeon repairing a complex fracture – needs to plan the procedure (including choice of implants) and refine the plan during the procedure Oncologist planning radiotherapy – needs to visualize iso- dose profiles and prepare a treatment plan Each clinical specialty and each type of procedure utilizes different volume viewing techniques 24 June 2011Towards DICOM n-Dimensional Presentation State11

12. Intervention/Surgery Procedure Support Vi ews are created to determine Exact locations and shapes of lesions Specific tissue types and structure surfaces for segmentation Size and type of implants and surgical tools Routes for surgical or interventional access Mapping of specific actions (e.g., animated procedure views) Views are dynamically updated to guide the work Fusion of pre-procedure imagery (e.g. CT, MR, PET, etc.) with intra-procedure real-time imagery (e.g. US) to track progress Removal of surfaces or objects obscuring desired view Illustration of steps to stay on-plan Guidance of tools and/or implants to procedure site Before and after Views to document and support follow-up 24 June 2011Towards DICOM n-Dimensional Presentation State12

13. Intervention/Surgery Pre-Procedure 24 June 2011Towards DICOM n-Dimensional Presentation State13

14. Intervention/Surgery Procedure 24 June 2011Towards DICOM n-Dimensional Presentation State14

15. DICOM Working Group 11 Presentation State is the charter of DICOM Working Group 11 WG-11’s current goal is to create a DICOM standard for Multi-Dimensional Presentation States Process and current status Gathering and reviewing clinical use cases Deriving requirements from clinical use cases Seeking consensus on requirement glossary Creating the draft supplement document capturing the approach we plan to use, preparing for First Read 24 June 2011Towards DICOM n-Dimensional Presentation State15

16. Call for Participation We would value your participation in the development of the n-D Presentation States standard: To provide or review clinical use cases To review requirements To monitor the ongoing development work To actively participate in the development … Contact: the author joe.luszcz@philips.com, orjoe.luszcz@philips.com MITA secretary Stephen Vastagh svastagh@medicalimaging.com svastagh@medicalimaging.com 24 June 2011Towards DICOM n-Dimensional Presentation State16

17. Thank you for your attention 24 June 2011Towards DICOM n-Dimensional Presentation State17

18. Agenda How do we view volume data? Role of Presentation State Clinical application of Presentation State Diagnostics Intervention and Surgery DICOM Standardization of Multi-Dimensional Presentation State Call for Participation 24 June 2011Towards DICOM n-Dimensional Presentation State18

19. Standardization Challenges 19

20. DICOM Standardization Process DICOM Committee assigns work item Working Group (WG) chooses approach to follow First Read review of approach WG creates a draft of the new standard Public Comment review, release for comments WG revises draft to respond to comments Letter Ballot review, release for letter ballot WG revises document to address ballot comments Final Text review, create Final Text version of doc Final Text document is now part of DICOM 24 June 2011Towards DICOM n-Dimensional Presentation State20