1. IHE NA Webinar Series 2008 What IHE Delivers 1 NM Image IHE North America Webinar Series 2008 Chris Lindop IHE Radiology GE Healthcare

2. IHE NA Webinar Series 2008 2 NM Image The Problem Product support is inconsistent  DICOM NM object coding techniques very  NM full-body display needs misunderstood  NM cardiac display needs misunderstood  Clinical Analysis Applications results distribution unsupported Poor communiction during product purchase  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

3. IHE NA Webinar Series 2008 3 General NM Viewing Suboptimal NMPACS

4. IHE NA Webinar Series 2008 4 General NM Viewing Suboptimal NMPACS

5. IHE NA Webinar Series 2008 5 General NM Viewing Suboptimal Click and move mouse down to adjust window level, right to adjust window center

6. IHE NA Webinar Series 2008 6 Cardiac Viewing Suboptimal If sent as Short axis  Images not displayed in a useful format. If sent as screen snapshots (ie, static Secondary Capture)  Can’t separately adjust stress and rest images  Can’t view gated cine

7. IHE NA Webinar Series 2008 7 NM Image Value 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

8. IHE NA Webinar Series 2008 8 NM Image Abstract / Scope Content Profile   for users to request   For vendors to claim No New Actors or Transactions   Additional requirements on existing actors and transactions   Total of 4 options

9. IHE NA Webinar Series 2008 9 NM Image Standards Used DICOM NM Image Object DICOM Multiframe Secondary Capture  Dynamic Results  Static Results DICOM Secondary Capture  Static Results ACC NM Cardiac Display format

10. IHE NA Webinar Series 2008 10 NM Image Transaction Diagram

11. IHE NA Webinar Series 2008 11 NM Image Actors Acquisition Modalities  Create NM objects as specified (Series, attribute & vector handling)  Include clinical coding in Cardiac studies Image Manager/Archives  Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects  Support Query on Study Description Evidence Creators  Create NM objects as specified (Series, attribute & vector handling)  Include process-specific coding in Cardiac studies  Use cardiac codes during processing Image Displays  Display NM and Secondary Capture (SC & MFSC) Images  Support specified display capabilities  Handles specific NM DICOM attributes

12. IHE NA Webinar Series 2008 12 Result Screen Export Option

13. IHE NA Webinar Series 2008 13 Result Screen Export Option: Evidence Creators Render Dynamic Result Screens  Capture Dynamic Results using the following DICOM Objects: Multi-Frame Secondary Capture –Grayscale Byte –True Color Render Static Result Screens  Capture the Static Results using either single frame Multi-frame (preferred) Must generate appropriate Secondary Capture objects from any Result Screens rendered.

14. IHE NA Webinar Series 2008 14 Image 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

15. IHE NA Webinar Series 2008 15 Options: Image Displays General NM Option  Whole body display Cardiac NM Option  ACC NM Cardiac display Displays must support at least one of these options!

16. IHE NA Webinar Series 2008 16 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 Display

17. IHE NA Webinar Series 2008 17 Image Display Scale “intelligently” to avoid presenting postage-stamp size NM images Allow user to select different vectors/framesets of complex multi- frame images Allow user to separately adjust intensity for different framesets (eg, phases) in the same “image”

18. IHE NA Webinar Series 2008 18 Display Formats Grid display  Frames from one image set A 32 … ………………… …………………… …………………A9A9 A8A8 A7A7 A6A6 A5A5 A4A4 A3A3 A2A2 A1A1 C1C1 C1C1 B2B2 B1B1 A2A2 A1A1 Fit display   Frames from multiple image sets

19. IHE NA Webinar Series 2008 19 ACC NM Cardiac Display Generate long axis from short axis images Display of 2 image sets (Stress and Rest) Use patient state tags to set display order Follow ACC guidelines for display Controls for adjusting stress and rest  Image alignment  Window upper and lower levels.

20. IHE NA Webinar Series 2008 20 ACC NM Display Example Short axis Horizontal Long Vertical Long

21. IHE NA Webinar Series 2008 21 ACC NM Display Example Short Horizontal Vertical Stress Rest Stress Rest Stress Rest Stress Rest

22. IHE NA Webinar Series 2008 22 MPR Option: Image Displays Adds Image Display requirements to support Review of SPECT NM Images with Multi-planar reconstruction (MPR)  Transaxial  Sagittal  Coronal

23. IHE NA Webinar Series 2008 23