1. 1 DICOM Anniversary 2003 Monday, September 22nd, 2003 15:00-15:20 Renaissance Harborplace Hotel Baltimore

2. 2

3. 3 Advances in DICOM will Enhance the clinical operation of MR Kees Verduin, Philips Medical Systems Chair DICOM WG16

4. 4 Presentation outline The new MR StandardThe new MR Standard The clinical examples of its benefitsThe clinical examples of its benefits Roadmap for effective implementationRoadmap for effective implementation

5. 5 What is new ? Three new object definitions Three new object definitions: –Enhanced MR Image –MR Spectroscopy –Raw Data

6. 6 A new set of DICOM MR objects Not this time: the new Enhanced MR Image object serves the whole range of DICOM users: –from the modality specialist –to the user of a simple viewer in the same way. So…. what is so exiting about it? A new object, as such, is not great news.

7. 7 Multi-stack Color Spectroscopy Dimensions Multi-frame Real World Values Raw Data A new MR Standard (Supplement 49)

8. 8 The basics of Supplement 49 Support of newest applications by New attributes Less ambiguity through Stricter definitions and rules Clear relationships through Reference mechanism Header size reduction through Multi-frame technique Context information from Image Type and Dimensions File size flexibility through Concatenations Functional images with Real World Values Functional images with Palette Color LUT information ALL these improve Interoperability

9. 9 What is really new ? Multi-Frame module with its Shared and Non-Shared header parts Dimensions and Dimension Organizations Coded Object relationships All these provide CONTEXT INFORMATION ! Further: –Real World Values –Grayscale images with Color information

10. 10 The Multi-frame properties Whenever possible, all images of a scan-series shall become frames in one object. What is common to all frames, shall not be repeated: Elements that do not change vs. elements that change. These have a different place in the object header. Related elements are defined in functional groups.

11. 11 From Single Image to Multi-frame N Objects, N Headers Pixel data (not to scale) Non-Shared (per-frame) Header Shared Header N Frames, One Header HEADER SIZE REDUCTION = less MB, faster transfer KV

12. 12 From Single-frame to MultiFrame N Objects, N Headers N Frames, One Header Pixel data (not to scale)Dimension data (not to scale) Per-frame header Fixed Header

13. 13 Multi-Frame not only for MR! The Enhanced MR Image and MR Spectroscopy have a multi- frame structure that is also useful for adoption by other modalities also useful for adoption by other modalities.

14. 14 Dimensions MR images can have many attributes that change from frame to frame. Dimension ModuleWhen such a change in an attribute is fundamental for the object, this data element can be structured by the creator as part of the Dimension Module. It supplies the Context Information required for a specialized workstation. It also provides an explicit display ordering for the frames in the MR object, that can be used by viewing systems without specific MR application knowledge.

15. 15 Object Relationships Referenced Image SequenceSource Image Sequence

16. 16 Clinical Examples

17. 17 Diffusion Imaging “Diffusion b-values” from 0 to 8000 and an ADC image

18. 18 Diffusion Tensor Imaging data Reconstructed Fiber Maps in the colors as seen by the creator

19. 19 MR Perfusion Imaging time non perfused stroke area Signal delayed perfusion time-to-peak map Real World Value Slope (0040,9225) Real World Value Intercept (0040,9224) RW values Stor ed valu es Quantitative data with Real World Values

20. 20 Cardiac Cine Loops Enables automatic multi-slice / multi-phase display, even for standard workstations

21. 21 Total body Imaging Display the correct image at the correct spot using Stacks and In-stack positions 1 3 4 12354 2 5

22. 22 Functional Brain Imaging 10-60 slices all slices measured in one TR repeated 100-1000 times to get sufficient signal leading to > 60,000 images in one object Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module

23. 23 Relative NAA peak-height Ratio of Choline and Creatinine peaks Spectroscopy Imaging

24. 24 Spectroscopy Relations Relation: MR Image Metabolite map Ratio of Choline and Creatinine peaks Relative NAA peak-height

25. 25 CT Multi-frame The CT Multi-frame solution addresses the same data-explosion issues as for MR. Multi-detector CTMulti-detector CT generates large volumes of images that need to be provided with sufficient and adequate context information. Multi-frame solutions may provide more interoperability for navigation and processing. But, 3D processing requires more than a Multi- frame structure.

26. 26 Multi-modality - Multi-frame Implementations for processing of the generated volumetric data will largely benefit from multi-modality implementations of the multi-frame concept. Common structures may lead to common architecture, which in turn will speed up the implementations.

27. 27 Implementation Roadmap Who should be the first ?

28. 28 The timing dilemma for the Enhanced MR object For the MR vendorsFor the MR vendors: –Why implement it, while nobody is ready to use it? For the Workstation vendors:For the Workstation vendors: –Why implement it, when no one is creating it? For the PACS vendorsFor the PACS vendors: –Support it, but how to deal with the mix of workstations that can yes/no receive it ?

29. 29 MR Archive Workstation Negotiate Negotiate The Negotiation scenario Decide to send New object or send Old object Negotiate Decide to send New object or send Old object Decide to send New object or Cancel

30. 30 MR Archive Workstation Negotiate Negotiate The Partial Conversion scenario Decide to send New object or send Old object Negotiate Decide to send New object or send Old object Decide to send New object or Convert object

31. 31 MR Archive Workstation Negotiate Negotiate The Full Conversion scenario Decide to send New object or Convert Negotiate Decide to send New object or Convert Decide to send New object or Convert object All old objects will be identical

32. 32 When will implementation be required ? As soon as stability is proven. As soon as the object definition is tested As soon as resulting changes are implemented in the standard. Or….. So, pacing may be needed As soon as possible!

33. 33 NEMA Members are funding a Demonstration & Test Tool Purpose Purpose: Prove that implementation is possible Prove the multi-frame header construction Prove the use of dimensions Provide a test tool for vendors and other implementers Validate implemented objects

34. 34 NEMA Demonstration &Test-tool

35. 35 Tool availability The tool is available to the funding participants It is currently under test The tool will become available in the public domain in 2003 But… No need to wait with implementation

36. 36 Collective support is needed The benefits of Supplement 49 as described in this presentation will only be visible if and when : –MR scanners (creators) –DICOM workstations (receivers) –PACS systems (intermediaries) will collectively support the new MR DICOM objects will collectively support the new MR DICOM objects.

37. 37 Vendors of Workstations / PACS need to prepare for implementation: What should be done?

38. 38 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline What should be done?

39. 39 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects What should be done?

40. 40 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI What should be done?

41. 41 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI –Prepare for Dimensions and Dimension Organizations What should be done?

42. 42 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI –Prepare for Dimensions and Dimension Organizations What should be done?

43. 43 And finally… or first ? Vendors of Workstations / PACS need to decide on the conversion scenario. What should be done?

44. 44 Summary The New DICOM MR Objects:The New DICOM MR Objects: –will enhance interoperability –will increase cross system functionality –will reduce transfer time Success requires also action by Workstation and PACS implementers.Success requires also action by Workstation and PACS implementers.

45. 45 Further Information More in-depth discussions and presentations about: Relationships between images Concatenations Dimension Organization Real World Value mapping Extended Image Type Color Mapping can be found at : http://medical.nema.org/dicom/presents.html

46. 46 Acknowledgement and copyright Images for this presentation were provided by: –GE Medical Systems –Philips Medical Systems –Siemens Medical Systems The slides of this presentation may be quoted if reference and credit to DICOM WG-16 is properly indicated

47. 47 Thank you for your attention

48. 48