Integrating the Healthcare Enterprise NM Image Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte June 28-29, 2005 IHE Interoperability Workshop

IHE Radiology Integration Profiles Scheduled Workflow Charge Posting Presentation of Grouped Procedures Reporting Workflow Teaching Files & Clinical Trials Export Patient Info. Recon-ciliation Post-Processing Workflow NM Image Consistent Presentation of Images Evidence Docs Key Image Notes Simple Image & Numeric Reports XDS for Imaging Portable Data for Imaging Access to Radiology Information Audit Trail & Node Authentication - Radiology Option June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image – The Problem DICOM NM objects are different and support in products is inconsistent NM clinical display practices are different and support in products is inconsistent Clinical Analysis Programs are used extensively (particularly for Cardiology), but no support for distribution and display of those Result Screens 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 June 28-29, 2005 IHE Interoperability Workshop

NM Image Abstract / Scope Content Profile for Users to request and Vendors to claim No New Actors or Transactions Additional requirements on existing actors and transactions Two New Options New Informative Text in Vol. 1 Clarifications of NM Workflow mapping to SWF Explanation of NM Data Explanations of NM Clinical Display concepts New Normative Text in Vol. 2 < See Following Slides > June 28-29, 2005 IHE Interoperability Workshop

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 June 28-29, 2005 IHE Interoperability Workshop

NM Image Transaction Diagram June 28-29, 2005 IHE Interoperability Workshop

NM Image Standards Used DICOM NM Image Object DICOM Multiframe Secondary Capture Dynamic Results Collection of Static Results DICOM Secondary Capture Static Results June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image Actors Acquisition Modalities Create NM objects as specified (Series, attribute & vector handling) Include specific codes in Cardiac studies Evidence Creators Image Manager/Archives Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects Support Query on Study Description Image Displays Display NM and Secondary Capture (SC & MFSC) Images Support specified display capabilities June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop 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 Review Option June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop Image Display 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 June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image Format NM Image Image vectors Understood by dedicated NM systems Often Misunderstood by general storage and display systems Multiframe Dynamic Anterior Posterior Multi-energy June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image NM PACS June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image NM PACS June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop NM Image Click and move mouse down to adjust window level, right to adjust window center June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop 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” June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop Display Formats A32 … … A9 A8 A7 A6 A5 A4 A3 A2 A1 Grid display Frames from one image set Comparison display Compare frames from multiple image sets B8 B7 B6 B5 B4 B3 B2 B1 A8 A7 A6 A5 A4 A3 A2 A1 Fit display Frames from multiple image sets C1 B2 B1 A2 A1 June 28-29, 2005 IHE Interoperability Workshop

Review Option: Image Displays Adds Image Display requirements to support Review of NM Images MPR Display More series at once Different series types together Pixel value display June 28-29, 2005 IHE Interoperability Workshop

Result Screen Export Option June 28-29, 2005 IHE Interoperability Workshop

Result Screen Export Option: Evidence Creators Render Dynamic Result Screens Based on the following DICOM Objects: Multi-Frame Grayscale Byte Secondary Capture Multi-Frame True Color Secondary Capture Creating multiple single frame objects is NOT sufficient. Render Static Result Screens Using single frame DICOM Secondary Captures is sufficient Using Multi-frame to render single or several related static result screens is recommended provides better image comment/label attributes provides implicit display order displayed by stepping, not cine Must generate appropriate Secondary Capture objects from any Result Screens created. June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop Points of Interest - NM Appendix E, Volume 1 (Informative) New to Nuclear Medicine? Trouble matching NM to Scheduled Workflow? Start Here. E.2 NM Workflow – What happens in NM procedures E.3 NM Worklists – How to schedule/model it E.4 NM Data – What to expect in the DICOM E.5 NM Display – How it should be presented Many subtleties here June 28-29, 2005 IHE Interoperability Workshop

IHE Interoperability Workshop More information…. IHE Web sites: www.ihe.net Technical Frameworks & Supplements Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements June 28-29, 2005 IHE Interoperability Workshop