Radiology Participant Workshop, Oct 2004 Nuclear Medicine Image (NM) Integration Profile Kevin O’Donnell IHE Radiology Technical Committee Member, Toshiba Medical Systems Company

Radiology Participant Workshop, Oct 2004 NM – Actors and Transactions

Radiology Participant Workshop, Oct 2004 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

Radiology Participant Workshop, Oct 2004 Points of Interest – Acquisition Modality Acquisition Modality – Modality Images Stored [8] – Create NM objects as specified additional attribute & vector handling –e.g. Cardiac context codes, slice spacing, patient orientation Study & Series UID creation clarification –e.g. After PPS complete, new images MUST be new series –e.g. Reconstructed images MUST be new series

Radiology Participant Workshop, Oct 2004 Points of Interest – Image Manager/Archive Image Manager/Archive – Store/Retrieve NM Objects – Store/Retrieve Secondary Capture Objects Refer to list in the spec. – “Level 2” storage requirement clarification e.g. keep private tags – Support for Series Description as Query matching/return key

Radiology Participant Workshop, Oct 2004 Points of Interest – Evidence Creator Evidence Creator – Creator Images Stored [18] – Ditto. (i.e. See Acquisition Modality) – Result Screen Export Option

Radiology Participant Workshop, Oct 2004 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.

Radiology Participant Workshop, Oct 2004 Example Result Screen

Radiology Participant Workshop, Oct 2004 Points of Interest – Image Display Image Display – Retrieve Images [16] – Display NM and Result-Screen Images Note requirement for Color, Greyscale, Static & Dynamic Secondary Capture – Support specified NM essential display capabilities – Additional attribute handling e.g. Patient State, Image Orientation, Detector Sequence, View Code Sequence – Review Option

Radiology Participant Workshop, Oct 2004 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 (recommended) Display Series Description tag …, etc. Points of Interest – Image Display

Radiology Participant Workshop, Oct 2004 Points of Interest – 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”

Radiology Participant Workshop, Oct 2004 Display Formats Grid display – Frames from one image set A1A1 A2A2 A3A3 A4A4 A5A5 A6A6 A7A7 A8A8 A9A9 ………………… …………………… …………………A 32 … A1A1 A2A2 A3A3 A4A4 A5A5 A6A6 A7A7 A8A8 B1B1 B2B2 B3B3 B4B4 B5B5 B6B6 B7B7 B8B8 A1A1 A2A2 B1B1 B2B2 C1C1 C1C1 Fit display – Frames from multiple image sets Comparison display – Compare frames from multiple image sets

Radiology Participant Workshop, Oct 2004 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 More reason to review Appendix E in detail