Advances in X-Ray Angiography Projection Imaging and 3D DICOM WG-02 Advances in X-Ray Angiography Projection Imaging and 3D SPIE Medical Imaging 2010, San Diego Authors: Heinz Blendinger Siemens Healthcare Bas Revet Philips Healthcare Francisco Sureda GE Healthcare (Chair DICOM WG-02)

Presentation Outline Introduction Overview of X-Ray Angiography in DICOM X-Ray N-Dimensional Presentation Cases 3D Shutter Volume Subtraction Stabilized Region in Moving Volume Trajectory Tracking in Volume 2D-3D Blending Conclusion

Approved in the Standard Overview of X-Ray Angiography in DICOM Approved in the Standard Work in Progress X-Ray Acquisition Follow-up of IHE REM Profile Supp 94: Radiation Dose Reporting CR-DX Dose Reporting 2D Projection Images Supp 83: Enhanced XA/XRF Supp 139-LB: Enhanced XA Informative Annex Supp 140: Presentation State 3D Reconstruction X-Ray 3D Informative Annex Supp 116: X-Ray 3D Storage N-Dimensional Presentation State

Workflow in X-Ray N-Dimensional Presentation Enhanced XA Storage SOP Class X-Ray Acquisition Procedure X-Ray 3D Storage SOP Class Reconstruction Procedure In progress N-D Presentation State SOP Class X-Ray Calibration Procedure Calibration Data Proprietary Visualization Visualization X-Ray Acquisition System X-Ray 3D Reconstruction System 3D Visualization Systems

X-Ray 3D Angiography – Rotational Acquisition Frame #5: X-ray settings 5 Geometry settings 5 Frame #4: X-ray settings 4 Geometry settings 4 Optimized 3D Reconstruction Frame #3: X-ray settings 3 Geometry settings 3 Frame #2: X-ray settings 2 Geometry settings 2 Frame #1: X-ray settings 1 Geometry settings 1

X-Ray 3D Angiography – Presentation State Needs for 3D Angiography Presentation Presentation features common to all 3D modalities (rendering...) Speficic presentation of X-Ray 3D Angiography: Acquisition 3D shutter (e.g. collimation) Volume Subtraction and voxel shift Stabilized point in all volumes (e.g. cardiac wall motion, stent stabilized) Catheter tracking trajectory in one volume 2D-3D blending presentation (3D conic projection on 2D fluoroscopy) N-Dimensional Presentation State Work Item 2008-04-C. Addresses needs of multi-modalities Led by Working Group 11, participation of Web3D Consortium and other DICOM working groups Supplement in progress...

X-Ray 3D Angiography – Presentation State Volume Regions to define 3D shutter Punch Holes Clipping Planes Frames Proposal for Volume Region Sequence: Region Purpose : DT: “DISPLAY SHUTTER“ or “ROI“ Region Display Mode : DT: “DISPLAY“ or “HIDE“ Region Definition Method : Enumerated Values ... Punch Hole: EV: “ELLIPSE“ or “POLYGON“ Plane: Orientation, Position, inside or outside Frame: EV: “ELLIPSE“ or “POLYGON“ or “BITMAP“

X-Ray 3D Angiography – Presentation State Volume Subtraction Subtracted Contrast Mask Frames Contrast Frames Proposal for 3D Mask Subtraction Sequence: Mask Operation: DT: “Volume Selection“ Applicable Volume: Pair of Frame Numbers (e.g. N+1, N+k) Mask Volume: Pair of Frame Numbers (e.g. 1, N) Mask Voxel Shift: Triple of Float Numbers Mask Contrast Registration 4x3 matrix Mask Operation Explanation: Free Text Mask Selection Mode: DT: SYSTEM or USER Recommended Viewing Mode: DT: SUB or NAT

X-Ray 3D Angiography – Presentation State Stabilized region in moving volume Applicable to 4D data (i.e. 3D volumes with time) Goal: Stabilize the position and orientation of an object during the dynamic view Proposal for Stabilized Region Sequence: // contains as many items as number of volumes Applicable Volume: Pair of Frame Numbers Point: 3D coordinates View Angle: 3D view angle The result is an animated sequence to view the volumes stabilized at a given point: a) with same volume orientation b) or changing the orientation of the volume to keep the same orientation of the object of interest

X-Ray 3D Angiography – Presentation State Trajectory Tracking in Volume Applicable to 3D data Goal: View the volume along a pre-defined trajectory of the camera Example: During the planning phase of a catheterization intervention Define a 3D curve from point A to point B inside an artery (i.e. catheter trajectory) Define an animated sequence to view the progress of the curve: a) from the outside of the volume, with same volume orientation b) from the outside of the volume, changing the orientation of the volume to be perpendicular to the tip of the curve c) from inside the artery (fly-thru) as virtual endoscopy A B

2D-3D Blending in X-Ray Angiography (1/2) X-Ray 3D Reconstruction X-Ray Rotational Acquisition 3D Viewing Settings X-Ray 2D Projection SOP Class 3D View X-Ray 3D Storage SOP Class new 3D Segmentation Segmentation SOP Class Conic Projection 2D Presentation 3D Presentation Same Frame Of Reference X-Ray 2D Projection SOP Class 2D-3D Blending X-Ray Acquisition 2D View 2D Presentation SOP Class X-Ray Acquisition System

2D-3D Blending in X-Ray Angiography (2/2) 3D Image (CT, …) 3D Viewing Settings 3D View CT Storage SOP Class new 3D Segmentation Segmentation SOP Class new Registration to Isocenter System Conic Projection 2D Presentation 3D Presentation X-Ray 2D Projection SOP Class 2D-3D Blending X-Ray Acquisition 2D View 2D Presentation SOP Class X-Ray Acquisition System

Conclusion Enhanced XA (2D) XA Presentation State (2D) Supplement 139 in Letter Ballot. Informative (DICOM Part 17) Will facilitate the adoption of the Enhanced XA SOP Class (Sup 83) XA Presentation State (2D) Supplement 140 in Final Text X-Ray 3D Angiography New IOD approved in Standard 2007 (Supplement 116) Application cases (Informative) - Work In Progress N-D Presentation State N-D Presentation State - Work In Progress To get involved in WG-02 developments: contact chairman at francisco.sureda@ge.com