1. Integrating the Healthcare Enterprise Consistent Presentation of Images Integration Profile
Ellie Avraham
Kodak Health Imaging
IHE Planning and Technical Committees
Sept 13-15, 2004
IHE Interoperability Workshop

2. IHE Integration profiles
Patient Informa-tion Reconci-liation ,
Scheduled Workflow
Charge Posting
Reporting Workflow
Presentation of Grouped Procedures -
Post-Processing Workflow
Consistent Presentation of Images
Evidence Documents
Key Image Notes
Simple Image and Numeric Reports
Access to Radiology Information
Basic Security
Sept 13-15, 2004
IHE Interoperability Workshop

3. The Grayscale Consistency Problem:
The Visual Appearance of grayscale images displayed on different types of softcopy display devices or printed on different types of hardcopy output devices is in general inconsistent and may impact the clinical Diagnostics
Sept 13-15, 2004
IHE Interoperability Workshop

4. Problems of Display Inconsistency
VOI chosen on one display device
Rendered on another with different display
Mass expected to be seen is no longer seen
mass visible
mass invisible
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

5. Problems of Inconsistency in Display Luminance range
0.5
1.0
Not all display levels are perceivable on all devices
1.5
3.0
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

6. Problems of Inconsistency in Display Luminance range
0.5
1.0
Not all display levels are perceivable on all devices
1.5
3.0
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

7. Problems of Hardcopy-Softcopy Inconsistency
Laser Printer
Digital Modality
Printed images don’t look like displayed images
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

8. Causes of Inconsistency
Display devices vary in the maximum luminance they can produce
Display CRT Luminance vs. Film Optical Density on a light box is an extreme example
1.0
.66
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

9. The cost effective solution
Consistent Presentation of Images IHE Objectives
Consistent distribution of Images across the healthcare enterprise :
Consistency among Hardcopy Images Printed on different Printers (from different Vendors).
Consistency among Softcopy Images view on different display devices (from different Vendors).
Consistency among Hardcopy and Softcopy Image view
The cost effective solution
to ensure that image quality is maintained across different monitors and film producing devices.
Sept 13-15, 2004
IHE Interoperability Workshop

10. Consistent Presentation of Images Requires:
Calibration of the Softcopy Display and the Hardcopy Output Devices using DICOM Grayscale Standard Display Function
Creating Hardcopy Output Using DICOM Basic Print with Presentation LUT Support
Preserving/Using the Softcopy Display Viewing Parameters in the DICOM Grayscale Softcopy Presentation State container
Cal
Hard
Soft
Sept 13-15, 2004
IHE Interoperability Workshop

11. Achieve Grayscale Consistency in Hardcopy Output and Softcopy Viewing
The DICOM Standard Defines:
A standard curve, the Grayscale Standard Display Function (GSDF), against which different types of display and hardcopy output devices should be calibrated – Adjust their Characteristic Curve to the GSDF curve.
Cal
Devices Have to Be Properly Calibrated
Sept 13-15, 2004
IHE Interoperability Workshop

12. Grayscale Standard Display Function
DICOM GSDF
.01 .1 1 10
100
1000
200
400
600
800
Grayscale Standard Display Function
JND Index
Monitors
Film
Barten Model: preserves the human perceptual response based on eye contrast sensitivity
Mapping of the P-values to the view luminance or optical density value
Sept 13-15, 2004
IHE Interoperability Workshop
Slide Provided by David Clunie

13. Standardizing a Display
Cal
Standardizing a Display
0.1 1 10
100 50
150
200
250
DDL or P-Values
Standard
Characteristic Curve
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

14. IHE Interoperability Workshop
To Achieve Consistent Presentation of Images Printed, the DICOM Standard Defines:
Hard
Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output
Sept 13-15, 2004
IHE Interoperability Workshop

15. Basic Print Request with Presentation LUT
Composer
Server
DICOM Film Session N-CREATE
Print Composer
DICOM Presentation LUT N-CREATE
Print Request
Print Presentation LUT
DICOM Film Box N-CREATE
DICOM Image Box N-SET
DICOM Film Box N-ACTION
DICOM Film Session N-ACTION
Print Server
Print Status (DICOM N-EVENT-REPORT)
Hard
Printer Status
Sept 13-15, 2004
IHE Interoperability Workshop

16. Basic Print Request with Presentation LUT
Print Composer – A system that generates DICOM print requests as a DICOM Print SCU. Print composer has to apply image processing manipulations, and requests to Print server will specify P-Values in the form of a Presentation Look-Up Table (Presentation LUT) or implicitly by Presentation LUT Shape.
Print Server – A system that accepts and processes DICOM print requests as a DICOM Print SCP and performs image rendering on hardcopy media. The system must support pixel rendering to optical density according to the DICOM Grayscale Standard Display Function.
Hard
Sept 13-15, 2004
IHE Interoperability Workshop

17. IHE Interoperability Workshop
To Achieve Consistent Presentation of Images, the DICOM Standard Defines:
Soft
Grayscale Softcopy Presentation State (GSPS): an object for storing and communicating the parameters that describe how an image or set of images should be displayed.
A GSPS object contains references to the images it applies to, and the transformations (grayscale transformations, shutter transformation, image annotation, spatial transformations, and displayed area annotation) that should be applied when the images are presented on a softcopy display, or printed on film.
Sept 13-15, 2004
IHE Interoperability Workshop

18. Reporting Radiologist
Consistent Presentation of Images
Referring Physician or
Reviewing Radiologist
Reporting Radiologist
Area Of
Interest
Annotate
Achieving
Consistent Presentation
Area Of
Interest
Soft
Presentation State
Presentation LUT
Zoom
Grayscale Standard
Flip
Window Level
Original Image
Without
Consistent Presentation
Sept 13-15, 2004
IHE Interoperability Workshop

19. DICOM Grayscale Image Transformation Model
Soft T r a n s f o m t i V O I L U ( S u b c ) M k d l y A g e h p D .
Presentation
LUT
Transformation
Window/Level
or VOI LUT
Rescale Slope/Intercept
or Modality LUT
Original
Image
Display
P-Values
Grayscale Transformations
Shutter, Annotation and Spatial Transformations e
Sept 13-15, 2004
IHE Interoperability Workshop

20. GSPS Stored, and Query/Retrieve GSPS
Image
Creator
Modality Presentation
State Stored 9
Acquisition
Modality
Creator Presentation 19
Display
Query
Presentation State 15
Retrieve 17
Archive
IHE Transaction - an Acquisition Modality or Image Creator Actor sends a DICOM GSPS C-STORE request to an Image Archive Actor
IHE Transaction - an Image Display Actor issues a C-FIND request to an Image Manager Actor
IHE Transaction - an Image Display Actor issues a C-MOVE request to an Image Archive Actor
Soft
Sept 13-15, 2004
IHE Interoperability Workshop

21. Consistent Presentation of Images
Acquire
Print
Display
Slide Provided by David Clunie
Sept 13-15, 2004
IHE Interoperability Workshop

22. IHE Interoperability Workshop
More information….
IHE Web sites:
Technical Frameworks:
ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
May 2004: Radiology
August 2004: Cardiology, IT Infrastructure
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
Sept 13-15, 2004
IHE Interoperability Workshop