1. 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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

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

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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. IHE Interoperability Workshop
More information….
IHE Web sites:
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