1. February 9, 2005IHE Europe Participants' Workshop 1 Integrating the Healthcare Enterprise Nuclear Medicine Image - NM Dr. Jerry Wallis (SNM) IHE Radiology Technical Cmte Kevin O’Donnell (Toshiba Corp.) Co-Chair, IHE Radiology Planning Cmte

2. February 9, 2005IHE Europe Participants' Workshop 2 Nuclear Medicine Image - NM Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

3. February 9, 2005IHE Europe Participants' Workshop 3 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

4. February 9, 2005IHE Europe Participants' Workshop 4 NM Image Format Understood by dedicated NM systems Often Misunderstood by general storage and display systems Multiframe  Dynamic  Anterior  Posterior  Multi-energy NM Image Image vectors

5. February 9, 2005IHE Europe Participants' Workshop 5 NM Image NMPACS

6. February 9, 2005IHE Europe Participants' Workshop 6 NM Image NMPACS

7. February 9, 2005IHE Europe Participants' Workshop 7 NM Image Click and move mouse down to adjust window level, right to adjust window center

8. February 9, 2005IHE Europe Participants' Workshop 8 NM – The Solution New 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  Connectathon to help test and confirm

9. February 9, 2005IHE Europe Participants' Workshop 9 NM – Actors and Transactions

10. February 9, 2005IHE Europe Participants' Workshop 10 NM Image Profile Acquisition Modalities (Modality Images Stored [8])  Create NM objects as specified (additional attribute & vector handling)  Include specific codes in Cardiac studies Evidence Creators (Creator Images Stored [18])  Create NM objects as specified (additional attribute & vector handling)  Include specific codes in Cardiac studies Image Manager/Archives  Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects Image Displays (Retrieve Images [16])  Display NM and Secondary Capture (SC & MFSC) Images  Support specified display capabilities

11. February 9, 2005IHE Europe Participants' Workshop 11 Result Screen Export Option Provides storage, retrieval and display of Static and Dynamic Result Screens  Based on the following DICOM Objects: Secondary Capture Multi-Frame Grayscale Byte Secondary Capture Multi-Frame True Color Secondary Capture Evidence Creators  Generate appropriate Secondary Capture objects from any Result Screens created.

12. February 9, 2005IHE Europe Participants' Workshop 12 Review Option Adds requirements to the Image Display to allow Review of NM Images Image Displays  Must additionally support MPR Display, more frames, different series types together, etc.

13. February 9, 2005IHE Europe Participants' Workshop 13 PACS  NM Workstation ? No !  No filtering  No ROI  No TAC  No renal, lung … processing  No reframing  No cardiac processing

14. February 9, 2005IHE Europe Participants' Workshop 14 Image Display Support separate adjustment of upper and lower window levels Show multiple cines Display grayscale and color result screens Display dynamic result screens Apply local color tables to grayscale screens Add color tables to system Change intensity of grayscale result screens  (strongly recommended)

15. February 9, 2005IHE Europe Participants' Workshop 15 Image Display Must use “intelligent” scaling to avoid presenting postage-stamp size NM images  Just because it was acquired at 64x64 doesn’t mean they want to review it at 64x64

16. February 9, 2005IHE Europe Participants' Workshop 16 Image Display Must use “intelligent” scaling to avoid presenting postage-stamp size NM images Must allow the user to select different vectors/framesets of complex multi-frame images Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image”

17. February 9, 2005IHE Europe Participants' Workshop 17 Display Formats Grid display  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  Multiple image sets Comparison display  Multiple image sets

18. February 9, 2005IHE Europe Participants' Workshop 18 Multiple Cines

19. February 9, 2005IHE Europe Participants' Workshop 19 Multiple Cines

20. February 9, 2005IHE Europe Participants' Workshop 20 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. 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