1. Radiology Update: CT/MR Contrast Perfusion profile Wim Corbijn van Willenswaard Chair DICOM WG16 Philips Healthcare

2. Introduction DICOM has standardized the ENHANCED MR IOD in 2002, followed by CT in 2004 and later for others. First IHE profiles for Enhanced IODs were created in 2009. Current update has removed major roadblocks for creating the necessary data at modalities, as defined by the profile. This will improve the acceptance of Enhanced SOP Classes by industry and users.

3. Agenda for this session Benefits of Enhanced DICOM Dimension Module Concept Contrast Perfusion in CT/MR Use case Object Requirements –Restrictions for Modalities, additional requirements Display requirements Summary Q&A

4. Benefits of Enhanced DICOM Modern Acquisition Techniques are fully covered. (no longer dependent on private attributes) Multi-frame packaging for fast transfer. (reduced number of files to transfer) Explicit Dimensions. (this provides context information, guiding (viewing) applications how to order/display the sequence of frames) Implementing Enhanced DICOM for one modality will pave the way for all other implementations which have the same structure

5. DICOM Dimension Module Two parts define how to traverse Multi-Volume data correctly: The dimension attributes (these play a role in the object dimension, like : time, position, echo, phase, contrast, …….): >Dimension Index Pointer (0020,9165) The index values for these attributes: >Dimension Index Values (0020,9157) See notes

6. Temporal order for slice 1 Multi-Phase / Multi-Slice time Temporal Position Index 6 5 4 3 2 1 6 5 4 3 2 1 123 6 5 4 3 2 1 In-stack Position Number (Slice- Index) Frame number 1-6 Frame number 7-12Frame number 13-18 Slice Order for temporal 1 Image frames can be sorted/displayed independent of the frame order 4\14\24\3 Slice Order for temporal 2 Dimension index values: Temporal order for slice 5

7. IHE Profile PERF Contrast Perfusion in CT/MR

8. This Integration Profile facilitates the exchange of contrast enhanced images created as a stack of images at different timeslots, in order to demonstrate the uptake of a contrast agent over time The exchange of standard attributes for time and position allows for correct and convenient display on standard display systems This is a major improvement compared to the older single-frame DICOM image objects (where applications need to depend on proprietary timing attributes) offering improved interoperability

9. MR Perfusion Imaging 9 time non perfused stroke area Signal delayed perfusion time-to-peak map

10. Requirements for creators 1.A Volume may not be spread over Enhanced SOP Instances (a Temporal Position may not be present in multiple objects) 2.Creator provides dimension indices for: Stack ID In Stack Position Number Temporal Position Index 3.Data requirements: Image Type and Frame Type: Value 1: ORIGINAL Value 2: PRIMARY Value 3: PERFUSION

11. Functional Requirements for Image Display 1.Provide at least one viewport for display of frames with the same In-Stack Position Number (Slice-index). (More viewports may be used for displaying images for other In- Stack Position Numbers = simultaneous scrolling) 2.Be able to scroll the images by Temporal Position Index for the same in-stack position (Temporal Position-index = time related movie).

12. Required display layout Position = 1Position = 2Position =..Position = n Time = 1 Time = 2 Time =.. Time = n scroll

13. Alternative display layout Time = 1Time = 2Time =..Time = n Position = 1 Position = 2 Position =.. Position = n Switching Position and Time scroll

14. Data Requirements for Display Attribute NameTag Enhanced Contrast/Bolus Module Contrast/Bolus Agent Sequence(0018,0012) >Contrast/Bolus Administration Route Sequence(0018,0014) Frame Type Value 3(0008,9007) Frame Content Sequence(0020,9111) >Temporal Position Index(0020,9128) >Stack ID(0020,9056) >InStackPositionNumber(0020,9057) Time Offset value(0020,930D)

15. Summary CT/MR Perfusion Imaging with Contrast profile is updated to be in line with the modality way of working. Series can be stored in more than one object, but a Temporal Position (Volume) is always stored in one object. Extra explanation how to use the DIMENSION information. Use of the profile will facilitate the display of the more complex acquisitions on standard display systems. The other Enhanced Profiles will be updated to the same structure.

16. Thank You Any Questions ?