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

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

3. Sept 13-15, 2004IHE Interoperability Workshop 3 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 The Grayscale Consistency Problem:

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

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

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

7. Sept 13-15, 2004IHE Interoperability Workshop 7 Problems of Hardcopy-Softcopy Inconsistency Digital Modality Laser Printer Printed images dont look like displayed images Slide Provided by David Clunie

8. Sept 13-15, 2004IHE Interoperability Workshop 8 Causes of Inconsistency 1.0.66 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 Slide Provided by David Clunie

9. Sept 13-15, 2004IHE Interoperability Workshop 9 Consistent Presentation of Images IHE Objectives Consistent distribution of Images across the healthcare enterprise : 1. Consistency among Hardcopy Images Printed on different Printers (from different Vendors). 2. Consistency among Softcopy Images view on different display devices (from different Vendors). 3. 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.

10. Sept 13-15, 2004IHE 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

11. Sept 13-15, 2004IHE 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

12. Sept 13-15, 2004IHE Interoperability Workshop 12 DICOM GSDF.01.1 1 10 100 1000 02004006008001000 Grayscale Standard Display Function JND Index Monitors Film Slide Provided by David Clunie Cal Mapping of the P-values to the view luminance or optical density value Barten Model: preserves the human perceptual response based on eye contrast sensitivity

13. Sept 13-15, 2004IHE Interoperability Workshop 13 Perceptual Linearization.01.1 1 10 100 1000 02004006008001000 Grayscale Standard Display Function JND Index Same number of Just Noticeable Difference == Same perceived contrast Despite different change in absolute luminance Slide Provided by David Clunie Cal

14. Sept 13-15, 2004IHE Interoperability Workshop 14 Printer Calibration Tools (Densitometer) Cal

15. Sept 13-15, 2004IHE Interoperability Workshop 15 Display Calibration Tools (Photometer) Cal

16. Sept 13-15, 2004IHE Interoperability Workshop 16 Monitor Characteristic Curve 0.01 0.1 10 100 050100150200250300 Digital Driving Level Ambient Light Slide Provided by David Clunie Cal

17. Sept 13-15, 2004IHE Interoperability Workshop 17 Standard Display Function.01.1 1 10 100 1000 02004006008001000 Grayscale Standard Display Function JND Index Monitors Capability Jmax == P-Value of 2 n -1 Jmin == P-Value of 0 Minimum Luminance + Ambient Light Maximum Luminance + Ambient Light Slide Provided by David Clunie Cal

18. Sept 13-15, 2004IHE Interoperability Workshop 18 Standardizing a Display Slide Provided by David Clunie Cal 0.1 1 10 100 050100150200250 DDL or P-Values Standard Characteristic Curve

19. Sept 13-15, 2004IHE Interoperability Workshop 19 To Achieve Consistent Presentation of Images Printed, the DICOM Standard Defines: Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output Hard

20. Sept 13-15, 2004IHE Interoperability Workshop 20 Basic Print Request with Presentation LUT Print Composer Print Server DICOM Film Session N-CREATE DICOM Film Box N-CREATE DICOM Image Box N-SET DICOM Film Box N-ACTION DICOM Film Session N-ACTION Print Status (DICOM N-EVENT-REPORT) DICOM Presentation LUT N-CREATE Print Composer Print Server Print Request Printer Status Hard Print Presentation LUT

21. Sept 13-15, 2004IHE Interoperability Workshop 21 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

22. Sept 13-15, 2004IHE Interoperability Workshop 22 To Achieve Consistent Presentation of Images, the DICOM Standard Defines: 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. Soft

23. Sept 13-15, 2004IHE Interoperability Workshop 23 Consistent Presentation of Images Reporting Radiologist Referring Physician or Reviewing Radiologist Presentation State Presentation LUT Grayscale Standard Original ImageWindow LevelFlip Zoom Area Of Interest Annotate Without Consistent Presentation Achieving Consistent Presentation Area Of Interest Soft

24. Sept 13-15, 2004IHE Interoperability Workshop 24 DICOM Grayscale Image Transformation Model e Transformation VOI LUT (Subtraction) Mask Modality LUT Transformation Annotation Image Transformation ShutterSpatial Transformation Annotation Disp. Area Presentation LUT 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 Soft

25. Sept 13-15, 2004IHE Interoperability Workshop 25 Image Creator Modality Presentation State Stored 9 Acquisition Modality Creator Presentation State Stored 19 Image Display Query Presentation State 15 Retrieve Presentation State 17 Image Archive GSPS Stored, and Query/Retrieve GSPS 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

26. Sept 13-15, 2004IHE Interoperability Workshop 26 IHE requirement for Presentation State Specific Query Matching and Return Keys Query Keys Matching Query Keys Return Attribute Name Tag SCUSCPSCUSCP Presentation Label (0070,0080)OOR+R+ Presentation Description (0070,0081)OOOR+ Presentation Creation Date (0070,0082)OOR+R+ Presentation Creation Time (0070,0083)OOR+R+ Presentation Creators Name (0070,0084)OOR+R+ Referenced Series Sequence (0008,1115)OOR+R+ > Series Instance UID (0020,000E)OOOR+ > Referenced Image Sequence (0008,1140)OOOR+ >> Referenced SOP Class UID (0008,1150)OOOR+ >> Referenced SOP Instance UID (0008,1155)OOOR+ Soft

27. Sept 13-15, 2004IHE Interoperability Workshop 27 Acquire DisplayPrint Consistent Presentation of Images Slide Provided by David Clunie

28. Sept 13-15, 2004IHE Interoperability Workshop 28 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