1. Consistent Presentation of Images - Integration Profile Ellie Avraham Kodak Health Imaging IHE Planning and Technical Committees

2. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 2 Patient Information Reconciliation Unknown patients and unscheduled orders Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps IHE Integration Profiles Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Consistent Presentation of Images Hardcopy and Softcopy Image Consistency

3. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 3 Consistent Presentation of Images Objectives Consistent distribution of Images across the healthcare enterpriseConsistent distribution of Images across the healthcare enterprise Consistency among Hardcopy Images Printed on different Printers (from different Vendors).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 Softcopy Images view on different Display devices (from different Vendors). Consistency among Hardcopy and Softcopy Image viewConsistency among Hardcopy and Softcopy Image view This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices.This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices.

4. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 4 Consistent Presentation of Images Requires: Calibration of the Softcopy Display and the Hardcopy Output Devices using DICOM Grayscale Standard Display FunctionCalibration 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 SupportCreating Hardcopy Output Using DICOM Basic Print with Presentation LUT Support Saving the Softcopy Display Viewing Parameters using DICOM Grayscale Softcopy Presentation StateSaving the Softcopy Display Viewing Parameters using DICOM Grayscale Softcopy Presentation State 1 2 3

5. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 5 The Grayscale Image Presentation Problems: Device capabilities/ characteristics vary * Device Luminance range * Display Characteristic Curve: DDL -> Luminance * Device Display Resolution: Non-Standard Interpretation of Pixel value to Output Device Luminance

6. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 6 The 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 at times may impact clinical perception The Grayscale Consistency Problem:

7. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 7 Optimal image viewing parameters (e.g. window/ level) selected on one device appear different when displayed on a different deviceOptimal image viewing parameters (e.g. window/ level) selected on one device appear different when displayed on a different device Device capabilities/ characteristics vary - the same number of gray levels cannot be rendered or perceived on different devicesDevice capabilities/ characteristics vary - the same number of gray levels cannot be rendered or perceived on different devices Displayed images look different from printed imagesDisplayed images look different from printed images …other…other The Grayscale Consistency Problem:

8. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 8 Problems of 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

9. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 9 Problems of Inconsistency 0.5 1.5 1.0 3.0 Not all display levels are perceivable on all devices Slide Provided by David Clunie

10. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 10 Problems of Inconsistency 0.5 1.5 1.0 3.0 Not all display levels are perceivable on all devices Slide Provided by David Clunie

11. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 11 Problems of Inconsistency Digital Modality Laser Printer Printed images don’t look like displayed images Slide Provided by David Clunie

12. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 12 Causes of Inconsistency 1.0.66 Display devices vary in the maximum luminance they can produce Display CRT vs. film on a light box is an extreme example Slide Provided by David Clunie

13. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 13 Standardize Display Systems to Achieve Grayscale Consistency, Hardcopy Output and Softcopy Viewing Devices Have to Be Properly Calibrated 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 A standard curve, the Grayscale Standard Display Function (GSDF), against which different types of display and hardcopy output devices should be calibrated 1

14. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 14 The GSDF Standard Characteristic Display Systems Curve The GSDF transformation defines the mapping of the P-values to the view Luminance or optical density value, and preserving the Human perceptual response, based on the Human Contrast Sensitivity. 1

15. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 15

16. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 16

17. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 17 Printer Calibration Tools (Densitometer)

18. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 18 Display Calibration Tools (Photometer)

19. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 19 DICOM GSDF.01.1 1 10 100 1000 02004006008001000 Grayscale Standard Display Function JND Index Monitors Film Slide Provided by David Clunie

20. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 20 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

21. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 21 Monitor Characteristic Curve 0.01 0.1 10 100 050100150200250300 Digital Driving Level Ambient Light Slide Provided by David Clunie

22. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 22 Standard Display Function.01.1 1 10 100 1000 02004006008001000 Grayscale Standard Display Function JND Index Monitor’s 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

23. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 23 Standardizing a Display 0.1 1 10 100 050100150200250 DDL or P-Values Standard Characteristic Curve Slide Provided by David Clunie

24. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 24 Standardizing a Display Mapping P-Values to Input of Characteristic Curve (DDL’s) 0 50 100 150 200 250 300 050100150200250300 P-Values DDL Slide Provided by David Clunie

25. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 25 To Achieve Consistent Presentation of Images, the DICOM Standard Defines:  Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output 2

26. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 26 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

27. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 27 Basic Print Management Meta SOP Class Print (SCU) Print (SCP) Association Negotiation - “Contract Agreement” Agreed set of SOP Classes and Transfer Syntaxes ( Basic Print Meta SOP Class) Film Sheet Basic Print Meta SOP Class consist of four SOP Classes (Film Session, Film Box, Image Box, and Printer) N-Create (create film sheet, format printer) N-Set (place images on film sheet) N-Action (request to print the film sheet) N-Event-Report (status of the printer) Slide Provided by Don Van Syckle

28. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 28 Basic Print Request with Presentation LUT Print Composer Print Server DICOM Film Session N-CREATE DICOM Presentation LUT 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) Print Composer Print Server Print Request Printer Status

29. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 29 Basic Print Request with Presentation LUT IHE Transaction - a Print Composer Actor issues a DICOM Print request to a Print Server Actor. The Print request includes a Presentation LUT for display consistency.IHE Transaction - a Print Composer Actor issues a DICOM Print request to a Print Server Actor. The Print request includes a Presentation LUT for display consistency. Print Server Print Request with Presentation LUT 23 Print Composer

30. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 30 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 Presentation Look-Up Tables (Presentation LUTs) or implicitly by Presentation LUT Shape.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 Presentation Look-Up Tables (Presentation LUTs) 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.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.

31. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 31 Basic Print Request with Presentation LUT Required transaction for both Print Composer and Print Server ActorsRequired transaction for both Print Composer and Print Server Actors Print Composer shall be grouped with one of the following:Print Composer shall be grouped with one of the following: –Acquisition Modality Actor –Image Manager Actor –Image Display Actor –Image Creator Actor

32. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 32 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. 3

33. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 33 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

34. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 34 GSPS Module Table:

35. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 35 Composite object containing the image display settings parameters Composite object containing the image display settings parameters Composite object links to one or more images (Series, filters); stored using same Study Instance UID (same Storage SOP Class!) Composite object links to one or more images (Series, filters); stored using same Study Instance UID (same Storage SOP Class!) Uses regular Storage services (C-STORE); uses Query/Retrieve services Uses regular Storage services (C-STORE); uses Query/Retrieve services GSPS SOP Instances are immutable: changes require a new SOP Instance UID GSPS SOP Instances are immutable: changes require a new SOP Instance UID Note: generation and specific application of GSPS is outside the scope of DICOM, but not outside the scope of IHE (e.g. Presentation of Grouped Procedures) Note: generation and specific application of GSPS is outside the scope of DICOM, but not outside the scope of IHE (e.g. Presentation of Grouped Procedures) Grayscale Softcopy Presentation State:

36. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 36 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 ActorIHE 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 ActorIHE 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 ActorIHE Transaction - an Image Display Actor issues a C- MOVE request to an Image Archive Actor

37. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 37 Creator Presentation State Stored Image Creator Image Archive C-STORE (Presentation State Stored)

38. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 38 Query for Grayscale Softcopy Presentation States Image Display Image Archive Query/Retrieve Presentation States (C-FIND/C-MOVE) Presentation States (C-STORE)

39. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 39 IHE Year 4: 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 Creator’s 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+

40. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 40 Acquire DisplayPrint Consistent Presentation of Images Slide Provided by David Clunie

41. April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA 41 Questions? Documents Available On the Web at: www.rsna.org/IHE or www.himss.org