1. 1 RSNA/ IHE 2003 DICOM, a second generation image standard for MR, CT and X-Ray Angio: large data sets and new applications. Tuesday, December 2nd, 2003 08:45-09:30 InfoRad / IHE Classroom RSNA

2. 2 Agenda Enhanced MR and Enhanced CTEnhanced MR and Enhanced CT Enhanced XAEnhanced XA Implementation PlanImplementation Plan

3. 3

4. 4 Advances in DICOM will Enhance the clinical operation of MR and CT Kees Verduin, Philips Medical Systems Chair DICOM WG16

5. 5 Presentation outline The new MR StandardThe new MR Standard The clinical examples of its benefitsThe clinical examples of its benefits CTCT Roadmap for effective implementationRoadmap for effective implementation

6. 6 What is new ? Three new object definitions Three new object definitions: –Enhanced MR Image –MR Spectroscopy –Raw Data

7. 7 A new set of DICOM MR objects Not this time: the new Enhanced MR Image object serves the whole range of DICOM users: –from the modality specialist –to the user of a simple viewer in the same way. So…. what is so exiting about it? A new object, as such, is not great news.

8. 8 Multi-stack Color Spectroscopy Dimensions Multi-frame Real World Values Raw Data A new MR Standard (Supplement 49)

9. 9 The basics of Supplement 49 Support of newest applications by New attributes Less ambiguity through Stricter definitions and rules Clear relationships through Reference mechanism Header size reduction through Multi-frame technique Context information from Image Type and Dimensions File size flexibility through Concatenations Functional images with Real World Values Functional images with Palette Color LUT information ALL these improve Interoperability

10. 10 What is really new ? Multi-Frame module with its Shared and Non-Shared header parts Dimensions and Dimension Organizations Coded Object relationships All these provide CONTEXT INFORMATION ! Further: –Real World Values –Grayscale images with Color information

11. 11 The Multi-frame properties Whenever possible, all images of a scan-series shall become frames in one object. What is common to all frames, shall not be repeated: Elements that do not change vs. elements that change. These have a different place in the object header. Related elements are defined in functional groups.

12. 12 From Single Image to Multi-frame N Objects, N Headers Pixel data (not to scale) Non-Shared (per-frame) Header Shared Header N Frames, One Header HEADER SIZE REDUCTION = less MB, faster transfer KV

13. 13 From Single-frame to MultiFrame N Objects, N Headers N Frames, One Header Pixel data (not to scale)Dimension data (not to scale) Per-frame header Fixed Header

14. 14 Multi-Frame not only for MR! The Enhanced MR Image and MR Spectroscopy objects have a multi- frame structure that is also useful for adoption by other modalities also useful for adoption by other modalities.

15. 15 Dimensions MR images can have many attributes that change from frame to frame. Dimension ModuleWhen such a change in an attribute is fundamental for the object, this data element can be structured by the creator as part of the Dimension Module. It supplies the Context Information required for a specialized workstation. It also provides an explicit display ordering for the frames in the MR object, that can be used by viewing systems without specific MR application knowledge.

16. 16 Object Relationships Referenced Image SequenceSource Image Sequence

17. 17 Clinical Examples

18. 18 Diffusion Imaging “Diffusion b-values” from 0 to 8000 and an ADC image

19. 19 Diffusion Tensor Imaging data Reconstructed Fiber Maps in the colors as seen by the creator

20. 20 MR Perfusion Imaging time non perfused stroke area Signal delayed perfusion time-to-peak map Real World Value Slope (0040,9225) Real World Value Intercept (0040,9224) RW values Stor ed valu es Quantitative data with Real World Values

21. 21 Cardiac Cine Loops Enables automatic multi-slice / multi-phase display, even for standard workstations

22. 22 Total body Imaging Display the correct image at the correct spot using Stacks and In-stack positions 1 3 4 12354 2 5

23. 23 Functional Brain Imaging 10-60 slices all slices measured in one TR repeated 100-1000 times to get sufficient signal leading to > 60,000 images in one object Store thousands of images in one object and display them in a consistent way using Multi-frame Header and Dimension Module

24. 24 Relative NAA peak-height Ratio of Choline and Creatinine peaks Spectroscopy Imaging

25. 25 Spectroscopy Relations Relation: MR Image Metabolite map Ratio of Choline and Creatinine peaks Relative NAA peak-height

26. 26 Supplement 58 Enhanced CT

27. 27 Supplement 58 Enhanced CT New applications such as –cardiac CT, –gated studies, –perfusion CT, –CT fluoroscopy, –contrast tracking and –post-processing (e.g. lung cancer screening, colonography); are not supported by the current standard. Not only are technique attributes insufficient, but also, the organization of increasingly large datasets as single-frame objects is awkward, and limitations of the existing definitions of spatial and temporal attributes are apparent.

28. 28 DICOM Header Information Restrictive handling of parameters to ensure interoperability; Detailed description of parameters needed, e.g.: –meaning of table position, –image flavour and image type definition, –acquisition type –device information Exposure information and X ray details Bolus application included Synchronisation model, e.g. ECG, Respiratory Precondition is Soft Copy Presentation Handling of palette colour

29. 29 Geometry of CT Acquisition System

30. 30 CT Multi-frame The CT Multi-frame solution addresses the same data-explosion issues as for MR. Multi-detector CTMulti-detector CT generates large volumes of images that need to be provided with sufficient and adequate context information. Multi-frame solutions may provide more interoperability for navigation and processing. But, 3D processing requires more than a Multi- frame structure.

31. 31 Multi-modality - Multi-frame Implementations for processing of the generated volumetric data will largely benefit from multi-modality implementations of the multi-frame concept. Common structures may lead to common architecture, which in turn will speed up the implementations.

32. 32 Implementation Roadmap Who should be the first ?

33. 33 The timing dilemma for the Enhanced MR/CT objects For the MR / CT vendorsFor the MR / CT vendors: –Why implement it, while nobody is ready to use it? For the Workstation vendors:For the Workstation vendors: –Why implement it, when no one is creating it? For the PACS vendorsFor the PACS vendors: –Support it, but how to deal with the mix of workstations that can yes/no receive it ?

34. 34 MR/CT Archive Workstation Negotiate Negotiate The negotiation scenario Decide to send New object or send Old object (depending on hospital workflow) Negotiate Decide to send Old object Decide to send old object (if available) Or Cancel Supports Enhanced SOP Class

35. 35 When will implementation be required ? As soon as stability is proven. As soon as the object definition is tested As soon as resulting changes are implemented in the standard. Or….. So, pacing may be needed As soon as possible!

36. 36 NEMA Members are funding a Demonstration & Test Tool Purpose Purpose: Prove that implementation is possible Prove the multi-frame header construction Prove the use of dimensions Provide a test tool for vendors and other implementers Validate implemented objects

37. 37 NEMA Demonstration &Test-tool

38. 38 Tool availability The tool is available to the funding participants It is currently under test The tool will become available in the public domain in 2003 But… No need to wait with implementation

39. 39 Collective support is needed The benefits of Supplements 49 and 58 as described in this presentation will only be visible if and when : –MR scanners (creators) –DICOM workstations (receivers) –PACS systems (intermediaries) will collectively support the new MR and CT DICOM objects will collectively support the new MR and CT DICOM objects.

40. 40 Vendors of Workstations / PACS need to prepare for implementation: What should be done?

41. 41 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline What should be done?

42. 42 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects What should be done?

43. 43 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI What should be done?

44. 44 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI –Prepare for Dimensions and Dimension Organizations What should be done?

45. 45 Vendors of Workstations / PACS need to prepare for implementation: –Prepare the color pipeline –Prepare your databases for large objects –Create your real-world values UI –Prepare for Dimensions and Dimension Organizations What should be done?

46. 46 Summary The New DICOM MR and CT Objects:The New DICOM MR and CT Objects: –will enhance interoperability –will increase cross system functionality –will reduce transfer time Success requires also action by Workstation and PACS implementers.Success requires also action by Workstation and PACS implementers.

47. 47 Further Information More in-depth discussions and presentations about: Relationships between images Concatenations Dimension Organization Real World Value mapping Extended Image Type Color Mapping can be found at : http://medical.nema.org/dicom/presents.html A new CT Standard

48. 48 Acknowledgement and copyright Images for this presentation were provided by: –GE Medical Systems –Philips Medical Systems –Siemens Medical Systems The slides of this presentation may be quoted if reference and credit to DICOM WG-16 is properly indicated

49. 49 Thank you for your attention Now over to X-rays…..

50. 50 A Glimpse at the emerging Enhanced XA/XRF Object (DICOM Supplement 83) Heinz Blendinger, Siemens Medical Solutions Chair DICOM WG-02 Presented by Rainer Thieme, Siemens Medical Solutions

51. 51 Presentation outline The emerging XA/XRF StandardThe emerging XA/XRF Standard –Difference to other Enhanced IODs –Clinical Benefit of Enhanced XA Call for ParticipationCall for Participation

52. 52 The add-ons of Supplement 83 New Functional groups (not complete) –Projection Pixel Calibration Macro –Table Position Macro –X-Ray Collimator Macro –Reversed Modality LUT Macro Multi-frame Presentation Module Enhanced XA/XRF Image Module Attributes ALL these improve Functionality & Interoperability

53. 53 New functionality: an example Dimension Module in enhanced XA images. Rotational Angiography examination can include the cardiac cycle as structural information. Dimensions can be used to group multi-frame image frames taken at identical positions of a stepping table device.

54. 54 ECG ECG-gated Cardiac Application #Px D 1 12 2 3 3

55. 55 New attributes Simple Filter Factor DSA Window Values Dedicated Reversed Modality DeLog LUT Dedicated Sequence to Reference other plane for Biplan Acquisition Context attributes

56. 56 Multi-Frame Presentation Module Edge Enhancement Not the same, but “closer” XA Object: private encoding Reason: Hard to “standardize” Algorithms Approximation XA enhanced: Attribute for “applied percentage”

57. 57 Dedicated Calibration Module Attributes to describe iso-centric geometry Include Table plane in geometric context Object plane relative to table

58. 58 UKK 2001 (TVP-1/2 TD) °Rot °Ang #Px D D = # Px *  Px * SOD / SID SOD = ISO - (TVP - 1/2 TD) / cos°Rot * cos°Ang Internal Calibration for Quantitative Assessments => Practical solution based on user experience

59. 59 Supplement 83 Roadmap

60. 60 Further work Differentiation on “processed” or “original” contents needed?Differentiation on “processed” or “original” contents needed? –Super SOP Class and SOP Classes for particular use –“For Processing” or “For Presentation” SOP Classes “Cut-line” between shared and non-shared contents“Cut-line” between shared and non-shared contents Further new attributes to support new applications or procedures.Further new attributes to support new applications or procedures.

61. 61 Summary The New DICOM enhanced XA/XRF Objects:The New DICOM enhanced XA/XRF Objects: –will enhance interoperability –will increase cross system functionality –will create platform for new applications Success requires more clinical inputSuccess requires more clinical input –Use Cases –Requirements for new applications and –Procedures

62. 62 Further Information / Contacts Please contact WG-02 chairman Heinz.Blendinger@siemens.com Supplement 83 Draft can be found at : http://dclunie.com/dicom-status/status.html Next meetings:  December 9 th and 10 th, 2003 in Berlin  February 11 th and 12 th, 2004 at NEMA  May 4 th and 5 th, 2004 in Europe

63. 63 Thank you for your attention Now over to …implementation..

64. 64 Introduction of the new DICOM MR and CT Enhanced Multi-frame Image Standard Charles Parisot, GE Medical Systems Chair NEMA DICOM Advancement Committee

65. 65 After 10+ years of effective DICOM connectivity in MRI and CT introducing a new Image Object poses three challenges: A new CT Standard –Avoid user confusion Inform about the benefits of the enhanced multi-frame image standard and need to manage coexistence. –Synch-up industry Facilitate availability of compatible PACS and Workstations along with the release of the MRI and CT scanners. –Reduce incompatibilities Provide to interested vendors testing tools and opportunities to quickly retire misinterpretations or bugs.

66. 66 NEMA Advancement Committee Foster industry cooperation to facilitate the adoption of new DICOM capabilitiesFoster industry cooperation to facilitate the adoption of new DICOM capabilities Members are NEMA Medical Imaging Informatics Section members, plus other vendors & users.Members are NEMA Medical Imaging Informatics Section members, plus other vendors & users. Establish a voluntary plan and process to assist in introduction. Does not dictate product release.Establish a voluntary plan and process to assist in introduction. Does not dictate product release. Has done this successfully for 10 years.Has done this successfully for 10 years. Independent from the DICOM Standards Committee. Cooperation with COCIR in Europe and JIRA in Japan.Independent from the DICOM Standards Committee. Cooperation with COCIR in Europe and JIRA in Japan.

67. 67 What is the proposed plan ? Release test images and test viewer: –Done in 2003 for Enhanced MR Image –To be planned for Enhanced CT: Oct 2004 A testing event followed by an education event –Commitment by interested vendors 2Q 2004 –Plan testing event for 2Q 2005 –Plan education and promotion event for 2Q 2005 –Finalize education and promotion at RSNA 2005. Reach Industry Agreement on plan by 1Q 2004

68. 68 How can vendors get involved ? To get involved in the proposed NEMA Initiative Contact Stephen Vastagh at NEMA: ste_vastagh@nema.org ste_vastagh@nema.org Interested Users are Welcome