1. IHE Workshop – June 2006What IHE Delivers 1 Todd Kantchev, Siemens Molecular Imaging Jerold Wallis, Mallinckrodt Institute of Radiology Kevin O’Donnell, Toshiba America Medical Systems Image Fusion Profile

2. IHE Workshop – June 2006 2 Image Registration and Fusion Translate Rotate Rigid Registration Scale Warp- optional (Deformable Registration) Fuse

3. IHE Workshop – June 2006 3 Image Fusion- General Use Case Tech acquires two or more series of images, possibly separated in time. Tech reconstructs images into volumes, performs registration, and stores results data. Radiologist reads study or Oncologist completes RT planning on RT Planning System. Referring Physician or Researcher reviews results. CTMR

4. IHE Workshop – June 2006 4 Fusion- The Integration Problem Results not readily transferable between systems  Proprietary or inconsistent implementations  Lack of guidance Results presented on different systems may not appear the same. Systems must correctly handle issues such as  Identifying and retrieving the right datasets  Matching data between single-slice and multi-slice datasets  Performing spatial translations  Rendering the fused display

5. IHE Workshop – June 2006 5 Fusion- The Integration Solution A collection of DICOM objects exists to address the problem. Their use is constrained and clarified to avoid misinterpretation and promote compatibility.

6. IHE Workshop – June 2006 6 Essential Clinical Features: MDs will be Ecstatic MPR Fusion Side-by-side  Registered

7. IHE Workshop – June 2006 7 Value Proposition Interoperable DICOM encoding for registered/fused data Consistent and reliable acquisition, storage and presentation of fused data across vendors Allows separation of workflow steps: Acquisition on “A”; Fusion on “B”; Display on “C” Wider distribution of results Separable registration for re-doing if necessary Can easily request basic interoperable fusion features. E.g. blended display, MPR, side by side display, etc. Supports PET-CT (primary initial interest) viewing on general radiology PACS displays Modality independent Supports general needs in radiation oncology pre-planning

8. IHE Workshop – June 2006 8 Image Fusion Technical Basis Spatial Registration Object Encodes transformation to align images in a common registered space Identifies the registered space References the images to be aligned Not required for already-registered PET- CT data from a hybrid scanner

9. IHE Workshop – June 2006 9 Image Fusion Technical Basis Blending Presentation Object References one set of underlying images (e.g. CT) References one set of superimposed images (e.g. PET) References (optionally) a Registration Object to align both image sets before blending. Encodes the window level for each set Encodes the blending factor (0 to 100%) of the overlay transparency

10. IHE Workshop – June 2006 10 50% Blending Presentation Overlay Transparency 20% 50% 100% 80% 50%

11. IHE Workshop – June 2006 11 Use Case- The IT Solution Store CT Store MR Retrieve CT, MR Register MR to CT Store SRO Store BSPS Retrieve CT, MR, SRO, BSPS Fuse CT and MR Apply T to MR Modality MR Modality CT Image Archive Evidence Creator Image Display

12. IHE Workshop – June 2006 12 Image Fusion Actors and Transactions Acquisition Modality Evidence Creator Image Manager ↓ [RAD 18] Creator Images Stored ↓ [RAD 57] Blending Presentation States Stored ↓ [RAD 56] Spatial Registrations Stored ↓ [RAD 10] Storage Commitment ↓ [RAD 14] Query Images ↓ [RAD 16] Retrieve Images ↓ [RAD 15] Query Presentation States ↓ [RAD 17] Retrieve Presentation States ↓ [RAD 58] Retrieve Spatial Registrations Image Archive [RAD 8] Modality Images Stored ↓ [RAD 57] Blending Presentation States Stored ↓ [RAD 56] Spatial Registrations Stored ↓ [RAD 10] Storage Commitment ↓ Image Display

13. IHE Workshop – June 2006 13 Load CT and PET images Align images (automatically or manually) and fuse with desired blending factor Store the alignment, including  Registration object  Blending State (defining the blending factor, window levels and referencing all other objects) Storage can be on PACS or disk. Images do not need to be stored if already stored. Fusion- The Creating Process Blending State Registration Object CT PET

14. IHE Workshop – June 2006 14 Blending state can be searched and retrieved from PACS  Can be used to retrieve the image data and the alignment automatically. User selects a Blending state.  Automatically load the referenced CT and PET images and the Registration object. Alignment can be applied, PET re- sampled to CT and displayed fused automatically. Display is required to provide  Scrolling through volume  Adjustment of fusion blending and window levels  MPR  Side-by-side display Fusion- The Displaying Process Blending State Registration Object CT PET

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