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 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

7. IHE Workshop – June 2006 7 Blending Presentation 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

8. IHE Workshop – June 2006 8 50% Blending Presentation Overlay Transparency 20% 50% 100% 80% 50%

9. IHE Workshop – June 2006 9 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

10. IHE Workshop – June 2006 10 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

11. IHE Workshop – June 2006 11 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

12. IHE Workshop – June 2006 12 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

13. IHE Workshop – June 2006 13 Essential Clinical Features: MDs will be Ecstatic MPR Fusion Side-by-side  Registered

14. IHE Workshop – June 2006 14 What are other Benefits to the User? Consistent and reliable acquisition, storage and presentation of fused data across vendors.  Fusion on vendor “A” system  Display on vendor “B” system Have a basis to request minimum set of compatible fusion related features. For example blended display and MPR, side by side display etc. PET-CT will be the major use of the profile in the near-term – designed to meet the needs of PET-CT viewing on general radiology PACS displays. Will meet general needs in radiation oncology pre- planning. Modality independent.

15. IHE Workshop – June 2006 15 What are The Benefit to the Supplier? o A framework on how to encode the DICOM objects in order to achieve interoperability with other vendors when exporting fused data. o Guidelines on what minimum features should their displays have in order to be compatible with fused data of other vendors. o A convenient way for vendors to offer a required set of functionality to the customer. o Easier integration of third party applications in own existing or new solutions when necessary. o Easier management of fusion systems over time with more flexibility and without a huge cost involved for replacement, migration and reconfiguration. The Fusion Profile Provides:

16. IHE Workshop – June 2006 16 Image Fusion Profile Status The IHE Image Fusion Profile is published for Trial Implementation. http://www.ihe.net/Technical_Framework/upload/IHE_RAD- TF_Suppl_FUS_TI_2006-04-13.pdfhttp://www.ihe.net/Technical_Framework/upload/IHE_RAD- TF_Suppl_FUS_TI_2006-04-13.pdf Portions of the profile are applicable to acquisition systems, processing workstations, image storage devices, and images displays, so inquiries from all are welcome. Vendors can verify that their software works with data of other vendors at a multi-vendor testing session (connect-a-thon)  RSNA headquarters in Chicago in January 2007. Choosing to comply with the profile will allow vendors to meet users needs when their products reach the marketplace. In the meantime, users should start asking vendors “Do you offer systems that comply with the Image Fusion Profile?”

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