1. Sept 13, 2006IHE Webinar 1 Integrating the Healthcare Enterprise NM Image Jerold Wallis Washington University Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte

2. Sept 13, 2006IHE Webinar 2 NM Image Transaction Diagram Evidence Creator Image Manager Image Archive Image Display Acquisition Modality Vol 1- 16.1 Actors and Transactions in NM Profile

3. Sept 13, 2006IHE Webinar 3 NM Image Transaction Diagram Evidence Creator Image Manager Image Archive Image Display Acquisition Modality

4. Sept 13, 2006IHE Webinar 4 Acquisition Modalities Create NM objects as specified (Series, attribute & vector handling)  Image orientation  Patient orientation Include specific codes in Cardiac studies  Patient state codes  Reorientated cardiac image codes  Slice progression direction 4.8.4.1.2.2 Storage of NM Images (NM)  Also see revisions of table 4.8-2 in CP

5. Sept 13, 2006IHE Webinar 5 Table 4.8-2 (Revised) AttributeTagImage Type GeneralCardiac STATICSTATIC DYNAMICDYNAMIC WHOLEBODYWHOLEBODY GATEDGATED TOMOTOMO RECONTOMORECONTOMO TOMOTOMO RECONTOMORECONTOMO GATEDTOMOGATEDTOMO RECONGATEDTOMORECONGATEDTOMO Detector Information Sequence (0054,0022) > Image Position(0020,0032)R+ > Image Orientation(0020,0037)R+ > View Code Sequence (0054,0220) >> Code Value(0008,0100)R+R+ 1 >> Coding Scheme Designator (0008,0102)R+R+ 1

6. Sept 13, 2006IHE Webinar 6 NM Image Transaction Diagram Evidence Creator Image Manager Image Archive Image Display Acquisition Modality

7. Sept 13, 2006IHE Webinar 7 Evidence Creators Create NM objects as specified (Series, attribute & vector handling) Include specific codes in Cardiac studies 4.8.4.1.2.2 Storage of NM Images (NM) Also see revisions of table 4.8-2 in CP

8. Sept 13, 2006IHE Webinar 8 Result Screen Export Option

9. Sept 13, 2006IHE Webinar 9 Result Screen Export Option: Evidence Creators Render Dynamic Result Screens  Multi-Frame Grayscale Byte Secondary Capture  Multi-Frame True Color Secondary Capture  Creating multiple single frame objects is NOT sufficient. Render Static Result Screens  Using single frame DICOM Secondary Captures is sufficient  Using Multi-frame to render single or several related static result screens is recommended Must generate appropriate Secondary Capture objects from any Result Screens created. 4.18.4.1.2.4 Result Screen Export Option

10. Sept 13, 2006IHE Webinar 10 NM Image Transaction Diagram Evidence Creator Image Manager Image Archive Image Display Acquisition Modality

11. Sept 13, 2006IHE Webinar 11 Image Manager/Archives Store/Retrieve NM Objects Store/Retrieve Secondary Capture (SC & MFSC) Objects Must not strip private elements Support Query on Study Description Must return Series Description when requested 4.8.4.1.3 Expected Actions 4.18.4.1.3.1 DICOM Image Storage SOP Classes Table 4.14-1. Images Query Matching and Return Keys

12. Sept 13, 2006IHE Webinar 12 NM Image Transaction Diagram Evidence Creator Image Manager Image Archive Image Display Acquisition Modality

13. Sept 13, 2006IHE Webinar 13 Image Display Display NM and Result-Screen Images Support specified NM essential display capabilities Additional attribute handling, with display of values or use as indicated  e.g. Patient State, Image Orientation, Detector Sequence, View Code Sequence 4.16.4.2.2.3 Display of NM Images Revision in CP

14. Sept 13, 2006IHE Webinar 14 NM Image Format Understood by dedicated NM systems Often Misunderstood by general storage and display systems Multiframe  Dynamic  Anterior  Posterior  Multi-energy NM Image Image vectors Volume 1 – E.4

15. Sept 13, 2006IHE Webinar 15 Options: Image Displays General NM Option  Whole body display Cardiac NM Option  ACC NM Cardiac display Displays must support at least one of these options! 4.16.4.2.2.3.7 Cardiac NM Option4.16.4.2.2.3.6 General NM Option In CP

16. Sept 13, 2006IHE Webinar 16 Handle multi-frame / multi-vector images Multiple simultaneous cines Grayscale and color result screens Dynamic and static result screens Original resolution and scaled Separate adjustment of upper and lower window levels Apply local color tables to grayscale screens Add new local color tables to system Change intensity of grayscale result screens Display Series Description tag Display orientation labels Image Display

17. Sept 13, 2006IHE Webinar 17 Upper and Lower Levels Upper and lower window levels (Not just center/width) Separate Design is up to you

18. Sept 13, 2006IHE Webinar 18 Image Display Allow user to select different vectors/framesets of complex multi- frame images Allow user to separately adjust intensity for different framesets (eg, phases) in the same “image”

19. Sept 13, 2006IHE Webinar 19 Multiple Cines

20. Sept 13, 2006IHE Webinar 20 Display Formats Grid display  Frames from one image set in a grid A 32 … ………………… …………………… …………………A9A9 A8A8 A7A7 A6A6 A5A5 A4A4 A3A3 A2A2 A1A1 C1C1 C1C1 B2B2 B1B1 A2A2 A1A1 Fit display  Frames from multiple image sets in a grid Comparison Display removed in CP

21. Sept 13, 2006IHE Webinar 21 Table 4.16-1 (Revised) Image Type (0008,0008) Value 3 Frame Increment Pointer (0028,0009) [i.e. vectors] Required Frame Selection 1 E = single E = all Display Capabilities (See 4.16.4.2.2.3.2) # of Simultan eous Framese ts Ge ne ral N M Op tio n Cardi ac NM Optio n STATICEnergy Window (0054,0010) Detector (0054,0020) E D Grid Display11 Fit Display12 WHOLEBODYEnergy Window(0054,0010) Detector(0054,0020) E D Wholebody Display2- DYNAMIC.Energy Window (0054,0010) Detector (0054,0020) Phase (0054,0100) Time Slice (0054,0030) E D P T Grid Display11 Cine11 GATEDEnergy Window (0054,0010) Detector (0054,0020) R-R Interval (0054,0060) Time Slot (0054,0070) E D I TGrid Display11 Cine36 TOMOEnergy Window (0054,0010) Detector (0054,0020) Rotation (0054,0050) Angular View (0054,0090) E D R AGrid Display11 Cine33 GATED TOMOEnergy Window(0054,0010) Detector (0054,0020) Rotation (0054,0050) R-R Interval (0054,0060) Time Slot (0054,0070) Angular View (0054,0090) E D R I T A Grid Display11 Cine13 RECON TOMOSlice (0054,0080)SGrid Display11 ACC NM Cardiac Display 2 GATED RECON TOMO R-R Interval (0054,0060) Time Slot (0054,0070) Slice (0054,0080) I T S Grid Display11 ACC NM Cardiac Display with Cine 2

22. Sept 13, 2006IHE Webinar 22 Table 4.16-1 (Revised) DICOM Image type VectorsSelections for display Display typesGenGen CardCard WHOLE BODY Energy Window (0054,0010) Detector(0054,0020) E D Wholebody Display2- Revised table in CP

23. Sept 13, 2006IHE Webinar 23 ACC NM Cardiac Display Generate long axis from short axis images Display of 2 image sets (Stress and Rest) Use patient state tags to set display order Follow ACC guidelines for display Controls for adjusting stress and rest  Image alignment  Window upper and lower levels. Description in CP

24. Sept 13, 2006IHE Webinar 24 ACC NM Display Example Short axis Horizontal Long Vertical Long Only Short axis data supplied

25. Sept 13, 2006IHE Webinar 25 ACC NM Display Example Short Horizontal Vertical Stress Rest Stress Rest Stress Rest Stress Rest Upper/lower Adjustments Stress Rest

26. Sept 13, 2006IHE Webinar 26 Another ACC Display Example Different Layout Same stress and rest views

27. Sept 13, 2006IHE Webinar 27 MPR Option: Image Displays Adds Image Display requirements to support Review of SPECT NM Images with Multi-planar reconstruction (MPR)  Transaxial  Sagittal  Coronal Described in CP

28. Sept 13, 2006IHE Webinar 28 Points of Interest - NM Appendix E, Volume 1 (Informative)  New to Nuclear Medicine?  Trouble matching NM to Scheduled Workflow?  Start Here.  E.2 NM Workflow – What happens in NM procedures  E.3 NM Worklists – How to schedule/model it  E.4 NM Data – What to expect in the DICOM  E.5 NM Display – How it should be presented

29. Sept 13, 2006IHE Webinar 29 Questions ? This document is at  http://gamma.wustl.edu/ihe  (Also is on the IHE FTP server) Links to the Framework and CP at  www.snm.org/ihe

30. Sept 13, 2006IHE Webinar 30 NM Image Standards Used DICOM NM Image Object DICOM Multiframe Secondary Capture  Dynamic Results  Collection of Static Results DICOM Secondary Capture  Static Results ACC NM Cardiac Display format