1. DICOM and NM: The IHE Nuclear Medicine Profile Jerold Wallis, MD

2. NM Image NMPACS

3. NM Image NMPACS

4. NM Image Problem Click and move mouse down to adjust window level, right to adjust window center

5. RSNARSNA HIMSSHIMSS VendorsVendors Achieving Real-World InteroperabilityAchieving Real-World Interoperability Uses existing standards (DICOM etc) to define specific ways of meeting clinical needsUses existing standards (DICOM etc) to define specific ways of meeting clinical needs IHE “Profiles”IHE “Profiles” Integrating the Healthcare Enterprise

6. Profiles Users document needUsers document need Vendors agree on how to address that needVendors agree on how to address that need Uniform implementationUniform implementation DocumentationDocumentation Opportunity for testingOpportunity for testing Users can ask for the profileUsers can ask for the profile

7. NM Profile New for 2004New for 2004 Vendors will evaluate and implement over the summerVendors will evaluate and implement over the summer Testing in JanuaryTesting in January

8. NM Profile Part I—Informative Explains the DICOM NM image formatExplains the DICOM NM image format NM IODNM IOD (PET IOD)(PET IOD) Multiframe – –Dynamic – –Anterior – –Posterior – –Multi-energy NM Image Image vectors

9. NM Profile Part II—Required Image creatorsImage creators Processing stationsProcessing stations Storage devicesStorage devices Image displaysImage displays Participation is voluntary Must support features if claim compliance Review option –+ SPECT display Result screen export option –Gated & Static processed screens

10. Image Displays Must support separate adjustments of upper and lower window levelsMust support separate adjustments of upper and lower window levels

11. Image Displays Must use “intelligent” scaling to avoid presenting postage-stamp size NM imagesMust use “intelligent” scaling to avoid presenting postage-stamp size NM images

12. Image Displays Must use “intelligent” scaling to avoid presenting postage-stamp size NM imagesMust use “intelligent” scaling to avoid presenting postage-stamp size NM images Must allow the user to separate out different vectors of complex multi-frame imagesMust allow the user to separate out different vectors of complex multi-frame images Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image”Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image”

13. Display Formats Grid displayGrid display –One image set A1A1 A2A2 A3A3 A4A4 A5A5 A6A6 A7A7 A8A8 A9A9 ………………… …………………… …………………A 32 … A1A1 A2A2 A3A3 A4A4 A5A5 A6A6 A7A7 A8A8 B1B1 B2B2 B3B3 B4B4 B5B5 B6B6 B7B7 B8B8 A1A1 A2A2 B1B1 B2B2 C1C1 C1C1 Fit displayFit display –Multiple image sets Comparison displayComparison display –Multiple image sets (SPECT display)(SPECT display) –Review option

14. Multiple Cines

16. PACS  NM Workstation ? No !No ! –No filtering –No ROI –No TAC –No renal, lung … processing –No reframing –No cardiac processing

17. Cardiac Issues: Image Creator (Acquisition system) Image typesImage types –Projections –Transaxials –Short axis  –Vertical long  –Horizontal long  Patient statesPatient states –Stress  –Rest  –Reinjection  –Redistribution  –Delayed redistribution 

18. Cardiac Issues: Evidence Creator (Processing station) Angle encodingAngle encoding –Oblique slices Short axis stacking order Short axis stacking order  –Apex-to-base Use Patient state  and image type  codesUse Patient state  and image type  codes –Image selection Output of processed screens (for PACS)Output of processed screens (for PACS) –Static –Gated –(Result Screen export option)

19. Cardiac Issues: Image Display (PACS Display) Show multiple cinesShow multiple cines Display grayscale and color result screensDisplay grayscale and color result screens Display cine result screensDisplay cine result screens Apply local color tables to grayscale screensApply local color tables to grayscale screens Add color tables to systemAdd color tables to system Change intensity of grayscale result screensChange intensity of grayscale result screens –(strongly recommended)

20. Image Storage Provider Store NM imagesStore NM images Retrieve NM imagesRetrieve NM images –Complete with private header info

21. But Wait, There’s More NM Image ProfileNM Image Profile –50 pages –Technical –Available at www.rsna.org/IHE/ CAIC Web site gamma.wustl.edu/caic.html  www.snm.org/caic

22. What’s Missing: PET NMPACS

23. What’s Missing: PET / CT PET fusion profilePET fusion profile Next year?Next year?

24. Action Needed: NM Vendors Cardiac software authors PACS By You Ask for the NM Image Profile