Integrating the Healthcare Enterprise Consistent Presentation of Images Integration Profile

1. Integrating the Healthcare EnterpriseConsistent Presentation of ImagesIntegration Profile Ellie Avraham Kodak Health Imaging IHE Planning andTechnical Committees IHE Interoperability Workshop

2. IHE Integration profiles Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow , Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes - Access to Radiology Information Basic Security IHE Interoperability Workshop

3. The Grayscale Consistency Problem: • The Visual Appearance of grayscale images displayed on different types of softcopy display devices or printed on different types of hardcopy output devices is in generalinconsistent and may impact the clinical Diagnostics IHE Interoperability Workshop

4. Problems of Display Inconsistency VOI chosen on one display device Rendered on another with different display Mass expected to be seen is no longer seen mass visible mass invisible Slide Provided by David Clunie IHE Interoperability Workshop

5. Problems of Inconsistency in Display Luminance range 0.5 1.0 Not all display levelsare perceivable on alldevices 1.5 3.0 Slide Provided by David Clunie IHE Interoperability Workshop

6. Problems of Inconsistency in Display Luminance range 0.5 1.0 Not all display levelsare perceivable on alldevices 1.5 3.0 Slide Provided by David Clunie IHE Interoperability Workshop

7. Problems of Hardcopy-Softcopy Inconsistency Digital Modality Laser Printer Printed images don’t looklike displayed images Slide Provided by David Clunie IHE Interoperability Workshop

8. Causes of Inconsistency Display devicesvary in the maximumluminance they canproduce Display CRT Luminance vs. Film Optical Density on a light box is an extreme example 1.0 .66 Slide Provided by David Clunie IHE Interoperability Workshop

9. Consistent Presentation of Images IHE Objectives Consistent distribution of Images across the healthcareenterprise : • Consistency among Hardcopy Images Printed on different Printers (from different Vendors). • Consistency among Softcopy Images view on different display devices (from different Vendors). • Consistency among Hardcopy and Softcopy Image view The cost effective solution to ensure that image quality is maintained acrossdifferentmonitors and film producing devices. IHE Interoperability Workshop

10. Consistent Presentation of Images Requires: • Calibration of the Softcopy Display and the Hardcopy Output Devices using DICOM Grayscale Standard Display Function • Creating Hardcopy Output Using DICOM Basic Print with Presentation LUT Support • Preserving/Using the Softcopy Display Viewing Parameters in the DICOM Grayscale Softcopy Presentation State container Cal Hard Soft IHE Interoperability Workshop

11. Achieve Grayscale Consistency in Hardcopy Output and Softcopy Viewing The DICOM Standard Defines: A standard curve, the Grayscale Standard Display Function (GSDF), against which different types of display and hardcopy output devices should be calibrated – Adjust their Characteristic Curve to the GSDF curve. Cal Devices Have to Be Properly Calibrated IHE Interoperability Workshop

12. Cal DICOM GSDF Grayscale Standard Display Function 1000 Film 100 10 Monitors 1 0 200 400 600 800 1000 .1 .01 JND Index Barten Model: preserves thehuman perceptual response based on eye contrast sensitivity Mapping of the P-values to theview luminance or optical density value IHE Interoperability Workshop Slide Provided by David Clunie

13. Cal Standardizing a Display 100 Standard 10 1 0 50 100 150 200 250 Characteristic Curve 0.1 DDL or P-Values Slide Provided by David Clunie IHE Interoperability Workshop

14. To Achieve Consistent Presentation of Images Printed, the DICOM Standard Defines: Hard • Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output IHE Interoperability Workshop

15. Basic Print Request with Presentation LUT DICOM Presentation LUT N-CREATE Print Print Composer Server DICOM Film Session N-CREATE Print Composer Print Request Print Presentation LUT DICOM Film Box N-CREATE DICOM Image Box N-SET DICOM Film Box N-ACTION DICOM Film Session N-ACTION Print Server Print Status (DICOM N-EVENT-REPORT) Hard Printer Status IHE Interoperability Workshop

16. Basic Print Request with Presentation LUT • Print Composer – A system that generates DICOM print requests as a DICOM Print SCU.Print composer has to apply image processing manipulations, and requests to Print server will specify P-Values in the form of a Presentation Look-Up Table (Presentation LUT) or implicitly by Presentation LUT Shape. • Print Server – A system that accepts and processes DICOM print requests as a DICOM Print SCP and performs image rendering on hardcopy media.The system must support pixel rendering to optical density according to the DICOM Grayscale Standard Display Function. Hard IHE Interoperability Workshop

17. To Achieve Consistent Presentation of Images, the DICOM Standard Defines: Soft Grayscale Softcopy Presentation State (GSPS): an object for storing and communicating the parameters that describe how an image or set of images should be displayed. A GSPS object contains references to the images it applies to, and the transformations (grayscale transformations, shutter transformation, image annotation, spatial transformations, and displayed area annotation) that should be applied when the images are presented on a softcopy display, or printed on film. IHE Interoperability Workshop

18. Area Of Interest Area Of Interest Achieving Consistent Presentation Flip Zoom Annotate Original Image Without Consistent Presentation Window Level Consistent Presentation of Images Referring Physician or Reviewing Radiologist Reporting Radiologist Soft Presentation State Presentation LUT Grayscale Standard IHE Interoperability Workshop

19. Rescale Slope/Intercept or Modality LUT Window/Level or VOI LUT Presentation LUT Presentation LUT Transformation Original Image M o d a l i t y M a s k V O I L U T L U T Grayscale Transformations ( S u b t r a c t i o n ) T r a n s f o r m a t i o n T r a n s f o r m a t i o n S h u t t e r P-Values Display T r a n s f o r m a t i o n I m a g e D i s p . A r e a S p a t i a l Shutter, Annotation and Spatial Transformations T r a n s f o r m a t i o n A n n o t a t i o n A n n o t a t i o n DICOM Grayscale Image Transformation Model Soft e IHE Interoperability Workshop

20. GSPS Stored, and Query/Retrieve GSPS Image Display Image Creator 15 Query Presentation State 19 Creator Presentation Retrieve Presentation State 17 State Stored Image Archive 9 Modality Presentation State Stored Acquisition Modality • IHE Transaction - an Acquisition Modality or Image Creator Actor sends a DICOM GSPS C-STORE request to an Image Archive Actor • IHE Transaction - an Image Display Actor issues a C-FIND request to an Image Manager Actor • IHE Transaction - an Image Display Actor issues a C-MOVE request to an Image Archive Actor Soft IHE Interoperability Workshop

21. Consistent Presentation of Images Print Display Acquire Slide Provided by David Clunie IHE Interoperability Workshop

22. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements IHE Interoperability Workshop