Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise NM Image Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte IHE Interoperability Workshop

2. IHE Radiology Integration Profiles Scheduled Workflow Charge Posting Teaching Files & Clinical Trials Export Presentation ofGrouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Presentation ofImages EvidenceDocs Access to Radiology Information XDS for Imaging Portable Data for Imaging Patient Info. Recon-ciliation Post-Processing Workflow Audit Trail & Node Authentication - Radiology Option IHE Interoperability Workshop

3. NM Image – The Problem • DICOM NM objects are different and support in products is inconsistent • NM clinical display practices are different and support in products is inconsistent • Clinical Analysis Programs are used extensively (particularly for Cardiology), but no support for distribution and display of those Result Screens • NM Users are not adept at getting these requirements accurately included in RFPs • Vendors (especially of general purpose systems) are not adept at accurately representing their support for such features IHE Interoperability Workshop

4. NM ImageAbstract / Scope • Content Profile • for Users to request and Vendors to claim • No New Actors or Transactions • Additional requirements on existing actors and transactions • Two New Options • New Informative Text in Vol. 1 • Clarifications of NM Workflow mapping to SWF • Explanation of NM Data • Explanations of NM Clinical Display concepts • New Normative Text in Vol. 2 • < See Following Slides > IHE Interoperability Workshop

5. NM ImageValue Proposition Use general Radiology Infrastructure to: • Satisfy Basic NM Data Needs • Access to NM Images • Access to usable presentations of NM Images • Access to Clinical Processing Results • Satisfy NM Workflow Needs • Map Cardiac and Multi-phase Studies to SWF • Improved Query IHE Interoperability Workshop

6. NM ImageTransaction Diagram IHE Interoperability Workshop

7. NM ImageStandards Used • DICOM NM Image Object • DICOM Multiframe Secondary Capture • Dynamic Results • Collection of Static Results • DICOM Secondary Capture • Static Results IHE Interoperability Workshop

8. NM Image Actors • Acquisition Modalities • Create NM objects as specified (Series, attribute & vector handling) • Include specific codes in Cardiac studies • Evidence Creators • Create NM objects as specified (Series, attribute & vector handling) • Include specific codes in Cardiac studies • Image Manager/Archives • Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects • Support Query on Study Description • Image Displays • Display NM and Secondary Capture (SC & MFSC) Images • Support specified display capabilities IHE Interoperability Workshop

9. Image Display • Display NM and Result-Screen Images • Support specified NM essential display capabilities • Additional attribute handling • e.g. Patient State, Image Orientation, Detector Sequence, View Code Sequence • Review Option IHE Interoperability Workshop

10. Image Display • 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 IHE Interoperability Workshop

11. Understood by dedicated NM systems Often Misunderstood by general storage and display systems Multiframe Dynamic Anterior Posterior Multi-energy NM Image Format NM Image • Image vectors IHE Interoperability Workshop

12. NM Image NM PACS IHE Interoperability Workshop

13. NM Image NM PACS IHE Interoperability Workshop

14. NM Image Click and move mouse down to adjust window level, right to adjust window center IHE Interoperability Workshop

15. Image Display • Scale “intelligently” to avoid presenting postage-stamp size NM images • 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” IHE Interoperability Workshop

16. Display Formats A1 A2 A3 A4 A5 A6 A7 A8 A9 … … … … … … … … … … … … … … … … … … … … … … A32 … A1 A2 A3 A4 A5 A6 A7 A8 B1 B2 B3 B4 B5 B6 B7 B8 A1 A2 B1 B2 C1 C1 • Grid display • Frames from one image set • Comparison display • Compare frames from multiple image sets • Fit display • Frames from multiple image sets IHE Interoperability Workshop

17. Review Option: Image Displays • Adds Image Display requirements to support Review of NM Images • MPR Display • More series at once • Different series types together • Pixel value display IHE Interoperability Workshop

18. Result Screen Export Option IHE Interoperability Workshop

19. Result Screen Export Option:Evidence Creators • Render Dynamic Result Screens • Based on the following DICOM Objects: • 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 • provides better image comment/label attributes • provides implicit display order • displayed by stepping, not cine • Must generate appropriate Secondary Capture objects from any Result Screens created. IHE Interoperability Workshop

20. 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 • Many subtleties here IHE Interoperability Workshop

21. More information…. • IHE Web sites: www.ihe.net • Technical Frameworks & Supplements • 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