NM Image

1. NM Image Marco Eichelberg IHE-D Technical Manager

2. NM ImageThe Problem • DICOM NM objects are different and support in products is inconsistent • NM cardiac display needs 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

3. General NM Viewing Suboptimal NM PACS

4. General NM Viewing Suboptimal NM PACS

5. General NM Viewing Suboptimal Click and move mouse down to adjust window level, right to adjust window center

6. If sent as Short axis Images not displayed in a useful format. If sent as screen snapshots(ie, static Secondary Capture) Can’t separately adjust stress and rest images Can’t view gated cine Cardiac Viewing Suboptimal

7. New in 2006 ! • Cardiac Option • Better addresses cardiac needs • Minor restructuring of remaining profile • General NM option • MPR option • (Review option retired) • (Comparison display eliminated)

8. NM Image Abstract / Scope • Content Profile • for Users to request and Vendors to claim • No New Actors or Transactions • Additional requirements on existing actors and transactions • Total of 4 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 >

9. 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

10. NM ImageTransaction Diagram

11. NM ImageStandards 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

12. 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

13. 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

14. General NM Option Whole body display Cardiac NM Option ACC NM Cardiac display Displays must support at least one of these options! Options: Image Displays

15. 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

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

17. 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”

18. A1 A2 A3 A4 A5 A6 A7 A8 A9 … … … … … … … … … … … … … … … … … … … … … … A32 … A1 A2 B1 B2 C1 C1 Display Formats • Grid display • Frames from one image set • Fit display • Frames from multiple image sets

19. 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.

20. Short axis ACC NM Display Example • Vertical Long • Horizontal Long

21. Short ACC NM Display Example Stress Rest Stress Rest • Vertical Stress Rest • Horizontal Stress Rest

22. Another ACC Display Example • Different Layout • Same stress and rest views

23. MPR Option: Image Displays • Adds Image Display requirements to support Review of SPECT NM Images with Multi-planar reconstruction (MPR) • Transaxial • Sagittal • Coronal

24. Result Screen Export Option

25. 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.

26. 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