Sept 13-15, 2004 IHE Interoperability Workshop1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Nuclear Medicine Image - NM

Dr. Jerry Wallis (SNM)

IHE Radiology Technical Cmte

Kevin O’Donnell (Toshiba Corp.)

Co-Chair, IHE Radiology Planning Cmte

Sept 13-15, 2004 IHE Interoperability Workshop2

Nuclear Medicine Image - NMNuclear Medicine Image - NM

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage

NMImage

Sept 13-15, 2004 IHE Interoperability Workshop3

NM Image – The ProblemNM Image – The ProblemDICOM 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

Sept 13-15, 2004 IHE Interoperability Workshop4

NM Image FormatNM 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

Sept 13-15, 2004 IHE Interoperability Workshop5

NM ImageNM Image

NM PACS

Sept 13-15, 2004 IHE Interoperability Workshop6

NM ImageNM Image

NM PACS

Sept 13-15, 2004 IHE Interoperability Workshop7

NM ImageNM Image

Click and move mouse down to adjust window level, right to adjust window center

Sept 13-15, 2004 IHE Interoperability Workshop8

NM – The SolutionNM – The SolutionNew 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>

Connectathon to help test and confirm

Sept 13-15, 2004 IHE Interoperability Workshop9

NM – Actors and TransactionsNM – Actors and Transactions

Sept 13-15, 2004 IHE Interoperability Workshop10

NM Image ProfileNM Image Profile

Acquisition Modalities (Modality Images Stored [8]) Create NM objects as specified (additional attribute & vector

handling) Include specific codes in Cardiac studies

Evidence Creators (Creator Images Stored [18]) Create NM objects as specified (additional attribute & vector

handling) Include specific codes in Cardiac studies

Image Manager/Archives Store/Retrieve NM & Secondary Capture (SC & MFSC) Objects

Image Displays (Retrieve Images [16]) Display NM and Secondary Capture (SC & MFSC) Images Support specified display capabilities

Sept 13-15, 2004 IHE Interoperability Workshop11

Result Screen Export OptionResult Screen Export Option

Provides storage, retrieval and display of Static and Dynamic Result Screens

Based on the following DICOM Objects:• Secondary Capture• Multi-Frame Grayscale Byte Secondary Capture• Multi-Frame True Color Secondary Capture

Evidence Creators

Generate appropriate Secondary Capture objects from any Result Screens created.

Sept 13-15, 2004 IHE Interoperability Workshop12

Review OptionReview Option

Adds requirements to the Image Display to allow Review of NM Images

Image Displays

Must additionally support MPR Display, more frames, different series types together, etc.

Sept 13-15, 2004 IHE Interoperability Workshop13

PACS PACS →→ NM Workstation ? NM Workstation ?

No !

No filtering No ROI No TAC No renal, lung … processing No reframing No cardiac processing

Sept 13-15, 2004 IHE Interoperability Workshop14

Image DisplayImage Display

Support separate adjustment of upper and lower window levels

Show multiple cines

Display grayscale and color result screens

Display dynamic result screens

Apply local color tables to grayscale screens

Add color tables to system

Change intensity of grayscale result screens (strongly recommended)

Sept 13-15, 2004 IHE Interoperability Workshop15

Image DisplayImage Display

Must use “intelligent” scaling to avoid presenting postage-stamp size NM images Just because it was acquired at 64x64

doesn’t mean they want to review it at 64x64

Sept 13-15, 2004 IHE Interoperability Workshop16

Image DisplayImage Display

Must use “intelligent” scaling to avoid presenting postage-stamp size NM images

Must allow the user to select different vectors/framesets of complex multi-frame images

Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image”

Sept 13-15, 2004 IHE Interoperability Workshop17

Display FormatsDisplay Formats

Grid display

One image set

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

Fit display Multiple image sets

Comparison display Multiple image sets

Sept 13-15, 2004 IHE Interoperability Workshop18

Multiple CinesMultiple Cines

Sept 13-15, 2004 IHE Interoperability Workshop19

Multiple CinesMultiple Cines

Sept 13-15, 2004 IHE Interoperability Workshop20

More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://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