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New DICOM CT/ MR objects will New DICOM CT/ MR objects will
enhance clinical radiologyenhance clinical radiology
Budapest, Hilton Westend
Tuesday, November 27th , 2005; 8:05 –8:25 a.m.
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New DICOM CT/ MR objects will New DICOM CT/ MR objects will
enhance clinical radiologyenhance clinical radiology
Kees VerduinKees VerduinPhilips Medical SystemsPhilips Medical Systems
CoCo--Chair CTChair CT--MR Taskforce, Chair DICOM WG16 (MR)MR Taskforce, Chair DICOM WG16 (MR)
CoCo--author: Reinhard Rufauthor: Reinhard Ruf
Siemens Medial SolutionsSiemens Medial Solutions
CoCo--Chair CTChair CT--MR TaskforceMR Taskforce
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AbstractAbstract
• This presentation will describe the enhanced enhanced enhanced enhanced interoperabilityinteroperabilityinteroperabilityinteroperability for many clinical CT and MR applications in distributed networks once the new standard has been implemented in both the modalities and in clinical workstations.
• We will summarize the results of the SCAR 2005 session and familiarize those that have not been involved so far with the future plans of the Enhanced CTEnhanced CTEnhanced CTEnhanced CT----MR TaskforceMR TaskforceMR TaskforceMR Taskforce for RSNA 2005.
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Clinical QuestionsClinical Questions
• Can I store my research results with the clinical images,
without a separate server
• Can I store the raw data for a second reconstruction
• Can I store my Spectroscopy results?
• Can I separate the different Diffusion images
• Can I sort cardiac images according to their timing
• Can I improve the performance of transfer for CT/MR
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YESYES
All these questions can be answered with YES
when both the modality and the PACS
support the Enhanced CT or MR objects
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What is the difference?What is the difference?
• DICOM 1993
– contained many MR and CT attributes,
without much of a structure
• DICOM 2003
– contains more attributes,
but now with a clinically oriented structure.
– The new attributes remove the need for many Private
attributes,
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What is the consequence?What is the consequence?
• The Clinical Structure enables the combination of the attributes in functional groups. (this required a lot of analysis)
• The values in a Functional group may be equal for all images in a series, or differ from image to image.
• The combination of images into frames of a multi-frame object.
• The structure herewith provides context information
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Dataset (attributes+pixels)
C-Store response (acknowledgement)
C-Store request
A
s
s
o
c
i
a
t
i
o
n
Store, parse, check
DB DB DB
DB
ImplementationImplementation--dependent delaydependent delay
Imagine 10.000 images = 10.000 delays of 1 sec
Networking PerformanceNetworking Performance
1delay only
~3 hours~3 hours
11Multi-stack Color
Dimensions pr
ovide context Multi-frame
More Clinical InformationMore Clinical Information
available in less timeavailable in less time
Real World Values
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Diffusion Tensor Imaging dataDiffusion Tensor Imaging data
Reconstructed Fiber Maps in the colors as seen by the creator
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MR Perfusion ImagingMR Perfusion Imagingtime
non perfusedstroke area
Signal delayed perfusion
time-to-peak map
Real World
Value Slope
(0040,9225)
Real World
Value Intercept
(0040,9224)
RW
values
Stor
ed
valu
es
Quantitative data with Real World Values
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Cardiac Cine LoopsCardiac Cine Loops
Enables automatic multi-slice / multi-phase display, even for
standard workstations
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Total body ImagingTotal body Imaging
Display the correct image at the correct spot using Stacks and In-stack positions
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3
4
1 2 3 54
2
5
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Functional Brain ImagingFunctional Brain Imaging
• 10-60 slices
• all slices measured in one TR
• repeated 100-1000 times to get sufficient signal
• leading to > 60,000images in one object
Store thousands of images in one object and display them in a
consistent way using Multi-frame Header and Dimension Module
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Relative
NAA
peak-height
Ratio of
Choline
and
Creatinine
peaks
Spectroscopy andSpectroscopy and
Spectroscopic ImagingSpectroscopic Imaging
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New Standard’s BenefitsNew Standard’s Benefits
• Improved networking performance
• Improved context information
• Improved clinical information
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Vendors of CTVendors of CT--MR, Workstations & MR, Workstations &
Archives prepare for implementation:Archives prepare for implementation:
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Functional Color on Anatomic Grayscale Images
....
Palette
Color
Number
of
entries
Range of
Stored
Values to be
mapped to
grayscale
Range of
Stored
Values to be
mapped to
color
R G B
Largest
Monochrome
Pixel Value
Modality
LUT
Color
Display
Mapped to gray level
RGB values by display
deviceVOI
LUT
P-
LUT
+Prepare the color pipeline
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Concatenations
• An object may be split up into two or more SOP
Instances, using the same concatenation UID
Legend:
Pixel data (not on scale)
Dimension data (not on scale)
Per-frame header
Fixed Header
Prepare the databases for large objects
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Real World Values
• Relates the pixel value to the actual value
and unit it represents (e.g., velocity in mm/sec)
Value Unit
StoredValues
RealValueLUT
VOILUT
PLUT Display
Real worldvalue
Modality
LUT
MeasurementUnits CodeSequence(0040,08EA)
Real WorldValue LUTData
(0040,9212)
Real WorldValue Interceptand Slopeattributes
or
Prepare for real-world values
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Multi Stack
Stack ID3
Frame Number1 - 5
Frame Number
6-10
Frame Number11-15
54321
In-Stack Position
Stack ID2
Stack ID1
54321
In-Stack Position
54321
In-Stack Position
BH
Prepare for Dimensions and
Dimension Organizations
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How to manage the transition ...How to manage the transition ...
•• The DICOM Standards Committee and the The DICOM Standards Committee and the
DICOM Working groups for CT and MR DICOM Working groups for CT and MR
have decided for: have decided for:
– The creation of a facility to introduce and test the facility to introduce and test the
new objects. new objects.
– an educational programeducational program for users and vendors
They have established a taskforcetaskforce to arrange this.
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CTCT--MR Taskforce: activitiesMR Taskforce: activities
•• Create CTCreate CT--MR DICOM TestMR DICOM Test--tool (contracted to tool (contracted to PixelMed (D.Clunie))PixelMed (D.Clunie))
– Create Sample Enhanced MR Image sets
– Create Sample Enhanced CT Image sets
– Display of images and DICOM header tags
– Import of enhanced image sets
– Validation tool for enhanced image sets
•• Organize: Organize: TTest and demonstrate “early and est and demonstrate “early and successful” implementations at SCAR 2005successful” implementations at SCAR 2005
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““The” Test and Demonstration session The” Test and Demonstration session
hosted by SCAR 2005,hosted by SCAR 2005,
for the implementation and promotion of:for the implementation and promotion of:
–– Enhanced CT ImageEnhanced CT Image
–– Enhanced MR ImageEnhanced MR Image
–– MR Spectroscopy dataMR Spectroscopy data
–– Raw DataRaw Data
Ready For The New CT & Ready For The New CT &
MRI DICOM Standard? MRI DICOM Standard?
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Participating companies/groups at Participating companies/groups at
SCAR 2005:SCAR 2005:– Agfa,
– Dynamic Imaging,
– GE,
– Hitachi,
– INFINITT,
– jMRUI,
– McKesson,
– Philips,
– Siemens,
– Toshiba,
– Vital Imaging (not demonstrating)
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Agenda for SCAR 2005 (Orlando)Agenda for SCAR 2005 (Orlando)
•• a testing session open to participating vendors only: a testing session open to participating vendors only:
–– June 1June 1stst and 2and 2ndnd
•• a dedicated education session: a dedicated education session:
–– June 3June 3rdrd 8:008:00--9:30 am9:30 am
•• 2 days of demonstration for all SCAR participants: 2 days of demonstration for all SCAR participants:
–– June 3June 3rdrd 9:30 am 9:30 am –– 4:30 pm and June 44:30 pm and June 4th th 9:30 am 9:30 am –– 12 noon12 noon
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Group AGroup A
Image Manager
McKesson
MR
Philips
WS
INFINITT
WS
jMRUI
CT
Siemens
WS
GE
CT
Hitachi
spectro
Philips SpectroCardiac
Hitachi Abdomen
Hitachi “Go and Return” Abdomen
“Go and Return”
CT Thorax Siemens CT Thorax
Philips Cardiac
Siemens CT Thorax
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Group BGroup B
Image Manager
Dynamic Imaging
MR
GE
MR
Siemens
WS
Agfa
WS
Philips
WS
Siemens
MR
Toshiba
perfusion
Siemens Perfusion
diffusion
perfusion
Toshiba Perfusion
GE Diffusion
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Supported optionsSupported options
• Dimensions (limitations on functional groups)
• Concatenations (max size per object)
• Real world mapping (LUT or Rescale Intercept)
• Color images (color only or mixed)
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Purpose of the test and demo sessionPurpose of the test and demo session
• Show that it works
• Show the benefits
• Explain that users have to invest,
if they want the benefits in their
infrastructure
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Dimension choicesDimension choices
SpaceSpace
TimeTimeNavigation in multiNavigation in multi--dimensional datasets ?dimensional datasets ?
• Dimension Module gives a clue
• May be used by specialist systems
• Or they decide to take another order
Still there is some freedom in the construct of the dimension moStill there is some freedom in the construct of the dimension moduledule
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How to deal with the freedom of How to deal with the freedom of
choice ?choice ?
• Provide Clinical Scenarios
• Ask vendors to adhere to them
• Get feedback from clinical users
• At InfoRad at RSNA 2005
• After that provide the adapted scenarios to IHE for
the development of Clinical Profiles
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Clinical ScenariosClinical Scenarios
• Cardiac CT and MR ,
• Perfusion,
• Multi-station Peripheral Angio,
• Diffusion,
• fMRI
• Spectroscopy
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Promotion at RSNAPromotion at RSNA
•• RSNA 2005: RSNA 2005:
– Repeat and extension of SCAR demonstration
– Provide 2-tier approach
– Tier 1 for Technical Compliance with tools
– Tier 2 for Clinical Compliance with Scenarios
Educational sessions daily at the booth
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RSNA RSNA InforadInforad ParticipantsParticipants
– Agfa,
– Dynamic Imaging,
– Hitachi,
– INFINITT,
– jMRUI,
– McKesson,
– Philips,
– Siemens,
– Toshiba,