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New DICOM CT/ MR objects willenhance clinical radiologyBudapest, Hilton WestendTuesday, November 27th , 2005; 8:05 –8:25 a.m.1

New DICOM CT/ MR objects willenhance clinical radiologyKees VerduinPhilips Medical SystemsCo-Chair CT-MR Taskforce, Chair DICOM WG16 (MR)Co-author: Reinhard RufSiemens Medial SolutionsCo-Chair CT-MR Taskforce2

Abstract This presentation will describe the enhancedinteroperability for many clinical CT and MRapplications in distributed networks once thenew standard has been implemented in boththe modalities and in clinical workstations. We will summarize the results of the SCAR2005 session and familiarize those that havenot been involved so far with the future plansof the Enhanced CTCT-MR Taskforce for RSNA2005.3

Clinical 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/MR4

YESAll these questions can be answered with YESwhen both the modality and the PACSsupport the Enhanced CT or MR objects5

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 Privateattributes,6

What is the consequence? The Clinical Structure enables the combination of theattributes in functional groups. (this required a lot ofanalysis) The values in a Functional group may be equal for allimages in a series, or differ from image to image. The combination of images into frames of a multi-frameobject. The structure herewith provides context information7

19932003FunctionalGroups8

12N1NPixel values Frame 1-NnssioPer-FrameFrame 1-NnmeDiShared29

AssociationDBNetworking Performance1delay onlyImagine 10.000 images 10.000 delays of 1 sec 3 hoursDBDBDBStore, parse, checkC-Store requestDataset (attributes pixels)Implementation-dependent delayC-Store response (acknowledgement)10

More Clinical Informationavailable in less frameReal World Values 11

Diffusion Imaging“Diffusion b-values” from 0 to 8000 and an ADC image12

Diffusion Tensor Imaging dataReconstructed Fiber Maps in the colors as seen by the creator13

MR Perfusion Imagingtimenon perfusedstroke areaStoredvaluesReal WorldValue Slope(0040,9225)SignalReal WorldValue Intercept(0040,9224)RWvaluesdelayed perfusionQuantitative data with Real World Valuestime-to-peak map14

Cardiac Cine LoopsEnables automatic multi-slice / multi-phase display, even forstandard workstations15

Total body Imaging543211234516Display the correct image at the correct spot using Stacks and In-stack positions

Functional Brain Imaging 10-60 slices all slices measuredin one TR repeated 100-1000times to getsufficient signal leading to 60,000images in one objectStore thousands of images in one object and display them in aconsistent way using Multi-frame Header and Dimension Module17

Spectroscopy andSpectroscopic ImagingRelativeNAApeak-heightRatio ofCholineandCreatininepeaks18

New Standard’s Benefits Improved networking performance Improved context information Improved clinical information19

Vendors of CT-MR, Workstations &Archives prepare for implementation:Multi StackPrepare for Dimensions andDimension OrganizationsFrame Number11-1554In-Stack Position32Stack ID31Frame Number6-1054In-Stack Position321Stack ID2Frame Number1-55In-Stack PositionBH43261Stack ID11ConcatenationsLegend:Fixed HeaderPer-frame headerDimension data (not on scale)Pixel data (not on scale)Prepare the databases for large objects An object may be split up into two or more SOPInstances, using the same concatenation UID107Real World Values Relates the pixel value to the actual valueand unit it represents (e.g., velocity in mm/sec)Prepare for real-world TDisplayReal worldvalueReal WorldReal WorldValue LUT or Value InterceptDataand Slope(0040,9212)attributesValue UnitMeasurementUnits CodeSequence(0040,08EA)111Functional Color on Anatomic Grayscale ImagesPrepare the color pipelineRange ofStoredValues to bemapped tograyscaleModalityLUTLargestMonochromePixel ValueVOILUTRGBPLUTMapped to gray levelRGB values by displaydevice ColorDisplayPaletteColorNumberofentriesRange ofStoredValues to bemapped tocolor20.116

How to manage the transition . The DICOM Standards Committee and theDICOM Working groups for CT and MRhave decided for:– The creation of a facility to introduce and test thenew objects.– an educational program for users and vendorsThey have established a taskforce to arrange this.21

CT-MR Taskforce: activities Create CT-MR DICOM Test-tool (contracted toPixelMed (D.Clunie))–––––Create Sample Enhanced MR Image setsCreate Sample Enhanced CT Image setsDisplay of images and DICOM header tagsImport of enhanced image setsValidation tool for enhanced image sets Organize: Test and demonstrate “early andsuccessful” implementations at SCAR 200522

Ready For The New CT &MRI DICOM Standard?“The” Test and Demonstration sessionhosted by SCAR 2005,for the implementation and promotion of:– Enhanced CT Image– Enhanced MR Image– MR Spectroscopy data– Raw Data23

Participating companies/groups atSCAR 2005:–––––––––––Agfa,Dynamic ,Siemens,Toshiba,Vital Imaging (not demonstrating)24

Agenda for SCAR 2005 (Orlando) a testing session open to participating vendors only:– June 1st and 2nd a dedicated education session:– June 3rd 8:00-9:30 am 2 days of demonstration for all SCAR participants:– June 3rd 9:30 am – 4:30 pm and June 4th 9:30 am – 12 noon25

The New CT and MR DICOMObjects: Why All the Fuss?Brad EricksonDavid Clunie26

MRPhilipsGroup AWSjMRUIspectroCardiacCTSiemensPhilips SpectroImage ManagerMcKessonWSGECT ThoraxSiemens CT ThoraxHitachi AbdomenPhilips CardiacCTHitachiWSINFINITTAbdomen“Go and Return”Hitachi “Go and Return”Siemens CT Thorax 27

MRToshibaGroup Siemens PerfusionImage ManagerDynamic ImagingWSSiemensGE DiffusionWSAgfaToshiba Perfusion28

Supported options Dimensions (limitations on functional groups)Concatenations (max size per object)Real world mapping (LUT or Rescale Intercept)Color images (color only or mixed)29

Purpose 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 theirinfrastructure30

Dimension choicesSpaceSpaceNavigation in multi-dimensional datasets ?TimeTime Dimension Module gives a clue May be used by specialist systems Or they decide to take another orderStill there is some freedom in the construct of the dimension module31

How to deal with the freedom ofchoice ? 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 forthe development of Clinical Profiles32

Clinical Scenarios Cardiac CT and MR ,Perfusion,Multi-station Peripheral Angio,Diffusion,fMRISpectroscopy33

Promotion at RSNA RSNA 2005:––––Repeat and extension of SCAR demonstrationProvide 2-tier approachTier 1 for Technical Compliance with toolsTier 2 for Clinical Compliance with ScenariosEducational sessions daily at the booth34

RSNA Inforad c emens,Toshiba,35

Thank you36

enhance clinical radiology Budapest, Hilton Westend Tuesday, November 27 th, 2005; 8:05 -8:25 a.m. 2 New DICOM CT/ MR objects will enhance clinical radiology Kees Verduin . -McKesson, -Philips, -Siemens, -Toshiba, 36 Thank you. Title: Microsoft PowerPoint - B101_Ruf_New DICOM CT-MR objects will enhance clinical radiology.ppt