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 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 IHE Interoperability Workshop

4. General NM Viewing Suboptimal NM PACS IHE Interoperability Workshop

5. General NM Viewing Suboptimal NM PACS IHE Interoperability Workshop

6. General NM Viewing Suboptimal Click and move mouse down to adjust window level, right to adjust window center IHE Interoperability Workshop

7. 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 IHE Interoperability Workshop

8. New this year ! • Cardiac option • Better addresses cardiac needs • Minor restructuring of remaining profile • General NM option • MPR option • (Review option retired) • (Comparison display eliminated) IHE Interoperability Workshop

9. 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 > IHE Interoperability Workshop

10. 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

11. NM ImageTransaction Diagram IHE Interoperability Workshop

12. 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 IHE Interoperability Workshop

13. 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

14. 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 IHE Interoperability Workshop

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

16. 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

17. 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

18. 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

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

20. 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. IHE Interoperability Workshop

21. Short axis ACC NM Display Example • Vertical Long • Horizontal Long IHE Interoperability Workshop

22. Short ACC NM Display Example Stress Rest Stress Rest • Vertical Stress Rest • Horizontal Stress Rest IHE Interoperability Workshop

23. Another ACC Display Example • Different Layout • Same stress and rest views IHE Interoperability Workshop

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

25. Result Screen Export Option IHE Interoperability Workshop

26. 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

27. 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

28. 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