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DICOM and NM: The IHE Nuclear Medicine Profile

DICOM and NM: The IHE Nuclear Medicine Profile. Jerold Wallis, MD. NM Image. NM. PACS. NM Image. NM. PACS. NM Image Problem. Click and move mouse down to adjust window level, right to adjust window center. RSNA HIMSS Vendors. Achieving Real-World Interoperability

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DICOM and NM: The IHE Nuclear Medicine Profile

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  1. DICOM and NM:The IHE Nuclear Medicine Profile Jerold Wallis, MD

  2. NM Image NM PACS

  3. NM Image NM PACS

  4. NM Image Problem Click and move mouse down to adjust window level, right to adjust window center

  5. RSNA HIMSS Vendors Achieving Real-World Interoperability Uses existing standards (DICOM etc) to define specific ways of meeting clinical needs IHE “Profiles” Integrating the Healthcare Enterprise

  6. Profiles • Users document need • Vendors agree on how to address that need • Uniform implementation • Documentation • Opportunity for testing • Users can ask for the profile

  7. NM Profile • New for 2004 • Vendors will evaluate and implement over the summer • Testing in January

  8. Explains the DICOM NM image format NM IOD (PET IOD) Multiframe Dynamic Anterior Posterior Multi-energy NM Image • Image vectors NM ProfilePart I—Informative

  9. Image creators Processing stations Storage devices Image displays Participation is voluntary Must support features if claim compliance NM ProfilePart II—Required • Review option • + SPECT display • Result screen export option • Gated & Static processed screens

  10. Image Displays • Must support separate adjustments of upper and lower window levels

  11. Image Displays • Must use “intelligent” scaling to avoid presenting postage-stamp size NM images

  12. Image Displays • Must use “intelligent” scaling to avoid presenting postage-stamp size NM images • Must allow the user to separate out different vectors of complex multi-frame images • Must allow the user to separately adjust intensity for different framesets (eg, phases) in the same “image”

  13. Display Formats • Grid display • One image set • Fit display • Multiple image sets • Comparison display • Multiple image sets • (SPECT display) • Review option

  14. Multiple Cines

  15. Multiple Cines

  16. PACS  NM Workstation ? • No ! • No filtering • No ROI • No TAC • No renal, lung … processing • No reframing • No cardiac processing

  17. Image types Projections Transaxials Short axis  Vertical long  Horizontal long  Patient states Stress  Rest  Reinjection  Redistribution  Delayed redistribution  Cardiac Issues: Image Creator(Acquisition system)

  18. Angle encoding Oblique slices Short axis stacking order  Apex-to-base Use Patient state  and image type  codes Image selection Output of processed screens (for PACS) Static Gated (Result Screen export option) Cardiac Issues: Evidence Creator(Processing station)

  19. Cardiac Issues: Image Display(PACS Display) • Show multiple cines • Display grayscale and color result screens • Display cine result screens • Apply local color tables to grayscale screens • Add color tables to system • Change intensity of grayscale result screens • (strongly recommended)

  20. Image Storage Provider • Store NM images • Retrieve NM images • Complete with private header info

  21. But Wait, There’s More • NM Image Profile • 50 pages • Technical • Available at www.rsna.org/IHE/ • CAIC Web site • gamma.wustl.edu/caic.html  www.snm.org/caic

  22. What’s Missing: PET NM PACS

  23. What’s Missing: PET / CT • PET fusion profile • Next year?

  24. Action Needed: By You Ask for the NM Image Profile NM Vendors Cardiac software authors PACS

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