Integrating the Healthcare Enterprise Consistent Presentation of Images Integration Profile

1
Integrating the Healthcare Enterprise
Consistent Presentation of ImagesIntegration
Profile
Ellie Avraham Kodak Health Imaging IHE Planning
and Technical Committees
2
IHE Integration profiles

-


Access to Radiology Information

Basic Security


3
The Grayscale Consistency Problem

• The Visual Appearance of grayscale images
  displayed on different types of softcopy display
  devices or printed on different types of hardcopy
  output devices is in general inconsistent and may
  impact the clinical Diagnostics

4
Problems of Display Inconsistency
VOI chosen on one display device Rendered on
another with different display Mass expected to
be seen is no longer seen
mass visible
mass invisible
Slide Provided by David Clunie
5
Problems of Inconsistency in Display Luminance
range
0.5
1.0
Not all display levelsare perceivable on
alldevices
1.5
3.0
Slide Provided by David Clunie
6
Problems of Inconsistency in Display Luminance
range
0.5
1.0
Not all display levelsare perceivable on
alldevices
1.5
3.0
Slide Provided by David Clunie
7
Problems of Hardcopy-Softcopy Inconsistency
Printed images dont looklike displayed images
Slide Provided by David Clunie
8
Causes of Inconsistency
Display devicesvary in the maximumluminance
they canproduce Display CRT Luminance vs. Film
Optical Density on a light box is an extreme
example
1.0
.66
Slide Provided by David Clunie
9
Consistent Presentation of Images IHE Objectives

• Consistent distribution of Images across the
  healthcare enterprise
• Consistency among Hardcopy Images Printed on
  different Printers (from different Vendors).
• Consistency among Softcopy Images view on
  different display devices (from different
  Vendors).
• Consistency among Hardcopy and Softcopy Image view

The cost effective solution to ensure that image
quality is maintained acrossdifferent monitors
and film producing devices.
10
Consistent Presentation of Images Requires

• Calibration of the Softcopy Display and the
  Hardcopy Output Devices using DICOM Grayscale
  Standard Display Function
• Creating Hardcopy Output Using DICOM Basic Print
  with Presentation LUT Support
• Preserving/Using the Softcopy Display Viewing
  Parameters in the DICOM Grayscale Softcopy
  Presentation State container

Cal
Hard
Soft
11
Achieve Grayscale Consistency in Hardcopy Output
and Softcopy Viewing
The DICOM Standard Defines A standard curve,
the Grayscale Standard Display Function (GSDF),
against which different types of display and
hardcopy output devices should be calibrated
Adjust their Characteristic Curve to the GSDF
curve.
Cal
Devices Have to Be Properly Calibrated
12
DICOM GSDF
Cal
Barten Model preserves thehuman perceptual
response based on eye contrast sensitivity
Mapping of the P-values to theview luminance or
optical density value
Slide Provided by David Clunie
13
Perceptual Linearization
Cal
Despite different change in absolute luminance
Same number of Just Noticeable Difference Same
perceived contrast
Slide Provided by David Clunie
14
Cal
Printer Calibration Tools (Densitometer)
15
Cal
Display Calibration Tools (Photometer)
16
Monitor Characteristic Curve
Cal
Monitor Characteristic Curve
100
10
0.1
Ambient Light
0.01
0
50
100
150
200
250
300
Digital Driving Level
Slide Provided by David Clunie
17
Standard Display Function
Cal
Slide Provided by David Clunie
18
Standardizing a Display
Cal
Slide Provided by David Clunie
19
To Achieve Consistent Presentation of Images
Printed, the DICOM Standard Defines

• Basic Print Management with Presentation Look Up
  Table, for controlling the consistent appearance
  of preformatted images on printed output

Hard
20
Basic Print Request with Presentation LUT
Print
Print
Composer
Server
DICOM Film Session N-CREATE
Print Composer
Print Request
Print Presentation LUT
DICOM Film Box N-CREATE
DICOM Image Box N-SET
DICOM Film Box N-ACTION
DICOM Film Session N-ACTION
Print Server
Print Status (DICOM N-EVENT-REPORT)
Hard
Printer Status
21
Basic Print Request with Presentation LUT

• Print Composer A system that generates DICOM
  print requests as a DICOM Print SCU.Print
  composer has to apply image processing
  manipulations, and requests to Print server will
  specify P-Values in the form of a Presentation
  Look-Up Table (Presentation LUT) or implicitly by
  Presentation LUT Shape.
• Print Server A system that accepts and
  processes DICOM print requests as a DICOM Print
  SCP and performs image rendering on hardcopy
  media.The system must support pixel rendering to
  optical density according to the DICOM Grayscale
  Standard Display Function.

Hard
22
To Achieve Consistent Presentation of Images, the
DICOM Standard Defines
Soft
Grayscale Softcopy Presentation State (GSPS) an
object for storing and communicating the
parameters that describe how an image or set of
images should be displayed. A GSPS object
contains references to the images it applies to,
and the transformations (grayscale
transformations, shutter transformation, image
annotation, spatial transformations, and
displayed area annotation) that should be applied
when the images are presented on a softcopy
display, or printed on film.
23
Consistent Presentation of Images
Referring Physician or Reviewing Radiologist
Reporting Radiologist
Soft
Presentation State
Presentation LUT
Grayscale Standard
24
DICOM Grayscale Image Transformation Model
Soft
e
25
GSPS Stored, and Query/Retrieve GSPS

• IHE Transaction - an Acquisition Modality or
  Image Creator Actor sends a DICOM GSPS C-STORE
  request to an Image Archive Actor
• IHE Transaction - an Image Display Actor issues a
  C-FIND request to an Image Manager Actor
• IHE Transaction - an Image Display Actor issues a
  C-MOVE request to an Image Archive Actor

Soft
26
IHE requirement for Presentation State Specific
Query Matching and Return Keys
Soft
Query Keys Matching
Query Keys Return
Attribute Name
Tag
SCU
SCP
SCU
SCP
Presentation Label
(0070,0080)
O
O
R
R
Presentation Description
(0070,0081)
O
O
O
R
Presentation Creation Date
(0070,0082)
O
O
R
R
Presentation Creation Time
(0070,0083)
O
O
R
R
Presentation Creators Name
(0070,0084)
O
O
R
R
Referenced Series Sequence
(0008,1115)
O
O
R
R
gt Series Instance UID
(0020,000E)
O
O
O
R
gt Referenced Image Sequence
(0008,1140)
O
O
O
R
gtgt Referenced SOP Class UID
(0008,1150)
O
O
O
R
gtgt Referenced SOP Instance UID
(0008,1155)
O
O
O
R
27
Consistent Presentation of Images
Display
Print
Acquire
Slide Provided by David Clunie
28
More information.

• IHE Web sites
• http//www.himss.org/IHE
• http//www.rsna.org/IHE
• http//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