Enhanced MR addresses Multi-Vendor interoperability issues in clinical radiology - PowerPoint PPT Presentation

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Enhanced MR addresses Multi-Vendor interoperability issues in clinical radiology

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It will not be easy, if not impossible, to solve this in a standard. ... Why is it different for every scanner vendor ? 31. Enhanced DICOM, MultiFrame ... – PowerPoint PPT presentation

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Title: Enhanced MR addresses Multi-Vendor interoperability issues in clinical radiology


1
Enhanced MR addresses Multi-Vendor
interoperability issues in clinical radiology
  • Kees Verduin,
  • WG16-MR
  • Philips Healthcare

2
Problem Statement
  • Multi Dimensional datasets create problems in a
    multi-vendor environment.

3
Content
  1. Enhanced MR Features /Benefits
  2. Multidimension storage
  3. From Chaos to Structure
  4. Dimension Module
  5. Clinical examples
  6. Implementation scenarios
  7. Conclusion

4
A new Standard, since 2003
Enhanced DICOM (e.g. for MR,CT,XA,PET,..) with Di
mension Module
5
Enhanced MR Features
Dimension Module
Real World Values
Multi-frame
Spectroscopy
Palette Color
Raw Data
Multi-stack
6
Enhanced MR Benefits
  • Transport Performance
  • through new Multi-Frame concept
  • Better scan information
  • new attributes for new scan techniques
  • Better Interoperability
  • through more strict attribute rules
  • Context Information
  • Dimension Module
  • From chaos to structure

7
Enhanced MR Benefits
  • Transport Performance
  • through new Multi-Frame concept
  • Better scan information
  • new attributes for new scan techniques
  • Better Interoperability
  • through more strict attribute rules
  • Context Information
  • Dimension Module
  • From chaos to structure

8
Total body Imaging
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This is how these images were scanned !
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This is how these images were scanned !
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This is how these images were scanned !
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This is how these images were scanned !
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This is how these images were scanned !
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This is how these images must be displayed !
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This is how these images must be displayed !
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This is how these images must be displayed !
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This is how these images must be displayed !
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This is how these images must be displayed !
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Total Body Imaging display
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How to store the images ?
  • for easy retrieval
  • for consistent display
  • for optimal interpretation of parameters

21
Where to find the relevant data ?
  • DICOM images are sent as separate objects.
  • The relationship between the objects must be
    searched in Series attributes in these objects
  • Like Series Number, Series Description,
    Protocol Name, Sequence Name.
  • Despite 25 years of Image Format standardization,
    useful values for these attributes are not
    standardized !
  • It will not be easy, if not impossible, to solve
    this in a standard.
  • Interpretation of image information is especially
    difficult when the objects are from different
    series.
  • Also when the relevant attributes themselves do
    not exist in the DICOM standard. (private
    attributes like number of .. !)

22
From Chaos to Structure
  • Before Enhanced MR there was no standard way
    to solve this.
  • Now Enhanced DICOM for MR (and also for
    CT/XA/RF/PET etc..) can structure a dataset by
  • packaging all images in one object
  • and
  • using specific and better standardized
    attributesfor the organization.
  • The Dimension Module can disclose the
    organization of the dataset to the receiving
    application.

23
Where is the structure needed ?
  • In fact, this affects ALL Workstation SW
    implementations !

Note in this presentation most examples are from
MR, but similar problems exist for other
modalities.
24
What should be done ?
  1. There was a problem for (MR) users in a
    multi-vendor environment.
  2. This was specifically a dimension problem, that
    has increased in importance over time.
  3. Since 5 years there is already a solution !
  4. This is only slowly adopted by workstations and
    PACS vendors.
  5. Users should update their workstations and PACS
    systems to support Enhanced DICOM.

25
MR creates, conceptually, a Multi-Dimensional
Image dataset
  • Combinations of changing parameters create a
    whole space of images, which is defined by
    different dimensions.

(Typical numbers)
Echo (1-20)
Time (30-10.000)
Position (1-1000)
Diffusion b-Value (3-10)
Image type (1-3)
Any parameter (x)
26
There is an endless number of combinations and
more .
  • Multi-Direction Diffusion scans
  • changing Diffusion gradient directions
  • Multi-Slice Dynamic scans
  • changing anatomic position
  • Multi-Slice Perfusion scans
  • changing contrast over time
  • Multi-Slice Cardiac imaging
  • synchronized with the heart phase
  • Multi-Slice Multi-Echo scans
  • Multi-Slice EPI (Echo Planar Imaging) scans
  • And more

27
MR creates, conceptually, aMulti-Dimensional
Image dataset
  • MR Scanners and MR Workstations from single
    vendors have dealt with this, in the classic
    DICOM MR Images.
  • The penalty was
  • the use of private attributes for
    identificationand
  • vendors using different strategies for separating
    images into separate series.

28
Why was this not so much a problem in the past?
  • Most users had scanners and workstations from one
    vendor.
  • The storage choices were known by their own
    workstation SW Engineers.
  • The third-party workstation vendors had to
    reverse-engineer the separation strategies.

29
Increasing importance due to larger Enterprises
  • More and more hospitals are merging into bigger
    Healthcare Enterprises.
  • Users have more scanners and workstations from
    different vendors.
  • New Independent Workstations
  • New Independent PACS systems

30
Multiple images of the same slice,most likely in
different series.
  • This leads to display problems for reading
    radiologists
  • How can I see the values of the parameters that
    make the images different ?
  • How does my workstation organize the images that
    belong together ?
  • Why is it different for every scanner vendor ?

31
Enhanced DICOM, MultiFrame with Dimension Modules
  • All images are stored as frames in one image
    object.
  • Attributes may change from frame to frame.
  • Attributes that are important for the display
    order of the frames, will be structured in the
    Dimension Module by the creator.
  • This provides an explicit display scenario for
    the frames in the Enhanced (MR) object.
  • This scenario can be used by viewing systems,
    even without specific (MR) application knowledge.
  • It is vendor independent.

32
Clinical example Perfusion One slice at many
time points
time
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Clinical example Perfusion One slice at many
time points
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Multi dimensional datasetsOrganization Attributes
  • Example Multi-slice Multi-time acquisitions
  • Every Frame has
  • a slice order attribute value (In-Stack Position
    Number) and a time order attribute value
    (Trigger Delay Time).
  • These attributes are used as index in the
    Dimension Module.
  • The Dimension Module gives herewith the default
    display order

35
One Enhanced MR Image object
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Enhanced MR, supports the Multi-Dimension
structure
  • All images stay together in one object.
  • The Dimension Module describes all relevant
    dimensions and indicates the priority for the
    display order.
  • A dedicated workstation may deviate from the
    suggested image ordering, by moving lower ranked
    dimensions upwards.

37
Total body Imaging requiresDimension Attributes
Use Stack-ID and In-Stack Position Number for
correct display
38
Other ExamplesDiffusion Imaging
Diffusion b-values from 0 to 8000 and an ADC
image
39
Other Examples Cardiac Cine Loops
Enables automatic multi-slice / multi-phase
display, even for standard workstations
40
Implementation Roadmap
  • What if not all your systems are ready for
    Enhanced DICOM ?

41
The Negotiation scenario
PACS can not send and must cancel !
MR decides to send Enhanced object
Archive
MR
Negotiate
Negotiate
Negotiate
Workstation
MR decides to send the Classic MR object
Conclusion One can not configure a PACS for
Enhanced MR, as long as it is not supported in
the diagnostic workflow.
42
Back to Square one ?
MR decides to send the Classic MR object
PACS decides to send the Classic MR object
Archive
MR
Negotiate
Negotiate
Workstation
Conclusion No support for Enhanced MR (and
chaos continues)
43
Action requiredAdapt the workstations !
PACS can not send and must cancel !
PACS decides to send Enhanced object !
MR decides to send Enhanced object
Archive
MR
Negotiate
Negotiate
Workstation
Action Replace the blocking (part of the)
Workstations
44
Conclusions
  • All Workstations and all Image Managers should
    support and use Enhanced DICOM SOP Classes with
    the Dimension Module.
  • Enhanced (MR) objects exist worldwide.gt1600 MR
    systems are waiting to send their data.
  • Only then, the clinical users can benefit from
    the other features of Enhanced Objects

45
Summary
  • Enhanced DICOM solves Multi Vendor Dimension
    problems.
  • Workstation and PACS vendors must implement
    this.
  • Hospitals must invest in upgrades to fully
    benefit.

46
Further Information ?
  • See
  • Henri Matthijssen
  • with his poster
  • about the
  • Philips Implementation
  • of Enhanced MR
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