Title: Enhanced MR addresses Multi-Vendor interoperability issues in clinical radiology
1Enhanced MR addresses Multi-Vendor
interoperability issues in clinical radiology
- Kees Verduin,
- WG16-MR
- Philips Healthcare
2Problem Statement
- Multi Dimensional datasets create problems in a
multi-vendor environment.
3Content
- Enhanced MR Features /Benefits
- Multidimension storage
- From Chaos to Structure
- Dimension Module
- Clinical examples
- Implementation scenarios
- Conclusion
4A new Standard, since 2003
Enhanced DICOM (e.g. for MR,CT,XA,PET,..) with Di
mension Module
5Enhanced MR Features
Dimension Module
Real World Values
Multi-frame
Spectroscopy
Palette Color
Raw Data
Multi-stack
6Enhanced 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
7Enhanced 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
8Total body Imaging
9This is how these images were scanned !
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10This is how these images were scanned !
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11This is how these images were scanned !
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12This is how these images were scanned !
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13This is how these images were scanned !
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14This is how these images must be displayed !
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15This is how these images must be displayed !
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16This is how these images must be displayed !
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17This is how these images must be displayed !
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18This is how these images must be displayed !
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19Total Body Imaging display
20How to store the images ?
- for easy retrieval
- for consistent display
- for optimal interpretation of parameters
21Where 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 .. !)
22From 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.
23Where 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.
24What should be done ?
- There was a problem for (MR) users in a
multi-vendor environment. - This was specifically a dimension problem, that
has increased in importance over time. - Since 5 years there is already a solution !
- This is only slowly adopted by workstations and
PACS vendors. - Users should update their workstations and PACS
systems to support Enhanced DICOM.
25MR 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)
26There 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
27MR 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.
28Why 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.
29Increasing 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
30Multiple 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 ?
31Enhanced 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.
32Clinical example Perfusion One slice at many
time points
time
33Clinical example Perfusion One slice at many
time points
34Multi 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
35One Enhanced MR Image object
36Enhanced 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.
37Total body Imaging requiresDimension Attributes
Use Stack-ID and In-Stack Position Number for
correct display
38Other ExamplesDiffusion Imaging
Diffusion b-values from 0 to 8000 and an ADC
image
39Other Examples Cardiac Cine Loops
Enables automatic multi-slice / multi-phase
display, even for standard workstations
40Implementation Roadmap
- What if not all your systems are ready for
Enhanced DICOM ?
41The 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.
42Back 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)
43Action 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
44Conclusions
- 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
45Summary
- Enhanced DICOM solves Multi Vendor Dimension
problems. - Workstation and PACS vendors must implement
this. - Hospitals must invest in upgrades to fully
benefit.
46Further Information ?
- See
- Henri Matthijssen
- with his poster
- about the
- Philips Implementation
- of Enhanced MR