Integrating the Healthcare Enterprise Consistent Presentation of Images Integration Profile

February 8, 2005 IHE Europe Educational Event1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Consistent Presentation of ImagesConsistent Presentation of ImagesIntegration ProfileIntegration Profile

Ellie AvrahamEllie AvrahamKodak Health ImagingKodak Health Imaging

IHE Planning andIHE Planning and Technical CommitteesTechnical Committees


IHE Integration profilesIHE Integration profilesPatient

Informa-tion

Reconci-liation

,

Access to Radiology Information

Basic Security

-

Evidence

Documents

Key Image

Notes

Simple

Image and Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Consistent Presentation of

Images


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

The Grayscale Consistency The Grayscale Consistency Problem:Problem:


Problems of Display InconsistencyProblems of Display Inconsistency

mass visible mass invisible

VOI chosen on one display device

Rendered on another with different display

Mass expected to be seen is no longer seen

Slide Provided by David Clunie


Problems of Inconsistency in Problems of Inconsistency in Display Luminance rangeDisplay Luminance range

0.5

1.5

1.0

3.0

Not all display levelsare perceivable on alldevices



Problems of Inconsistency in Display Problems of Inconsistency in Display Luminance rangeLuminance range

0.5

1.5

1.0

3.0

Not all display levelsare perceivable on alldevices



Problems of Hardcopy-Softcopy InconsistencyProblems of Hardcopy-Softcopy Inconsistency

Digital Modality Laser Printer

Printed images don’t looklike displayed images



Causes of InconsistencyCauses of Inconsistency

1.0 .66

Display devicesvary in the maximumluminance they canproduce

Display CRT Luminance vs. Film Optical Density on a light box is an extreme example



Consistent Presentation of Images Consistent Presentation of Images IHE ObjectivesIHE Objectives

Consistent distribution of Images across the healthcare enterprise :

1. Consistency among Hardcopy Images Printed on different Printers (from different Vendors).

2. Consistency among Softcopy Images view on different display devices (from different Vendors).

3. Consistency among Hardcopy and Softcopy Image view

The cost effective solutionto ensure that image quality is maintained across

different monitors and film producing devices.


Consistent Presentation of Consistent Presentation of Images Requires: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

CalCal

HardHard

SoftSoft


Achieve Grayscale ConsistencyAchieve Grayscale Consistency in in Hardcopy Output and Softcopy ViewingHardcopy 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.

CalCal

Devices Have to Be Properly CalibratedDevices Have to Be Properly Calibrated


DICOM GSDF DICOM GSDF

.01

.1

1

10

100

1000

0 200 400 600 800 1000

Grayscale Standard Display Function

JND Index

Monitors

Film


CalCal

Mapping of the P-values to theview luminance or optical density value

Barten Model: preserves thehuman perceptual response based on eye contrast sensitivity


Standardizing a DisplayStandardizing a Display


CalCal

0.1

1

10

100

0 50 100 150 200 250

DDL or P-Values

Standard

Characteristic Curve


To Achieve Consistent Presentation of To Achieve Consistent Presentation of Images Printed, the DICOM Standard Images Printed, the DICOM Standard

Defines:Defines:

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

HardHard


Basic Print Request with Presentation LUTBasic Print Request with Presentation LUT

PrintComposer

PrintServer

DICOM Film Session N-CREATE

DICOM Film Box N-CREATE

DICOM Image Box N-SET

DICOM Film Box N-ACTION

DICOM Film Session N-ACTION

Print Status (DICOM N-EVENT-REPORT)

DICOM Presentation LUT N-CREATEDICOM Presentation LUT N-CREATEPrint Composer

Print Server

Print Request

Printer StatusHardHard

Print Presentation LUT


Basic Print Request with Presentation LUTBasic 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.

HardHard


To Achieve Consistent Presentation of To Achieve Consistent Presentation of Images, the DICOM Standard Defines:Images, the DICOM Standard Defines:

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.

SoftSoft


Consistent Presentation of ImagesConsistent Presentation of ImagesReporting Radiologist Referring Physician or

Reviewing Radiologist

Presentation StatePresentation LUT

Grayscale Standard

Original Image

Window Level

Flip

Zoom

Area Of

Interest

Annotate

WithoutConsistent Presentation

AchievingConsistent Presentation

Area Of

Interest

SoftSoft


DICOM Grayscale Image DICOM Grayscale Image Transformation ModelTransformation Model

Transformation

VOI LUT(Subtraction)

MaskModality

LUT

Transformation

Annotation

Image

Transformation

Shutter SpatialTransformation

Annotation

Disp. Area

Presentation LUT

Presentation LUT

Transformation

Window/Levelor VOI LUT

Rescale Slope/Interceptor Modality LUT

OriginalImage

DisplayP-Values

Grayscale Transformations

Shutter, Annotation and Spatial Transformations

SoftSoft


Image Creator

Modality Presentation

State Stored

9

AcquisitionModality

Creator Presentation

State Stored

19

Image Display

QueryPresentation State

15

RetrievePresentation State

17

ImageArchive

GSPS Stored, and Query/Retrieve GSPS Stored, and Query/Retrieve GSPSGSPS

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

SoftSoft


Acquire DisplayPrint

Consistent Presentation of ImagesConsistent Presentation of Images



More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://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