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Sept 13-15, 2004 IHE Interoperability Workshop1
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
Sept 13-15, 2004 IHE Interoperability Workshop2
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
Sept 13-15, 2004 IHE Interoperability Workshop3
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:
Sept 13-15, 2004 IHE Interoperability Workshop4
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
Sept 13-15, 2004 IHE Interoperability Workshop5
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
Slide Provided by David Clunie
Sept 13-15, 2004 IHE Interoperability Workshop6
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
Slide Provided by David Clunie
Sept 13-15, 2004 IHE Interoperability Workshop7
Problems of Hardcopy-Softcopy InconsistencyProblems of Hardcopy-Softcopy Inconsistency
Digital Modality Laser Printer
Printed images don’t looklike displayed images
Slide Provided by David Clunie
Sept 13-15, 2004 IHE Interoperability Workshop8
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
Slide Provided by David Clunie
Sept 13-15, 2004 IHE Interoperability Workshop9
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.
Sept 13-15, 2004 IHE Interoperability Workshop10
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
Sept 13-15, 2004 IHE Interoperability Workshop11
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
Sept 13-15, 2004 IHE Interoperability Workshop12
DICOM GSDF DICOM GSDF
.01
.1
1
10
100
1000
0 200 400 600 800 1000
Grayscale Standard Display Function
JND Index
Monitors
Film
Slide Provided by David Clunie
CalCal
Mapping of the P-values to theview luminance or optical density value
Barten Model: preserves thehuman perceptual response based on eye contrast sensitivity
Sept 13-15, 2004 IHE Interoperability Workshop18
Standardizing a DisplayStandardizing a Display
Slide Provided by David Clunie
CalCal
0.1
1
10
100
0 50 100 150 200 250
DDL or P-Values
Standard
Characteristic Curve
Sept 13-15, 2004 IHE Interoperability Workshop19
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
Sept 13-15, 2004 IHE Interoperability Workshop20
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
Sept 13-15, 2004 IHE Interoperability Workshop21
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
Sept 13-15, 2004 IHE Interoperability Workshop22
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
Sept 13-15, 2004 IHE Interoperability Workshop23
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
Sept 13-15, 2004 IHE Interoperability Workshop24
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
Sept 13-15, 2004 IHE Interoperability Workshop25
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
Sept 13-15, 2004 IHE Interoperability Workshop27
Acquire DisplayPrint
Consistent Presentation of ImagesConsistent Presentation of Images
Slide Provided by David Clunie
Sept 13-15, 2004 IHE Interoperability Workshop28
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