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					                                                                 North American 2010
                                       Connectathon & Interoperability Showcase Series

                                                                    Radiology Update
                                                         Profiles for Media Exchange

                      Chris Lindop
                      Interoperability & Standards Mgr
                      GE Healthcare
                      Radiology Committee Co-chair

June-September 2009            
       Profiles for Imaging Media Exchange
IHE two core profiles for Imaging media exchange
  Portable Data for Imaging (PDI)
    Standardize CD media
  Import Reconciliation Workflow
    Fix demographics, IDs and codes

Now include:
  Portable Data for Imaging (PDI) – Extensions
    New media(DVD & USB), Compression & Security
  IHE Basic Image Review (BIR) Profile
    Baseline behavior for viewer software

Portable Data for Imaging (PDI)– Value Statement

 Easier, perhaps.

  You may be part of the problem.
Portable Data for Imaging (PDI)– Value Statement


Portable Data for Imaging (PDI)

       Portable Data for Imaging (PDI)

   Compatibility requirements
     Standard CD format and file system
     Consistent disc organization
     Use most generic DICOM media profile
     Images MUST be present in DICOM
       o   May have copies as “web content” (i.e. JPEGs)
     Avoid most common mistakes (highlighted)

                       PDI –Extensions

   Additional Media:

   Compression
     Optionally allowed
       •   Both Lossless and lossy specified; but lossless is recommended
     On-board “Sender Software” recommended.
     Optionally allowed; password-based or key-based
     Please consider support needs before creating

                   PDI –Extensions

          Sending Software

                1) Insert CD; Run Sending Software

                            2) “Enter Password:”
                            3) Sending Software Decrypts CD Images
                            4) “Enter Destination:”
                            6) Sending Software decompresses &
                                     convertsImages (as needed)

5) DICOM Association          7) Send Images (C-STORE)

      PDI - Extensions Actors/Transactions

New Actor for PDI

 Portable Media

                                   New Media type Options
  Baseline Media: CD
    DICOM STD-GEN-CD Media Application Profile

  New Media Options:
    DVD Option
       •   Creator Uses DICOM STD-GEN-DVD-JPEG or
       •   DICOM STD-GEN-DVD-J2K Media Application Profile*
    USB Option
       •   Creator UsesDICON STD-GEN-USB-JPEG or
       •   DICON STD-GEN-USB-J2K Media Application Profile*

  Both options include support for compression
    JPEG lossy and lossless
    JPEG 2000 reversible and irreversible

NOTE: DVD option will allow for CD Compression
            * Importer must support both Media Application Profiles
                           Privacy Protection Options
Privacy Protection Options
  Standard Password-Based Encryption (PBE)
  RSA Public Key Infrastructure (PKI)
Use the secure DICOM Media Application Profiles
Options require encryption of all DICOM files
  including the DICOMDIR, and any files with Patient identifiable
Note: Options NOT compatible with the Web Option
Media supplied viewers or sending SW must be capable of requesting
  password (PBE option) or
  use the RSA private key (PKI Option)

                    Portable Media Sender Option
Required when disk is encrypted (Privacy Protection Option)

  Only required to be capable of decryption if encrypted

  decrease risk of unreadable data by recipient

Transfers objects on the media

  to an Image Manager and/or Report Manager

Reconciles key patient and study attributes

Decompresses instances if necessary

Decrypts instances if necessary

Required to convert multi-frame to single frame if necessary

Import Reconciliation Workflow (IRWF)

Import Reconciliation Workflow – Value Statement

   “The Images are in the PACS but are messed up”
     The patient ID is wrong, it doesn’t come up in a query
     I can’t hang the new images with the old
     The unknown procedure codes mess up my hanging protocols
     The images aren’t linking to the EMR.
      Patient’s chart won’t come up
   Impact:
     Lost time
     Incomplete data
     Drags on effectiveness

Import Reconciliation Workflow (IRWF)

   During image import, details are fixed to match
    (or not conflict with) local values
     Patient IDs, Name
     Procedure Codes, Accession Numbers, etc.

   Two ways of getting demographics
     DICOM Worklist Query
     HL7 Patient Demographics Query

            Basic Image Review (BIR)

   BASIC Image Review
   Defines a Baseline
     Feature set
     Look and feel
     Performance*
     Minimum Platform*

   “Advanced” Button = Show me what else you can do

* PDI-Basic viewer Option only

Basic Image Review ( BIR) - Value Statement

      Basic Image Review (BIR) – Value Statement
   Facilities distribute images; Physicians review them
     Often a physician has own viewer but may need to rely on the
       media-supplied viewer
   Rising frustration; too often the viewer:
     requires installation on a locked down machine
     does not successfully run
     starts up too slowly
     does not successfully load the images
     warns the images are of “non-diagnostic quality”
     is missing some basic critical function
     has Yet Another GUI where basic operations are non-obvious

   Impact:
     delayed care, inaccessible information, repeat examination and
       irradiation, and poor use of valuable clinician time.

             Basic Image Review (BIR)
   Trial Implementation Spec released

   Potential applications of BIR Spec.
     Media Viewer (PDI Option)
       o Requires a BIR Compliant viewer be placed on media

     Clinician’s Desktop Viewer
     Basic Radiology Review Station
     Web Portal

                                                             SOP Class Support
   SOP Class UID                                     SOP Class Name
1.2.840.10008.      Computed Radiography Image Storage
1.2.840.10008.      CT Image Storage
1.2.840.10008.    Digital X-Ray Image Storage – For Presentation
1.2.840.10008.      MR Image Storage
1.2.840.10008.    Multi-frame Grayscale Byte Secondary Capture Image Storage
1.2.840.10008.    Multi-frame Grayscale Word Secondary Capture Image Storage
1.2.840.10008.    Multi-frame Single Bit Secondary Capture Image Storage
1.2.840.10008.    Multi-frame True Color Secondary Capture Image Storage
1.2.840.10008.     Nuclear Medicine Image Storage
1.2.840.10008.    Positron Emission Tomography Image Storage
1.2.840.10008.      Secondary Capture Image Storage
1.2.840.10008.    Ultrasound Image Storage
1.2.840.10008.    Ultrasound Multi-frame Image Storage
1.2.840.10008.   X-Ray Angiographic Image Storage
1.2.840.10008.   X-Ray Radiofluoroscopic Image Storage

    PDI Basic Viewer Option - requires only SOP Class support on media
    non-PDI requires a partial display requirement for SOP classes not listed

                     Simple Restricted Feature Set
Display of grayscale and color images from any modality
basic grayscale or color rendering of the images as encoded
    without additional image processing
visual navigation of series through the use of thumbnails
side-by-side comparison of at least two sets of image
    with synchronized scrolling, panning and zooming
annotation of laterality, of body part and sagittal side, orientation
Simple nuclear medicine windowing mode
spatial localization of cross-sectional images
annotation of demographics, management and basic technique
simple measurements of linear distance and angle
cine capability
    Example: cardiac US, XA, CT or MR
Reference ICONS are provided to enhance common look & feel
                               Performance Requirements
   Benchmark                   Target for Large Target for Small
                                   Dataset          Dataset
 Start-up to ready to select            60 seconds                    30 seconds
 Series thumbnail select to      2 seconds for any series              2 seconds
 first image of series                                               for any series
 Series thumbnail select to      20 seconds for 311 slice      10 seconds for 21 slice MR
 last image of series               PET/CT CT series                 localizer series
 Select different series         2 seconds for any series       2 seconds for any series
 Scroll frame rate              30 slices/per second for 311              n.a.
                               slice PET/CT 512x512x12 bit
                                          CT series
 Zoom time                             0.5 seconds                        n.a.
                                   for1880 x 2016 DX
                                   PA Chest 20051208
 Window center and width        approximately 0.1 seconds                 n.a.
 change response time.         (near visually imperceptible)
                                   for1880 x 2016 DX
                                   PA Chest 20051208
   PDI- BIR Option Only
   Reference platform and image set specified for testing
   Large data-set and small data set available in the IHE website
June - September 2009