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Consistent Presentation of Images Integration Profile Charles Parisot GE Medical Systems IT Planning and Consistent Presentation of Images Integration Profile Charles Parisot GE Medical Systems IT Planning and Technical Radiology Committees

IHE Integration profiles Patient Information Reconciliation Scheduled Workflow , Charge Posting - Presentation Post. IHE Integration profiles Patient Information Reconciliation Scheduled Workflow , Charge Posting - Presentation Post. Reporting of Grouped Processing Workflow Procedures Workflow Consistent Presentation of Evidence Images Documents Key Image Notes Access to Radiology Information Basic Security HIMSS/RSNA April 2003 Workshop Simple Image and Numeric Reports

The Grayscale Consistency Problem: l The appearance of grayscale images displayed on different types The Grayscale Consistency Problem: l The 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 at times may impact clinical perception HIMSS/RSNA April 2003 Workshop

Problems of Inconsistency VOI chosen on one display device Rendered on another with different Problems of Inconsistency VOI chosen on one display device Rendered on another with different display Mass expected to be seen is no longer seen mass visible mass invisible Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Problems of Inconsistency 0. 5 1. 0 Not all display levels are perceivable on Problems of Inconsistency 0. 5 1. 0 Not all display levels are perceivable on all devices 1. 5 3. 0 Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Problems of Inconsistency 0. 5 1. 0 Not all display levels are perceivable on Problems of Inconsistency 0. 5 1. 0 Not all display levels are perceivable on all devices 1. 5 3. 0 Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Problems of Inconsistency Digital Modality Printed images don’t look like displayed images Slide Provided Problems of Inconsistency Digital Modality Printed images don’t look like displayed images Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop Laser Printer

Causes of Inconsistency Display devices vary in the maximum luminance they can produce Display Causes of Inconsistency Display devices vary in the maximum luminance they can produce Display CRT vs. film on a light box is an extreme example 1. 0 . 66 Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Consistent Presentation of Images IHE Objectives Consistent distribution of Images across the healthcare enterprise Consistent Presentation of Images IHE 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 solution to ensure that image quality is maintained across different monitors and film producing devices. HIMSS/RSNA April 2003 Workshop

Consistent Presentation of Images Requires: l Calibration of the Softcopy Display and the Hardcopy Consistent Presentation of Images Requires: l Calibration of the Softcopy Display and the Hardcopy Output Devices using DICOM Grayscale Standard Display Function l Creating Hardcopy Output Using DICOM Basic Print with Presentation LUT Support l Preserving/Using the Softcopy Display Viewing Parameters in the DICOM Grayscale Softcopy Presentation State Cal Hard Soft HIMSS/RSNA April 2003 Workshop

Achieve Grayscale Consistency in Hardcopy Output and Softcopy Viewing Cal The DICOM Standard Defines: Achieve Grayscale Consistency in Hardcopy Output and Softcopy Viewing Cal 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 Devices Have to Be Properly Calibrated HIMSS/RSNA April 2003 Workshop

Cal DICOM GSDF Grayscale Standard Display Function 1000 Film 100 10 Monitors 1 0 Cal DICOM GSDF Grayscale Standard Display Function 1000 Film 100 10 Monitors 1 0 200 400 600 800 1000 preserves the human perceptual response based on eye contrast sensitivity . 1 . 01 JND Index Mapping of the P-values to the view luminance or optical density value HIMSS/RSNA April 2003 Workshop Slide Provided by David Clunie

Cal Perceptual Linearization Grayscale Standard Display Function 1000 Despite different change in absolute luminance Cal Perceptual Linearization Grayscale Standard Display Function 1000 Despite different change in absolute luminance 100 10 1 0 200 400 600 800 1000 . 1 . 01 JND Index Same number of Just Noticeable Difference == Same perceived contrast Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Cal Printer Calibration Tools (Densitometer) HIMSS/RSNA April 2003 Workshop Cal Printer Calibration Tools (Densitometer) HIMSS/RSNA April 2003 Workshop

Cal Display Calibration Tools (Photometer) HIMSS/RSNA April 2003 Workshop Cal Display Calibration Tools (Photometer) HIMSS/RSNA April 2003 Workshop

Cal Monitor Characteristic Curve 100 10 0. 1 Ambient Light 0. 01 0 50 Cal Monitor Characteristic Curve 100 10 0. 1 Ambient Light 0. 01 0 50 100 150 Digital Driving Level 200 250 Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop 300

Cal Standard Display Function Grayscale Standard Display Function 1000 Maximum Luminance + Ambient Light Cal Standard Display Function Grayscale Standard Display Function 1000 Maximum Luminance + Ambient Light 100 Monitor’s Capability 10 1 Minimum Luminance + Ambient Light . 1 . 01 0 200 400 600 800 1000 Jmax == P-Value of 2 n-1 Jmin == P-Value of 0 JND Index Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Cal Standardizing a Display 100 Standard 10 1 0 0. 1 50 100 150 Cal Standardizing a Display 100 Standard 10 1 0 0. 1 50 100 150 200 250 Characteristic Curve DDL or P-Values Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

To Achieve Consistent Presentation of Images, the DICOM Standard Defines: Hard · Basic Print To Achieve Consistent Presentation of Images, the DICOM Standard Defines: Hard · Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output HIMSS/RSNA April 2003 Workshop

Basic Print Request with Presentation LUT Print Composer Print Server DICOM Film Session N-CREATE Basic Print Request with Presentation LUT Print Composer Print Server DICOM Film Session N-CREATE Print Composer DICOM Presentation LUT N-CREATE DICOM Film Box N-CREATE Print Request Print Presentation LUT DICOM Image Box N-SET DICOM Film Box N-ACTION DICOM Film Session N-ACTION Print Server Print Status (DICOM N-EVENT-REPORT) Printer Status Hard HIMSS/RSNA April 2003 Workshop

Basic Print Request with Presentation LUT • Print Composer – A system that generates Basic 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. Hard HIMSS/RSNA April 2003 Workshop

To Achieve Consistent Presentation of Images, the DICOM Standard Defines: Soft Grayscale Softcopy Presentation To Achieve Consistent Presentation of Images, the DICOM Standard Defines: Soft 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. HIMSS/RSNA April 2003 Workshop

Consistent Presentation of Images Reporting Radiologist Soft Area Of Interest Presentation State Presentation LUT Consistent Presentation of Images Reporting Radiologist Soft Area Of Interest Presentation State Presentation LUT Referring Physician or Reviewing Radiologist Area Of Interest Grayscale Standard Achieving Consistent Presentation Annotate Zoom Flip Without Consistent Presentation Window Level Original Image HIMSS/RSNA April 2003 Workshop

DICOM Grayscale Image Transformation Model Soft Rescale Slope/Intercept or Modality LUT Original Image Modality DICOM Grayscale Image Transformation Model Soft Rescale Slope/Intercept or Modality LUT Original Image Modality LUT Transformation Window/Level or VOI LUT Mask VOI LUT (Subtraction) Transformation Presentation LUT Transformation Grayscale Transformations Shutter P-Values Transformation Image Annotation Spatial Transformation Disp. Area Annotation Shutter, Annotation and Spatial Transformations HIMSS/RSNA April 2003 Workshop Display

GSPS Stored, and Query/Retrieve GSPS Image Display Image Creator IHE Transaction - an Acquisition GSPS Stored, and Query/Retrieve GSPS Image Display Image Creator IHE Transaction - an Acquisition Modality or Image Creator Actor sends a DICOM GSPS C-STORE request to an Image Archive Actor l IHE Transaction - an Image Display Actor issues a C-FIND request to an Image Manager Actor l IHE Transaction - an Image Display Actor issues a C-MOVE request to an Image Archive Actor l Query Presentation State 15 Retrieve Presentation State Image Archive 9 Modality Presentation State Stored Acquisition Modality HIMSS/RSNA 19 17 Creator Presentation State Stored April 2003 Workshop Soft

Soft IHE Year 4: Presentation State Specific Query Matching and Return Keys Attribute Name Soft IHE Year 4: Presentation State Specific Query Matching and Return Keys Attribute Name Tag Query Keys Matching Query Keys Return SCU SCP Presentation Label (0070, 0080) O O R+ R+ Presentation Description (0070, 0081) O O O R+ Presentation Creation Date (0070, 0082) O O R+ R+ Presentation Creation Time (0070, 0083) O O R+ R+ Presentation Creator’s Name (0070, 0084) O O R+ R+ Referenced Series Sequence (0008, 1115) O O R+ R+ > Series Instance UID (0020, 000 E) O O O R+ > Referenced Image Sequence (0008, 1140) O O O R+ >> Referenced SOP Class UID (0008, 1150) O O O R+ >> Referenced SOP Instance UID (0008, 1155) O O O R+ HIMSS/RSNA April 2003 Workshop

Consistent Presentation of Images Acquire Print Display Slide Provided by David Clunie HIMSS/RSNA April Consistent Presentation of Images Acquire Print Display Slide Provided by David Clunie HIMSS/RSNA April 2003 Workshop

Questions? Documents Available On the Web at: www. rsna. org/IHE HIMSS/RSNA April 2003 Workshop Questions? Documents Available On the Web at: www. rsna. org/IHE HIMSS/RSNA April 2003 Workshop