Consistent Presentation of Images — Integration Profile Ellie

Consistent Presentation of Images - Integration Profile Ellie Avraham Kodak Health Imaging IHE Planning and Technical Committees April 8, 2002 Year 4 Vendor Workshop HIMSS / RSNA

IHE Integration Profiles Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders April 8, 2002 Year 4 Vendor Workshop Consistent Presentation of Images Hardcopy and softcopy Softcopy grayscale and Image Consistency presentation state 2 HIMSS / RSNA

Consistent Presentation of Images Objectives • Consistent distribution of Images across the healthcare enterprise • Consistency among Hardcopy Images Printed on different Printers (from different Vendors). • Consistency among Softcopy Images view on different Display devices (from different Vendors). • Consistency among Hardcopy and Softcopy Image view • This IHE Integration Profile is the cost effective solution to ensure that image quality is maintained across different monitors and film producing devices. April 8, 2002 Year 4 Vendor Workshop 3 HIMSS / RSNA

Consistent Presentation of Images Requires: 1 2 3 • 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 • Saving the Softcopy Display Viewing Parameters using DICOM Grayscale Softcopy Presentation State April 8, 2002 Year 4 Vendor Workshop 4 HIMSS / RSNA

The Grayscale Image Presentation Problems: Device capabilities/ characteristics vary * Device Luminance range * Display Characteristic Curve: DDL -> Luminance * Device Display Resolution: Non-Standard Interpretation of Pixel value to Output Device Luminance April 8, 2002 Year 4 Vendor Workshop 5 HIMSS / RSNA

The Grayscale Consistency Problem: • 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 April 8, 2002 Year 4 Vendor Workshop 6 HIMSS / RSNA

The Grayscale Consistency Problem: • Optimal image viewing parameters (e. g. window/ level) selected on one device appear different when displayed on a different device • Device capabilities/ characteristics vary - the same number of gray levels cannot be rendered or perceived on different devices • Displayed images look different from printed images • …other April 8, 2002 Year 4 Vendor Workshop 7 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 8 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 9 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 10 HIMSS / RSNA

Problems of Inconsistency Digital Modality • Printed images don’t look like displayed images Laser Printer Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 11 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 12 HIMSS / RSNA

Standardize Display Systems to Achieve Grayscale Consistency, Hardcopy Output and Softcopy Viewing Devices Have to Be Properly Calibrated 1 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 April 8, 2002 Year 4 Vendor Workshop 13 HIMSS / RSNA

The GSDF Standard Characteristic Display Systems Curve 1 The GSDF transformation defines the mapping of the P-values to the view Luminance or optical density value, and preserving the Human perceptual response, based on the Human Contrast Sensitivity. April 8, 2002 Year 4 Vendor Workshop 14 HIMSS / RSNA

April 8, 2002 Year 4 Vendor Workshop 15 HIMSS / RSNA

April 8, 2002 Year 4 Vendor Workshop 16 HIMSS / RSNA

Printer Calibration Tools (Densitometer) April 8, 2002 Year 4 Vendor Workshop 17 HIMSS / RSNA

Display Calibration Tools (Photometer) April 8, 2002 Year 4 Vendor Workshop 18 HIMSS / RSNA

DICOM GSDF Grayscale Standard Display Function 1000 Film 100 10 Monitors 1 0 200 400 600 800 1000 . 1 . 01 JND Index Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 19 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 20 HIMSS / RSNA

Monitor Characteristic Curve 100 10 0. 1 Ambient Light 0. 01 0 50 100 150 Digital Driving Level 200 250 300 Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 21 HIMSS / RSNA

Standard Display Function Grayscale Standard Display Function 1000 Maximum Luminance + Ambient Light 100 Monitor’s Capability 10 1 Minimum Luminance + Ambient Light 0 200 400 600 1000 Jmax == P-Value of 2 n-1 . 01 800 Jmin == P-Value of 0 JND Index Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 22 HIMSS / RSNA

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 April 8, 2002 Year 4 Vendor Workshop 23 HIMSS / RSNA

Standardizing a Display Mapping P-Values to Input of Characteristic Curve (DDL’s) 300 250 DDL 200 150 100 50 0 0 50 100 150 200 250 300 P-Values Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 24 HIMSS / RSNA

To Achieve Consistent Presentation of Images, the DICOM Standard Defines: 2 · Basic Print Management with Presentation Look Up Table, for controlling the consistent appearance of preformatted images on printed output April 8, 2002 Year 4 Vendor Workshop 25 HIMSS / RSNA

DICOM Grayscale Image Transformation Model 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 P-Values Shutter Transformation Image Spatial Transformation Annotation Disp. Area Annotation Display Shutter, Annotation and Spatial Transformations April 8, 2002 Year 4 Vendor Workshop 26 HIMSS / RSNA

Basic Print Management Meta SOP Class Association Negotiation - “Contract Agreement” Agreed set of SOP Classes and Transfer Syntaxes ( Basic Print Meta SOP Class) Print (SCP) Print (SCU) Basic Print Meta SOP Class consist of four SOP Classes (Film Session, Film Box, Image Box, and Printer) N-Create (create film sheet, format printer) Film Sheet N-Set (place images on film sheet) N-Action (request to print the film sheet) N-Event-Report (status of the printer) Slide Provided by Don Van Syckle April 8, 2002 Year 4 Vendor Workshop 27 HIMSS / RSNA

Basic Print Request with Presentation LUT Print Composer Print Server Print Composer DICOM Film Session N-CREATE Print Request DICOM Presentation LUT N-CREATE DICOM Film Box N-CREATE 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 April 8, 2002 Year 4 Vendor Workshop 28 HIMSS / RSNA

Basic Print Request with Presentation LUT • IHE Transaction - a Print Composer Actor issues a DICOM Print request to a Print Server Actor. The Print request includes a Presentation LUT for display consistency. Print Composer Print Server 23 April 8, 2002 Year 4 Vendor Workshop Print Request with Presentation LUT 29 HIMSS / RSNA

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 Presentation Look-Up Tables (Presentation LUTs) 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. April 8, 2002 Year 4 Vendor Workshop 30 HIMSS / RSNA

Basic Print Request with Presentation LUT • Required transaction for both Print Composer and Print Server Actors • Print Composer shall be grouped with one of the following: – Acquisition Modality Actor – Image Manager Actor – Image Display Actor – Image Creator Actor April 8, 2002 Year 4 Vendor Workshop 31 HIMSS / RSNA

To Achieve Consistent Presentation of Images, the DICOM Standard Defines: 3 1. 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. April 8, 2002 Year 4 Vendor Workshop 32 HIMSS / RSNA

Consistent Presentation of Images Reporting Radiologist 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 April 8, 2002 Year 4 Vendor Workshop 33 HIMSS / RSNA

GSPS Module Table: IE Module Usage Patient M Study General Study M Patient Study U General Series M Presentation Series M Equipment General Equipment M Presentation State M Series Modality LUT C - Required if to be applied Mask C - Required if multi-frame and to be applied VOI LUT C - Required if to be applied Softcopy Presentation LUT M Graphic Annotation Spatial Transformation C - Required if to be applied C - Required if rotation, flipping or magnification are to be applied Displayed Area M Display Shutter C - Required if to be applied and the Bitmap Display Shutter Module is not present Bitmap Display Shutter C - Required if to be applied and the Display Shutter Module is not present Overlay Plane C - Required if to be applied or the BM Displ. Shutter Module is present Displ. Overlay/Curve Activation C- Required if image contains curve or overlay which is to be displayed Graphic Layer C - Required if Graphic Annotation or Overlays or Curves are to be applied SOP Common M April 8, 2002 Year 4 Vendor Workshop 34 HIMSS / RSNA

Grayscale Softcopy Presentation State: l l l Composite object containing the image display settings parameters Composite object links to one or more images (Series, filters); stored using same Study Instance UID (same Storage SOP Class!) Uses regular Storage services (C-STORE); uses Query/Retrieve services GSPS SOP Instances are immutable: changes require a new SOP Instance UID Note: generation and specific application of GSPS is outside the scope of DICOM, but not outside the scope of IHE (e. g. Presentation of Grouped Procedures) April 8, 2002 Year 4 Vendor Workshop 35 HIMSS / RSNA

GSPS Stored, and Query/Retrieve GSPS Image Display Image Creator 15 Query Presentation State Retrieve 17 Presentation State • 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 CMOVE request to an Image Archive Actor 19 Creator Presentation State Stored Image Archive 9 Modality Presentation State Stored Acquisition Modality April 8, 2002 Year 4 Vendor Workshop 36 HIMSS / RSNA

Creator Presentation State Stored Image Creator Image Archive C-STORE (Presentation State Stored) April 8, 2002 Year 4 Vendor Workshop 37 HIMSS / RSNA

Query for Grayscale Softcopy Presentation States Image Display Query/Retrieve Presentation States (C-FIND/C-MOVE) Image Archive Presentation States (C-STORE) April 8, 2002 Year 4 Vendor Workshop 38 HIMSS / RSNA

IHE Year 4: Presentation State Specific Query Matching and Return Keys Attribute Name Tag Query Keys Matching SCU Query Keys Return SCP 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+ April 8, 2002 Year 4 Vendor Workshop 39 HIMSS / RSNA

Consistent Presentation of Images Acquire Print Display Slide Provided by David Clunie April 8, 2002 Year 4 Vendor Workshop 40 HIMSS / RSNA

Questions? Documents Available On the Web at: www. rsna. org/IHE or www. himss. org April 8, 2002 Year 4 Vendor Workshop 41 HIMSS / RSNA