UCSF Radiology / Agfa PACS Open House
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Transcript UCSF Radiology / Agfa PACS Open House
The SCAR TRIPTM Initiative
& DICOM
Katherine P. Andriole
Society for Computer Applications in Radiology
PACS Clinical Coordinator
University of California at San Francisco
Department of Radiology
Laboratory for Radiological Informatics
and
Department of Bioengineering
University of California at Berkeley
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OUTLINE
The Problem
The SCAR TRIPTM Initiative
Historical Review
–Imaging in Other Fields vs Medicine
»Entertainment Industry, DoD & NASA
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OUTLINE
Concepts Involved
–Human Perception, Image Processing,
Visualization, Navigation, Usability,
Standards, Databases, Integration,
Evaluation, Validation
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OUTLINE
Affected Processes
–Interpretation, Communication, Workflow
& Efficiency, Diagnostic Accuracy, Quality
of Care
Role of / Impact on DICOM
–Incorporated but not widely used concepts
–Necessary new features & functionality
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The Problem
Information & Image Data Overload
Requires medical image interpretation
paradigm shift to evaluate, manage &
exploit the massive amounts of data
acquired for improved
–Efficiency
–Accuracy
–Survival
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The SCAR TRIP Initiative
TM
Transforming the Radiological
Interpretation Process
to spearhead research, education, &
discovery of innovative solutions to
address the problem of information
& image data overload.
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SCAR TRIP Initiative
TM
Radiology must shift its image
interpretation & management processes
to deal with the burgeoning medical
image data sets acquired by digital
imaging devices.
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SCAR TRIP Initiative
TM
Will foster interdisciplinary research
on technological, environmental &
human factors to better manage &
exploit the massive amount of data.
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SCAR TRIP Initiative
TM
Will focus on:
–Improving efficiency of interpretation
–Improving timeliness & effectiveness
–Decreasing medical errors
Goal is to improve the quality & safety of
patient care.
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Historical Review – Why Is
Medicine So Far Behind?
(DoD, NASA, Hollywood)
Special & Challenging Environment
–Urgency of Results
–Safety Limitations & Restrictions
–Cost of Error
–Tremendous Variability of Human
Data within & between Individuals.
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Why Is Medicine So Far Behind?
Special & Challenging Environment
–Difficult to Validate Performance
–Poor Understanding of Human
Perception & its Relationship to the
Art of Medicine.
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Why Is Medicine So Far Behind?
Slower Adoption of Technology in General
–Cultural & Practicality Barriers
–More Difficult to See Clinical Impact Initially
–Interdisciplinary Nature of the Solution
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Often there is a disconnect between
Scientist-Researchers & End-Users
in the Clinical Arena
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Enabling Technologies
(creating urgency for TRIPTM)
Computing & Networking Capabilities
–“Real-Time” Processing
–Increased Bandwidth & Ubiquitous Access
Visualization Technologies
–3-D Rendering, Color, Motion
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Enabling Technologies
Digital Imaging Modalities
–True 3-D Data Acquisition & Isotropic Voxels
More Intuitive Graphical User Interfaces
–Although much more needs to be done
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Concepts Involved
Human Perception
Image Processing & CAD
Visualization
Navigation – Usability
Standards, Databases & Integration
Evaluation & Validation
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Human Perception
Develop a Standard for Image Quality
Develop Objective Methodologies & Criteria
–From which to determine optimal
presentation parameters
–Based on Diagnostic Performance
Develop Display Standards
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Psychophysical Models for
Detection of Abnormalities
Define & Develop Optimal Presentation
Parameters by understanding
–What is desired by the observer
–What properties of radiological images are
most useful in their interpretation
–How can these properties be enhanced to
improve accuracy of interpretation.
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DICOM Role
WG 11: Display Function Standard
–Gray Scale Std Display Function GSDF
–Presentation-LUT
IHE: Consistent presentation of images
AAPM TF18: Image Quality, QA
Still must address Clinical Correspondence
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Image Processing & CAD
Man-Machine Systems for Image-Based
Diagnosis which take advantage of both
human & machine capabilities.
–Relinquish more routine chores to the
computer.
–Have human concentrate on judgment
& comprehension tasks.
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Image Processing & CAD
Develop Computer Aids for Feature Perception
–Cuing, Overlay & Annotation
Develop Radiology Workstation of the Future
–Implement computer aids into a broadly
supportive workstation.
–Decision Support, Data Mining & Reference
Libraries
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Image Processing & CAD
–Design a workstation that can grow to
accommodate future computer tools &
advances.
–Support clinical, research & teaching
needs.
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DICOM Role
Image processing capabilities at the
PACS display are currently very minimal.
Processing typically done at the modality
and/or required specialty workstations.
How can DICOM pass image processing
parameters without disclosing proprietary
information?
Structured Reporting & CAD (WG8 & 15)
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Visualization
Static Film
Dynamic Soft Copy & Image Manipulation
Tile Mode
Stack or Cine Mode
Linked Stack Mode for 3-D Correspondence
Multimodality Image Fusion
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Combining Functional &
Anatomical Information
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3D Spectra Anatomy Overlay
“Normal”
Tumor
Necrosis
Courtesy Cynthia Chin, M.D., UCSF
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Visualization
Maximum Intensity Projection
Multi-Planar Reconstruction
3-D Surface/Volume Rendering
Virtual Reality Representations
???
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CT Cholangiogram - Axial
Courtesy Richard S.Breiman, M.D., UCSF
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Sliding MIP
Bile Duct
Anomalies
missed by
MRCP in
potential
partial liver
donors.
Courtesy Richard S.Breiman, M.D., UCSF
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3-D Surface/Volume Rendering
Courtesy Gary R. Caputo, M.D., UCSF
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Courtesy Cynthia Chin, M.D.,
UCSF
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DICOM Role
Currently most 3-D representations must be
– processed on specialty workstations
–some must be saved as screen-capture
–manually push to PACS workstations &
Enterprise-wide Web (if capable of displaying)
–Raw data often not stored.
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DICOM Role
How can DICOM pass 3D Model without
disclosing proprietary information?
How simplify interoperability?
–Unify Architecture
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DICOM Role
DICOM conceived as a strategy for moving &
storing collections of single images.
–Network utilization is suboptimal
PACS must accommodate multiple images
which can be treated as a single unit
–Series-Awareness, 3D, 4D, Functional Sets,
Cross-Referencing of Objects & Fusion
Unified presentation of Color WG11 & others.
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DICOM Role
WG16, Supplement 49 defines multiframe
(MR) images; model for CT; WG17, 20, 21.
–enhanced image storage SOP class
–allows multiple images to be combined
into one instance
–Raw Data
–Dimensionality
–Context Info
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Navigation & Usability
3-D & Motion
Virtual Reality – Fly-Throughs
Hand-Eye Cues
Hand-Helds for Point-of-Care Delivery
Context Matching
Voice Activation
???
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3-D Surface Rendering
CABG
Courtesy Gary R. Caputo, M.D., UCSF
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Virtual Reality Fly-Through
of Coronary Arteries
Courtesy Gary R. Caputo, M.D., UCSF
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Sliding VR
Courtesy Richard S.Breiman, M.D., UCSF
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Michael Teistler, Technical Institute of Braunschweig
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Hand-Helds for Point-of Care
Delivery
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DICOM Role
Navigation by radiologist/clinician
at the PACS display (or enterprisewide web) in real-time
–Raw Data & Processing Model
–Color Encoding
–Overlays
–Waveforms
–Audio or Other Sense?
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Standards, Databases &
Integration
Open Standards
Real-Time Processing at PACS Display
3-D Integrated into PACS Display & Web
Other Relevant Data – Integrated HISRIS-PACS-Speech & IHE (maintaining
user & patient focus)
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Evaluation & Validation
Objective Methodologies
Standard Datasets for Performance Testing
Collaborative & Comparison Research
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Affected Processes
Interpretation
Communication
Workflow & Efficiency
Diagnostic Accuracy
–Reduction of Medical Errors
Quality of Care
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We Have Come a Long Way,
But…
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What SCAR Hopes To Do
Bring Forward the Problem
Facilitate Exchange of Ideas
–Between Researchers, End-Users,
Industry, Other Fields
–Via Workshops & Forums
–By Lobbing NIH & Other Agencies
Sponsor Research
Communicate Issues & Results
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DICOM Role
(especially)
WG4 Compression
WG10 Strategic
WG8 Structured Reporting
WG11 Display Function Std
WG16 Magnetic Resonance, Sup49
WG17 3D
WG20 Imaging & Information Systems Integration
WG21 Computed Tomography
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DICOM Role
Join in the TRIP!
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