What s New; What s Next

Transcription

1 What s New; What s Next in DICOM, IHE and QIBA Kevin O Donnell, MASc. Toshiba Medical Systems

2 The future is already here it's just not evenly distributed. William Gibson

3 Secretariat: RSNA & HIMSS Scope: Profiling existing standards to address specific use cases in healthcare 13 Domains Radiology, Cardiology, IT Infrastructure, Lab/Pathology, Patient Care Coord, Eyecare,

4 IHE Process Add Profiles to IHE Technical Frameworks Steps: (Annual Cycle) Profile Proposal Public Comment Trial Implementation Final Text

5 IHE Radiology What s New Recent Publications REM for Nuclear Medicine (REM-NM) Web Image Capture (WIC) Remote Reading Workflow (RRR-WF) Cross-Enterprise Remote Read Workflow Definition (XRR-WD)

6 IHE REM-NM Profile Hot Lab or Infusion Device Archive Dose Analysis & Reporting National Registry NM Camera or PET Camera #SIIM17 > Track & manage radiopharmaceutical dose

7 IHE Web Image Capture (WIC) Step 1: Setup Patient and Study Context (if needed) Image Manager Patient Demographics Supplier Fill Study Context ID Name Birthdate John Doe 12/31/2011 #SIIM17 Patient Demographics Consumer / Image Capturer > Turn snapshots into medical documents * Courtesy Brad Genereaux

8 IHE Web Image Capture (WIC) Step 2: Store Composite Objects Image Manager Patient Demographics Supplier Create DICOM header in JSON / XML #SIIM17 Patient Demographics Consumer / Image Capturer > Turn snapshots into medical documents * Courtesy Brad Genereaux

9 Remote Radiology Reporting Workflow (RRR-WF) Workflow uses UPS-RS RESTful mechanisms Scheduled tasks or open worklists Lists of inputs and outputs Notification of Progress/completion Data flow uses: XDS, XDS-I DICOMweb WADO, STOW DICOM C-STORE, C-MOVE Reporting Worklist XDS Repository Academic Specialist Nighthawk Radiologist Central Hospital #SIIM17 > Manage distributed reading workflows

10 Cross-Enterprise Remote Read Workflow Definition (XRR-WD) #SIIM17 > Manage distributed reading workflows

11 Cross-Enterprise Remote Read Workflow Definition (XRR-WD) #SIIM17 > Manage distributed reading workflows

12 IHE Radiology What s Next #SIIM17 Entering Trial Implementation: Management of Acquisition Protocols (MAP) Collect/Manage/Distribute CT Protocols Standardized Operational Log of Events (SOLE) Capture Operational Events related to Imaging Public Comment: Report Distribution (RD) Send radiology results (i.e. reports) by HL7 ORU Follow-Up of Non-Critical Results (FUNC) Trigger/track notification of actionable findings

13 IHE IT Infrastructure What s New Advanced Patient Privacy Consent (APPC) Catalog fine grained document access/restriction policies Mobile Alert Communication Management (macm) Send text alerts to humans, record reaction; crisis & reminders RESTful Query for ATNA Retrieve audit events matching a query filter Updated to HL7 FHIR DSTU2: Patient Identifier Cross-reference for Mobile(PIXm) Patient Demographic Query for Mobile (PDQm) Mobile Access to Health Documents (MHD) Appendix Z on HL7 FHIR #SIIM17

14 IHE IT Infrastructure What s Next Entering Trial Implementation: Remove Metadata and Documents (RMD) Delete from XDS Registries and Repositories #SIIM17 Public Comment: Patient Data-Element Location Service (PDLS) Extract data elements (FHIR resources) from CDA shared documents (XDS, MHD, etc) using PCC QEDm (Query for Existing Data mobile) Non-patient File Sharing (NPFS) FHIR sharing of stylesheets, blank forms, workflow definition documents, etc mobile Care Services Discovery (mcsd) FHIR version of CSD (SOAP) and HPD (LDAP)

15 Secretariat: MITA dicom.nema.org Scope: data and workflow compatibility between imaging systems and HIT systems diagnostic, therapeutic & associated data in medical disciplines that use digital images 31 Working Groups CT, MR, Dentistry, Physics, Web Technology, etc.

16 DICOM Process Add Supplements to DICOM Standard Steps: New Workitem Proposal Public Comment Letter Ballot Final Text

17 DICOM What s New CT Protocol Storage (Sup121) Second Gen. Radiotherapy Prescription (Sup147) Simplified Echo SR (Sup169) RESTful Services for Non-Patient Instances (Sup194) Advanced Blending Presentation State (Sup189) Volume Rendering Presentation State (Sup190) Patient Radiation Dose SR (Sup191) HEVC/H.265 Video Coding (Sup195) Ophthalmic OCT-A Image Storage (Sup197)

18 Advanced Blending Presentation State (Example) + Relative Opacity 0.6 Anatomical DTI (Relative Opacity 0.7) (Relative Opacity 0.3) Relative Opacity * Courtesy Wim Corbijn #SIIM17 fmri (Relative Opacity 0.33) fmri (Relative Opacity 0.33) fmri (Relative Opacity 0.33)

19 Volume Rendering Presentation State (Example) #SIIM17 3D Voxel Data 2D Pixel Data Volumetric Graphic Annotation Projection Graphic Annotation VOI LUT Cropping Classification RGBA Volume Rendering P-Values or PCS-Values Graphics Layer P-Values or PCS-Values Cropping Specification Index value, Volume Cropping Render Display Render Geometry Render Shading * Courtesy WG-11

20 Patient Dose SR Modality FOR X-Ray Equipment Modality Image Radiation Dose SR Radiation Exposure Information - X-Ray exposure techniques - Table, Gantry Angle, Beam Geometry, collimation - Dose measure: CTDI, DAP,... Patient Dose Surface Parts of Patient Dose SR Patient Model Patient Model FOR Equipment Information - Table dimension - Attenuating material, Organ Dose Reporter System Patient Dose Map #SIIM17 Registration IOD Patient Registration Information - Patient position on table - Fiducials - Registration of Patient FOR and Equipment FOR Patient Dose SR * Courtesy WG-28

21 HEVC / H.265 Video Coding DICOM Video coding history MPEG-2 (1994): Standardized in DICOM in 2004 Supplement #40 MPEG-4/AVC (2003): Standardized in DICOM in 2010 Supplement #149 and # Compression ratio to MPEG-2 HEVC/H.265 (2013): Standardized in DICOM 2016 Supplement #195 MPEG-2 AVC HEVC

22 OCT Angiography (Ophthalmology) * Courtesy WG-9

23 DICOM What s Next Multi-Energy CT Storage (Sup188) Contrast Injection SR (Sup164) Realtime Video (TBA) Web Services Redoc (Part 18) DICOM Conformance Statement reorg (WG-31) 3D Print objects (WG-17) and lots more

24 Multi-Energy CT 4 families Multi Energy Imaging Standard CT Image Objective Image Family Material Quantification Family Material Labeling Family Material Visualization Family many flavors #SIIM17 Virtual Monoenergetic Image (VMI) Effective Atomic Number (Z) Image Electron Density Image Material- Specific Image Iodine Map; Bone Density Material- Removed Image Virt. Non- Contrast; Virt. Non-Ca; Proportional Map Image Discrete Labeling Image Probability Map Image Value based Map Gout crystals Image CT IOD Material- Modified Image Highlighted; Partially- Suppressed Other IOD Color Overlay Image Color Blending Image Color Map Image * Courtesy WG-21

25 Multi-Energy CT * Courtesy WG-11

26 Contrast Administration SR Performed Administration SR Programmed at injector device Contains Actually delivered by injector device 1 1 Programmed Plan Delivered Plan 1-n 1-n Steps Steps Pressure Vs. Time Graphs Flow Rate Vs. Time Graphs 1-n 1-n * Courtesy WG-6 #SIIM17 Phases Phases

27 DICOM Realtime Video

28 Secretariat: RSNA Scope: Improve the value and practicality of quantitative biomarkers by reducing variability across devices, clinical sites and time 4 Coordination Committees (CT, MR, PET, US) Collaboration with Europe (EIBALL) and Japan

29 QIBA Industrializing Biomarkers Problem Analysis Solution? Measure = 7 ±6 Goal! Treat Wait Treat Wait ± 6 Sources of Variance Differences in: - Patient Handling - Acq. Protocols - Reconstruction - Segmentation... Protocol Reqs Recon Reqs Resolution Reqs Noise Reqs Segment. Reqs Patient Prep & Operation Reqs Segment. Reqs Calibration Reqs When all participating actors conform #SIIM17 Measure = 7 ±2

30 QIBA Process Add Profiles to QIBA Library Steps: Biomarker Proposal Groundwork Public Comment Consensus Technical Confirmation Claim Confirmation Clinical Confirmation

31 QIBA Recently Published FDG-PET/CT for Tumor Evaluation Claim: Tumor glycolytic activity (SUVmax) measurements have a within-subject coefficient of variation of 10-12%. CT Tumor Volumetry Claim: A true change in tumor volume occurred with 95% confidence if measured change is > 24% / 29% / 39% respectively for tumors with initial diameters of / / mm. DCE-MRI for Tumor Response Claim: Microvascular property (Ktrans & IAUGCBN) measurements have a within-subject coefficient of variation of 20% from 1.5T DCE-MRI using low molecular weight extracellular gadolinium-based contrast. #SIIM17 * claims have been paraphrased/simplified

32 QIBA More Work in Progress MR DWI for Tumor Evaluation MR Proton Density Fat Fraction fmri BOLD for Pre-Op Mapping of Cortex UL Shearwave for Liver Elastography CT Lung Density for COPD PET Amyloid for Neurologic Disease SPECT Dopamine for Neurodegenerative Disease

33 Participate Great opportunity to learn Great opportunity to contribute All three communities (DICOM, IHE, QIBA) open to new members/contributors Application process Patent policy