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The SCAR TRIP TM Initiative & DICOM

The SCAR TRIP TM Initiative & DICOM. Katherine P. Andriole S ociety for C omputer A pplications in R adiology PACS Clinical Coordinator University of California at San Francisco Department of Radiology Laboratory for Radiological Informatics and Department of Bioengineering

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The SCAR TRIP TM Initiative & DICOM

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  1. 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

  2. OUTLINE • The Problem • The SCAR TRIPTM Initiative • Historical Review • Imaging in Other Fields vs Medicine • Entertainment Industry, DoD & NASA

  3. OUTLINE • Concepts Involved • Human Perception, Image Processing, Visualization, Navigation, Usability, Standards, Databases, Integration, Evaluation, Validation

  4. 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

  5. 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

  6. The SCAR TRIPTM Initiative Transforming the Radiological Interpretation Process • to spearhead research, education, & discovery of innovative solutions to address the problem of information & image data overload.

  7. SCAR TRIPTM Initiative • Radiology must shift its image interpretation & management processes to deal with the burgeoning medical image data sets acquired by digital imaging devices.

  8. SCAR TRIPTM Initiative • Will foster interdisciplinary research on technological, environmental & human factors to better manage & exploit the massive amount of data.

  9. SCAR TRIPTM Initiative • Willfocus on: • Improving efficiency of interpretation • Improving timeliness & effectiveness • Decreasing medical errors • Goal is to improve the quality & safety of patient care.

  10. 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.

  11. 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.

  12. 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

  13. Often there is a disconnect between Scientist-Researchers & End-Users in the Clinical Arena

  14. Enabling Technologies(creating urgency for TRIPTM) • Computing & Networking Capabilities • “Real-Time” Processing • Increased Bandwidth & Ubiquitous Access • Visualization Technologies • 3-D Rendering, Color, Motion

  15. Enabling Technologies • Digital Imaging Modalities • True 3-D Data Acquisition & Isotropic Voxels • More Intuitive Graphical User Interfaces • Although much more needs to be done

  16. Concepts Involved • Human Perception • Image Processing & CAD • Visualization • Navigation – Usability • Standards, Databases & Integration • Evaluation & Validation

  17. 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

  18. 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.

  19. 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

  20. 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.

  21. 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

  22. Image Processing & CAD • Design a workstation that can grow to accommodate future computer tools & advances. • Support clinical, research & teaching needs.

  23. 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)

  24. Visualization • Static Film • Dynamic Soft Copy & Image Manipulation • Tile Mode • Stack or Cine Mode • Linked Stack Mode for 3-D Correspondence • Multimodality Image Fusion

  25. Combining Functional & Anatomical Information

  26. “Normal” Tumor Necrosis 3D Spectra Anatomy Overlay Courtesy Cynthia Chin, M.D., UCSF

  27. Visualization • Maximum Intensity Projection • Multi-Planar Reconstruction • 3-D Surface/Volume Rendering • Virtual Reality Representations • ???

  28. CT Cholangiogram - Axial Courtesy Richard S.Breiman, M.D., UCSF

  29. Sliding MIP Bile Duct Anomalies missed by MRCP in potential partial liver donors. Courtesy Richard S.Breiman, M.D., UCSF

  30. 3-D Surface/Volume Rendering Courtesy Gary R. Caputo, M.D., UCSF

  31. Courtesy Cynthia Chin, M.D., UCSF

  32. 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.

  33. DICOM Role • How can DICOM pass 3D Model without disclosing proprietary information? • How simplify interoperability? • Unify Architecture

  34. 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.

  35. 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

  36. Navigation & Usability • 3-D & Motion • Virtual Reality – Fly-Throughs • Hand-Eye Cues • Hand-Helds for Point-of-Care Delivery • Context Matching • Voice Activation • ???

  37. 3-D Surface RenderingCABG Courtesy Gary R. Caputo, M.D., UCSF

  38. Virtual Reality Fly-Through of Coronary Arteries Courtesy Gary R. Caputo, M.D., UCSF

  39. Sliding VR Courtesy Richard S.Breiman, M.D., UCSF

  40. Michael Teistler, Technical Institute of Braunschweig

  41. Hand-Helds for Point-of Care Delivery

  42. DICOM Role • Navigation by radiologist/clinician at the PACS display (or enterprise-wide web) in real-time • Raw Data & Processing Model • Color Encoding • Overlays • Waveforms • Audio or Other Sense?

  43. Standards, Databases & Integration • Open Standards • Real-Time Processing at PACS Display • 3-D Integrated into PACS Display & Web • Other Relevant Data – Integrated HIS-RIS-PACS-Speech & IHE (maintaining user & patient focus)

  44. Evaluation & Validation • Objective Methodologies • Standard Datasets for Performance Testing • Collaborative & Comparison Research

  45. Affected Processes • Interpretation • Communication • Workflow & Efficiency • Diagnostic Accuracy • Reduction of Medical Errors • Quality of Care

  46. We Have Come a Long Way, But…

  47. 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

  48. DICOM Role(especially) WG4 Compression WG8 Structured Reporting WG10 Strategic WG11 Display Function Std WG16 Magnetic Resonance, Sup49WG17 3D WG20 Imaging & Information Systems Integration WG21 Computed Tomography

  49. DICOM Role Join in the TRIP!

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