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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