DICOM
nD Presentation State
Toshiba Cross-Sectional Imaging
Use Cases
Updated 15 Feb, 2011
Modalities Considered
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CT
MR
PET
4/13/2015
nD Presentation State Use Cases
2
Clinical Specialties Considered
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Radiology
Cardiology
Gastroenterology
4/13/2015
nD Presentation State Use Cases
3
CT Coronary Artery Stenosis
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium
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Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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Three MPRs aligned with the axes of the heart intersecting at the point of stenosis
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Curved MPR following the centreline of the stenotic vessel with stenosis marked
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Cross-curved MPR at the point of stenosis with % stenosis measurement
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SVR and / or volumetric MIP, oriented to show stenosis
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Position of cross-curved MPR
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Orientation and VOI for SVR / MIP
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W/L for MPR and MIP views
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Opacity for SVR views – accuracy of colour mapping unimportant
4/13/2015
nD Presentation State Use Cases
4
CT Coronary Artery Plaque Evaluation
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium
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Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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Slab MPR aligned with the affected vessel
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3-4 MPR views perpendicular to the above view demonstrating the extent of the plaque
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Curved MPR following the centreline of the affected vessel
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Set of cross-curved MPRs with colour-coded plaque burden
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Width and Intensity Projection of MPRs
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Position of cross-curved MPRs
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
5
CT Coronary Artery Stent Evaluation
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium

Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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MPR aligned with the affected vessel
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3-4 MPR views perpendicular to the above along the length of the stent
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Curved MPR following the centreline of the affected vessel
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Set of cross-curved MPRs along the length of the stent
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Position of cross-curved MPRs
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
6
CT Coronary Artery Aneurysm Evaluation
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium

Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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Curved MPR following the centreline of the affected vessel
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Cross-curved MPR at end-points of aneurysm and point of maximal diameter with measurements
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Position of cross-curved MPRs
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
7
CT Coronary Artery Anomalous Vessel Evaluation
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium

Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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Three MPRs intersecting at the vessel origin
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Slab MPR demonstrating the vessel anomaly
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Width and Intensity Projection of MPRs
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
8
CT Coronary Artery CABG Evaluation
Input is a gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Heart / myocardium
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Coronary arteries
Automated / semi-automated coronary artery centreline finding
Views saved:
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Curved MPR following the centreline of the bypass graft
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SVR views oriented to show junction of bypass graft and coronary artery with different VOIs (survey and focused on junction)
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Markers / measurements
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Position and orientation of MPRs
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Orientation and VOI for SVR / MIP
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W/L for MPR views
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Opacity for SVR views – accuracy of colour mapping unimportant
4/13/2015
nD Presentation State Use Cases
9
CT Cardiac 4D Valve Evaluation
Input is a retrospectively gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
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CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Left ventricle endocardium
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Left ventricle epicardium
Views saved:
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Three MPRs aligned with the axes of the heart intersecting at the aortic valve cycling through cardiac phases
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SVR view oriented to show the aortic valve cycling through cardiac phases
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Three MPRs aligned with the axes of the heart intersecting at the mitral valve cycling through cardiac phases
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SVR view oriented to show the mitral valve cycling through cardiac phases
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Device/user using presentation state to replicate derived views
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Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Position and orientation of MPRs
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Cine details?
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Orientation and VOI for SVR
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W/L for MPR views
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Colour / opacity guideline – accuracy of colour and opacity mapping unimportant
4/13/2015
nD Presentation State Use Cases
10
CT Cardiac 4D Myocardial Contractility
Input is a retrospectively gated, contrast-enhanced CT cardiac exam
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:

Left ventricle endocardium
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Left ventricle epicardium
Views saved:
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Three MPRs aligned with the axes of the heart intersecting at the left ventricle cycling through cardiac phases
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SVR view oriented to show the left ventricle valve cycling through cardiac phases
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:

Segmentation

Position and orientation of MPRs

Orientation and VOI for SVR
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W/L for MPR views
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Colour / opacity guideline – accuracy of colour and opacity mapping unimportant
4/13/2015
nD Presentation State Use Cases
11
CT Calcium Scoring
Input is a retrospectively gated, non-enhanced CT cardiac phase
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Device/user creating derived views and presentation states
CT technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Coronary artery calcification
Output saved:
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Assignment of calcification to coronary arteries
Device/user using presentation state to replicate derived views
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Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Assignment of calcification to coronary arteries
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Use case may be more appropriate to a CAD-like object than to an nD PS
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4/13/2015
nD Presentation State Use Cases
12
CT Colonography
Input is a combination of prone, supine and decubitus CT volumes, with or without contrast
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Device/user creating derived views and presentation states
CT technologist, radiologist or gastroenterologist using post-processing application
Automated / semi-automated segmentation of:
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Luminal surface of colon
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Colonic centerline
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Air in small intestine
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Polyps/flat lesions
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Contrast tagged stool
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Residual fluid
Views saved:
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SVR of air in colon
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MPR/slab views to illustrate individual lesions
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Endoscopic (SVR/SSD) of colon
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Dissected SVR view
Device/user using presentation state to replicate derived views
Radiologist / gastroenterologist performing primary read after tech workup
Radiologist / gastroenterologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Centrelines
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Position and orientation of MPRs
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Orientation and VOI for SVR
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W/L for MPR views
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Opacity /threshold for SVR/SSD views – accuracy of colour mapping unimportant
4/13/2015
nD Presentation State Use Cases
13
CT Angiography
Input is a contrast-enhanced CT angiography exam
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Device/user creating derived views and presentation states
CT technologist or radiologist using post-processing application
Automated / semi-automated segmentation of:
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Arteries to be analyzed
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Bone adjacent to arteries of interest
Automated / semi-automated artery centreline finding
Views saved:
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Three MPRs aligned with the artery intersecting at the point of stenosis
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Curved MPR following the centreline of the stenotic vessel with stenosis marked

Cross-curved MPR at the point of stenosis with % stenosis measurement

SVR and / or boneless volumetric MIP, oriented to show stenosis
Device/user using presentation state to replicate derived views
Radiologist performing primary read after tech workup
Radiologist reviewing priors alongside follow-up exams
Need to reproduce:

Segmentation

Centrelines

Markers / measurements

Position and orientation of MPRs

Position of cross-curved MPR

Orientation and VOI for SVR / MIP
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W/L for MPR and MIP views
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Opacity for SVR views – accuracy of colour mapping unimportant
4/13/2015
nD Presentation State Use Cases
14
MR Cardiac LV Analysis
Input is a gated, contrast-enhanced MR cardiac exam
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Device/user creating derived views and presentation states
MR technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Left ventricle endocardium
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Left ventricle epicardium
Views saved:
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Set of LV short axis views with overlaid segmentation
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
15
MR Cardiac Perfusion
Input is a contrast-enhanced MR cardiac perfusion exam
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Device/user creating derived views and presentation states
MR technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated segmentation of:
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Left ventricle endocardium

Left ventricle epicardium
Views saved:
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Set of LV short axis views with functional overlays – stress and rest acquisitions
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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W/L for MPR views
4/13/2015
nD Presentation State Use Cases
16
MR Cardiac Delayed Enhancement
Input is a delayed-enhancement MR cardiac exam
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Device/user creating derived views and presentation states
MR technologist, radiologist or cardiologist using post-processing application
Automated / semi-automated determination of infarct enhancement threshold
Automated / semi-automated segmentation of infarct
Views saved:
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Cross-sectional view highlighting infarct with overlays and measurements
Device/user using presentation state to replicate derived views
Radiologist / cardiologist performing primary read after tech workup
Radiologist / cardiologist reviewing priors alongside follow-up exams
Need to reproduce:
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Segmentation
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Signal intensity threshold used to perform infarct segmentation
4/13/2015
nD Presentation State Use Cases
17
PET / CT Fusion – Added 15 Feb
Input is a set of registered PET /CT exams, typically from a combined PET / CT scanner. A set of prior exams may also be loaded.
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Device/user creating derived views and presentation states
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Technologist or radiologist using post-processing application
If views are not already registered, registration is performed
Views saved:
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Blended CT / PET MIP views demonstrating areas of interest with measurement overlays (point measurements or ROIs)
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3D MIP view with an inverted W/L
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Device/user using presentation state to replicate derived views
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Radiologist performing primary read after tech workup
Radiologist reviewing priors alongside follow-up exams
Need to reproduce:
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MPR positions
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Blending function
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W/L and or color maps
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Measurement position and ROI details
4/13/2015
nD Presentation State Use Cases
18